COMPARISON OF X-RAY PICTURES WITH GROSS SPECIMENS IN DUODENAL ULCER Tsuneyoshi Yao 1,2 1Dept. of Internal Med., Faculty of Medicine, Kyushu University. pp.1355-1372
Published Date 1969/11/25
DOI https://doi.org/10.11477/mf.1403110917
  • Abstract
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 In order to find diagnostic limit of ulcer of the duodenal bulb, 41 lesions (including ulcer scars) in 20 ulcer of cases that region, surgically resectetl amply enough so that their nature might be examined in detail both macroscopically and microscopically, have been investigated by correlating them their x-ray pictures. All cases were examined roentgenologically by the author himself within one week before operation, by taking 24 to 52 frames of spot filming after intravenous injection of a blocking agent. The positions for examination were: barium-filled erect frontal; barium-filled prone frontal; erect frontal with compression applied; and prone and supine horizontal (double contrast study). The results are as follows:

 1) Diagnosis of the number of ulcers (diagnosis of existence): Lesions recognized macroscopically in resected specimens have been well delineated in x-ray pictures excepting 2 cases, 6 lesions. A doctor with five years' experience in x-ray study of the digestive system, having no knowledge of cases examined, was able to diagnose accurately 16 cases, 33 lesions by x-ray pictures.

 For existence diagnosis of ulcer, pictures of mucosal convergence proved of great account in affording the author a clue to the existence of an ulcer. The diagnosis had nothing to do with the size of ulcer; smaller lesions 2 or 3mm in diameter was ascertained. On the contrary, it was very difficult in complex lesions found in marked deformity of the bulb.

 2) Differential diagnosis of ulcers between those on the anterior and on the posterior walls was accurately made by the said doctor in 13 out of 20 cases. Double contrast picture of both walls was very helpful, but not omnipotent in the diagnosis of this type of ulcer. Kissing ulcers were mostly confirmed by comparing pictures of compresson visualized on both sides of the spine.

 3) Differentiation between ulcer scar and active ulcer: Accurate diagnosis was made only in 50 to 60 per cent. In x-ray diagnosis, ulcer scar is apt to be regarded as open ulcer. A reference has also been made to the diagnostic criteria of ulcer scar.

Copyright © 1969, Igaku-Shoin Ltd. All rights reserved.


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