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R D Halpert

Publications and source records attributed to R D Halpert.

47 records · Page 3Linked to original sources
PubMed1984

Small colonic polyps: a reappraisal of their significance.

With the advent of fiberoptic endoscopy and modern radiographic techniques, the majority of detected polyps are less than 1 cm. During a seven-month period, we studied 140 patients who had radiographically demonstrated colonic polyps that were confirmed by pathologic study. Tissue specimens were obtained by proctoscopy, colonoscopy, or surgery. There were 222 polyps of which 144 (65%) were 1 cm or less in size, with the preponderance (80%) of these being adenomatous. Of the 82 polyps that ranged in size from 6-10 mm, 68 (83%) were adenomas, including one carcinoma and five villous adenomas. Forty-seven (72%) of the diminutive polyps (less than or equal to 5 mm) were adenomatous, including two with atypia. Our results correspond to those of several recent endoscopic studies, reporting that a small colonic polyp is most likely to be adenomatous, and that it possesses the potential for growth and malignant transformation. The detection of small polyps during barium enema examination is thus warranted, particularly in the proximal colon where the majority are adenomatous. The clinical management of polyps is becoming more aggressive, and the removal of even small lesions (less than or equal to 5 mm) is now performed if they are found incidentally during colonoscopy.

Adenoma↗
PubMed1984

Computed tomographic findings in penetrating peptic ulcer.

Four cases of peptic ulcer penetrating the head of the pancreas were diagnosed by computed tomography (CT). Findings common to 3 cases included (a) an ulcer crater, (b) a sinus tract, and (c) enlargement of the head of the pancreas. Additional findings, not seen in all patients, included (d) edema involving the base of the ulcer and/or the adjacent bowel wall and (e) loss of fascial planes between the base of the ulcer and the head of the pancreas. Unlike other modalities, the inherent spatial resolution of CT allows a confident diagnosis of this important complication of peptic ulcer disease.

Aged↗
PubMed1984

Radiologic recognition of colonic diverticula simulating polyps.

The differentiation of colonic polyps and diverticula on the double-contrast barium enema is generally straightforward, using current diagnostic criteria. However, diverticula may be misinterpreted on the double-contrast barium enema as polyps when they appear uncommonly as filling defects within the barium pool. As a result of such erroneous interpretation, the patient may subsequently undergo costly and inconvenient repeat barium enema or colonoscopy. Carefully studied scout films, oblique views, compression spot images, and postevacuation films generally can differentiate these diverticula from polyps. The usual reason that a diverticulum assumes the appearance of a polyp is that it contains impacted stool.

Aged↗
PubMed1984

Barrett's esophagus: radiological and clinical considerations.

We reviewed the radiographic findings in thirty patients with columnar-lined (Barrett's) esophageal mucosa. Gastroesophageal reflux was observed in 90%, hiatal hernia in 83%, stricture in 80% and esophageal ulceration in 33%. Superficial nodular mucosal changes were detected on 50% of the air contrast esophagrams. Prominence of this pattern may be associated with dysplastic or early malignant change. In addition, four conditions associated with secondary lower esophageal sphincter incompetence were identified in our patient group. These were scleroderma, previous myotomy for achalasia, previous gastric surgery and long-term indwelling nasogastric tubes.

Adult↗
PubMed1984

Air contrast tube esophagram: technique and clinical examples. Technical note.

The air-contrast tube esophagram is performed by positioning a soft thin rubber catheter in the proximal esophagus. The patient drinks high density, low viscosity barium while the esophagus is insufflated with air through the tube. The procedure can usually be completed in five to eight minutes. In the majority of patients there is minimal discomfort. The advantage of the tube esophagram is the fact that it provides reliable, uniform full-column air distention.

Esophagus↗
PubMed1983

Compensation filtration for decubitus radiography during double-contrast barium enema examinations.

Lateral decubitus images obtained during double-contrast barium enema examinations may be difficult to interpret because of the large difference in density between the various parts of the radiographs. Several types of filters are described which can be used to rectify this problem, thus improving the quality of the decubitus radiographs and achieving a slight reduction in radiation exposure.

Barium Sulfate↗
PubMed1983

Adenocarcinoma of the esophagus in patients with scleroderma.

Three cases of patients with esophageal involvement by scleroderma, chronic reflux esophagitis, and adenocarcinoma of the distal esophagus are presented. An underlying columnar metaplasia (Barrett esophagus) was identified in two patients and postulated in the third. It is believed that scleroderma patients with symptomatic chronic gastroesophageal reflux should be investigated for Barrett epithelium. If it is present, these patients should be followed and considered as having an increased risk for development of adenocarcinoma of the esophagus.

Adenocarcinoma↗
PubMed1983

Barrett's metaplasia and dysplasia in postmyotomy achalasia patients.

Three patients who were 8 to 30 years status postmyotomy for achalasia were shown to develop Barrett's columnar metaplasia of the esophagus. In one instance, the patient had multiple areas of severe dysplasia to carcinoma in situ. There have been only a few reports in the world literature of Barrett's metaplasia occurring in postmyotomy achalasia patients. Our experience would indicate it may be a more common complication than previously appreciated. Also, a possible causal relationship between surgical intervention, Barrett's epithelium, and adenocarcinoma in achalasia is suggested.

Adenocarcinoma↗