High-resolution genomic alterations in Barrett's metaplasia of patients who progress to esophageal dysplasia and adenocarcinoma

The main risk factor for esophageal dysplasia and adenocarcinoma (DAC) is Barrett's esophagus (BE), characterized by intestinal metaplasia. The critical genomic mechanisms that lead to progression of nondysplastic BE to DAC remain poorly understood and require analyses of longitudinal patient cohorts and high-resolution assays. We tested BE tissues from 74 patients, including 42 nonprogressors from two separate groups of 21 patients each and 32 progressors (16 in a longitudinal cohort before DAC/preprogression-BE and 16 with temporally concurrent but spatially separate DAC/concurrent-BE). We interrogated genome-wide somatic copy number alterations (SCNAs) at the exon level with high-resolution SNP arrays in DNA from formalin-fixed samples histologically confirmed as nondysplastic BE. The most frequent abnormalities were SCNAs involving FHIT exon 5, CDKN2A/B or both in 88% longitudinal BE progressors to DAC vs. 24% in both nonprogressor groups (p = 0.0004). Deletions in other genomic regions were found in 56% of preprogression-BE but only in one nonprogressor-BE (p = 0.0004). SCNAs involving FHIT exon 5 and CDKN2A/B were also frequently detected in BE temporally concurrent with DAC. TP53 losses were detected in concurrent-BE but not earlier in preprogression-BE tissues of patients who developed DAC. CDKN2A/p16 immunohistochemistry showed significant loss of expression in BE of progressors vs. nonprogressors, supporting the genomic data. Our data suggest a role for CDKN2A/B and FHIT in early progression of BE to dysplasia and adenocarcinoma that warrants future mechanistic research. Alterations in CDKN2A/B and FHIT by high-resolution assays may serve as biomarkers of increased risk of progression to DAC when detected in BE tissues.

FBXW7 mutations in melanoma and a new therapeutic paradigm

BACKGROUND

Melanoma is a heterogeneous tumor with subgroups requiring distinct therapeutic strategies. Genetic dissection of melanoma subgroups and identification of therapeutic agents are of great interest in the field. These efforts will ultimately lead to treatment strategies, likely combinatorial, based on genetic information.

METHODS

To identify "driver" genes that can be targeted therapeutically, we screened metastatic melanomas for somatic mutations by exome sequencing followed by selecting those with available targeted therapies directed to the gene product or its functional partner. The FBXW7 gene and its substrate NOTCH1 were identified and further examined. Mutation profiling of FBXW7, biological relevance of these mutations and its inactivation, and pharmacological inhibition of NOTCH1 were examined using in vitro and in vivo assays.

RESULTS

We found FBXW7 to be mutated in eight (8.1%) melanoma patients in our cohort (n = 103). Protein expression analysis in human tissue samples (n = 96) and melanoma cell lines (n = 20) showed FBXW7 inactivation as a common event in melanoma (40.0% of cell lines). As a result of FBXW7 loss, we observed an accumulation of its substrates, such as NOTCH1. Ectopic expression of mutant forms of FBXW7 (by 2.4-fold), as well as silencing of FBXW7 in immortalized melanocytes, accelerated tumor formation in vivo (by 3.9-fold). Its inactivation led to NOTCH1 activation, upregulation of NOTCH1 target genes (by 2.6-fold), and promotion of tumor angiogenesis and resulted in tumor shrinkage upon NOTCH1 inhibition (by fivefold).

CONCLUSIONS

Our data provides evidence on FBXW7 as a critical tumor suppressor mutated and inactivated in melanoma that results in sustained NOTCH1 activation and renders NOTCH signaling inhibition as a promising therapeutic strategy in this setting.

Aronia melanocarpa fruit extract exhibits anti-inflammatory activity in human aortic endothelial cells

Background

Altered expression of cell adhesion molecules (CAMs) has been implicated in a variety of chronic inflammatory conditions, including atherosclerosis. Regulation of adhesion molecule expression by specific redox-sensitive mechanisms has been reported. Additionally, it has been observed that the extract of Aronia melanocarpa (A. Melanocarpa) fruits, rich in polyphenols, exhibits potent anti-oxidant properties and displays cardioprotective activity.

