The multiphasic upper gastrointestinal examination.

The upper gastrointestinal series traditionally includes fluoroscopy and filming of the esophagus, stomach, and duodenum. Optimal use of each of the available examination techniques in these regions is discussed in this article.

Colorectal cancer. Screening strategies.

Colorectal cancer is both curable and preventable; however, systemic screening has not yet been instituted in the United States. There are a number of diagnostic tests, imaging procedures, and endoscopic examinations available to detect colorectal cancer and polyps in their early stages. This article reviews these various screening options and concludes that the barium enema is the most cost-effective method.

Anatomy of the liver.

Controversy still exists over the anatomic configuration of the liver. Even such basic considerations as the means by which the inferior radiographic border of the liver is formed remain an enigma. This article reflects the current knowledge of the anatomy of the liver as perceived by the radiologist.

Esophageal bezoar resulting from enteral feedings.

Esophageal bezoars are rare but are known to occur in patients with structural or functional abnormalities of the esophagus. Additionally, sucralfate and casein containing enteral feeding formulas have been implicated in the formation of esophageal bezoars, particularly in the setting of decreased esophageal pH. We present a case in which a patient with functional impairment of the esophagus related to myasthenia gravis developed an esophageal bezoar. Gastroesophageal reflux, altered esophageal pH, and direct instillation of feeding formula through a rent in the feeding tube were additional factors likely leading to bezoar formation in this patient. Endoscopic examination revealed puttylike material consistent with coagulated enteral feeding formula. An esophagram demonstrated a large bezoar filling the middle and distal thirds of the esophagus. The conditions predisposing to bezoar formation and the proposed mechanisms are discussed. We also summarize the reported cases of esophageal bezoars related to enteral feeding formula, sucralfate, or both.

The future of barium radiology.

Barium radiology of the gastrointestinal tract has had a long history but its survival into the next century will be a challenge. The numbers of barium studies performed has declined in recent decades due to several factors; also, health care reforms in the United States will further impact on the use of barium examinations. The future status of these radiological procedures will change depending on these factors and the organ system being examined; an increased emphasis on functional evaluation of the gastrointestinal tract will also have an effect on the evolving role of barium radiology. We provide a brief historical review of the evolution of barium radiology in the twentieth century, discuss the present and changing status of the various gastrointestinal examinations, and offer our thoughts concerning the potential future of this specialty.

Postoperative hysterosalpingography. Radiographic appearances and clinical results following tubal surgery.

Medical records and postoperative hysterosalpingograms on 23 women following tubal surgery who failed to become pregnant within 2-28 months were reviewed. A total of 39 tubes were analyzed. The surgical indications were reversal of tubal ligation in 24 tubes and correction of tubal or perifimbrial disease in 15 tubes. Tubal ligation had been performed by a variety of methods. At surgery, tubal patency, as shown by chromotubation, was seen in 37 (95%) of 39 tubes. On postoperative hysterosalpingography, tubal spillage was present in 32 (82%) of 39 tubes. Radiographically, the tubes that spilled appeared normal except for occasional shortening after reversal of tubal ligation. The eventual pregnancy rate was 8 (35%) of 23 patients, with 7 intrauterine. Pregnancy occurred only in women under 35 years and was more likely in the group having reversal of tubal ligation. We conclude that among patients who do not initially become pregnant following tubal surgery for infertility, tubal patency is restored in most. During hysterosalpingography, tubes operated on may appear normal or shortened. On long-term follow-up, younger patients and those requiring tubal anastomosis only had a higher pregnancy rate.

Locating the kidneys on CT to guide nephrotomography.

Tomography of the kidneys is a routine procedure performed during intravenous urography. Precisely locating the kidneys, however, can be difficult. This article describes a study performed to determine a simple and accurate measurement for kidney location as a guide to obtaining initial nephrotomographic sections. The authors measured the distance from the midplane of the kidney to the posterior skin line on abdominal CT images in 26 patients. This distance averaged one-third the thickness of the abdominal region. The best depth for the nephrotomographic cut was found to be one-third the thickness of the abdomen plus the thickness of any table pad.

The Japanese-style double-contrast examination of the stomach.

Western radiologists are using the Japanese-style double-contrast examination of the stomach with increasing frequency. Extensive experience now indicates that the double-contrast technique greatly increases the accuracy of the radiologic examination of the stomach. Lesions characterized by small irregularities in the mucosal surface of the stomach, such as superficial carcinomas, small or shallow ulcers, gastric erosions, and ulcer scars, are particularly apt to be detected only by double-contrast technique. The double-contrast study also increases the detectability of lesions in the proximal stomach, where compression and palpation are difficult to apply effectively.

The double-contrast upper gastrointestinal examination in the Japanese style.

An experience with over 2,000 Japanese-style double-contrast upper gastrointestinal examinations is presented. Results indicate that, in combination with the conventional single-contrast films, the double-contrast examination of the stomach greatly increased the yield and accuracy of the radiographic procedure. The double-contrast study appears to have particular applicability in detecting lesions which do not greatly elevate or depress the surface of the stomach, such as early carcinomas, shallow ulcers, ulcer scars, small polyps and other similar mucosal abnormalities.

Imaging of the colon.

The highlight of articles published on radiologic examination of the colon is the increasing indication for use of the barium enema for screening for colorectal carcinoma. Radiologic screening for colorectal cancer promises to be more effective than mammograptive screening and more cost-effective than alternative means, such as colonoscopy. Important work on defocography suggests that measurements of anorectal angle and pelvic floor descent are nondiagnostic, and that rectal-wall changes are the important findings. Findings on CT scanning continue to be investigated in diseases, such as diverticulitis and tuberculosis, that affect both the colonic mucosa and pericolonic tissues. An important new trend is the use of sonography to investigate the colon for the presence of neoplasms.