X-ray method for examination of patients with obstructive diseases of the large bowel

The paper presents a new priority X-ray method for examining the large bowel in patients with strictures. It is based on the principle of one-stage double contrasting, that has been substantially modified and supplemented by some distinctive signs and original methodological techniques. A randomized study of 150 patients with stenotic tumors of the distal colon assessed this method in comparison to traditional irrigoscopy and classical double contrasting. The study provided strong evidence for the advantage of the proposed method over the well-known ones. In the presence of stenosis, this method makes it possible to completely examine all the portions of the large bowel in 90% of the cases, to reduce the time of examination by almost 15 minutes and a radiation load per patient by 4 m3v. When the method is applied, the informative value of X-ray characteristics of a colonic stricture maximally retains. This is of great value in examining the category of patients with obstructive diseases of the large bowel, which presents a problem in making a differential diagnosis.     

Ultrasound study in the diagnosis of colon obstruction

The authors present the results of their investigations into the use of routine transabdominal sonography and ultrasound irrigoscopy in the diagnosis of acute colon obstruction in 70 patients. In 55 patients, the cause of this pathology was tumor-induced obturation of colon lumen and in 15 cases, the pathology resulted from colon evacuation dysfunction due to congenital abnormalities, acquired stenosis due to inflammatory diseases. Ultrasound irrigoscopy was first applied to determine the presence and degree of colon obstruction and to establish its causes. The procedure and semiotics of ultrasound irrigoscopy and routine transabdominal sonography for this abnormality have been developed and are described in detail. Analysis of the findings has demonstrated that ultrasound irrigoscopy used in the diagnosis of acute colon obstruction is on a par with X-ray irrigoscopy in its informative value and may be widely employed in the used arsenal of diagnostic techniques.     

Radiation diagnosis of tumors at four sites (the lung, breast, stomach, and large bowel) in the organizational and methodological standpoints of practical public health of the Russian Federation

The basic idea of the paper is to put forth today's vision of detecting tumors at four sites (cancer of the lung, breast, stomach, and large bowel) at the level of municipal and regional public health systems. Based on their many years' experience in "contacting" this pathology, the authors characterize the role and significance of basic radiation techniques applied to each of these four tumors, which should be used in their diagnosis. The authors also underline the need for reasonably certifying radiation diagnostic apparatuses for municipal and regional public health systems, which would efficiently combine their diagnostic and economic profitability, which will be able to avoid materializing the potential of expensive radiation equipment by just 15-20% of its built-in efficiency. By taking into account the present epidemiological situation with each of the tumors in question and scientific-and-technological achievements of current diagnostic equipment, the authors underline the need for correcting diagnostic approaches applied in their detection. The paper also presents the opinion of the authors as to selective screening. They are sure that it is impossible without its use to gain even some moderate improvement of the results of diagnosis and hence those of treatment of tumors at four sites, which are all responsible for 50% of all malignancy. The idea that it is necessary to actively return radiation studies to the diagnosis of cancer of the lung, breast, stomach, and large bowel runs throughout the paper. As applied to tumors at each of these sites, the authors express their opinion as to their radiation diagnosis. Naturally, they could not ignore the fact that the authorities of medical industry in our country should take an active part in the solution of organizational problems touched upon in the paper.     

To differential diagnosis of esophageal cancer and other diseases with the similar clinical symptoms, by using traditional X-ray study

The principal purpose of the paper is to assess the role of the X-ray section of current radiation diagnosis in obtaining objective information and interpreting it in esophageal cancer. The study was methodically based on its serial studies, by comparing the data of clinical, radiation, and endoscopic diagnosis with those of morphological studies of the biopsy specimens taken at resection for cancer of the esophagus and the upper stomach, and histologically examined them in diseases running with the similar clinical symptoms. The complex of radiation techniques included traditional X-ray study (compact filling, double contrasting). A specially developed procedure that allowed physicians the opportunity to examine the cardioesophageal area in the fragmentary fashion was used during morphological studies. In cancer of the upper stomach, the lower esophageal segments were also involved in the process in 79.9%. It should be also noted that this number of observations includes some cases that clinical symptomatology and endoscopy strongly suggest cancer of the lower third of the esophagus. The authors have arrived at the conclusion that the present-day X-ray semiotics of esophageal diseases running with the similar clinical symptomatology permits their differential diagnosis just before the use of endoscopy and histology of biopsy specimens and that the unique advantage of radiation diagnosis over endoscopy is to specify the initial site of a tumor, namely, to detect primary gastric damage in cardioesophageal carcinoma.     

