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We carried out a prospective, double-blind study at three institutions, comparing esophagography with esophagoscopy for the detection of simultaneous cancer of the esophagus in patients with other squamous cell cancers of the head and neck. The goal was to determine whether esophagography and esophagoscopy are necessary for the examination of patients before treatment. One hundred eighty-two patients were studied; both examinations were done in 148 patients. Twenty-one patients could not undergo esophagoscopy; esophagography was inadequate in 9 patients; 4 patients could have neither examination. Concordance was noted between the two procedures in 86.5% of patients. Sixty-five percent were normal, and 21.5% were abnormal. One esophageal cancer was found in this series that was diagnosed by both methods. Our data suggest that esophagoscopy and esophagography may be complementary in evaluating squamous cell carcinoma of the head and neck in patients before treatment. Esophagography alone was useful in patients in whom esophagoscopy could not be performed.

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We document a case of acute nonobstructive appendicitis and critically evaluate the pertinent literature. Although undoubtedly a rare entity, nonobstructive appendicitis may occur and should be differentiated from a normal appendix by barium enema examination. Mucosal and intramural inflammatory abnormalities are described which permit the diagnosis of nonobstructive appendicitis.

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Lymphoma and regional enteritis may demonstrate strikingly similar patterns in the small bowel. Fifty cases of regional enteritis and small-bowel lymphoma were reviewed. Of these, there were 12 cases of both diseases in which a confident radiographic distinction could not be made. Both diseases may narrow the terminal ileum, present as inflammatory processes, and demonstrate nodular patterns. Other similarities include aneurysmal dilatation, several types of ulceration, fistula formation, mesenteric masses, and involvement of the terminal ileum either alone or in association with skip areas. Clinical implications and the pathologic processes responsible for the radiographic similarity between these entities are discussed.

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Growth characteristics of human esophageal epithelial cells have been determined in primary explant and serial culture. Normal human esophagus was obtained from donor patients in a heart/lung transplantation program; tissue obtained at autopsy (6 to 22 h after death) was not viable. When mucosal specimens (1.5 mm2) were explanted on a plastic surface and attached with a plasma clot, 35% of explants detached from the surface within 48 h. The addition of epsilon amino caproic acid (EACA) to the culture medium increased explant attachment to 93% (P less than 0.001). Outgrowth kinetics were similar in both the presence and absence of EACA. No advantage of human serum over nonhuman sera was observed in primary culture. Esophageal epithelium could be frozen in 10% dimethyl sulfoxide without affecting growth kinetics. Addition of dexamethasone (DEX) significantly altered esophageal cell morphology in primary culture and increased viability on serial culture. Studies of pH revealed an optimum at pH 7.4 with significantly decreased growth occurring at 6.8 and no growth at 6.2. Esophageal cells in primary explant cultures could be released by trypsin and passaged two additional times with an eightfold increase in total number. An increased rate of attachment and multiplication was observed for cells plated on a collagen substrate compared to plastic. The addition of EACA and DEX to the culture media and the subculture on a collagen substrate provide a method for the isolation and serial cultivation of human esophageal cells from biopsy-sized specimens of normal esophageal epithelium.

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An in vitro model using esophageal epithelial explant cultures has been developed. Esophageal mucosa from New Zealand white rabbits was cut into 1.5-mm2 sections and fixed to a plastic petri dish using chick plasma. Appropriate outgrowth medium was added, and the explants were incubated in a humidified CO2 incubator at 37 degrees C. Cell outgrowth was measured directly, and lipid content was determined qualitatively. Esophageal epithelial cells grow as confluent sheets of multilayered cuboidal cells. Three growth phases were identified. Increased oxygen tensions inhibited growth. Optimum growth occurred at pH 7.4. Growth was significantly inhibited at pH 6.4, and no growth occurred at pH 5.8. Cells may be released by trypsin and five subcultures obtained. These results demonstrate that monolayer cultures of normal esophageal epithelium may be routinely established and maintained in cell culture for extended periods from small samples of tissue and that factors affecting growth may be quantitatively determined.

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The authors describe a simple method for obtaining double-contrast images of the lower esophagus with the patient in a prone position. This technique has a high success rate, allows repeated imaging, and is easily incorporated into routine upper gastrointestinal studies. Diagnostic double-contrast studies were obtained in 78% of 28 patients. Ten abnormalities, including a Mallory-Weiss tear, were demonstrated. Single-contrast esophagrams, performed immediately afterwards, demonstrated only six abnormalities.

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Certain roentgenographic features have been considered typical of benign gastric ulcers, based almost entirely on studies of the lesser curvature. However, these features frequently are not present on the profile view in benign greater curvature ulcers. Moreover, features stated to suggest malignancy in gastric ulcers are commonly simulated by benign greater curvature ulcers. The authors reviewed the profile roentgenographic features of 19 benign greater curvature ulcers and found that they often appeared to be intraluminal and had shouldered edges due to spasm of the surrounding circular muscles. In 6 patients the adjacent gastric contour was scalloped. These features frequently cause radiologists to misinterpret benign greater curvature ulcers as malignant.

