Maurice L. Kelley

Skin lesions associated with chronic ulcerative colitis

The types of cutaneous lesions occurring among 119 patients with chronic ulcerative colitis seen at the Strong Memorial Hospital during an 11-year period have been reviewed. These included erythema nodosum (12 cases), erythema multiforme (3), papular-pustular dermatitis (7), aphthous stomatitis (6), eczema (4), and herpes zoster (2). In several patients the skin lesions presented the major problem. Activity of the inflammatory bowel disease seemed to be related to the development of the cutaneous eruptions. It is suggested that a hypersensitivity state is implicated in a number of the skin eruptions, and that this may bear a relationship to the pathogenesis of the ulcerative colitis.SummaryThe types of cutaneous lesions occurring among 119 patients with chronic ulcerative colitis seen at the Strong Memorial Hospital during an 11-year period have been reviewed. These included erythema nodosum (12 cases), erythema multiforme (3), papular-pustular dermatitis (7), aphthous stomatitis (6), eczema (4), and herpes zoster (2). In several patients the skin lesions presented the major problem. Activity of the inflammatory bowel disease seemed to be related to the development of the cutaneous eruptions. It is suggested that a hypersensitivity state is implicated in a number of the skin eruptions, and that this may bear a relationship to the pathogenesis of the ulcerative colitis.The types of cutaneous lesions occurring among 119 patients with chronic ulcerative colitis seen at the Strong Memorial Hospital during an 11-year period have been reviewed. These included erythema nodosum (12 cases), erythema multiforme (3), papular-pustular dermatitis (7), aphthous stomatitis (6), eczema (4), and herpes zoster (2). In several patients the skin lesions presented the major problem. Activity of the inflammatory bowel disease seemed to be related to the development of the cutaneous eruptions. It is suggested that a hypersensitivity state is implicated in a number of the skin eruptions, and that this may bear a relationship to the pathogenesis of the ulcerative colitis.

Intraluminal manometry in the evaluation of malignant disease of the esophagus

Intraluminal esophageal manometric recordings in patients with adenocarcinoma of the gastric cardia and carcinoma of the distal esophagus registered distortion of the resting pressure profile of the gastroesophageal sphincter, impaired sphincteric relaxation and contraction with swallowing, and excessively powerful, prolonged and repetitive deglutitive responses indicative of obstruction in the body of the esophagus. Although not specific for malignant disorders these abnormal pressure patterns are useful in documenting evidence of organic disease particularly in patients with long standing functional complaints who develop carcinoma. Motility studies can also serve to exclude achalasia mimicked by malignancies of the distal esophagus—particularly those without mucosal involvement—or to confirm the diagnosis of achalasia in persons with lymphoma and esophageal dilatation erroneously attributed to obstruction by mediastinal lymphadenopathy or lower esophageal lymphomatous infiltration. In addition pressure tracings are useful in ascertaining the degree of visceral dysfunction produced by myopathy associated with carcinoma remote from the gastrointestinal tract.

Clinical and histological observations in fatal non-tropical sprue

Abstract A case of severe malabsorption syndrome in a fifty-one year old man is described. Conventional therapy including a gluten-free diet was unsuccessful. Administration of corticosteroids failed to produce the sustained improvement which has often been observed in such patients. Operative biopsy of the jejunum showed mucosal thinning with fusion and thickening of the villi as well as crowding together of the epithelial cells lining the crypts. Infiltration with chronic inflammatory cells was noted in the lamina propria and submucosa and there was also a considerable degree of fibrosis. Fourteen months later at postmortem examination, following prolonged treatment with cortisone and prednisone, there had been little alteration in the pathological process and possibly some progression.

Deglutitive pressure responses in the gastroesophageal sphineters of symptomatic hiatal hernia patients