Current X-ray diagnosis of stomach cancer (comparison of radiologic and morphological methods of investigation)

By using the principles of wide comparisons of the data of radiation diagnosis (routine X-ray study, ultrasonography (USG), CT, MRI) with the morphological findings of resected gastric specimens from patients with endophytic gastric cancer (EGC) (n = 85), the authors propose some points in the problem associated with its diagnosis. They believe that by taking into account the fact that there is an obvious growth of endophytic parietally growing gastric cancer with the concurrent reduction in its intestinal forms, it is necessary to restore current radiation to its leading place, along with endoscopy, in detecting the cancer. The authors makes a highly positive assessment of USG, CT, MRI in addition to routine X-ray study and endoscopy particularly in those cases when difficulties emerge in histological verification of the existing signs of parietally growing cancer. The paper makes indications for USG, CT, MRI concrete. The authors also show how to stage gastric cancer.     

Potential use of radiation diagnosis of esophageal achalasia

The prime objective of the paper is to attempt to reevaluate the potentialities of current radiation diagnosis of esophageal achalasia. Moreover, its main idea is to assess the procedure of a traditional X-ray section of radiation study. In the authors' opinion, the main motivation of writing this paper was the emergence of new recent potentialities of radiation diagnosis, including its traditional X-ray section in gastroenterological pathology, as well as a considerable body of information on esophageal achalasia (144 cases). The tasks to be solved in the paper include the differential diagnosis of esophageal achalasia and cardioesophageal cancer, as well as the basic capacities of radiation diagnosis to help clinicians in characterizing the changes caused by medical and surgical treatments for this disease. The authors consider that the obtained volume of necessary information on this abnormality rather frequently encountered in esophagogastroenterological pathology can be increased by applying the current possibilities of radiation study and mainly its traditional X-ray section.     

Current problems in the diagnosis of gastric cancer

Based on their own long-term experience in diagnosing gastric cancer and by taking into account the fact that clinicians and diagnosticians analyze this problem insufficiently objectively, the authors of the paper try to convince the reader that it is necessary to revert to the problems of its diagnosis again. They proceed from recent new reports on gastric cancer pertaining to both its morphological forms and diagnostic capacities wherein current radiation diagnosis requires its active return to the problem of its detection. This standpoint of the authors is based on the date of over 6000 comprehensive studies of the stomach, of them 2800 cases have been diagnosed as having tumor lesions. In addition to the assessment of current radiation diagnosis of gastric cancer, which involves both routine X-ray study and ultrasonography, X-ray computed tomography, and magnetic resonance imaging of the stomach, the authors express their opinion on some organizational issues without which the diagnosis of this disease cannot be improved.     

Possibilities of radiologic methods (ultrasonography, computed tomography) in the preoperative evaluation of intramural invasion of gastric cancer

By analyzing the findings in 72 patients with gastric cancer, the authors show the potentialities of noninvasive techniques of radiation diagnosis (transabdominal ultrasonography (USG) and X-ray computed tomography (CT) in the preoperative evaluation of the T-stage of gastric cancer. Ultrasound and computed tomographic semiotics of intramural invasion of gastric carcinoma is made. Ultrasonography was found to have the highest specificity in detecting early-stage gastric cancers prior to computed tomography. In the authors' opinion, a complex use of the data obtained by these techniques reveals the degree of invasion of gastric carcinoma and its extent with high precision. Transabdominal USG and CT should rank with the initial methods used for diagnosing gastric cancer. Transabdominal USG should be most expediently used as an initial technique of the above studies, by taking into account its wide accessibility, easiness-to-use, and lack of radiation load.     

Current possibilities of X-ray diagnosis of small intestine diseases using the agent Entero-view

The paper analyzes the current capacities of routine (classical) X-ray study in the diagnosis of organ diseases of the small bowel. The distinctive feature of the paper is that in addition to routine barium passage through the small bowel, the new barium contrast agent Entero-view specially designed for its exploration is used. Of the 115 examined patients with various gastroenterological diseases, 76 underwent Entero-view examination that revealed different organ pathology of the small bowel in 28 cases (Crohn's disease in 18, tuberculosis in 3, lymphomas in 5, and cancer in 2). A normal X-ray pattern of the small bowel was diagnosed in 48 cases. The authors highly appreciate this agent. In their opinion, it is essentially helpful in solving one of the most difficult problems in X-ray gastroenterology--present-day X-ray diagnosis of small bowel pathology. The paper describes a procedure for using this agent. It gives a normal X-ray pattern of the small bowel, the agent's use has provided a particularly vivid image of both a normal part of the ileum and its different organ pathology-associated changes.     

