Alexander R. Margulis

Gastrointestinal Complications Following Renal Transplantation

Gastrointestinal complications developed in 29 (6%) of 510 patients following renal transplantation. Thirteen patients (45%) died as a result. Gastrointestinal bleeding, usually considered the commonest complication, was seen in only 7 cases. Other complications included pancreatitis and hyperamylasemia, massive ileus, fistulas with abscesses, bowel infarction, peptic ulcers without bleeding, obstruction, gangrenous cholecystitis, esophagitis, spontaneous perforation of the sigmoid colon, and pneumatosis cystoides intestinalis. Six patients had no clinical or laboratory findings suggesting the underlying gastrointestinal complication; it was the radiographic findings that called attention to the acute problem.

Computed Tomographic Evaluation of Disorders Affecting the Alimentary Tract

The use of computed tomography (CT) in diagnosing disorders affecting the hollow viscera of the alimentary tract has received little attention. The authors reviewed CT scans of 43 patients on which lesions affecting the gastrointestinal tract were demonstrated. All cases were correlated with barium-enema examinations, surgical reports, or autopsy findings. CT can provide valuable information on the extraluminal extent of masses arising in the bowel, mesenteric masses, and can define and characterize extrinsic lesions. The authorss results suggest that CT is a useful adjunct in evaluating intramural or mesenteric lesions of the gastrointestinal tract.

CT Scanning and Ultrasound in the Evaluation of Pancreatic Pseudocysts: A Preliminary Comparison

A retrospective review of 12 surgically proved cases of pancreatic pseudocyst was performed. CT correctly demonstrated 6/8 uncomplicated pseudocysts and 4/4 infected pseudocysts. Ultrasound identified 7/8 uncomplicated and 2/4 infected pseudocysts. Errors by one modality are due to limitations not shared by the other method. This suggests a basis for the complementary use of CT scanning and ultrasound in the evaluation of suspected pancreatic pseudocysts.

Lethal Effects of Tannic Acid in the Barium Enema1

The addition of tannic acid to barium sulfate suspensions employed in the roentgenographic examination of the colon has been recommended by a number of authors (1, 5, 7, 12, 16) and its use is widespread. The rationale is based on the following considerations: Tannic acid as an astringent stimulates contracture of the colon, inhibits the secretion of mucin, and causes precipitation of the protein of the superficial layers of the mucosa. It also makes barium sulfate adhere to the bowel wall (5, 7, 16) and is said to inhibit absorption of substances from the colon (16). The concentration of tannic acid recommended for use in barium enema examinations varies between 0.25 and 3.0 per cent (16). A variety of tannic acids are found in nature. They are water-soluble polymers of various hydroxybenzoic acids (10). Tannic acid in the form of baths, dressings, or jellies was utilized in the treatment of cutaneous burns for almost twenty years before its use was abandoned. Clinical evidence of its hepatotoxicity accu...

Combined CT colonography and 18F-FDG PET of colon polyps: potential technique for selective detection of cancer and precancerous lesions.

OBJECTIVE The purpose of this study was to determine the feasibility of imaging the colon with fused CT colonography (CTC) and 18F-FDG PET and to correlate the findings with the histologic features of polyps. SUBJECTS AND METHODS Eighteen patients with suspected colorectal polyps enrolled in this prospective study. Before colonoscopy, 17 of the patients underwent a combination of FDG PET and CTC. CTC consisted of 4-MDCT merged with PET. PET of the abdomen and pelvis was performed after each CTC scan. One radiologist and one nuclear medicine physician in consensus analyzed PET and CTC fusion data. PET standard uptake value was correlated with the findings at histologic examination of polyps. Patient feasibility was defined as the ability to tolerate prolonged scanning with good colonic distention. Technical feasibility was determined by how closely anatomically matched polyps overlapped on fusion images. RESULTS Seventeen of 18 patients tolerated scanning. Eighty-five percent of colon segments were optimally distended. Twenty-three of 27 FDG-avid polyps measuring 10 mm or more had excellent overlap at fusion imaging. PET depicted 23 of 39 premalignant polyps and even showed increased tracer activity associated with four small tubular adenomas (4-6 mm). Sixteen benign polyps (10-25 mm) were not depicted on PET. All nine cases of cancer (tumors measuring 11-60 mm) were detected with both PET and CTC. The standard uptake value of malignant tumors ranged from 4 to 20 (mean, 9). However, six benign flat polyps did not exhibit FDG avidity. CONCLUSION The novel combination of CTC and PET was feasible in 17 of 18 patients and allowed excellent image correlation in 23 of 27 proven polyps measuring 10 mm or more on PET-CTC fusion. This technique shows promise in accurate anatomic correlation of both malignant and premalignant lesions evaluated with FDG PET.