Resting pressures and pressure changes occurring with deglutition were recorded in each 0.5-cm. segment of the gastroesophageal sphincteric zone of 25 patients who had small, symptom-producing, sliding hiatal hernias. Pressures were detected by a water-filled balloon and laterally notched, water-filled polyethylene tubes attached to extracorporeal transducers and measured at end-expiration and end-inspiration. Mean maximal resting pressures in the sphincter were 10.5 cm. of water above gastric pressure (open-tip) and 21 cm. (balloon).SUMMARYResting pressures and pressure changes occurring with deglutition were recorded in each 0.5-cm. segment of the gastroesophageal sphincteric zone of 25 patients who had small, symptom-producing, sliding hiatal hernias. Pressures were detected by a water-filled balloon and laterally notched, water-filled polyethylene tubes attached to extracorporeal transducers and measured at end-expiration and end-inspiration. Mean maximal resting pressures in the sphincter were 10.5 cm. of water above gastric pressure (open-tip) and 21 cm. (balloon).With swallowing, a pressure decline below resting tone, indicating relaxation of subhiatal sphincteric segments, was often less pronounced than in health; slight increases occurred frequently. Contraction exceeded relaxation at the hiatus, a reverse of the findings in health. Contraction was most marked above the hiatus while relaxation became progressively less.Despite low resting sphincteric pressure (which probably predisposes to gastroesophageal reflux), impairment of the ability of the sphincter to relax, in addition to increases above resting tone in its subhiatal segments after deglutition, may produce an element of “functional obstruction” in some symptomatic hiatal hernia patients.Motor dysfunction of the body of the esophagus was frequent: 14 of the 25 patients studied exhibited severe or moderate derangements of contraction.Resting pressures and pressure changes occurring with deglutition were recorded in each 0.5-cm. segment of the gastroesophageal sphincteric zone of 25 patients who had small, symptom-producing, sliding hiatal hernias. Pressures were detected by a water-filled balloon and laterally notched, water-filled polyethylene tubes attached to extracorporeal transducers and measured at end-expiration and end-inspiration. Mean maximal resting pressures in the sphincter were 10.5 cm. of water above gastric pressure (open-tip) and 21 cm. (balloon). With swallowing, a pressure decline below resting tone, indicating relaxation of subhiatal sphincteric segments, was often less pronounced than in health; slight increases occurred frequently. Contraction exceeded relaxation at the hiatus, a reverse of the findings in health. Contraction was most marked above the hiatus while relaxation became progressively less. Despite low resting sphincteric pressure (which probably predisposes to gastroesophageal reflux), impairment of the ability of the sphincter to relax, in addition to increases above resting tone in its subhiatal segments after deglutition, may produce an element of “functional obstruction” in some symptomatic hiatal hernia patients. Motor dysfunction of the body of the esophagus was frequent: 14 of the 25 patients studied exhibited severe or moderate derangements of contraction.

ESOPHAGEAL MOTOR FUNCTION: NORMAL AND PATHOLOGICAL PHYSIOLOGY AS REFLECTED BY INTRALUMINAL MANOMETRIC STUDIES.

Esophageal motility studies provide an innocuous and relatively uncomplicated method for evaluating esophageal function in both health and disease. In addition to their investigative potential, intraluminal pressure tracings are of significant help in clinical medicine when used to supplement data accruing from the more conventional technics of roentgenologic and endoscopic evaluation. They are particularly useful in evaluating loss of esophageal motor function such as occurs in scleroderma, in detecting early and subtle cases of achalasia, and in documenting disordered peristalsis in individuals with chest pain and other symptoms secondary to esophageal spasm.ConclusionEsophageal motility studies provide an innocuous and relatively uncomplicated method for evaluating esophageal function in both health and disease. In addition to their investigative potential, intraluminal pressure tracings are of significant help in clinical medicine when used to supplement data accruing from the more conventional technics of roentgenologic and endoscopic evaluation. They are particularly useful in evaluating loss of esophageal motor function such as occurs in scleroderma, in detecting early and subtle cases of achalasia, and in documenting disordered peristalsis in individuals with chest pain and other symptoms secondary to esophageal spasm.Esophageal motility studies provide an innocuous and relatively uncomplicated method for evaluating esophageal function in both health and disease. In addition to their investigative potential, intraluminal pressure tracings are of significant help in clinical medicine when used to supplement data accruing from the more conventional technics of roentgenologic and endoscopic evaluation. They are particularly useful in evaluating loss of esophageal motor function such as occurs in scleroderma, in detecting early and subtle cases of achalasia, and in documenting disordered peristalsis in individuals with chest pain and other symptoms secondary to esophageal spasm.

Severe Histopathological Lesion of Sprue in Patient with Minimal Evidence of Malabsorption: Serial Jejunal Biopsy and Clinical Observations

Excerpt Basic understanding of the disorder known as celiac disease or nontropical sprue, has increased in recent years largely due to the recognition of characteristic histopathological abnormalit...

Silicone-Foam Molding of the Canine Ileocolonic Junctional Zone

SummaryMolds of the isolated ileocolonic junctional area were made in 61 dogs (2 conscious, 6 anesthetized, and 53 immediately after death) by the forceful injection into the proximal colon of a mixture of expanding silicone-foam rubbers. An annular constriction (mean width 0.83 cm. S.E.M. ±.067, mean length 0.40 cm. S.E.M. ±.026) was consistently demonstrated on the molds at the junction of small and large intestine. A similar ring-like impression (mean width 1.14 cm. S.E.M. ±.060, mean length 0.31 cm. S.E.M. ±.028) occurred at the point of meeting of cecum and colon. The configuration of the molds at both junctional zones indicates the presence of a narrow band of less distensible bowel at these sites.Microscopic examination of the tissue producing the indentation at the ileocolonic junction showed that the tissue was composed of smooth muscle derived from the inner circular muscle coat of the ileum and coated by a transitional colonic type of epithelium. This intraluminal projection conforms to the morphological definition of a “sphincter.” The anatomical narrowing is, in all likelihood, at least partially responsible for a zone of elevated pressure interposed between the small and large bowel.

Esophageal Motility Studies in the Evaluation of Hiatal Hernia.

Excerpt The purpose of this report is to describe and illustrate the three roles fulfilled by intraluminal manometric esophageal studies in the evaluation of patients with small sliding hiatal hern...