John R. Amberg

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?

Gray scale ultrasonic cholecystography: a comparison with conventional radiographic techniques.

A prospective study was designed to assess the accuracy of gray scale ultrasonography in the evaluation of cholelithiasis. A series of 111 patients with nonvisualization on first-day oral cholecystography underwent ultrasonic cholecystography, and the results were compared with subsequent second-day visualitzation or surgical findings. In 75 cases sufficient data were present to assess the accuracy of the method. Ultrasound correctly diagnosed 68 (91%) of these cases with regard to gallstones. Only 6 gallbladders could not be visualized ultrasonically and all subsequently proved to have gallstones. It is concluded that improved ultrasonic technique is of considerable value in investigating the nonvisualized gallbladder. Valuable information conderning other upper abdominal pathology was often discovered.

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...

Gastric Bezoars after Partial Gastrectomy Report of Five Cases

During the past three years, we have seen gastric bezoars after partial gastrectomy in 5 patients. All had had a Billroth I gastroduodenostomy and truncal vagotomy. Gastric bezoars appear to be a new complication of gastric surgery, as previous reports that contained follow-up data on many patients have not mentioned this possibility (5, 9). Only recently have case reports appeared of gastric bezoars in patients with such operations. Of particular interest in the etiology of gastric pouch bezoars is a case reported by Olivier et al. (7), in which peptic ulcer difficulties continued after a Billroth II gastrojejunostomy. The anastomosis was therefore converted to a Billroth I gastroduodenostomy which, however, did not control the symptoms, and a marginal ulceration developed. A vagotomy was the third operative procedure. Five months later, gastric fullness, vomiting, and epigastric pain led to the discovery of a large gastric bezoar that required surgical removal. Borg et al. (1) reported 3 cases of massiv...

Pulmonary Microembolism—Radiologic Findings

Pulmonary micro embolism may produce dramatic and distressing symptoms. The roentgenograms of the chest obtained during the symptomatic phase may also appear striking. In the past, a correct roentgenologic diagnosis of pulmonary microembolism was unusual except under circumstances that favored embolization of fat, contrast material, or amniotic fluid. Pulmonary microemboli formed from the components of normal blood have also been discovered in the lungs of patients who have died from a variety of disease processes (Table I). It is now recognized that these microemboli are of clinical significance (3) and the purpose of this paper is to present our observations of the roentgenographic manifestations of blood-element microembolization. Pathogenesis Shock results in peripheral vasoconstriction and diminished blood flow in the extremities. A stasis of blood on the venous side of the capillary bed results and leads to intravascular coagulation. When shock is corrected and the limbs are again perfused, the micr...

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.

Canine cholecystokinesis: effect of octapeptide of cholecystokinin.

The C-terminal octapeptide of cholecystokinin was given intravenously to dogs, and gallbladder contraction was monitored radiographically. Bolus doses from 5 to 320 ng/kg caused gallbladder contraction, but dose response relationships were nonuniform. Infusion doses resulted in good dose response relationships and essentially complete evacuation of the gallbladder at doses of 240 ng/kg-hour.

Contamination of Barium Sulfate Suspension

Three incidents of contamination of barium sulfate suspension are presented. Periodic monitoring and prophylactic measures are recommended to prevent the dangers inherent in this situation.

Colonie Polyp Detection: Role of Roentgenography and Colonoscopy

In order to determine the relative yields of colonoscopic and radiologic examinations of the colon, the following guidelines are suggested: (a) prospective data collection; (b) a standard, effective colon cleansing regimen; (c) colonoscopic and radiologic examiners of comparable expertise; (d) examiners should be unaware of each others findings; (e) a suitable method for demonstrating false-negative findings and for resolving conflicting findings between the two examinations; and (f) indexing of the study findings as to lesion size, lesion location, quality of colon cleansing, and examiners level of confidence. The two examinations should be used as complementary diagnostic procedures.