William G. Sauer

Inflammatory colon disease in Rochester, Minnesota, 1935-1964.

The medical records of the residents of Rochester, Minnesota, who depend largely on the Mayo Clinic for their , medical care, offer a unique opportunity to study the epidemiology of inflammatory disease of the colon over a 30-year period from 1935 through 1964. Local residents with this condition were divided into the following four arbitrary but distinct anatomic groups: type A, transient proctitis; type B, chronic or recurrent proctitis; type C, typical mucosal ulcerative colitis involving the rectum and continuous portions of the colon above the proctoscopic level; and type D, segmental disease (largely Crohns disease of the colon). During the study period the disease was newly diagnosed in 108 residents and, in an additional 32 patients who took up residence after the diagnosis had been established. Of the 108 cases, 23 (21%) were type A, 35 (32%) were type B, 31 (29%) were type C, and 19 (18%) were type D. The average annual incidence rate for all four types combined was 11.8 per 100,000 with rates for the four subtypes of 2.5, 3.8, 3.4, and 2.1 per 100,000, respectively. Incidence rates over the 30-year period showed a slight rise for all types except D. Fifty-three per cent of all cases represented disease which never progressed beyond proctoscopic level. Carcinoma of the colon occurred subsequently in 5 cases, all type C, which was a significantly higher number than would be expected in the general population.

NORMAL AND SOME ABNORMAL COLONIC MOTOR PATTERNS IN MAN

Two methods for recording motor activity in the colon have been employed in the laboratory. The first involves the use of balloons1! and the second the use of a miniature pressure They measure 3 cm. across and 5 cm. in length and when filled but not distended they contain about 35 ml. T o minimize the likelihood of the elastic properties of their walls contributing to the pressure recorded, the balloons never contain more than 20 to 25 ml. of water when in place in the bowel. Tandem balloon systems (FIGURE lc) have often been placed in the large bowel through colonic stoma^.^, lo Sometimes, in the lower part of the large bowel the two balloons were separated by a greater distance so that one rested well within the pelvic colon and the other within the ampulla of the rectum.3 The great advantage of the tandem system is that some assessment of the degree of coordination in the motility of adjoining segments of the bowel can be made. The changes of pressure within the balloons have been recorded by means of glass spoon manometers shown in FIGURE la. A rise of pressure in the spoon opens it. This movement is transmitted by the reflection of a beam of light from a mirror mounted on the tip of the spoon to a moving photographic film (FIGURE 2). When the pressure rises in the balloon, the spoon opens and the light beam moves upward on the film. Between the balloon and the spoon, an air chamber of about 120 ml. is inserted so that the contractions of the bowel force water from the balloon into the reservoir in precisely the same fashion as they would move the contents of the bowel into adjoining segments. The tiny electrically operated pressure transducer is mounted in the end of a Sawyer gastric tube (FIGURE 3a and b). A cross section of this little apparatus helps to illustrate its modus operandi (FIGURE 3c). The principle involved is similar to that of the old inductorium used for so many years by physiologists as an electric stimulator. A soft iron core is surrounded by a primary coil carrying a current and a secondary coil iii which a current is induced. The strength of the current in the secondary coil is dependent upon the position of the iron core. In the transducer, the position of the soft iron core in turn depends upon the amount of pressure applied to the piston or valvelike structure to which it is attached. The piston is held in place by a rigid spring just like the valves in an automobile engine. The entire unit is housed in a metal cylinder. The piston or valve a t the open end of the cylinder is covered by a sheet

The Roentgen Diagnosis of Diverticulitis

The roentgen diagnosis of diverticulitis of the colon assumes greater importance with the growing number of elderly individuals in our society. Since diverticulosis and diverticulitis are more prevalent in the higher age groups, the greater life expectancy has increased the incidence of both diseases. Because earlier and better diagnosis is needed, a review of this subject was undertaken, with emphasis on the roentgen diagnosis of sigmoidal diverticulitis and on the relationship of the findings to the pathologic aspects of the disease. The pathologic anatomy of diverticulitis was first recognized and described by Cruveilhier (4) in 1849. Graser (7) in 1899 described the formation of diverticula of the intestine and stressed their frequency. In 1907, Mayo, Wilson, and Giffin (8) reported the first American series in which operation had been performed. The earliest complete treatise on diverticula of the colon was undertaken by Telling (11) in 1908. The first case demonstrated roentgenologically prior to op...

The Roentgen Diagnosis of Diverticulitis1

The roentgen diagnosis of diverticulitis of the colon assumes greater importance with the growing number of elderly individuals in our society. Since diverticulosis and diverticulitis are more prevalent in the higher age groups, the greater life expectancy has increased the incidence of both diseases. Because earlier and better diagnosis is needed, a review of this subject was undertaken, with emphasis on the roentgen diagnosis of sigmoidal diverticulitis and on the relationship of the findings to the pathologic aspects of the disease. The pathologic anatomy of diverticulitis was first recognized and described by Cruveilhier (4) in 1849. Graser (7) in 1899 described the formation of diverticula of the intestine and stressed their frequency. In 1907, Mayo, Wilson, and Giffin (8) reported the first American series in which operation had been performed. The earliest complete treatise on diverticula of the colon was undertaken by Telling (11) in 1908. The first case demonstrated roentgenologically prior to op...