Methods and results

Human aortic endothelial cells (HAECs) were pretreated with various concentrations (primarily 50 μg/mL) of Aronia Melanocarpa fruit extract prior to treatment with TNFα (10 ng/mL) for various periods of time. The surface protein and mRNA expression of ICAM-1 and VCAM-1 were determined using flow cytometry and real-time RT-PCR, respectively. Adhesion of peripheral blood mononuclear leucocytes (PBMLs) to TNFα-treated HAECs was evaluated by an adhesion assay. Activation of NF-κB was evaluated by measuring NF-κB p65 phosphorylation using flow cytometry. ROS production was determined by reduction in fluorescent 2′,7′-dichlorofluorescein diacetate (DCFH-DA). Tested A. Melanocarpa extract significantly inhibited the expression of ICAM-1 and VCAM-1, attenuated the phosphorylation of NF-κB p65 and decreased intracellular ROS production in TNFα-treated HAECs.

Conclusion

We conclude that A. Melanocarpa fruit extract exhibits anti-inflammatory effects in HAECs by inhibiting the expression of endothelial CAMs, activation of NF-κB and production of ROS.

Trans fatty acids induce a proinflammatory response in endothelial cells through ROS-dependent nuclear factor-κB activation

It has been shown that increased intake of trans fatty acids (TFAs) is associated with a higher risk of cardiovascular disease. In this study, we have investigated the effects of linoelaidic (LA) and elaidic (EA) acids on the proinflammatory response in endothelial cells, a key step in vascular disease. Human aortic endothelial cells (HAECs) were treated with different concentrations (100 μmol/l in most experiments) of LA or EA for different periods of time. The surface protein and mRNA expression of ICAM-1 and VCAM-1 were determined by flow cytometry and real time RT-PCR, respectively. Adhesion of leukocytes to TFA-treated HAECs was evaluated by an adhesion assay. Activation of nuclear factor-κB (NF-κB) was evaluated by measuring NF-κB p65 phosphorylation using flow cytometry. ROS production was determined by the reduction of fluorescent 2',7'-dichlorofluorescein diacetate (DCFH-DA). LA treatment significantly increased protein and mRNA levels of ICAM-1 and VCAM-1, leukocyte adhesion to HAECs, phosphorylation of NF-κB and ROS generation. Similar effects were achieved for cells incubated with EA. Experiments with HAECs pretreated with pyrrolidine dithiocarbamate, an inhibitor of NF-κB, revealed that both LA and EA-mediated induction of ICAM-1 and VCAM-1 is mainly regulated by NF-κB. The ROS production induced by both of the studied acids was inhibited in the presence of diphenyleneiodonium (DPI), a NADPH oxidase inhibitor, suggesting ROS production through the activation of NADPH oxidase. Furthermore, LA or EA-induced ICAM-1 and VCAM-1 expression, activation of NF-κB and adhesion of leukocytes to HAECs were abolished in the presence of DPI.

CONCLUSION

TFAs present in our diet have a direct proinflammatory effect, which promotes leukocyte adhesion to the endothelium through ROS-dependent NF-κB activation.

Giant medial parameniscal cyst in an osteoarthritic knee

Medial parameniscal cysts of the knee are typically 0.3 to 9 mm in diameter. Few cases of unusually large medial parameniscal cysts have been reported. We describe the treatment of a patient with osteoarthritis of the knee who presented with an extraordinarily large, ipsilateral, medial parameniscal cyst, 10 cm in diameter. We believe this to be the largest medial parameniscal cyst reported in the English literature. Based on the patient's severe tricompartmental arthritis and associated symptoms, total knee arthroplasty (TKA) was indicated with simultaneous excision of the parameniscal cyst. Perioperativley, the cyst was found to have penetrated beyond the menisco-capsular attachments that were adjacent to a degenerative posterior horn horizontal medial meniscal tear. Following excision of the cyst, the mass was measured with surgical tape to be 10x10x5 cm. After complete excision of the parameniscal cyst, TKA was performed. Histological examination confirmed a benign parameniscal synovial cyst. At 2-year follow-up, the patient was ambulating unassisted without difficulty. The wound had completely healed with no evidence of recurrence of the cyst. The patient's range of motion was 0 degrees to 110 degrees with no signs of instability. Our patient's pathology was most significant for the heretofore unseen large size of the paramensical cyst. Open excision of this giant parameniscal cyst followed by TKA was effective in treating the patient's degenerative joint disease and extraordinarily large, painful soft tissue mass.