A role and a place of ultrasound diagnosis of acute ileus

The main purpose of the authors is to present their view of a place of present-day ultrasonography in the diagnosis of acute small and large intestinal obstruction. A comparatively sizable material covering 218 verified cases of acute ileus, including 77 patients with large intestinal obstruction and 141 patients with impaired passage of the intestinal contents along the small bowel was used to outline the aspects of ultrasound techniques and the symptomatology of ileus, by differentiating its some types. Along with the general assessment of the methodological and semiotic aspects of ultrasound diagnosis of acute uleus, the authors emphasizes a role of sonography in the detection of large intestinal obstruction by outlining their modified procedure of ultrasound irrigoscopy. For greater objectivization of their positive assessment of the place of ultrasound in the diagnosis of acute ileus and large intestinal obstruction, the authors comparatively studied X-ray and ultrasound studies to reveal this pathology. In addition to their purely personal assessment of a role of ultrasound in the diagnosis of large intestinal obstruction, the lecture also shows its authors' opinion as to the organizational issues associated with the necessity of correcting the existing diagnostic algorithm to detect large intestinal obstruction.     

Ultrasound study in colonic diverticular microperforation

This paper deals with the results of ultrasound (US) study in 34 patients with a history of colonic diverticulosis, who have been admitted to hospital for the clinical manifestations of diverticular microperforation. Diverticulosis was verified by X-ray irrigoscopy in 15 patients, by oral contrast-enhanced computed tomography in 6, and by colonoscopy in 18. Analysis of US findings revealed the major US syndromes of colonic diverticular microperforation, namely a change in the intestinal wall as its thickening and lower echogenicity, as well as perifocal infiltration and local accumulation of free fluid outside the altered bowel.     

Cases of Crohn's disease involving the small bowel, diagnosed by the barium contrast agent ENTERO-VU

The paper deals with the capacities of X-ray diagnosis of Cronh's disease involving the small bowel, using the barium contract agent Entero-VU specially designed to examine the bowel. It describes 3 cases of Crohn's disease presented by its different stages and localization in the small bowel. In the author's opinion, the barium contrast agent Entero-VU designed to examine the small bowel has two basic advantages: it is easy-to-use and highly diagnostically effective.     

X-ray study in infants of the first year of life who had congenital heart diseases: traditions, specific features, new capacities

The paper analyzes the experience with ultrafast computed tomography (CT) used for 4 years to examine 178 babies with complicated congenital heart diseases (CHD), admitted to A.N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, for surgical treatment. It shows the comparative capacities of X-ray study, CT, and catheterized angiography in the diagnosis of CHD and concomitant lung diseases in patients of the first year of life in terms of the physiological and anatomic features of the course of disease. A complex of noninvasive radiation studies is shown to be of high informative value in evaluating the actual anatomy of complicated cardiac and pulmonary anomalies and in detecting the predictors of respiratory complications. The introduction of CT into the traditional algorithm of preoperative examination of patients with CHD has resulted in a considerable reduction in intracardiac diagnostic studies in neonates and infants of the first year of life.     

Use of modified irrigoradioscopy in the diagnosis of external and internal rectal prolapse

The paper gives colonic X-ray findings in 39 patients with rectal prolapse. Of them, 20 and 19 patients were found to have internal and external rectal prolapse, respectively. Studies were conducted by the modified irrigoscopy developed by the State Coloproctology Research Center, Ministry of Health of the Russian Federation, to explore the anatomic and functional status of the rectum and the fundus of the pelvis in patients with impaired defecation. The X-ray sign of circular invagination that had been detected by the authors allowed them to make the diagnosis of internal rectal prolapse with the greatest assurance. The modified irrigoscopy in combination with oral enterography for external rectal prolapse could show associated changes, including enterocele and sigmocele.     

Ultrasonography in the diagnosis of colonic obstruction

The authors of the present paper outline the results of studying the use of routine transabdominal sonography and ultrasound irrigoscopy (UI) in the diagnosis of acute colonic obstruction (ACO) in 70 patients. The cause of ACO was tumor-induced colonic luminal obturation in 55 patients and colonic evacuatory dysfunction due to congenital anomalies and acquired constrictions of inflammatory genesis in 15 cases. UI was used to determine the presence, degree, and causes of colonic obstruction. The paper details the UI procedure developed by the authors and the ultrasound semiotics of ACO, shown by routine transabdominal sonography and UI. Analysis of the results of the studies allows the authors to state that UI is as highly informative as X-ray irrigoscopy in the diagnosis of ACO and may be included into a diagnostic algorithm in these patients.     

