An anatomico -physiological Principle governing the direction of the gastro-intestinal mucosal folds during life

The mucosa, being the innermost layer of the gastrointestinal tract, is intimately concerned with digestion and absorption, and, presumably, also with the transport of intestinal contents. In anatomical, physiological and motility studies, possible movements of the mucosa and its folds are neither considered nor investigated. Dogmatic statements about the direction of the folds are often made. Radiologists have long been aware of mucosal movements, but after the fundamental work of Forssell, no further views have been put forward. Radiological procedures have been used to investigate the normal, macroscopic, physiological movements of mucosal folds. A general rule follows. Normally, when the intestine is filled, but inactive, the folds are circular; when the walls contract, the folds change in direction, to become longitudinal. This phenomenon is confirmed by in vivo baboon studies and elucidated by wire spirals. It is seen to be an inherent characteristic of 'peristaltic' and 'segmental' contractions. In this manner longitudinal mucosal furrows are formed simultaneously with the contraction wave of the walls, thus facilitating transit. Were this not so, peristalsis would be an ineffective mechanism, with contraction waves acting against the resistance of circular folds.S. Afr. Med. J., 48, 441 (1974)

Giant lower oesophageal ulcer in a Bushman baby

The case of a giant, penetrating lower oesophageal ulcer in a 14-month-old Bushman baby is reported. This would probably be classified as a Barrett's ulcer. Histological examination showed that the ulcer developed in columnar epithelium and that there was normal stratified squamous oesophageal mucosa both proximally and distally to the ulcer, indicating that it had developed in an islet of ectopic gastric mucosa. The ulcer originally described by Barrett developed in a short oesophagus, into which gastric mucosa extended in a continuous sheet. Lower oesophageal ulcers should probably be divided into a primary type, of which the present case is an example, and a secondary type. in which there is direct extension of gastric mucosa into the oesophagus due to metaplasia of oesophageal mucosa secondary to reflux oesophagitis

Praktiese moeilikhede met die radiologie van die grootboog van die maag

As die 4 illustrasies van die 4 verskillende gevalle ondersoek word, sal dit blyk hoe moeilik dit in die gewone bariummaal mag wees om te besluit in watter gevalle die grootboog van die maag 'n organiese letsel wys en in watter rue. In al 4 die gevalle was die radiologiese beeld min of meer konstant. Die gevalle is operatief gekontroleer.Indien die kliruese- en laboratorium-ondersoeke in sulke gevalle onseker is, as die gewone bariummaal en gastroskopie rue sekerheid gee nie, en as 'n laparotomie om een of ander rede nie gedoen kan word rue, is daar 'n paar minder bekende metodes van ondersoek wat kortliks bespreek sal word

Esosinophilic granuloma of the stomach

Two patients with eosinophilic granuloma of the stomach are discussed. The first patient had extensive and time-consuming investigations before the diagnosis was confirmed after surgery, while the second patient's presentation corresponded so closely to the first that a correct preoperative diagnosis was entertained with a minimum of investigations and delay. The barium-meal examinations in both patients were very typical of the condition, but the endoscopy findings and biopsy histology reports were noncontributory. Neither of the patients had a history of allergy or eosinophilia. The lesions were localized to the distal part of the stomach and the resected specimens were microscopically typical of eosinophilic granuloma of the stomach