Internal hemorrhoids: diagnosis with double-contrast barium enema examinations

Article Abstract:

Barium is one of the metallic, alkaline earth elements. When given as an enema, it can used as a contrast agent for subsequent X-ray examination. Barium enema (with X-ray examination) is typically used for patients with hemorrhoids to make sure that cancer is not involved. Although the technique is often used, there is limited information on how internal hemorrhoids are diagnosed. This study reviewed the records of 43 patients who underwent barium enema examination for suspected internal hemorrhoids. They had positive results and underwent further examination with endoscopy (visual examination with an optical device). Endoscopy found internal hemorrhoids in only 56 percent of the cases. Of the others, 35 percent had no abnormalities, and 9 percent had non-hemorrhoidal problems. Importantly, none of the suspected cases of internal hemorrhoids turned out to be cancer when endoscopy was subsequently performed (except in a few non-characteristic cases). It is also important to note that small hemorrhoids are often overlooked or not recorded during endoscopic examination; this may explain the low confirmation of internal hemorrhoids by endoscopy. Hemorrhoids appear on barium examination either as multiple, submucosal nodules or as lobulated folds. Hemorrhoids were more likely to be confirmed by endoscopy when barium results showed multiple, submucosal nodules than when lobulated folds were seen. Lobulated folds that extended more than 3 centimeters from the anorectal junction and solitary nodules were seen in a few patients and were indicative of possible cancer; these findings were excluded from consideration of the characteristics of internal hemorrhoids. These results suggest that specific criteria can be set for diagnosing internal hemorrhoids with barium enema examinations. When these criteria are not met, endoscopy should be used for further evaluation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Endoscopy, Hemorrhoids

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Giant, human immunodeficiency virus-related ulcers in the esophagus

Article Abstract:

Infection with the human immunodeficiency virus (HIV) can lead to the development of many rare or unusual diseases or infections. A number of HIV-positive patients develop large ulcers in the esophagus. Esophageal ulcers can be caused by a number of viral or fungal organisms. In many HIV patients, the ulcers are a direct result of HIV infection, but they can also be caused by cytomegalovirus (CMV). CMV-related ulcers can be treated with drug therapy. As this therapy is potentially toxic and is not effective against HIV-related ulcers, it is important to be able to easily diagnose the underlying cause. The cases of four patients with HIV-related ulcers were reviewed to examine characteristics and symptoms that may be useful in distinguishing HIV-related from CMV-related ulcers. The patients were HIV-positive males who were found to have esophageal ulcers upon X-ray. Cultures for viral and fungal causes of the ulcers were negative. Initial symptoms included an acute onset of chest pain below the sternum (breast bone). The pain gradually increased in severity and led to each patient's seeking medical attention. X-ray results in all four revealed giant, relatively flat esophageal ulcers, similar to CMV-related ulcers. Three patients had only one ulcer, while the other patient had more than ten ulcers. Endoscopic examination and removal of tissue samples showed no evidence of CMV. The patients were all treated for pain and two were given steroids to treat the ulcers directly. All four patients recovered quickly, with symptoms disappearing in an average of 8.3 days from the time treatment was begun. These results indicate that HIV-related esophageal ulcers are similar in appearance to CMV-related esophageal ulcers on X-rays. Endoscopic examination is required to differentiate between the two. Differentiation is important in determining treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Complications and side effects, HIV infection, HIV infections, Ulcers, Esophagus, Gastrointestinal system, Digestive system abnormalities

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CT evaluation of bowel obstruction: a landmark article - implications for the future

Article Abstract:

In the August 1991 issue of Radiology, Megibow et al report their success in using computed tomography (CT) to evaluate intestinal obstructions. CT is a specialized type of X-ray that uses a computer to generate images. The researchers examined 167 patients who had possible bowel obstruction. CT results correctly diagnosed the presence or absence of an obstruction in 159 of 167 patients and correctly diagnosed the cause of the obstruction in 73 percent of patients with obstructions. This study provides the foundation for further research on using CT in evaluating bowel obstructions. Future studies should focus on determining when CT imaging should be used as the major tool for evaluating small bowel obstructions and when other tools, such as barium studies, would be more appropriate. These studies should focus on different aspects of bowel obstruction in comparing the diagnostic techniques. The grade and duration of the obstruction is one aspect that should be assessed. In patients with long-standing obstructions, barium study results are often unclear, and CT may prove to be more effective in evaluating such patients. The site of the obstruction may also influence which diagnostic tool is more effective. The cause of the obstruction is likely to determine which technique gives better results. CT is a very useful addition to the diagnostic tools available for evaluating bowel obstructions. Further research should help define the role it should play in such evaluation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Editorial, Usage, CT imaging, CAT scans, Intestines, Intestinal obstruction

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