Role of visual control during percutaneous sclerosing therapy for soft tissue arteriovenous dysplasias

Based on the current concept of the obvious prevalence of surgical treatment of vascular angiodysplasias over low-invasive methods of interventional radiology, the author assesses the capacities of sclerotic therapy performed by the improved visual controlling procedure. By using the well-known semiotics of ultrasound studies of angiodysplasias, the author has made significant methodological amendments to the techniques of sclerotic therapy. The principle of the proposed procedure is a result of complex use of the potentialities of ultrasound visualization and interventional X-ray contrast studies of the vascular system. The procedure was successfully used in 9 patients. It is concluded that that the study of soft tissue angiodysplasias via direct puncture performed under ultrasound guidance, followed by mass contrasting and sclerotic therapy.     

Artificial contrasting of the hip joint in children and adolescents: X-ray anatomic study

The diagnostic capacities of currently available radiation diagnostic techniques in imaging some anatomic structures of the hip joint (HJ) were determined on the basis of studies of 70 sectional sets of HJs in children and adolescents aged 0 to 13 years through X-ray and anatomic comparisons. Magnetic resonance imaging (MRI) is the method of choice in visualizing the cartilaginous and soft-tissue structures of HJ in children and adolescents. MR-arthrography extends the capacities of the technique in imaging the articular surfaces and intraarticular structures of the joint. Contrast enhancement of the HJ cavity during X-ray study and computed tomography may be an alternative to MRI as it makes it possible to well visualize the cartilaginous head of the femur, the cartilaginous borders of the cotyloid cavity, the limbus, etc. Double contrasting enhances the capacities of detailed imaging of the articular surfaces, intraarticular structures, capsules, and ligamentous apparatus of HJ. The studies performed have specified the time course of anatomic changes during HJ growth and defined the method of choice or an alternative procedure of radiation techniques in the diagnosis of these changes, which is of great importance for early detection of pathological changes and for choice of therapeutic and diagnostic policy.     

New capacities of X-ray diagnosis in detection of small intestine pathology

The paper based on the data of more than 200 studies of the small bowel with the new agent Entero-VU specially designed for X-ray study of the bowel gives an objective evaluation of this agent. The authors of the paper analyze the capacities of Entero-VU in diagnosing 38 cases of Crohn's disease, tuberculosis and tumors of the small bowel. Moreover, as a separate section the paper provides an assessment of the agent in mapping the X-ray standards of the small bowel. In the authors' opinion, the use of this agent as though fills the existing gap in the X-ray study of the small bowel.     

New capacities of roentgen diagnosis in detecting small intestinal pathology

The paper based on the data of more than 200 studies of the small bowel with the new agent Entero-VU specially designed for X-ray study of the bowel gives an objective evaluation of this agent. The authors of the paper analyze the capacities of Entero-VU in diagnosing 38 cases of Crohn's disease, tuberculosis and tumors of the small bowel. Moreover, as a separate section the paper provides an assessment of the agent in mapping the X-ray standards of the small bowel. In the authors' opinion, the use of this agent as though fills the existing gap in the X-ray study of the small bowel.     

Cancer of the upper stomach: current problems of its diagnosis

Data on 1248 cases of stomaches radically operated on for cancer at the surgical departments of the Moscow Regional Research Clinical Institute in 1971 to 2000 were used to study a number of problems associated with cancer of the upper stomach, by regarding the present-day role of radiation diagnosis as of paramount importance. The following radiation diagnostic techniques were assessed. Among them there were traditional X-ray studies (in each case), the new radiation diagnostic techniques: ultrasound study and computed tomography (CT) (750 studies), magnetic resonance imaging (MRI) (120 studies). The potentialities of radiation diagnosis and endoscopy performed in all cases are compared. A specially developed procedure for exploring endophytic forms of gastric cancer was employed in the morphological studies of the material. The incidence of cancer of the upper stomach and its association with the esophagus are presented; some aspects of the morphogenesis of cancer of this site are discussed. The relationship of its clinical symptoms and its radiation image has been studied. In the authors' opinion, the past two decades' rise in the incidence of proximal gastric cancer is one of the main problems in diagnosing gastric cancer that continues holding its stand in the general structure of cancer morbidity. The tendency for diffuse and mixed forms to increase in the morphogenesis of gastric cancer provides evidence that radiation techniques should be actively used in its diagnosis. It is necessary to apply classical double-contrasting X-ray study and endoscopy on equal grounds as basic diagnostic methods at early stages. Only their concord use may change the poor situation associated with the diagnosis of cancer at this site. CT and MRI as additional techniques may substantially provide more required diagnostic information. This is first and foremost associated with difficulties in gastric endoscopic study when esophageal cancer is apparently proved.