Arthur M. Olsen

Studies of Oesophageal Motility, with Special Reference to the Differential Diagnosis of Diffuse Spasm and Achalasia (Cardiospasm)

It is not easy to study the oesophageal component of deglutition. The act of swallowing is complex, and food or fluid passes rapidly to the stomach. The speed at which a contrast medium traverses the oesophagus makes it difficult for the radiologist to analyse the mechanisms involved. Nevertheless, our knowledge of oesophageal physiology by radiology has been considerably increased, and the introduction of cineradiography should expand this field. We have been especially interested in the study of oesophageal motility by measurements of pressures within the body of the oesophagus and at its superior and inferior sphincters, and also in the hypopharynx and the fundus of the stomach. Characteristic patterns of motility have been demonstrated for the oesophagus in health and in

The Spectrum of Aspiration Pneumonitis

Our concern in this paper is not with syndromes produced by inhalation of infected or noxious material, but rather with those caused by aspiration of various agents into the bronchial tree. The line of demarcation between inhalation and aspiration is often very fine, and there is certainly some overlapping between inhalation and aspiration syndromes. I shall not attempt to cover disorders produced by the inhalation of microorganisms, the types of pneumonitis produced by the inhalation of nitrous vapors or the pulmonary lesions caused by the inhalation of particulate matter capable of producing pneumoconiosis. Nor does time permit a discussion of foreign bodies thus acquired.

Granular Cell Myoblastoma of the Esophagus Incidence and Surgical Treatment

Granular cell myoblastoma (Abrikossoffs tumor), although certainly a rare, almost always benign lesion, is being encountered with increasing frequency in areas of particular interest to the otolaryngologist or surgeon in the upper aerodigestive tract. Although such lesions have been found frequently in the oral cavity and larynx, only one case has been reported of such a lesion originating in the esophagus. The detailed clinical and pathologic findings of three additional patients with esophageal lesions are described. Conservative surgical removal of granular cell myoblastoma may be preferable to endoscopic dilatation.

Esophagology: An Update

Because of the great interest in the problem of gastroesophageal reflux, much emphasis has been placed on factors which control the competence of the lower esophageal sphincter (LES). Much study has been devoted to the effect of hormones and drugs on the LES. Of the various diagnostic methods available, 24-hour pH testing seems to offer the most information regarding reflux and its complications. Medical therapy should be given a careful trial before surgical procedures for reflux are considered. Diagnostic esophagoscopy is usually performed with fiberoptic instruments. Open-tube esophagoscopes are still preferable for most types of endoscopic therapy. However, flexible fiberscopes may be used for injection of esophageal varices and for laser coagulation of bleeding lesions or even tumors. Guide wires may be introduced through flexible scopes to aid in the dilation of esophageal strictures and also to aid in the placement of prosthetic tubes in patients with obstructing cancers. The performance of esophagoscopy by practitioners of several disciplines has resulted in fragmentation of the specialty. Ideally, all esophagoscopists should be competent with both open-tube and fiberoptic scopes and should be familiar with all of the newer knowledge of the physiology and pharmacology of the esophagus and its sphincters.

Study of esophageal motility in health and disease.

In 1883 Kronecker and Meltzer reported on their studies of the physiology of the esophagus. They had measured intraluminal pressures by means of an intra-esophageal balloon. Although their studies were quite remarkable, the presence of the balloon, filled with water or air, was a constant stimulus to swallowing; therefore, it was difficult for the investigators to measure resting pressures within the esophagus.

Place of Fiberoptic Endoscopy in Bronchoesophagology

Flexible and rigid instruments are both useful in the endoscopic examination of the tracheobronchial tree and esophagus. Although either instrument may be employed in many cases, there are specific indications for the use of flexible fiberoptic endoscopes in both bronchology and esophagology; and likewise, the rigid instruments are mandatory in the management of some endoscopic problems. Ideally, the bronchologist and the esophagologist should be proficient in the use of both the rigid and the fiberoptic endoscope. If this is not possible, those who are competent only with flexible fiberoptic endoscopes must work closely with the fully trained bronchoesophagologists. Peroral endoscopy is already shared by otolaryngologists, thoracic surgeons, gastroenterologists, and specialists in thoracic medicine. Although multiple disciplines probably will continue to be involved in bronchoscopy and esophagoscopy, these specialties must not be so broad that no one will be completely competent in bronchoesophagology.