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Biomedical subjects

Igor Laufer

Publications and source records attributed to Igor Laufer.

At least 19 recordsLinked to original sources
PubMed2006

Colorectal cancer: screening double-contrast barium enema examination in average-risk adults older than 50 years.

PURPOSE: To retrospectively determine the diagnostic yield of double-contrast barium enema examinations performed for colorectal cancer screening of neoplasms 1 cm or larger or advanced neoplastic lesions of any size in average-risk adults older than 50 years. MATERIALS AND METHODS: The Institutional Review Board at the affiliated Veterans Affairs Medical Center approved this HIPAA-compliant study protocol and did not require informed consent from patients. Computerized databases revealed 276 double-contrast barium enema examinations performed for colorectal cancer screening in average-risk adults older than 50 years. Radiographic and pathologic reports were reviewed to determine the number of patients who had polypoid lesions 1 cm or larger, polyps smaller than 1 cm, or advanced neoplastic lesions of any size. Forty-five (16.3%) of the 276 patients underwent follow-up sigmoidoscopy or colonoscopy. Medical, endoscopic, and pathologic records were reviewed and compared with radiographic findings. RESULTS: The results of double-contrast barium enema examination revealed 74 (26.8%) of 276 patients with 104 polypoid lesions in the colon, including 32 patients (11.6%) with 41 polypoid lesions 1 cm or larger, 15 patients (5.4%) with 19 polyps 6-9 mm, and 27 patients (9.8%) with 44 polyps 5 mm or smaller. Endoscopy was performed in 24 (75%) of 32 patients, the results of which confirmed 23 (72%) of 32 radiographically diagnosed lesions 1 cm or larger in 16 (67%) of 24 patients. In two of these individuals, the polyps were hyperplastic. The remaining 14 patients had a total of 21 neoplastic lesions 1 cm or larger, including 11 tubular adenomas, seven tubulovillous adenomas, one villous adenoma with marked dysplasia, and two cancers. The diagnostic yield of screening double-contrast barium enema examination was 5.1% (14 of 276 patients) for neoplastic lesions 1 cm or larger and 6.2% (17 of 276 patients) for advanced neoplastic lesions of any size. CONCLUSION: Double-contrast barium enema examinations performed in average-risk adults older than 50 years have a diagnostic yield of 5.1% for neoplastic lesions 1 cm or larger and 6.2% for advanced neoplastic lesions, regardless of size.

Age Factors↗
PubMed2006

Association between esophageal dysmotility and gastroesophaeal reflux on barium studies.

OBJECTIVE: To determine whether there is an association between abnormal primary peristalsis in the esophagus and gastroesophageal reflux (GER) on barium studies. METHODS: A computerized search of radiologic reports revealed 151 patients with esophageal dysmotility (characterized by intermittently decreased or absent peristalsis in the esophagus on upper gastrointestinal tract examinations) who fulfilled our study's entry criteria. These 151 patients were stratified into two groups depending on whether this dysmotility was associated with nonperistaltic contractions (NPCs): 92 patients had no NPCs (Dysmotility and No NPCs Group) and 59 had NPCs (Dysmotility and NPCs Group). An age-matched control group of 92 patients with normal motility was also generated from the radiologic reports. The reports were also reviewed for the presence and degree of GER and other complications of GER. The frequency and degree of GER were tabulated for each group, and the data were analyzed using a Pearson chi square test to determine if significant differences were present in the frequency and degree of GER or other findings among the groups. RESULTS: The frequency of GER was significantly higher in patients with abnormal peristalsis and no NPCs than in controls (p = 0.02). When GER was stratified based on the degree of reflux, the frequency of moderate-to-marked GER was significantly higher in patients with abnormal peristalsis and no NPCs than in patients with abnormal peristalsis and NPCs (p = 0.01) or in controls (p = 0.0031). The frequency of reflux esophagitis also was significantly higher in patients with abnormal peristalsis and no NPCs than in controls (p = 0.04). CONCLUSION: Our findings suggest that patients with esophageal dysmotility characterized by intermittently decreased or absent peristalsis without NPCs have a significantly higher frequency and degree of GER than patients with normal motility. The presence of this specific form of esophageal dysmotility on barium studies therefore should suggest underlying reflux disease.