N-(p-azido-3-[125I]iodophenethyl)spiperone binds to specific regions of P-glycoprotein and another multidrug binding protein, spiperophilin, in human neuroblastoma cells

P-glycoprotein (P-gp) is an energy-dependent drug extrusion pump with broad specificity for diverse hydrophobic anticancer agents and compounds known to reverse multidrug resistance (MDR). Among MDR reversing agents, phenothiazines (PTZs) and related compounds may sensitize MDR by interacting with a specific binding site(s) on P-gp and by other mechanisms. In order (1) to identify a binding site for PTZs and related compounds on P-gp, (2) to examine whether these compounds and other MDR modulators bind to the same domains of P-gp, and (3) to identify proteins with high specificity for these neuroleptic agents and other MDR modulators, we used a butyrophenone D2-dopamine receptor photoaffinity probe, N-(p-azido-3-[125I]iodophenethyl)spiperone ([125I]NAPS). [125I]NAPS was actively effluxed from vincristine (VCR)-resistant SH-SY5Y/VCR human neuroblastoma cells, and nonradioactive I-NAPS was a potent chemosensitizing agent. After photolabeling, the probe bound specifically and with high efficiency to P-gp and to another multidrug binding 17-kDa membrane-bound protein, spiperophilin, in these cells. The efficiency of [125I]NAPS binding to P-gp was 5-6-fold more than [3H]azidopine and [125I]arylazidoprazosin ([125I]AAP), known photoaffinity analogs for P-gp. [125I]NAPS photolabeling of P-gp was preferentially competed by MDR-related drugs, with vinblastine > VCR > colchicine > doxorubicin > actinomycin D. Many drugs that are known to reverse MDR were potent inhibitors of [125I]NAPS binding to P-gp. While PTZs and related compounds were potent inhibitors of [125I]NAPS binding to P-gp, most of them enhanced the binding of [125I]AAP significantly. cis-Flupentixol increased the binding of [125I]AAP to P-gp 9-fold more than did trans-flupentixol, but both were potent inhibitors of [125I]NAPS binding, suggesting their stereoselective effect on the [125I]AAP binding site. Proteolysis of [125I]NAPS-bound P-gp with Staphylococcus aureus V8 protease revealed that this probe binds to two major peptides, 6 and 8 kDa, and a number of minor ones, while [125I]AAP binds to only an 8-kDa peptide. These results suggest that modulators of MDR may interact with separate or overlapping domains. Furthermore, most MDR modulators, dopaminergic drugs, and beta-adrenergic antagonists used also inhibited binding of [125I]-NAPS to spiperophilin, suggesting that this protein may be a target for these drugs.

Paraesophageal hernia causing colonic obstruction

In a paraesophageal hernia, the esophagogastric junction remains below the hiatus while portions of the fundus or other parts of the stomach herniate in front and to the left of the esophagogastric junction through the hiatus into the thorax. We describe an unusual presentation of a paraesophageal hernia, in which herniation of the splenic flexure of the colon led to colonic obstruction.

Xanthogranulomatous pyelonephritis in children: analysis by diagnostic modalities

Xanthogranulomatous pyelonephritis (XGP), an uncommon chronic inflammatory renal disorder of middle-aged women, is rarely seen in childhood. We report the sonographic findings in a 2-year-old girl with the diffuse form of XGP and discuss the role of newer imaging modalities in the diagnosis and management of this disorder.

Obstructive jaundice secondary to multiple myeloma--a case report

Reported is a patient who presented with clinical obstructive jaundice caused by multiple myeloma involving the pancreatic head. This is a rare complication and a review of the literature showed only three similar reported cases.

Transient thoracic venous collaterals: an incidental CT finding

Four patients exhibited thoracic venous collateral circulation on CT of the chest. No clinical or CT evidence of venous obstruction was seen. Repeat CT in one patient following repositioning of the arms from hyperabducted to the anatomic position showed absence of collateral circulation. It appears that hyperabduction of the arms during performance of chest CT can occasionally cause transient obstruction of the subclavian vein and opacification of collateral venous channels.

Gastric involvement in abdominal wall hernias

Six cases of abdominal wall hernias involving the stomach are reported. Three of the hernias were incisional, 2 were epigastric, and 1 was umbilical. All the patients were middle-aged or elderly women. In 2 cases, the gastric herniation produced gastric outlet obstruction with resulting severe dehydration and electrolyte disturbances. Radiographically, the abnormality involved deformity of the stomach with shortening in the frontal views. Lateral profile views were essential in demonstrating the cause of this deformity. In 5 cases, there was mesenteroaxial torsion of the herniated stomach so that the efferent limb of the hernia was superior to the afferent limb. Two of these were associated with obstruction which developed at the neck of the efferent limb.

