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This atlas is a selection of roentgenograms of patients who visited
the radiology departments at the University Hospital in Leiden
between 1970 and 1978, the Free University Hospital in Amsterdam in
1979, and the radiology department at the Indiana University
Medical School in Indianapolis in 1977. The most common
radiological abnormalities of the small intestine are illustrated
clearly, unhindered by flocculation or segmentation of the contrast
fluid. The authors believe this book is a definite contribution to
the goal of precise early small bowel diagnosis. However, the key
to good diagnosis is not only a superb examination technique, but
also the knowledge, the character, and the personal perfectionism
of the physician. If these factors are optimal, then the best
possible roentgenographic series will be obtained - at least as far
as the technique is concerned. All patients illustrated here were
examined by using the enteroclysis technique. With this method of
small bowel examination, the contrast fluid is administered via an
infusion directly into the duodenum instead of orally. The infusion
method has added a new dimension to the usual radiological
examination of the small intestine. This method is also especially
suited for the comparative evaluation of motility, and the study of
disturbed motility. Throughout the course of the examination, the
technique can be adapted to special situations at any given moment
and can be modified to produce precise diagnostic roentgenograms
and diagnosis.
VI J. R. VON RONNEN PREFACE This atlas is a selection of the
roentgenograms of patients who visited the Radiology Department at
the University Hospital in Leiden between 1970 and 1974. The heads
of this department are Prof. J. R. von Ronnen and Prof. A. E. van
Voorthuisen. In this atlas, the most frequently occurring
radiological abnormalities of the small intestine are illustrated
as clearly as possible - without the shadows caused by flocculation
or segmentation of the contrast fluid. The author hopes it will be
a positive contribution towards the attainment of the highest
possible diagnostic score. It should be remembered that the key to
good diagnostics is not only a perfect examination technique, but
also the knowledge and character of the physician. If these factors
are optimal, then the best possible series of roentgenograms will
be obtained, at least as far as technique is concerned. All
patients were examined by the enteroclysis technique. With this
method of examination of the small intestine, the contrast fluid is
administered via an infusion directly into the duodenum instead of
orally. The infusion method has added a new dimension to the
radiological examination of the small intestine. This method has
turned out to be especially suitable for the comparative evaluation
of motility, and also for the study of disturbed motility.
Our knowledge of the diseases of the small intestine has increased
greatly since the second world war. The advances made in the
auxiliary sciences, in particular biochemistry and histology, are
mainly responsible and have led to their increased importance in
this field. It is unfortunate that although radiology also
contributed new understanding, it has not been able to match the
progress of the other sciences. In spite of the advancements made
in, for instance, vascular examination, radiology has experienced a
relative decrease in its importance to the differential diagnosis
of the diseases of the small intestine. The main reason for this is
that radiology can only offer an extremely modest contribution to
the differentiation between the many diseases with the
malabsorption syndrome. In a number of cases, radiological
differential diagnosis is in principle not possible because there
are only histological and biochemical abnormalities of the mucous
membrane of the small intestine without macroscopic abnormalities.
There remain however many diseases with malabsorption for which a
morphological examination can be highly valuable. This applies for:
1. diseases with gross anatomical abnormalities: anastomoses,
fistulae, blind loops; strictures, adhesions; diverticula. 2.
diseases with local, usually rather gross mucosal abnormalities:
leukemia, Hodgkin's disease, lymphosarcoma; intra-mural bleeding;
local edema due to venous congestion (e. g. thrombosis) or
lymphatic obstruction (irradiation treatment). 3. diseases with
more general mucosal abnormalities: edema due to: lymphangiectasis,
allergic reactions, protein-losing enteropathy; amyloidosis,
Whipple's disease, scleroderma.
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