Adult↗
PubMed2006

Detection of strictures on upper gastrointestinal tract radiographic examinations after laparoscopic Roux-en-Y gastric bypass surgery: importance of projection.

OBJECTIVE: Our objective was to determine the optimal radiographic projections for the detection of strictures at the gastrojejunal anastomosis after gastric bypass surgery. CONCLUSION: Steep oblique or lateral spot images routinely should be obtained during upper gastrointestinal radiographic studies after gastric bypass surgery to optimize detection of strictures at the gastrojejunal anastomosis.

Adult↗
PubMed2006

Esophageal stents: findings on esophagography in 46 patients.

OBJECTIVE: The purpose of this report is to assess the findings on esophagography in patients with esophageal stents for palliation of malignant tumors involving the esophagus. CONCLUSION: Radiologists should be familiar with findings of little importance (stent narrowing, flow of contrast medium around stent, stent kinks, and apparent esophageal narrowing below stent because of incompletely distended hiatal hernias) versus more important findings (polypoid defects above or below stent, narrowing within or below stent, delayed stent emptying, esophageal-airway fistulas, stent migration, and abutting of distal stent against greater curvature of stomach) on esophagography after stent placement to guide endoscopists regarding the need for stent revision.

Aged↗
PubMed2005

Idiopathic eosinophilic esophagitis in adults: the ringed esophagus.

PURPOSE: To retrospectively assess the findings of idiopathic eosinophilic esophagitis (IEE) at barium studies and determine the frequency of the ringed esophagus in patients with this condition. MATERIALS AND METHODS: The institutional review board approved all aspects of this retrospective study and did not require informed consent from patients whose records were included in the study. The study was compliant with the Health Insurance Portability and Accountability Act. A review of the pathology and radiology databases at the authors' institution revealed 14 patients (11 men and three women; mean age, 41.3 years) with IEE (defined as more than 20 eosinophils per high-power field in biopsy specimens) who had undergone barium studies and endoscopy. The radiographs were reviewed for strictures, esophagitis, or other abnormalities. The endoscopic reports, clinical records, and laboratory data were also reviewed and compared with the radiographic findings. RESULTS: Seven of the 14 patients (50%) had a history of allergies, and two of nine patients with complete blood cell counts (22%) had peripheral eosinophilia. Thirteen patients (93%) had dysphagia, six (43%) had food impactions, and six (43%) had reflux symptoms. Ten patients (71%) had a total of 11 strictures at barium studies (two in the upper part of the esophagus, two in the middle part, three in the distal part, one in the middle and distal parts, and three at the gastroesophageal junction). The strictures had a mean length of 5.1 cm. In seven patients (50%), the strictures contained multiple fixed ringlike indentations that produced a ringed esophagus. The ringlike indentations appeared as multiple, fixed, closely spaced, concentric rings traversing the stricture. Four patients (28%) had esophagitis. Of 13 patients who underwent recumbent imaging, 10 (77%) had hiatal hernias and nine (69%) had reflux. Eight of the 10 patients (80%) with strictures underwent endoscopic dilation procedures, which resulted in only temporary relief of dysphagia. CONCLUSION: The findings suggest that most patients with IEE have esophageal strictures, often with distinctive ringlike indentations that produce a ringed esophagus.

Adult↗
PubMed2005

Achalasia with complete relaxation of lower esophageal sphincter: radiographic-manometric correlation.

