. Archives of physical medicine and rehabilitation . secure a clear image the milliamperageand voltage should be appropriate, thetube should have a focus as sharp as isconsistent with reaf^onable endurance,the screen should be of the best quality,the patient should be close to the tubeand the diaphragm should be activelyemployed to narrow the field of obser-vation. In a case of cardiospasm the estab-lishment of its diagnosis by the roentgenray would seem to be sufficient, but Ihave been impressed by a few cases inwhich the condition was accompaniedby duodenal ulcer. The relationship ofduodenal
. Archives of physical medicine and rehabilitation . secure a clear image the milliamperageand voltage should be appropriate, thetube should have a focus as sharp as isconsistent with reaf^onable endurance,the screen should be of the best quality,the patient should be close to the tubeand the diaphragm should be activelyemployed to narrow the field of obser-vation. In a case of cardiospasm the estab-lishment of its diagnosis by the roentgenray would seem to be sufficient, but Ihave been impressed by a few cases inwhich the condition was accompaniedby duodenal ulcer. The relationship ofduodenal ulcer to gastric spasm is wellknown and it is not unreasonable tosuspect a similar connection with car-diospasm. At the clinic we now requestthat after dilation for cardiospasm thepatient be returned for examination ofthe duodenum. Occasional association of duodenalulcer with gastric ulcer is a familiarfact. When the latter is found a care-ful search for a possible companion inthe duodenum should ordinarily not beomitted. However, when the gastric. rigure I—(Case A-342931)—Spasticdeformity of the bull), diagrnosea asduodenal ulcer in a case of chronicappendicitis. 164 rigrure II—(Case A-363070)—De-fcrmity of the duodenal bulb, asso-ciated witJi cholecystitis and ad-hesions. This deformity was diag-nosed as duodenal ulcer. Fig-ure HI.—(Case A-59961)—Duo-denitis with spastic bulbar de-formity. ROEXTGEXOLOGIC DIAGX0SI3 OF DUODEXAL ULCER—CARMAN ulcer is obviously of such character thatperforation might result from manipula-tion, or when the patient is so weakthat the examination is harassing, theexaminer should be satisfied with thedemonstration of the gastric ulceralone. (Fig. 5). A duodenum which turns backwardfrom the pylorus and is overlapped bythe antral shadow in the anterior viewis much more difficult to examine thanthe erect cap. In such instances thestomach is usually of the steer-horntype, is swung more or less horizontally,and the pylorus lies well to the
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