Magnetic resonance imaging in the diagnosis of gastric cancer: X-ray versus MRI anatomic findings

The paper assesses the present-day role of MRI in the diagnosis of gastric cancer. The authors consider the major prerequisites for the main aim of their study to be: 1) a dramatic incidence of diffuse (endophytic) gastric carcinoma, which requires significant correction of today's approaches to its diagnosis and 2) a rather biased and, in the authors' opinion, present-day mainly negative attitude towards MRI of the stomach as a diagnostic method for its tumor lesions. By applying the X-ray-MRI anatomic principle to the comparative study of MRI findings in 50 patients with predominantly gastric intramural carcinoma and in 25 patients without gastric tumors (controls), the authors present their methods for gastric MRI, the MRI semiotics of gastric cancer by concurrently touching upon a variety of problems that characterize the potentialities of MRI of the stomach in the diagnosis of its tumor lesions, including their differential diagnosis. As a result, the authors highly appreciate gastric MRI and consider this method to be included into the diagnostic algorithm of radiation techniques used in the diagnosis of gastric cancer, which should occupy its definite diagnostic place.     

Role of computed tomography in every day practice of municipal health care of the Russian Federation

The basic idea of the paper is due to its authors' wish to provide a comprehensive objective assessment of the role and place of currently available technologies of radiation diagnosis in municipal health care of the Russian Federation on the basis of the computed tomography (CT) room of the Stupino Central Town Clinical Hospital that performs the function of the leading medical institution of the whole Stupino District, Moscow Region. The paper presents a detailed characterization of the basic lines of CT studies and an analysis of their scope in a great variety of clinical subunits of the multidisciplinary Stupino hospital offering 795 beds. The paper lays a great emphasis on the particularly organizational aspects associated with the CT diagnosis of different diseases at the level of municipal heart care. Moreover, the authors express the idea that the findings may be applied not only to CT, but also to the whole group of new radiation diagnostic technologies. By assessing CT at the level of municipal health care, the authors fix their attention on the technological aspects of this technique. Recommendations are given on the most suitable type of CT units for municipal health care depending on the size of the population under service and on the capacity of health care structures. One of the authors' main conclusions suggests that, in addition to the radiation diagnosis service, the administrators of both regional and municipal organizational entities of practical public health care of the Russian Federation should obligatorily participate in order to obtain the high efficiency of radiation techniques.     

To the ways of the most reasonable implementation of digital radiography into the practical public health of the Russian Federation

The main idea of the authors' paper is to propose the most reasonable way of actively introducing the digital principle into the traditional roentgenological section of radiation diagnosis. For this, a luminophore digital radiography system has been chosen. The authors of the paper give a full-scale assessment and appropriate recommendations for its use. The paper essentially discusses the entire complex of matters that permit assessment whether its sound use is possible in regional and municipal health care systems. This is both a section devoted to a dose load, by making a comparative assessment of luminophore radiography and "the green system" and a study of different clinical diseases (456 cases). In their study, the authors have applied an original principle in the formation of an image obtained and some other approaches in order to make a comprehensive assessment of this method. In the authors' opinion, luminophore radiography has a variety of advantages. Firstly, this technique can be simultaneously applied to several nondigital apparatuses, including those available in the ward and it shows a rather diagnostic effectiveness and economic profitability, yields a qualitative image of varying density tissues upon single exposure, and has some other capacities of the CR system as a digital technique. All this things considered, the authors consider that luminophore radiography may be one of the main ways of introducing a digital technique into the conventional roentgenological section of radiation diagnosis at the level of regional and municipal heath care systems.     

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.     

Capacities of ultrasound study in the diagnosis of diffuse gastric carcinoma

By using 237 verified cases of diffuse carcinoma and benign diseases of the stomach as an example, the authors assess the capacities of routine transabdominal ultrasound study (USS) of the stomach in the diagnosis of tumors and present their modification of the procedure facilitating the imaging of problem areas. In the authors' opinion, the symptoms of thickening of the wall of the stomach and abnormalities in its normal five-layered structure indicate diffuse gastric carcinoma. The authors consider USS to be a supplement to the basic diagnostic techniques--X-ray study and gastroscopy.     