PURPOSE: To evaluate retrospectively the presence of complete relaxation of the lower esophageal sphincter (LES) at manometry in patients with achalasia depicted on barium esophagograms. MATERIALS AND METHODS: The institutional review board approved this retrospective study and did not require informed consent. A search of radiology and manometry records identified 21 patients (12 men, nine women; mean age, 52.4 years) with achalasia depicted on barium esophagograms who had undergone manometric examinations and met the inclusion criteria. Radiologic reports and images were reviewed for presence or absence of primary peristalsis, impaired LES opening, esophageal dilatation, delayed emptying of barium, and nonperistaltic contractions. Manometry reports were reviewed for presence or absence of peristalsis or simultaneous esophageal contractions. Resting and residual LES pressures were recorded to determine whether LES relaxation was complete or incomplete. Medical records were reviewed to determine clinical presentation and follow-up (treatment and patient course), and radiographic files were reviewed to determine radiographic findings at follow-up examinations. Clinical characteristics (eg, age, dysphagia, and weight loss) were correlated with LES relaxation at manometry. Data were analyzed statistically with Fisher exact and Wilcoxon rank sum testing. RESULTS: All 21 patients with radiographic findings of achalasia had aperistalsis at manometry. Fourteen patients (67%) had incomplete LES relaxation at manometry during swallowing, and seven (33%) had complete LES relaxation. There were no significant differences between patients with complete LES relaxation and those with incomplete LES relaxation in mean age (P = .59), duration of dysphagia (P = .18), or weight loss (P > .99). Clinical follow-up findings were available for six patients with complete LES relaxation at manometry and 10 with incomplete relaxation. Symptoms resolved after treatment in all six patients with complete LES relaxation. Six (60%) of 10 patients with incomplete LES relaxation had resolution of symptoms after treatment, and four (40%) had substantial improvement. CONCLUSION: These data suggest that in patients with typical radiographic findings of achalasia, the barium study can be used to guide treatment without a need for manometry. If radiographic findings are equivocal, however, manometry may be required for a more certain diagnosis.

Adult↗
PubMed2005

Pharyngeal retention cysts: radiographic findings in seven patients.

OBJECTIVE: The purpose of this study was to better characterize the radiographic features of pharyngeal retention cysts on double-contrast pharyngograms. CONCLUSION: Pharyngeal retention cysts typically involve the valleculae, appearing on double-contrast pharyngograms as small, round or ovoid, well-circumscribed, smooth-surfaced submucosal masses that are best visualized on frontal views of the pharynx. Such features should be highly suggestive of benign retention cysts, obviating further diagnostic workup in asymptomatic patients. When the cysts are lobulated or completely obliterate the valleculae, however, further evaluation by otolaryngologic examination may be required to rule out malignant tumor in the pharynx.

Adult↗
PubMed2005

Crohn's disease in the ileal pouch after total colectomy for ulcerative colitis: findings on pouch enemas in six patients.

OBJECTIVE: The purpose of this study was to describe our experience with six patients who developed Crohn's disease in the ileal pouch or distal ileum after a total proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis. CONCLUSION: Pouch enemas showed characteristic findings of Crohn's disease, including nodularity, thickened folds, ulceration, cobblestoning, strictures, sinus tracks, and fistulas to the perianal region and vagina. It is important for radiologists to be aware of the findings of Crohn's disease in the ileal pouch and distal ileum on radiographic studies of the pouch after total proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis because of the implications for patient management.

Adult↗
PubMed2004

Radiographic examination of the small bowel: survey of practice patterns in the United States.

PURPOSE: To obtain understanding of the current practice patterns of academic and private radiology groups in the United States in radiographic examination of the small bowel. MATERIALS AND METHODS: The survey consisted of questions about small-bowel follow-through (SBFT) examinations, including frequency of overhead radiographs, use of fluoroscopic spot images, personnel performing fluoroscopy, practice settings, and degree of specialization. By using a standard sampling technique, the country was divided into nine regions, and one state from each region was randomly selected. The survey was mailed to 452 full-time chief technologists. The responses were tabulated, and statistical analysis of the data was performed with the chi(2) test. RESULTS: Completed questionnaires were returned by 236 (52%) of 452 chief technologists; 219 (93%) respondents, 176 (80%) in private and 43 (20%) in academic groups, indicated that their group performed SBFT studies. The studies were performed by general radiologists in 205 (94%) of the 219 groups and by gastrointestinal or abdominal radiologists in 11 (5%). Studies included overhead radiographs in all 219 groups, with spot images of the terminal ileum in 201 (92%). Thirty (14%) of 219 groups routinely obtained spot images of the remaining small bowel, 104 (48%) obtained spot images only if there were questionable findings on overhead radiographs, and 82 (37%) obtained no spot images. Eighteen (8%) of 219 groups performed peroral pneumocolon examinations and 80 (37%) performed enteroclysis. CONCLUSION: The majority of radiology groups perform SBFT studies. Regardless of the practice setting, these studies usually consist of a series of overhead radiographs, with routine spot images of the terminal ileum but not of the remaining small bowel. This approach may need to be reassessed in light of the American College of Radiology standards that all accessible small-bowel loops be visualized at fluoroscopy with representative radiographs to optimize the diagnostic yield of the examination.

