Biomedical subjects
Publications and source records attributed to R Toffler.
The radiological findings on barium enema examination of 239 patients with thyroid deficiency (192 hypothyroid and 47 myxedematous) were reviewed. A new radiologic finding of transverse ridging superimposed on megacolon is described in myxedema and an explanation for this finding is postulated. The colonic findings associated with thyroid deficiency are presented.
The gastrointestinal tract is a common target for adverse drug reactions. The resultant changes are often nonspecific (e.g., mucosal ulceration, intestinal infarction, motility disturbance) and in many cases no radiographically detectable lesion may occur. A comprehensive review of the reported drug-induced disorders of the digestive organs is herein presented and their radiographic manifestations are described.
Aperistalsis of the esophagus was demonstrated in six patients with esophagitis. This was observed in reflux, caustic, and infectious esophagitis, and has occurred both as a transient phenomenon with no further sequelae, and as the initial manifestation of involvement in patients who subsequently suffered stricture. Based on biopsy and autopsy specimens in two cases, a possible mechanism of aperistalsis related to the damage to neurons in Auerbach's plexus is postulated. The presence of aperistalsis has been the first significant clue to esophageal inflammation in several cases.
Four cases of megacolon associated with celiac sprue are described and the literature reviewed. On barium enema examination, the colon is dilated and redundant with normal evacuation. Dilatation may be related to increased stool bulk delivered to the colon and/or to an intrinsic colonic abnormality in celiac sprue.
A collection of barium simulating an ulcer, or a negative defect simulating a mass, frequently occurs at the junction of the first and second portions of the duodenum. This appearance may be related to several factors, including (a) distortion produced by flexion, (b) sphincter function, and (c) an extrinsic impression. Several such patients have had negative findings on endoscopy. The defect can be distinguished from a true lesion by its characteristic location and its variable appearance on different projections.
A case of aperistalsis of the esophagus secondary to isolated invasion of the myenteric plexus of Auerbach by metastatic carcinoma is presented. The unique pattern of tumor involvement and the resultant aperistalsis supports the contention that involvement of the neurons in the deep myenteric plexus, either by inflammation or tumor, may be the key factor in producing aperistalsis. No similar cases were found in the literature.
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