Biomedical subjects
Publications and source records attributed to J Mirwis.
Six patients with benign extrinsic oesophageal dysphagia are presented, 4 with dysphagia aortica and 1 each with dysphagia due to cervical osteophytes and traction diverticulum. The radiological features of these cases are discussed. It is emphasized that such cases form a small but significant entity.
A patient with oesophageal intramural pseudodiverticulosis (believed to be the first case reported in the southern African literature) is described and the literature is reviewed. Although the pathogenesis of the condition remains uncertain, reflux oesophagitis, increased intra-oesophageal pressure and chronic monilial oesophagitis may be important antecedents. The characteristic histopathological findings include dilatation of the excretory ducts of the submucosal oesophageal mucous glands with periductal inflammation. The appearance of multiple flask-shaped outpouchings on barium studies is diagnostic. More recently, computed tomography has been shown to be useful in confirming the diagnosis.
Three cases of traumatic intrapericardial diaphragmatic hernia are reported. The defect was limited to the central tendon of the diaphragm in all 3 cases with herniation of the transverse colon (n = 2) or small bowel (n = 1) into the pericardial sac. A correct preoperative diagnosis was made in all 3, using a dilute barium meal in 2 patients, and from the chest X-ray examination alone in 1. Successful operative repair was performed. Previous reports suggest that barium studies of the gastrointestinal tract are the most accurate method of diagnosis but should be used with caution as they may precipitate cardiac tamponade through distension of herniated bowel.
The clinical, radiological and endoscopic aspects of 2 cases of intramural oesophageal haematoma are presented. The diagnosis was firmly established at endoscopy, and both patients responded to conservative therapy. The value of endoscopy in the diagnosis and management of this condition is emphasized.
Most South African urban Blacks consult witchdoctors. In order to effect cures the witchdoctors often use enemas containing various ingredients. These enemas may result in complications, some of which may be fatal. The radiological manifestations of ritual-enema-induced colitis are described. The acute radiological abnormalities include segmental toxic dilatation, necrotising colitis, pseudopolypoid formation, ulcer formation, penetration and perforation. The chronic manifestations are loss of bowel calibre, skip stricture formation, diffuse stricture formation and loss of the normal haustral pattern. The spectrum of radiological appearances is both wide and kaleidoscopic, and may mimic many other colonic diseases.
Gastrointestinal tuberculosis is difficult to diagnose since it mimics many other abdominal conditions and has protean manifestations. The disease can present as an abdominal mass, bowel perforation, Crohn's disease and dysentery. These presentations are discussed with representative cases to illustrate the diagnostic difficulties. It is emphasized that to obviate the diagnostic pitfalls, tuberculosis should always be considered in the differential diagnosis of unusual gastrointestinal presentations particularly because radiological and laboratory tests may be noncontributory.
A patient who ingested a soft-drink bottle top and stones, which resulted in a chronic active ileitis, is described. Histological examination revealed a chronic active inflammatory process, probably indicating long-term ingestion of foreign material. The histological features in some respects resembled those of Crohn's disease.
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