Humans↗
PubMed2004

Upper gastrointestinal tract barium examination of postbulbar duodenal ulcers.

OBJECTIVE: The purpose of our investigation was to review the findings on barium studies in a series of eight patients with postbulbar duodenal ulcers in order to better characterize the clinical and radiographic features of these ulcers. CONCLUSION: Our experience suggests that ulcers in the postbulbar duodenum are considerably larger than those in the duodenal bulb and that they constitute a greater percentage of all duodenal ulcers than has previously been recognized. It is important for radiologists to be familiar with the characteristic radiographic features of postbulbar ulcers because of the increased risk of serious upper gastrointestinal tract bleeding in patients with this condition.

Adult↗
PubMed2004

Relationship between diffuse esophageal spasm and lower esophageal sphincter dysfunction on barium studies and manometry in 14 patients.

OBJECTIVE: We sought to reassess the function and clinical characteristics of the lower esophageal sphincter in a series of patients with radiographically defined diffuse esophageal spasm. MATERIALS AND METHODS: In reviewing records in the radiology database at our hospital, we identified 14 patients with diffuse esophageal spasm confirmed on barium studies who also underwent esophageal manometry. The radiographic findings were reviewed and correlated with the manometric findings. Medical records were also reviewed to determine the clinical presentation, treatment, and patient course. RESULTS: All 14 patients were symptomatic, presenting with dysphagia, chest pain, or both. All the barium studies revealed intermittently absent or weakened peristalsis, with nonperistaltic contractions that were moderate in six patients (43%) and marked in eight patients (57%) (contractions nearly obliterating the lumen in six and completely obliterating the lumen in two). Nine patients (64%) had impaired opening of the lower esophageal sphincter, manifested by beaklike narrowing of the distal esophagus, and five (36%) had normal opening of the lower esophageal sphincter. Manometry revealed abnormal peristalsis in all 14 patients, with repetitive simultaneous contractions in eight (57%) and lower esophageal sphincter dysfunction in 12 (86%). All eight patients with lower esophageal sphincter dysfunction or incomplete relaxation of the lower esophageal sphincter on barium studies or manometry who were treated with the Clostridium botulinum toxin or endoscopic balloon dilatation had a positive response. CONCLUSION: Our preliminary data show that diffuse esophageal spasm is characterized on barium studies by frequent lower esophageal sphincter dysfunction rather than a classic corkscrew appearance. Barium and manometric studies may have complementary roles in the evaluation of patients with diffuse esophageal spasm.

Adult↗
PubMed2003

Ileocecal valve: spectrum of normal findings at double-contrast barium enema examination.

PURPOSE: To characterize the spectrum of normal findings of the ileocecal valve at double-contrast barium enema examination to allow differentiation between a normal valve and one infiltrated by tumor. MATERIALS AND METHODS: A search of radiology and endoscopy files showed 106 patients who underwent double-contrast barium enema examination and colonoscopy. The radiographic images were reviewed by two authors to determine the morphology of the ileocecal valve and to evaluate whether it appeared normal or abnormal. The radiographic data were then correlated with endoscopic and pathologic findings. RESULTS: The ileocecal valve was visible in 91 (86%) of 106 patients. It was round or ovoid in 71 patients (78%) and triangular in 20 (22%). In the 88 patients with a normal valve at colonoscopy, mean valve height was 1.7 cm, and mean width was 2.8 cm. The valve was smooth in 75 patients (85%) and smoothly lobulated in 13 (15%). The lips of the valve were symmetric in 77 patients (88%) and asymmetric in 11 (12%). All 87 patients with a normal valve at double-contrast barium enema examination had a normal valve at colonoscopy, whereas the two patients with a valve suspicious for tumor at barium enema examination had neoplasms (one carcinoma and one villous adenoma) at colonoscopy. CONCLUSION: The ileocecal valve may show a spectrum of normal findings at double-contrast barium enema examination and may appear as a round, ovoid, or triangular structure with a maximal height of nearly 4 cm. The valve may be large, asymmetric, or smoothly lobulated, even in the absence of tumor.

