Henry I. Goldberg

Role of acid and pepsin in acute experimental esophagitis.

The roles of acid and pepsin in the production of acute feline esophagitis have been studied. Acid alone in high concentrations (pH 1.6 and 1.3) caused esophagitis. At lower acid concentration (pH 1.6 and 2.0), pepsin is an important factor in producing esophagitis. A suitable acid-pepsin solution has been selected for use as a standardized insult in an experimental model of esophagitis.

Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury

Background Since the role of a hiatal hernia in the pathophysiology of gastroesophageal reflux disease (GERD) has not been fully elucidated, we studied the effects of hiatal hernias on the function of the lower esophageal sphincter (LES) and esophageal acid clearance. Patients and methods Ninety-five consecutive patients with GERD diagnosed by 24-hour pH monitoring underwent upper gastrointestinal series (UGI), endoscopy, and esophageal manometry. Based on the presence (H+) or absence (H-) of a hiatal hernia on UGI series, they were divided into two groups: H+ (n = 51) and H- (n = 44). Then, using the size of the hiatal hernia, the H+ group was divided into three subgroups: I, H 5 cm (n = 6). Results Esophageal manometry showed that patients with larger hiatal hernias (groups II and III) had a weaker and shorter LES and less effective peristalsis compared to patients with a small or no hiatal hernia. Prolonged pH monitoring showed that patients with larger hiatal hernias were exposed to more refluxed acid and had more severely abnormal acid clearance. Endoscopy showed more severe esophagltis among patients with GERD and hiatal hernia compared with GERD patients without hiatal hernia, and the degree of esophagitis was proportionate to the size of the hernia. Conclusions Among patients with proven GERD, those with a small hiatal hernia and those with no hiatal hernia had similar abnormalities of LES function and acid clearance. In patients with larger hiatal hernias, however, the LES was shorter and weaker, the amount of reflux was greater, and acid clearance was less efficient. Consequently, the degree of esophagitis was worse in the presence of a large hiatal hernia.

Ultrasonic characteristics of frozen liver

The recent development of new ultrasound probes has made real-time intraoperative monitoring of cryosurgery, and thermocouple placement a possibility. It is shown that frozen tissue and thermocouple needles have acoustic characteristics that enable them to be easily visualized by ultrasound examination. Further in vivo animal studies are needed to examine temperature characteristics of visualized cryolesions, to develop scanning techniques, and to correlate ultrasonic findings with histologic changes in tissue.

Noninvasive quantitation of liver iron in dogs with hemochromatosis using dual-energy CT scanning.

The concentration of iron deposited in the livers of two dogs with experimentally induced iron overload was determined by use of dual energy computerized tomographic (CT) scanning. A phantom was constructed, containing known amounts of iron-dextran solutions. CT scans of the phantoms, at 80 and 120 kVp, corrected for the response of water, showed a linear relationship between known iron concentrations and difference in CT number at the two scanning energies, with a change of 24 H units per 1000 mg% iron. Using the graph of this linear relationship, the amount of iron in dog liver was predicted, compared with the amount of iron measured from biopsy specimens, and analyzed by neutron activation analysis. A close correlation existed between predicted liver iron and measured iron concentration (r = 0.99). Dual-energy CT scanning appears to provide an accurate, noninvasive method of quantitating liver iron.

The Relation of Liver Fat to Computed Tomography Numbers: A Preliminary Experimental Study in Rabbits

The relation of liver fat content to CT number was studied in 20 rabbits (17 experimental, 3 control), where fatty degeneration was produced by carbon tetrachloride (CCl4) ingestion. Liver scanning was performed before and 2--5 days after CCl4 administration.. Changes (decrease) in CT number were compared with triglyceride (TG), water, and protein content of resected livers. A decrease of 12--20 CT numbers (24--40 H) reflected a TG concentration of 20--40 mg/g.