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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 other's 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 examiner's level of confidence. The two examinations should be used as complementary diagnostic procedures.

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This investigation determined the site(s) of elicitation and origin of secondary peristalsis in the human esophagus and characterized the upper esophageal sphincter (UES) and proximal esophageal body responses accompanying intraluminal distention. In 7 normal persons, an intraluminal transducer probe manometrically recorded the UES and 5- and 10-cm levels of the esophageal body. A second probe with a balloon attached 2 cm above the proximal strain gauge was located so that the balloon was 3 and 4 cm below the UES and 4 distentions were done. The balloon probe was moved in 2-cm increments (four distensions at each site) until lower esophageal sphincter pressures were recorded. No secondary peristalsis occurred after distention in the proximal 6 cm. The incidence of secondary peristalsis increased as the distention site moved distally. Sixty-nine per cent of secondary peristaltic waves orignated in the esophageal body proximal to the distention site. The UES pressure significantly increased over resting pressure (augmentation) during 63% of distentions. The esophagus proximal to the balloon and below the UES usually responded to distention with augmentation. Augmentation of the UES and proximal esophageal body in response to esophageal intraluminal distention and the resultant initiation of secondary peristalsis above the distention site comprise a highly integrated pressure barrier to esophagopharyngeal reflex.

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The combination of orally administered barium and the introduction of air rectally at the time the barium column is in the region of the cecum and terminal ileum leads to an excellent visualization of the ileocecal region. It may be used whenever a conventional barium enema examination fails to show this region adequately.

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The utilization of a catheter semiconductor beta detector (CASRAD) to perform in vivo, sequential, esophageal nutrient blood flow distribution studies in cats is described. A diffusable radioisotope, Rubidium 86 (86Rb), was injected intravenously and the CASRAD placed within the esophageal lumen. The distribution of 86Rb remained stable within the feline esophagus for sufficient time to allow for counting at 1.5 cm levels in the esophagus. The accuracy limitations of the CASRAD system were assessed by comparing the in vivo, recorded distribution of 86Rb with the esophageal distribution of 86Rb as determined by a well-type scintillation counter. The distribution throughout most of the esophagus was similar by both techniques. Sequential esophageal studies performed with the CASRAD showed less variability than existed in the biological differences between cats and the methodology of obtaining and counting tissue by well-type scintillation counter (mean coefficient of variation 11.6% versus coefficient of variation 23.1%).

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Nine children were evaluated two to three years after institution of either medical or surgical management of their hiatal herniae. Four children treated medically ranged from 6 to 16 months of age. There were clinically cured of symptoms and one clinically improved, indicating the efficacy of medical management in some young children. The fifth medically treated child, age 10 years, was also clinically improved. Four children initially had surgical hiatal hernia repair: one (16 days old) because of pulmonary aspiration with associated cardiorespiratory arrest, two (ages 3 and 6 years) because medical management failed, and one (age 7 years) who presented with an esophageal stricture. Surgery for hiatal herniae in children should be reserved for patients in whom medical management has failed or for patients with serious complications.

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The outer, lateral esophageal walls in the distal half of the esophagus in each of five cats were labeled with small tantalum wires. About 8 wk later, esophageal motion associated with respiration and peristalsis, induced by injecting barium boli (5 ml each) into the proximal esophagus, was recorded on cine and serial biplane roentgenograms while recording intraluminal esophageal pressures simultaneously by manometry. Esophageal motion was also evaluated without a manometric tube in place. The coordinates for each marker were digitized and a computer was used to plot marker position against time. During respiration, the markers passively made a shallow, 2-10 mm excursion on the longitudinal esophageal axis. This movement was synchronous with thoracic and diaphragmatic movement and changes in intraluminal esophageal pressure. Immediately after the onset of peristalsis, the markers made a pronounced oral movement of 10 mm or more above their mean respiratory position, as if to engulf the bolus. Markers in opposing esophageal walls approximated one another and commenced an aboral movement as the bolus tail, which was essentially co-incident with onset of the manometric pressure complex, passed the marker sites. The markers returned to their respective rest positions essentially coincident with passage of the pressure complex peak and then moved below their respective rest positions. The aboral excursion occurred predominantly after the bolus had emptied into the stomach. The magnitude and duration of oral excursion was significantly greater for the distal than for the more proximal markers; conversely, the magnitude and duration of aboral excursion was greater for the proximal than for the more distal markers. During the peristaltic sequence, the labeled portion of the esophagus shortened from 26 to 46% of its resting length. No evidence of esophageal torque was shown. These findings suggest that both the longitudinal and circular esophageal musculature play an active and important role during peristaltic transport of a bolus through the esophagus.

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