Adult↗
PubMed2003

Epiphrenic diverticulum: clinical and radiographic findings in 27 patients.

The purpose of our study was to reassess the clinical and radiographic findings in patients with epiphrenic diverticula. A search of our radiology files revealed 27 patients with epiphrenic diverticula within 10 cm of the gastroesophageal junction. Medical records and radiographic reports and images were reviewed to determine the clinical and radiographic findings. Twenty-three patients had a solitary epiphrenic diverticulum, three had two diverticula, and one had three diverticula. The diverticula arose from the right side of the distal esophagus in 19 patients and the left side in eight. The diverticula had a mean width of 4.4 cm and a mean height of 3.7 cm. Other findings included prolonged retention of barium in the diverticula in 19 patients, preferential filling in 11, retained debris in 5, regurgitation of barium or debris in 5, compression of the esophagus in 5, pseudodiverticula formation in 3, and ulceration in 1. We found a significant correlation between the width of the diverticulum and preferential filling with barium. Twelve patients had abnormal esophageal motility, with diffuse esophageal spasm in two. Seventeen patients had symptoms attributable to the diverticulum (dysphagia in 11 and/or reflux symptoms in 12). We also found a significant correlation between the size or preferential filling of the diverticulum and the presence of symptoms. Conversely, we found no correlation between esophageal dysmotility and the presence of symptoms. Our experience suggests that the development of symptoms in patients with epiphrenic diverticula is more likely to be related to the morphologic features of the diverticula than to underlying esophageal motility disorders.

Aged↗
PubMed2003

Gastroesophageal reflux: comparison of barium studies with 24-h pH monitoring.

OBJECTIVE: To determine the correlation between massive gastroesophageal reflux (GER) on barium studies and pathologic acid reflux on 24-h pH monitoring. METHODS: A search of hospital records from January 1997 to January 2001 revealed 28 patients who underwent both barium studies and 24-h pH monitoring. The radiologic reports were reviewed to determine the presence and degree of GER. Patients with reflux to or above the thoracic inlet either spontaneously or with provocative maneuvers in the recumbent position were classified as having massive reflux, whereas the remaining patients with reflux below the thoracic inlet or no reflux comprised the control group. The pH monitoring reports were also reviewed to determine if pathologic acid reflux was present in the recumbent position. The findings on these studies were then compared to determine the frequency of pathologic acid reflux in the recumbent position on pH monitoring in patients with massive reflux on barium studies compared with the control group. RESULTS: Massive GER was observed on barium studies in 11 (39%) of the 28 patients and reflux below the thoracic inlet or no reflux in the remaining 17 patients (61%) who comprised the control group. All 11 patients (100%) with massive reflux on barium studies had pathologic acid reflux on pH monitoring in the recumbent position compared with six (35%) of 17 patients in the control group (P = 0.0009). The pH in the distal esophagus on pH monitoring was less than 4.0 for 13.1% of the recumbent period for patients with massive GER on barium studies compared with 6.2% of the recumbent period for the control group (P = 0.0076). CONCLUSION: Although 24-h pH monitoring remains the gold standard for the detection of GER, our experience suggests that patients with massive reflux on barium studies are so likely to have pathologic acid reflux in the recumbent position that these individuals can be further evaluated and treated for their gastroesophageal reflux disease (GERD) without need for pH monitoring.

Barium Sulfate↗
PubMed2003

Epiglottic carcinoma as a cause of laryngeal penetration and aspiration.