Some problems of radiation diagnosis of colon cancer

The paper gives the view of the author who is based on his many-year experience in studying a role of radiation diagnosis of colon cancer. It shows it necessary to enhance the significance of radiation diagnosis. More attention should be given to the traditional section on the current radiation study of the large bowel: to irrigoscopy and single double contrasting. By taking into account the labor-consumption of irrigoscopy, the author suggests that the procedure should be simplified without losing its diagnostic capacities. However, he considers single double contrasting of the bowel to be the optimum technique of traditional X-ray study of the bowel in detecting its tumors. Pneumocolonoscopy and iliocecal node study of the ileocecal angle are given in the paper as supplementary techniques of traditional X-ray study of the large bowel. Emphasis is also placed on the role of radiation diagnostic techniques, such as ultrasound diagnosis, X-ray computed tomography, and magnetic resonance imaging. By highly appreciating their significance in the diagnosis of colon cancer, the author believes that they should play a role of important, but additional ways of detecting this pathology. By pointing out the excellent capacities of fibrocolonoscopy, as applied to the problem discussed in the paper, the author does emphasize the certain limitations of this technique, by taking into account that its application can cause some complications. The author's opinion that the obvious increase in the incidence of endophytic carcinomas drastically enhances the role of their radiation diagnosis, but by obligatorily correcting currently available principal methodic and semiotic directives, runs through the entire paper.     

A place of outpatient screening in the formation of a current organizational scheme for better radical detection of breast cancer

The authors consider it necessary to revise the current views of breast cancer in women. In their opinion, excessive consideration of mammography as an independent section of radiation diagnosis does not contribute to better detection of breast cancer. The principle of including mammography into the general traditional section of current radiation diagnosis should be regarded as of paramount importance. Mammography should be widely introduced into the general polyclinic network of the practical health care system of the Russian Federation. The so-called mammological dispensaries (centers) that have been or being set up should more clearly define their functions mainly to rendering an organizational and methodological assistance in the diagnosis of breast cancer at a routine outpatient level, to make its specified diagnosis, and to define the tactics of rendering a medical care of detected breast pathology in the polyclinic. The authors consider that the wide introduction of screening for breast cancer into the practice of polyclincs is one of the basic ways of improving of its detection.     

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.     

A place of digital X-ray fluorography in the detection of lung diseases in the public health facilities of the Russian Federation

The paper shows the authors' opinion as to the use of digital X-ray fluorography (DXF) to detect pathology of the lung, primarily its tuberculosis and cancer from organizational-and-methodological and purely diagnostic standpoints. Based on a great body of data pooling 21,295 studies of patients, which comprised two (screening and routine clinical) groups, they authors state their views on the place and role of lung DXF in the work of public health facilities in the Russian Federation (RF). The objectivity of the authors' opinion is confirmed by the different nature of a lung abnormality detected by DXF at both the municipal and regional levels of the RF public health system and by a comparative analysis of the findings with those of film fluorography, routine X-ray study, linear tomography, X-ray computed tomography (XCT), and surgical evidence. The study has allowed the authors to express their opinion by recommending DXF as a method for primary diagnosis of lung diseases instead of film fluorography and routine X-ray study and to appreciate it in screenings. The authors' data indicate that XCT in its simplest variant rather than linear tomography should become the optimum method that specifies the diagnosis of lung diseases detected by DXT.     

Algorithms of diagnostic radiation methods in current urological pathology

Based on the results of 3600 studies using all basic methods of modern radiation diagnosis, the authors show it necessary to develop diagnostic algorithms applicable to certain groups of urological diseases (urolithiasis, inflammatory processes and bulky masses in the kidney). This necessity has recently stemmed from the advent of new technologies of radiation diagnosis and from the expediency of using a certain method at the specific stage of examination. At the same time, the authors underline the importance of using standardized examination programmes (algorithms) in practice, which is also due to the fact that unreasonable use of the whole set of new radiation techniques that are of highly diagnostic value may bear great material costs.     