Acoustic properties of polyvinyl chloride gelatin for use in ultrasonography

Visualization of superficial structures with conventional rapid scanners has been difficult. A solid flexible polyvinyl chloride (PVC) gelatin slab used as a stand-off material can provide a constant scan distance and thus overcome the problem of poor near field resolution. PVC gelatin expands the capability of the 3-4 MHz transducer to delineate superficial structures. We report on the acoustic properties of the PCV gelatin, including the values of velocity and attenuation as a function of both frequency and temperature, and the comparison of data with published values of velocity and attenuation for water, soft tissue, and a phantom material.

Enterolithiasis: a report of four cases

Enterolithiasis is a rarely encountered clinical and radiologic entity. Stasis of intestinal contents is the underlying cause of the stone formation. Four cases are presented, 3 in the colon and 1 in the small bowel. The chemical composition of these stones varies according to their site of origin. The clinical setting varies widely as does the radiologic differential diagnosis.

Elongation of the anterior tubercle of a cervical vertebral transverse process: an unusual variant

Elongation of the anterior tubercle of a transverse process of a cervical vertebra is a congenital anomaly that should be considered in a patient demonstrating a bony mass projecting anterior to the vertebral body on a lateral radiograph of the cervical spine. Reported is a case of elongation of the tubercles of the transverse processes of both C5 and C6 with the formation of an articulation. Computed tomography was used to definitively differentiate this variant from a fracture fragment, bone tumor, or osteophyte. This anomaly is probably a form of supernumerary cervical rib developing at a level above the lowest cervical vertebra.

Gastric carcinoid tumors: radiographic features in eight cases

A retrospective analysis of eight proven cases of gastric carcinoid tumors is reported with emphasis on the radiographic features. These tumors occur rarely in the stomach and have variable radiographic presentations: (1) intramural defects simulating leiomyomas, (2) multiple gastric polyps, (3) large gastric ulcers, and (4) polypoid intraluminal lesions. In this series, single submucosal lesions located in the fundus and body of the stomach were demonstrated in five patients, adjacent sessile polyps in one patient, and large gastric ulcerations in the other two patients. In five of the cases, ulcerations were clearly visualized radiographically. Three patients had pathologic evidence of metastatic dissemination. The unusual entity of argentaffin-cell adenocarcinoma of the stomach is illustrated and discussed together with a pertinent review of the literature.

Colonic obstruction within inguinal hernia

A review of the literature reveals that inguinal hernias rarely cause colonic obstruction. Three examples of colonic obstruction associated with inguinal hernia are presented. In two of the patients carcinoma of the colon in the hernia sac was responsible for the obstruction, while in the third, the hernia itself was the cause. Careful clinical and radiographic evaluation is recommended in all patients presenting with inguinal hernia and large bowel dilatation to the level of the hernia, to rule out the presence of an obstructing lesion within the hernia.

Segmental tuberculosis of the distal colon: radiographic features in 7 cases

The radiographic features of 7 cases of segmental colonic tuberculosis are described and illustrated. The lesions are generally short (5--7 cm) and may involve any part of the colon. They present radiographically as segmental granulomatous colitis or as annular, ulcerated lesions mimicking colonic carcinoma. Cases with sinus tract formation, severe narrowing, marked distortion, and fixation may occur. The association with pulmonary tuberculosis is common but not universal. The clinical findings are nonspecific, but the age group affected is mainly that of young adults. A short review of the pertinent literature is presented.

Retroperitoneal lipomatosis--report of two cases with an unusual distribution

Two cases of retroperitoneal lipomatosis with an unusual distribution are reported. In the first case the fat was confined to the perirectal soft tissues and the sigmoid mesentery, whereas in the second case it was peripancreatic and extended into the small bowel mesentery. The lipomatous nature of these retroperitoneal masses was suggested by the lucency of the fat on the plain abdominal roentgenograms. These cases were studied prior to the availability of computed tomography, so that the diagnoses were confirmed by surgical exploration, which may have been avoided by this currently available noninvasive technique.