Early radiographic manifestations of carcinoma of the esophagus.

The survival of patients with esophageal carcinoma is greatest if treatment is begun when the tumor is small and confined to the esophagus. To better define the early radiographic manifestations of this disease, we analyzed the clinical and pathological information and the radiographs from 9 patients with esophageal carcinomas 3.5 cm or less in diameter. All tumors involved one wall of the esophagus and most appeared as plaques or flat sessile polyps, occasionally with central ulceration. Air-contrast views of the distended esophagus demonstrated the tumors to best advantage and should facilitate early detection.

Arteriography and Microangiography of Gastric and Colonic Lesions

Arteriography of the gastrointestinal tract is still basically an experimental procedure. It has not assumed the role of peripheral arteriography in the study of tumors of the extremities (6, 9), of aortography in the evaluation of diseases of the kidney, or of carotid angiography in cerebral abnormalities (1). The explanation is simple and largely a technical one. It is difficult to inject selectively the superior (10) or inferior mesenteric arteries. When such an injection is performed, the resulting arteriogram shows only a maze of superimposed vessels coursing in all directions, following the many loops of the intestine. Fine differences in vascular patterns are not discernible. Previous studies by Margulis and Heinbecker (7) showed the value of operative mesenteric arteriography and demonstrated that it is possible to differentiate inflammatory from neoplastic and benign from malignant tumors of the stomach and colon. Arteriography offers advantages over conventional studies of the gastrointestinal t...

Annular pancreas: etiology and diagnosis using endoscopic retrograde cholangiopancreatography.

A case of annular pancreas diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) is described and the etiology of the abnormality considered. Annular pancreas is an anomaly of the ventral pancreas, and probably due to the persistence of the left ventral bud; the dorsal pancreas plays no apparent role in its development. In the diagnosis of annular pancreas, it appears that ERCP provides unequivocal evidence in some, quite possibly all, cases.

The Roentgen Findings in Primary Hepatoma in Infants and Children An Analysis of Eleven Cases

Primary Hepatoma is of relatively rare occurrence in infants but, in spite of its low incidence, it is one of the commonest neoplasms of the liver seen in infancy and early childhood. Although numerous articles have been written about its pathology, clinical aspects, and therapy, no study could be found in which there was an attempt to establish roentgen criteria for the diagnosis. This paper will deal with roentgen findings in 11 cases of primary hepatoma in infants and young children. It is significant that the cases to be presented, despite their relative rarity, were hitherto unreported. This may serve to indicate that such tumors are not really as rare as the isolated case reports (with reviews of all the previously recorded cases) would suggest. Steiner (18) found only 77 cases (including 2 of his own) in children under sixteen years in which he considered the diagnosis justified. Bigelow and Wright, in 1953, assembled 95 proved cases and added 1 of their own (2). Still another case was added by Tom...

The state of radiographic technique in the examination of the colon: a survey in 1987.

Results of an extensive multiple-choice questionnaire sent to 175 leading medical centers in the world were analyzed and compared with those of a similar survey from 1976. One hundred sixty-two (93%) responses were received. Both single- and double-contrast enema procedures are still employed, but the use of the double-contrast technique has markedly increased. Preparation of the colon is even more meticulous than in 1976 and is equal for both techniques. Pharmacologic aids are used more often but preparatory enemas less frequently than in 1976. The use of fluoroscopic equipment has not significantly changed. The decision on the appropriate sequence for the barium enema examination and colonoscopy is based on the individual clinical problem in the majority of cases, and the time interval between the barium enema examination and lower endoscopy with or without biopsy is significantly shorter than in 1976. The use of computed tomography and magnetic resonance imaging has increased since 1976, but angiography is used less often and mostly for unknown causes of bleeding and to stop bleeding.