F. Frank Zboralske

Presbyesophagus: Esophageal Motility in Nonagenarians*

Intraluminal manometry and cineradiography have permitted the characterization of esophageal motor activity in various pathologic states, notably achalasia, diffuse spasm, hiatus hernia, reflux esophagitis, and collagen diseases. The results of such investigations have been compared with those obtained from young or middle-aged normal subjects, without consideration of the effect of aging alone. Changes of esophageal motor function occurring with advanced age, although alluded to in the literature (1-7), have not been systematically studied. Wehave investigated 15 subjects of 90 years of age and older in an attempt to find answers to the following related questions: What are the changes in esophageal function related to age alone? Does the aged esophagus simulate any of the known clinical disorders of this organ?

Presbyesophagus: Cineradiographic Manifestations

The ever-increasing geriatric population makes it important for the radiologist to be acquainted with the changes which accompany advancing age. Alterations in the radiographic appearance of the esophagus in the elderly have been recognized and recorded by others (5, 8–10, 12, 13, 15), but have not previously been systematically studied. We have used the term “presbyesophagus” to describe the manifestations of degenerating motor function in the aged esophagus. The present investigation was undertaken to characterize the radiographic manifestations of presbyesophagus and to determine whether this state might simulate known esophageal diseases. In a recently completed study we examined esophageal function in 15 subjects ninety years of age or older, utilizing intraluminal manometry and cineradiography (14). The abnormal motor pattern found led us to study a larger group of nonagenarians in order to obtain a better estimate of the frequency of the cine-radiographic variations. Before presenting the radiologi...

The Esophageal Propulsive Force: Esophageal Response to Acute Obstruction

The response of the normal human esophagus to an obstructing intraluminal bolus was investigated and compared to the response evoked by transient intraluminal distention. A balloon, immobilized within the esophagus by external attachment to a force transducer, was inflated with from 3 to 25 ml of air for from 3 to 210 sec. Pressure phenomena occurring in the esophagus were simultaneously recorded from the body of the esophagus above and below the balloon. Transient distention (5 sec or less) with small volumes (5 ml or less) often evoked a secondary peristaltic wave in the esophagus distal to the balloon, but infrequently resulted in the registration of any force exerted upon the balloon to drive it downward. Conversely, distentions of longer duration and with greater volume elicited an esophageal propulsive force exerted upon the balloon oriented to propel it aborally, and much less often evoked a propagated wave of secondary peristalsis. The propulsive force, obviously resulting from esophageal muscular contraction, occurred promptly, and once initiated, was sustained until deflation of the balloon. It varied widely in magnitude, from 4 to 200 g, and was associated with no motor phenomena recorded from the body of the esophagus proximal or distal to the balloon which could account for its presence, onset, magnitude, or duration. The force was inhibited by deglutition, but arrival of the primary peristaltic wave at the bolus resulted in augmentation of the force. When the obstructing balloon was freed from its attachment, the persistent, stationary force was converted to a propagated one that propelled the balloon before it. It the balloon was arrested before entering the stomach, the moving contraction was also arrested and the persistent propulsive force acting upon the balloon was maintained. The velocity of the moving contraction wave was determined in great part by the resistance offered by the bolus. Unrestrained, the balloon was propelled aborally at 4-8 cm/sec by the esophageal propulsive force; when restrained by 50 g, the rate of passage was reduced to 0.2-0.8 cm/sec. The esophageal response to intraluminal distention is thus not limited to the uninterrupted wave of secondary peristalsis but is versatile and is determined by the nature of the distending bolus. Transient distention by a mobile or collapsible bolus elicits the propagated secondary peristaltic wave.

Metastatic Carcinoma to the Mesentery and Gut

Several reports have discussed the roentgenographic changes of metastatic carcinoma of the small bowel and colon (4, 6, 11, 15). We have noted that peritoneal carcinomatosis involving both the mesentery and gut produces a characteristic roentgenographic pattern in the small bowel or colon. In our experience, metastasis involves both the mesentery and the bowel wall more commonly than either alone. This report describes the cardinal roentgenographic changes observed in this condition and discusses several characteristics not emphasized previously. Primary Roentgenographic Signs The carcinomas most commonly metastasizing to the mesentery and gut are those from the pancreas, breast, lungs, stomach, ovary, colon, and uterus. The usual routes of spread are hematogenous or by direct tumor seeding to the mesentery or serosa, or to both. These implants then extend directly into the wall of the bowel. This process produces three roentgen characteristics, the pathophysiology of which will be discussed. Formation of...

PERCUTANEOUS TRANSRENAL VENOGRAPHY IN EXPERIMENTAL RENAL VEIN OBSTRUCTION AND HUMAN RENAL VEIN THROMBOSIS.

Renal vein obstruction may be suspected clinically, but in most instances the diagnosis is almost impossible to confirm and is usually made at postmortem examination. An accurate antemortem diagnosis might be more frequently possible if the renal venous outflow could be easily demonstrated by a direct radiologic technic. Our interest in this problem was recently stimulated by the accidental insertion of a needle transrenally into the renal vein during attempted splenoportography, without apparent injury to the kidney or patient. Leger et al. (1) reported 2 cases in which injection directly into the renal parenchyma during splenoportography subsequently opacified the renal vein. There was no apparent complication. We, therefore, undertook a study to investigate the possibility of demonstrating renal vein obstruction in dogs by percutaneous transrenal venography. The technic was subsequently performed in 2 patients. Anatomy The anatomy of the renal veins in dogs is similar to that in man (2–4). The venous d...

Cholecysto-cholestasis: A cause of cholecystographic error

SummaryTen normal persons underwent a study to compare the effects of a fat-free diet and a conventional pre-examination diet on the visualization of the normal gallbladder. Iopanoic acid was the contrast medium employed. The results support the concept that cholecysto-cholestasis is a cause of cholecystographic error.

Oncologic diagnostic radiology.

In their institution, the authors have established a specific diagnostic oncology subspecialty section in order to consolidate the roentgen aspects of teaching, research, and patient care in study of patients with neoplastic disease. This service is responsible for all arteriographic and venographic studies on patients with known or suspected neoplasms (excluding neuroradiology), lymphangiography, laryngography, percutaneous lung aspiration biopsy, chest tomography, bronchography, and mammography. It is also responsible for all x-ray examinations on patients with cancer being treated according to the various investigative clinical protocols. The diagnostic staff also participates in the weekly hospital Tumor Board and in radiotherapy work conferences concerned with patient care.