Dilute oral iron solutions as gastrointestinal contrast agents for magnetic resonance imaging; Initial clinical experience

Delineation of the gastrointestinal tract in magnetic resonance imaging (MRI) remains a problem. Ferric ammonium citrate is paramagnetic, producing a high MRI signal intensity by virtue of its spin-lattice (T1) relaxation rate enhancement properties. Water is diamagnetic, producing a low MRI signal intensity, especially with short TR and TE times. To compare efficacy for gastrointestinal contrast alteration, ferric ammonium citrate was administered to 18 patients and water was given to 10 patients. Spin-echo imaging at 0.35T was performed after administration of these agents. Ferric ammonium citrate produced high signal intensity within the esophagus, stomach, duodenum, and small intestine that aided in the differentiation of the gastrointestinal tract from adjacent tumors, vessels, and viscera. Delineation of the gut wall was superior using ferric ammonium citrate compared to that produced by water. Delineation of the margins of the pancreas, liver, and kidney from adjacent gastrointestinal tract was also better with ferric ammonium citrate. Optimal distinction between bowel and fat was better with water. Longer TE times (75 to 200 ms) may allow improved contrast between gut and intrabdominal fat using ferric ammonium citrate.

Sclerosing cholangitis: broad spectrum of radiographic features.

The broad spectrum of radiographic appearance of sclerosing cholangitis is illustrated in 19 cases. A classification of intrahepatic and extrahepatic features is presented, based on extent of narrowing of bile ducts, severity of narrowing, contour abnormalities, and presence of postsclerotic dilatation. In 13 of 19 cases, both intra- and extrahepatic ducts were involved. The most common form of intrahepatic involvement (8/19) was irregular stenosis obliterating peripheral ducts leaving only the more central ducts filled with contrast material. The most common type of extrahepatic duct involvement was a well-defined segment of either smooth or irregular narrowing. The most extensive involvement of intrahepatic ducts was often associated with more well-defined, less extensive extrahepatic duct involvement. In 7 patients, radiographic features were evaluated over periods ranging from several months to several years. Intrahepatic duct involvement either remained unchanged or worsened, while extrahepatic features more often remained unchanged. Our classification of patterns of involvement was applied to previous reports and revealed frequency of type of duct involvement similar to our series.

Gastrointestinal Complications Following Renal Transplantation

Gastrointestinal complications developed in 29 (6%) of 510 patients following renal transplantation. Thirteen patients (45%) died as a result. Gastrointestinal bleeding, usually considered the commonest complication, was seen in only 7 cases. Other complications included pancreatitis and hyperamylasemia, massive ileus, fistulas with abscesses, bowel infarction, peptic ulcers without bleeding, obstruction, gangrenous cholecystitis, esophagitis, spontaneous perforation of the sigmoid colon, and pneumatosis cystoides intestinalis. Six patients had no clinical or laboratory findings suggesting the underlying gastrointestinal complication; it was the radiographic findings that called attention to the acute problem.

Evaluation of plain abdominal radiographs in the diagnosis of abdominal pain.

In an effort to develop referral criteria for the ordering of abdominal radiographs for patients presenting with abdominal symptoms, we prospectively studied the relation between clinical data and radiographic abnormalities. Of 1780 examinations, 179 (10.0%) showed some radiographic abnormality. If abdominal radiographs would have been limited to those patients who had moderate or severe abdominal tenderness, or to patients with a high clinical suspicion of bowel obstruction, renal or ureteral calculi, trauma, ischemia, or gallbladder disease, regardless of the degree of tenderness, 956 (53.7%) examinations would not have been done. All radiographic abnormalities reflecting a serious pathologic process would have been identified. Only 33 (3.5%) abnormalities of limited significance, almost all localized or generalized ileus, would have been undetected. The adoption of these referral criteria would result in minimal loss of clinically useful information, large financial savings, and a reduction in radiation exposure.

Computed Tomographic Evaluation of Disorders Affecting the Alimentary Tract

The use of computed tomography (CT) in diagnosing disorders affecting the hollow viscera of the alimentary tract has received little attention. The authors reviewed CT scans of 43 patients on which lesions affecting the gastrointestinal tract were demonstrated. All cases were correlated with barium-enema examinations, surgical reports, or autopsy findings. CT can provide valuable information on the extraluminal extent of masses arising in the bowel, mesenteric masses, and can define and characterize extrinsic lesions. The authorss results suggest that CT is a useful adjunct in evaluating intramural or mesenteric lesions of the gastrointestinal tract.