Value of aspiration cytology of the thyroid in metastatic disease

Metastases may simulate primary malignant tumors of the thyroid, causing problems in the diagnosis and management of patients with a history of cancer. In the seven-year period of July 1978 through June 1985, 8 of 549 needle aspirates of the thyroid contained metastatic tumor, 6 of which were subsequently confirmed by histologic study. The primary sites of origin were the breast, kidney, colon and stomach as well as lymphoma. The cytologic features observed in the aspiration biopsy material from the six cases were characteristic of each of the primary tumors. Three of the patients had had prior resections of carcinomas (breast, colon and stomach) while in three patients the cytologic diagnosis of the thyroid aspirates led to the discovery of the primary tumor (kidney and two lymphomas). One case of lymphoma/leukemia and one case of previously biopsied lung carcinoma were confirmed on clinical grounds. It is of critical importance that primary thyroid neoplasms occurring in patients known to have primary tumors elsewhere be distinguished from disseminated tumors involving the thyroid. Our experience suggests that fine needle aspiration is of considerable value in this differential diagnosis. Needle aspirates of the thyroid are also of value in leading to the diagnosis of unsuspected nonthyroidal primary 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.     

Gastric and intestinal scintigraphy in the complex diagnosis of small bowel obstruction

An algorithm has been developed for radiation diagnosis of small bowel obstruction, which involves abdominal X-ray and ultrasound studies at the first stage and radionuclide evaluation of gastrointestinal transit, by using 100-150 ml of aqueous 99mTc-technefite or 99mTc-bromeside solution in a dose of 50-100 MBq (radiation load 0.7-1.4 MeV) per os. The sensitivity, specificity, and diagnostic efficiency of the whole radiation diagnostic complex and each procedure separately were determined by the results of examination in 180 patients with suspected small bowel obstruction, of whom 104 patients were operated on, but obstruction ceased during medical treatment. Inclusion of the radionuclide technique into the diagnostic complex involving plain radiography and ultrasonography was shown to enhance diagnostic efficiency up to 97-98%.     

An algorithm of radiation and endoscopic diagnosis of colonic tumors

By analyzing the results of examination and treatment in 87 patients, the authors show the potentialities of radiation and endoscopic studies in the diagnosis of malignant and benign tumors of the large bowel. The algorithm developed on the basis of the complex, multistage, goal-oriented use of radiation and endoscopic studies in terms of its specific features may timely and early detect malignant colonic tumors and preliminary rank them in accordance with the international TNM classification, to perform adequate treatment, and to monitor benign space-occupying lesions.     

Potentialities of ultrasound study in diagnosis of endophytic carcinoma of stomach

The data of studies of 45 patients with gastric cancer are used to consider the potentialities of ultrasonography (USG) in the diagnosis of its endophytic forms. Its use in the diagnosis of "small" gastric carcinomas is evaluated. The USG semiotics of endophytic tumors of the stomach, including its "small" and early forms, is presented. The place of USG in the diagnostic algorithmic of gastric cancer is specified. In the authors' opinion, gastric USG along with traditional X-ray and endoscopic studies should take an appropriate place as it is beneficial in solving a great deal of differential diagnostic problems associated with the intramural spread of tumors.     

Role of magnetic resonance imaging in the complex radiation diagnosis of hormonally active adrenal tumors

Based on the results of examination of 30 patients with hormonally active adrenal tumors, the authors consider the MRI sympatomatology of their different types and the potentialities of the technique in the complex radiation diagnosis of this pathology. The authors present their assessments of the relative intensity of a signal and the structure of each type of hormone-producing tumors of the glands by using different MRI pulse sequences that may be useful in establishing a presumptive morphological diagnosis. They identify MRI sequences that are of the greatest informative value for the diagnosis of each type of hormonally active adrenal tumors. There is evidence for that MRI is highly effective in detecting all types of hormonally active adrenal tumors and, in the context of their topographic and anatomic diagnosis, has an unquestionable advantage over ultrasonography and X-ray computed tomography in some cases.     

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.     

Environment and cancer in Brazil: an overview from a public health perspective

This paper presents the current pattern of cancer incidence in Brazil by analyzing the country's cancer epidemiological profile. The authors highlight the observed overlapping distribution of cancer incidence in Brazil in tumor sites normally associated with higher socioeconomic status (cancers of the breast, prostate, and colon/rectum, among others) and poverty (cervix, stomach, oral cavity, and penis). In addition to analyzing the demographic and social characteristics associated with current epidemiological distribution of cancer in Brazil, the authors present several of the most important environmental risk factors (smoking and exposure to radiation, pesticides, and other chemicals) and discuss their respective exposure levels in the Brazilian context.The article concludes with an evaluation of the principal challenges facing environmental cancer control programs in Brazil, particularly focusing on smoking and exposure to chemicals.     

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.     

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.