Raj K. Goyal

Experimental induction of isolated lower esophageal sphincter relaxation in anesthetized opossums.

Isolated lower esophageal sphincter (LES) relaxation, defined as a transient sphincteric relaxation unaccompanied by esophageal peristalsis, has been shown to precede most episodes of gastroesophageal reflux in humans. We studied the genesis of isolated LES relaxation in anesthetized opossums by observing the response of four components of the deglutition reflex (mylohyoid electrical activity, pharyngeal contraction, esophageal peristalsis, and LES relaxation) to pharyngeal tactile stimulation, electrical stimulation of superior laryngeal nerve (SLN) afferents or cervical vagal efferents, and to balloon distention of the esophageal body. A single pharyngeal stroking evoked isolated LES relaxation in 56% of 160 instances. The proportion of isolated relaxations in response to SLN electrical stimulation varied inversely with the stimulus frequency, occurring in 64% of the responses at 5 Hz and 4% of the responses at 30 Hz. A full four-component deglutition sequence was most likely to occur at the higher frequencies of SLN electrical stimulation. Esophageal balloon distention elicited isolated LES relaxations or no response at low distending volumes, whereas at higher volumes LES relaxation and esophageal contraction predominated. Isolated LES relaxation had significantly less magnitude than relaxations accompanied by esophageal contractions. Bilateral cervical vagotomy abolished all LES and esophageal body responses induced by pharyngeal stroking and SLN stimulation, and rendered the esophageal body and LES less responsive to small volumes of distention. Vagal efferent stimulation produced isolated LES relaxation at lower frequency stimulation and LES relaxation with esophageal contractions at higher frequency stimulation. These studies show that isolated LES relaxation represents incomplete expression of either the deglutitive reflex or the peripheral reflex mediating secondary peristalsis.

Effect of prostaglandin F 2 and gastrin pentapeptide on the lower esophageal sphincter.

Summary Prostaglandin F2α was found to increase the lower esophageal sphincter pressure in the intact opossum in vivo. Dose response curves of the effect of PGF2α showed that maximal response occurred with a dose of 4 μg/kg. The maximal response with gastrin pentapeptide occurred with a dose of 2 μg/kg for its action on increasing the lower sphincter pressure. We thank Dr. John Pike of the Upjohn Company for a generous gift of prostaglandin and the Ayerst Company for gastrin pentapeptide.

A computer-assisted technique for 24-hour esophageal monitoring

Modern computer design offers the opportunity to rapidly and objectively analyze the large quantity of data obtained during prolonged intraesophageal monitoring. The purpose of this study is: (1) to describe a rapid automated technique for acquisition and analysis of esophageal parameters, using a microcomputer; and (2) to compare computerized versus manual analysis of physiograph recordings. Ten normal subjects underwent 24-hr computerized monitoring of intraesophageal function, including: (1) pH recording at 5 and 10 cm above the lower esophageal sphincter (LES); (2) pharyngeal contraction; (3) esophageal contraction at 5 and 10 cm; (4) posteriorly directed LES pressures; and (5) gastric pressure. Segments from several studies were chosen for comparison of physiograph data with that obtained by computer. No significant differences were found except for the number of esophageal contractile events. This difference stems from a problem of shifting baseline related to subject position. Thus, the computer can be used for analysis of large quantities of data obtained from prolonged esophageal monitoring.

Hypercalcemia and Carcinoma of the Esophagus

Excerpt To the editor: Squamous cell carcinoma of the esophagus accounts for approximately 4% of all cancer deaths in the United States. Most of these patients die within a year of diagnosis in the...

Gonorrhea: Not Yet Controllable

Excerpt By any standards, gonorrhea is out of control in the United States, the estimated incidence having climbed to the neighborhood of 1,700,000 cases per year. One searches in vain for an easy ...

Hereditary angioneurotic edema. A case with recurring abdominal pain.

A case of hereditary angioneurotic edema in a 52-year-old Texas man who had repeated episodes of transient urticaria, laryngeal edema and abdominal pain is reported. He had a family history with various similar episodes, including urticaria following minor trauma in 1 son. His grandfather and an uncle died from laryngeal edema. The strong family background and the characteristic medical history of tracheostomies, negative laparotomy and facial edema are convincing evidence as to the nonsurgical nature of the abdominal symptoms in hereditary angioneurotic edema. Serum complement assay demonstrated depression of serum C1 esterase inhibitor.

Intestinal alkaline phosphatase in patients with liver disease.

Electrophoretic separation of the different isoenzymes of alkaline phosphatase was done, using polyacrylamide gel electrophoresis. In some patients with liver disease, two isoenzymes of alkaline phosphatase were detected—one corresponding to liver and the other, to intestinal fraction. In 17 of 51 patients with nutritional cirrhosis and in 6 of 14 with chronic active hepatitis, the intestinal band was observed in their fasting sera. Intestinal isoenzyme was not found, however, in the fasting sera of 23 patients with viral hepatitis, 16 with metastatic disease to the liver, 11 with obstructive jaundice or 33 healthy volunteers. The presence of intestinal isoenzyme was not dependent on the value of total serum phosphatase activity.