[Correlation between the radiologic study of deglutition and the clinical picture in systemic sclerosis (scleroderma)]. / Correlazione tra studio radiologico della deglutizione e quadro clinico nella sclerosi sistemica (sclerodermia).

Fifty-one patients with systemic sclerosis (scleroderma) were studied by means of videofluoroscopy in order to evaluate the abnormalities in the oropharyngeal and esophageal phases of deglutition and to correlate the radiological patterns with the clinical features of the disease. Thirteen patients (25.5%) exhibited swallowing disorders such as oral leakage, retention, penetration, mild or moderate aspiration and abnormal upper esophageal sphincter behavior. These dysfunctions were more evident in patients with esophageal motility abnormalities. A normal radiological pattern in the esophagus was not associated with swallowing alterations. Remarkably, patients with oral-pharyngeal disorders had a higher incidence of lung diseases. Forty-five patients (88%) exhibited disorders of the esophageal phase of deglutition, such as mild or severe motility abnormalities or hiatal hernia, gastro-esophageal reflux, reflux esophagitis, and stricture. Radiological findings in the esophagus can be abnormal in the early stages of the disease. On the other hand, the radiological pattern of esophageal motility can be occasionally negative in advanced or extensive disease. This indicates a discrepancy between clinical symptoms and radiological picture of the esophagus. The radiological examination of the oral-pharyngeal and esophageal phases of deglutition is important in patients with scleroderma in order to evaluate visceral involvement, motility disorders, and risk of aspiration. Such radiological information can be useful in preventing esophagitis and pulmonary complications.

[Dynamic radiologic study of deglutition in oro-pharyngeal-laryngeal neoplasms and results of their treatment]. / Studio radiologico dinamico della deglutizione nelle neoplasie oro-faringo-laringee ed esiti del loro trattamento.

Swallowing disorders due to oro-pharyngo-laryngeal cancer, or due to the consequences of surgical resection and radiotherapy, should be accurately evaluated to manage properly both nutritional therapy and dysphagia rehabilitation techniques. The site, size, and local spread of such tumors and, especially, the nature and extent of surgical resection and reconstruction, are important factors which are closely related to the functional disorders of deglutition. The aim of this paper is to demonstrate video-fluoroscopy capability to evaluate the incidence, type, and severity of such functional disorders. For this purpose we studied by means of dynamic radiology 23 patients with oral cancer and 33 patients with pharyngeal-laryngeal cancer, most of them after surgical and/or radiological treatment. Eighty-four per cent of the patients had swallowing disorders such as poor oral processing (25%), retention of the bolus in the pharynx (41%), penetration (41%) or aspiration (37%) of the bolus in the airway, dysmotility of upper esophageal sphincter (9%), and structural lesions (61%). The association of these functional disorders was closely related to the pathological background of each patient. In conclusion, a dynamic radiological study is recommended for both pre and postoperative evaluation of these patients, to choose the appropriate nutritional therapy and dysphagia rehabilitation technique.

[Radiologic aspects of the surface mucosa of the duodenal bulb. Correlation with the endoscopic and histological aspects]. / Aspetti radiologici della superficie mucosa del bulbo duodenale. Correlazione con gli aspetti endoscopici e istologici.

Double contrast barium meal, endoscopy and histology of the duodenal bulb were blindly compared in 47 consecutive patients. The agreement in the judgement of normality of the mucosal surface between radiology and endoscopy was 78%. The agreement in the diagnosis of presence or absence of nodularity and thickened folds was respectively 91% and 87%. The findings of nodularity correspond to duodenitis with pyloric metaplasia or to heterotopic gastric mucosa, while the thickened folds correspond to duodenitis with pyloric metaplasia, Brunner's hyperplasia, lymphatic nodular hyperplasia or cystic glandular dilatation. The diagnostic errors in the radiological examinations in respect to endoscopy is quite important in the case of erosions.

Small benign tumors of the esophagus: radiological diagnosis with double-contrast examination.

Benign tumors of the esophagus are rare. So far radiological examination has been useful in the diagnosis of fairly large benign tumors. In 4100 consecutive double-contrast studies we have found 22 incidental cases of protruded lesions of the esophagus with the appearance of submucosal tumor (8 cases) or polyp of the mucosa (14 cases). The lesions were small: 14 were less than 1 cm and 8 were between 1 and 3 cm. The histological data showed leiomyoma in the submucosal tumors and squamous papillomas in the polyps of the mucosa. A noteworthy feature is the unusual frequency of small squamous papillomas detected. The radiological diagnosis of benign tumors of the esophagus cannot be confined to large tumors in symptomatic patients but may include the accidental detection of small tumors. These call for histological verification and possibly endoscopic removal.