Unused colon in the adult -- roentgen findings

Two cases are reported of acquired microcolon distal to long-standing transverse colostomies performed 25 and 13 years previously. The radiologic appearance of the bypassed unused colon was similar to that of the microcolon of infants, demonstrating shortening, tubulation, and lack of haustrations.

Arterial dissection with use of catheter needle in retrograde femoral arteriography

A retrospective study of 82 cases of peripheral vascular occlusive disease examined by retrograde femoral arteriography with a catheter needle technique showed a 6% incidence of retrograde arterial wall dissection involving the iliac arteries and the aorta. In one patient, the dissection re-entered the abdominal aorta near the renal arteries, producing an iatrogenic chronic dissection. The others did not demonstrate any permanent side effects. In 1974, in view of the appreciable risk in the use of a catheter needle, the technique was changed to percutaneous femoral catheterization of the abdominal aorta using a catheter with multiple side holes. No further cases of iatrogenic aortic dissection were observed. A veriety of mechanisms may have been responsible for the dissections.

Colonic intussusception in uremia

Colonic intussusception is a condition primarily found in infants and young children. In adults, it is usually associated with a colonic neoplasm. The following report illustrates a case of colonic intussusception in an adult uremic patient in whom postmortem examination showed evidence only of intramural colonic hemorrhage.

Kaposi's sarcoma of the intestinal tract: roentgen manifestations

Five cases of generalized Kaposi's sarcoma are reported with roentgen evidence of involvement of the intestinal tract. In three instances, there was extensive involvement of the small bowel with multiple intramural nodules. The fourth patient demonstrated multiple polypoid lesions of the colon, and in the fifth a constricting lesion of the ileum was present. Two patients with small bowel involvement had significant malabsorption. This latter complication of diffuse Kaposi's sarcoma of the small bowel has not been previously reported. The diagnosis of the nature of the roentgen intestinal abnormality can usually be made, because intestinal involvement generally occurs late in the disease, when both extensive cutaneous nodules and edema of the extremities are apparent.

Shielding the hand during cross-compression angiography

A simple method of shielding the hand during cross-compression angiography is described. A standard lead glove with the fingertips cut out of the palmar aspect is used, allowing sensation and mobility while still protecting the hand.

Strangulating obstruction of the bowel: a reevaluation of radiographic criteria

Fifty consecutive cases of strangulating obstruction were compared with 100 consecutive cases of surgically proven simple obstruction due to adhesions or hernia. All cases were studied by the usual supine and either erect or decubitus abdominal films, and by two successive supine films made at 5 min intervals. Radiographic criteria previously described as signs of possible strangulation were evaluated in the two series. Reduced activity of the small bowel loops on the successive supine films was the only frequent sign (58% of the cases with strangulating obstruction) which showed a statistically significant difference in incidence between the two groups. Other signs seen with some frequency (22%-28% of the group with strangulation) were long air-fluid levels, loss of valvulae conniventes, retention of bubbly fecal matter in the right colon, and predominance of fluid-filled loops; however, they occurred with the same frequency in simple obstruction. The more specific signs of bowel congestion and necrosis (i.e., a narrow rigid loop or intramural gas) were seen in 10% and 2% of the cases, respectively. Only the incidence of a narrow rigid loop in strangulation reached statistical significance. This study confirms the difficulty of diagnosing strangulating obstruction using plain films of the abdomen. Successive abdominal films were shown to be valuable in providing information about small bowel activity, which can help in the differential diagnosis.

Hydronephrosis of the lower pole of the duplex kidney: another renal pseudotumor

Obstruction and reflux occur fairly commonly in the duplex kidney. Although obstruction with attendant hydronephrosis is more frequently seen in the upper pole of a duplex system, a similar process involving the lower pole should be considered in the differential diagnosis of renal mass lesions. Four cases are described in which lower pole hydronephrosis simulated neoplasm.

Postgastrostomy deformity of the stomach

Temporary postoperative tube gastrostomy may produce permanent deformity of the stomach as visualized on an upper gastrointestinal series. Six cases were studied illustrating two configurations of the gastric deformity. These appear to be related to the location of the gastrostomy opening in the stomach. The findings were either anterior displacement of the gastric antrumwith adherence to the anterior abdominal wall or acute angulation of the gastric body in a medial and anterior direction.

