Interstate medical journal . ecisive in the institu-tion of surgical interference. Haudeks niche, when present, is conclusive evidence of gastriculcer. In this we get the accumulation of the opaque meal, whichhas emerged through a penetrating ulcer and been walled off ina pouch on the lesser curvature or posterior wall of the the patient in the upright position the opaque meal gravi-tates to the bottom of the pouch and is usually surmounted by agas bubble. The hour-glass deformity due to cicatricial contraction of an oldulcer is so characteristic that little error is possible; it
Interstate medical journal . ecisive in the institu-tion of surgical interference. Haudeks niche, when present, is conclusive evidence of gastriculcer. In this we get the accumulation of the opaque meal, whichhas emerged through a penetrating ulcer and been walled off ina pouch on the lesser curvature or posterior wall of the the patient in the upright position the opaque meal gravi-tates to the bottom of the pouch and is usually surmounted by agas bubble. The hour-glass deformity due to cicatricial contraction of an oldulcer is so characteristic that little error is possible; it must, how-ever, be differentiated from spasmodic hour-glass or an unusuallydeep peristaltic contraction. The association of painful pressure Hubeny: Gastrointestinal Roentgenology 941 points with abnormal contours is highly suggestive. This is par-ticularly true with certain spasms. Care must be used to differen-tiate between spasma due to gastric ulcer, duodenal ulcer, pancreaticinvolvement, cholecystitis, and According to Carmen, three forms of spasm due to gastric ulcermay be recognized; first, the hour-glass stomach; second, diffuse 942 INTERSTATE MEDICAL JOURNAL spastic distortion; third, spasm of the pyloric sphincter. In in-durated gastric ulcer careful examination, particularly by the platemethod, will often reveal permanent indentations and impairedlocal peristalsis. Duodenal ulcer offers a more fruitful field than gastric the bulbar cap is clean cut, well defined, regular in out-line, and inclined toward symmetry. It appears to be continuouswith the pylorus, being separated from it by the sphincter demar-cation ; the sulcus thus formed is about one-fourth inch wide. Hereagain the fluoroscopic and plate methods should be used; in thisinstance, in my opinion, the serial plate examination greatly excels
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