OBJECTIVE. The purpose of our investigation was to review a series of patients with epiglottic carcinoma to elucidate the clinical and videofluoroscopic findings in these individuals. CONCLUSION. Patients with epiglottic carcinoma often present with symptoms of aspiration or pharyngeal dysphagia of relatively brief duration in the absence of a preexisting neurologic disease. In this clinical setting, barium studies are useful not only for detecting the epiglottic carcinoma but also for delineating the presence and mechanism of laryngeal penetration or tracheobronchial aspiration.

Adult↗
PubMed2003

Usefulness of barium studies for differentiating benign and malignant strictures of the esophagus.

OBJECTIVE: The purpose of our investigation was to determine the usefulness of barium studies for differentiating benign and malignant strictures of the esophagus. MATERIALS AND METHODS: A search of radiology and endoscopy files revealed 100 patients with esophageal strictures on barium studies who underwent endoscopy (with endoscopic brushings or biopsy specimens in 57). The images from these barium studies were reviewed by two gastrointestinal radiologists who were unaware of the clinical, endoscopic, and pathologic findings; these observers classified the strictures as having a benign, malignant, or equivocal appearance. The radiographic data were correlated with the endoscopic and pathologic findings to determine the usefulness of barium studies for differentiating benign strictures from malignant tumor. RESULTS: Of the 100 esophageal strictures detected on barium studies, 75 (75%) had a benign radiographic appearance, 11 (11%) had a malignant appearance, and 14 (14%) had an equivocal appearance. None of the 75 patients with radiographically benign strictures had malignant tumor on endoscopy, which revealed benign strictures in 48 patients and no definite strictures in the remaining 27. Conversely, all 11 patients (100%) with radiographically malignant strictures had malignant tumor on endoscopy. Finally, 13 (93%) of 14 patients with radiographically equivocal strictures had benign strictures without tumor on endoscopy and one (7%) had esophageal carcinoma. CONCLUSION: Radiographically benign esophageal strictures are not found to be caused by malignant tumor on endoscopy, so these patients can be treated medically before endoscopy or endoscopic dilatation procedures are performed. However, radiographically malignant or equivocal strictures require early endoscopy and biopsy for a definitive diagnosis.

Adult↗
PubMed2003

Videofluoroscopic studies of swallowing dysfunction and the relative risk of pneumonia.

OBJECTIVE: The purpose of our investigation was to determine the relationship between the degree of swallowing dysfunction observed on barium studies and the likelihood of developing pneumonia in a large series of patients. MATERIALS AND METHODS: The findings on videofluoroscopic swallowing studies in 381 patients were used to classify these patients into one of five groups: those with normal swallowing; those with abnormal swallowing but no laryngeal penetration or tracheobronchial aspiration; those with laryngeal penetration; those with tracheobronchial aspiration; and those with silent tracheobronchial aspiration. Clinical data were also reviewed to determine how many patients had developed pneumonia during the 6 months before or after the barium studies. The data were then analyzed to determine whether the risk of developing pneumonia increased significantly with each level of swallowing dysfunction seen on barium studies. RESULTS: No significant difference was found in the frequency of pneumonia in patients with abnormal swallowing but no laryngeal penetration or tracheobronchial aspiration compared with patients with normal swallowing on barium studies (p = 0.85). In contrast, patients with laryngeal penetration, tracheobronchial aspiration, or silent tracheobronchial aspiration were approximately four times (p = 0.008), 10 times (p < 0.0001), and 13 times (p < 0.0001), respectively, more likely to develop pneumonia than those with normal swallowing. CONCLUSION: Our findings indicate that the likelihood of developing pneumonia is directly related to the degree of swallowing dysfunction seen on videofluoroscopic studies. Patients with no laryngeal penetration-regardless of whether they had normal or abnormal swallowing-have the lowest risk of developing pneumonia. Patients with laryngeal penetration, tracheobronchial aspiration, or silent tracheobronchial aspiration are, in increasing order of magnitude, significantly more likely to develop pneumonia than patients with normal swallowing.

Adult↗