Successive abdominal roentgenograms: a new method of evaluating postoperative small bowel activity

The technique of two successive abdominal roentgenograms at a five minute interval is proposed as a new method of evaluating small bowel activity in the presence of postoperative intestinal distention. One hundred and forty-four cases of postoperative small bowel distention were studied with this technique and correlated with the clinical evaluation of the bowel sounds and with the development of a variety of postoperative complications. Correlation with the bowel sounds was fairly good, except in the presence of a clinical description of hypoactive sounds. Reduced activity on the successive roentgenograms after the third postoperative day was frequently associated with postoperative complications, while persistent small bowel distention in the presence of significant roentgen activity usually indicated mechanical small bowel obstruction. This method for determination of small bowel activity thus appears to be useful in evaluating postoperative problems.

Fluid filled small bowel loops in gallstone ileus: clinical and experimental observations

A bowel fluid gas index was developed for the degree of fluid filled distention in small intestinal obstruction, utilizing the proportion of fluid filled versus gas filled loops on plain abdominal films. Comparison of simple distal small bowel obstruction due to adhesions and gallstone ileus demonstrated a significantly higher index in gallstone ileus, indicating more cases of fluid filled distention. In an experimental study, fistulae between the gall bladder and duodenum were fashioned in a series of dogs. Distal small bowel obstruction was then produced in these dogs and in another series of dogs in whom a sham first operation had been performed. The bowel fluid gas index, as evaluated in a double blind study, was significantly higher in dogs with the fistulae and was similar to that in patients with gallstone ileus. The possible mechanism for these observations is proposed.

Osteodysplastia (Melnick-Needles syndrome). Radiological quiz

Postmortem examination of a child with osteodysplastia (Melnick-Needles syndrome) showed peculiar fibro-osseous tissue in the marrow cavity, with areas of bone constriction but no abnormality of endochondral ossification. Pectus excavatum and scalloping of the vertebral bodies were also present.

Intrapulmonary effusion. Effect of expiration on the pseudodiaphragmatic contour

The pseudodiaphragmatic contour of infrapulmonary effusion may differ from the contour of an elevated hemidiaphragm in the frontal view in that its medial portion is straight and shows a gradual inclination upward and laterally from the cardiac shadow, so that its apex is located more laterally. Previous studies have indicated that this configuration is seen only in about 50% of cases of infrapulmonary effusion. Using expiration radiographs, it is possible to routinely demonstrate this characteristic pseudodiaphragmatic contour. This study provides an additional sign of infrapulmonary effusion and aids in the explanation of the pseudodiaphragmatic contour.

Chronic calcified aortic dissection

Two cases of chronic aortic dissection are presented. In both, plain chest roentgenograms revealed calcification in the outermost aspect of the dilated aorta. It is clear that this represented calcification of the dissection rather than of the true intima. These cases indicate that apparent aortic intimal calcification with dilatation of the aorta is not completely diagnostic of an arteriosclerotic aneurysm and that a chronic calcified aortic dissection must also be considered in the differential diagnosis.

Layering of contrast material in oral cholecystography

Serial erect roentgenograms of the gallbladder during oral cholecystography were taken in 50 patients before and after a fatty meal. In the presence of good opacification, layering of opaque and nonopaque bile was noted in most cases 2 hours after the fatty meal. The degree of layering was related to the extent of gallbladder contraction produced by the fatty meal and the degree to which the gallbladder refilled by the inflow of nonopaque liver bile. The layering phenomenon thus appears to be a manifestation of a normally functioning gallbladder and occurs when the gallbladder refills with fresh nonopaque bile.

Idiopathic intestinal pseudo-obstruction

This is a case report of a patient with a variant of idiopathic intestinal pseudo-obstruction (IIPO). The patient, a 53-year old female with polycystic kidney disease, had intermittent episodes of intestinal distention with megaduodenum and megasigmoid noted at roentgen study and postmortem examination. The etiology of this abnormality is unclear and no significant changes in the innervation of the bowel were noted on gross or histologic study.

Roentgen problems in evaluating the atrophic stomach of the elderly

Gastric atrophy in the elderly may cause problems in the interpretation of gastrointestinal studies. Seventeen such cases are reported: 8 patients showed limited distensibility and irregularity of the distal stomach simulating scirrhous carcinoma; 6 patients showed gastric retention of food; and 2 patients showed gastric retention of oral cholecystographic medium. Awareness of these phenomena may prevent serious errors in roentgen diagnosis.