High-frequency catheter-based ultrasound (US) transducers can be inserted into the esophagus transnasally to evaluate esophageal wall structures. Studies were performed in two sheep esophagus specimens in vitro, in 17 healthy human subjects, and in 16 patients with esophageal abnormalities (eight with achalasia, four with scleroderma, three with esophageal carcinoma, and one with esophagitis). In the sheep specimens, endoluminal US delineated seven layers of the esophageal wall; these results correlated closely with histologic findings. Real-time US of the normal esophageal wall was performed during resting and swallowing. Muscles at the lower esophageal sphincter (LES) were shown to be thicker than muscles in the body of the esophagus. Thickening of the muscular layers at the LES in achalasia, dilated blood vessels within the submucosa in esophagitis, and fibrotic changes within the muscular layers in scleroderma were demonstrated. Extramural structures adjacent to the esophagus were also seen. These preliminary results suggest that transnasal esophageal US may become an important diagnostic tool in evaluation of the esophagus.

The paracervical ganglia of the female rat were studied to elucidate the variety of neural elements in the ganglia. Light and electron microscopy, histochemistry, and immunohistochemistry were employed to reveal subtypes of neurons; small, intensely fluorescent (SIF) cells; and nerve terminals and to examine the relationships between these elements. On the basis of their histochemical markers, four subtypes of principal neurons were identified: acetylcholinesterase (ACHE)-positive, noradrenergic, neuropeptide tyrosine-immunoreactive (NPY-I), and vasoactive intestinal polypeptide-immunoreactive (VIP-I). The NPY-I neurons appeared to be the most numerous and the noradrenergic the least common type of neuron. Four subtypes of chemically coded SIF cells were revealed: catecholamine-containing, NPY-I, and those immunoreactive for calcitonin-gene-related peptide (CGRP-I) and cholecystokinin-octapeptide (CCK-8-I). The SIF cells were present as single cells among and adjacent to principal neurons and as large clusters near the edges of the ganglia or in nearby nerve trunks. Synaptic contacts on SIF cells, or between SIF-cell processes and neurons, were not observed. Seven subtypes of nerve terminals were stained: ACHE-positive, CGRP-I, CCK-8-I, VIP-I, substance P-I, enkephalin-I, and atrial natriuretic factor-I. Nerve terminals enwrapped the neurons as perineuronal plexuses in synaptic-like relationships. These results demonstrate that the paracervical ganglia of the female rat are a complex system of neural elements. For example, several classes of chemically coded neurons, SIF cells, and terminals exist in the ganglia. Each of these components contains a number of substances, some of which are putative neurotransmitters, which could influence activity in the ganglia or in the effector organs innervated by the ganglia.

This is the case of a 71 year old male who developed multiple myeloma (MM) and chronic myelogenous leukemia (CML) within a two year period. The patient initially presented with osteolytic lesions of the lumbar spine, and following the initial work-up a diagnosis of multiple myeloma with an IgG kappa paraproteinemia was made and appropriate treatment was given. Two years later the patient developed a progressively worsening leukocytosis which was found to be due to Philadelphia Chromosome (Ph1) positive CML. The occurrence in the same patient of two distinct hematologic malignancies suggests a neoplastic transformation of a pluripotent stem cell. A review of the literature appears to support the existence of a relationship between MM and CML as well as a relationship between MM and the myeloproliferative disorders.

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A 20 MHz ultrasound transducer housed in a 6.2 Fr catheter was used to image human esophageal au· topsy specimens from six cadavers. Histologic sections taken from the areas imaged were correlated with cross-sectional sonographic images. Six echo layers were seen in the non-fluid-filled esophagus whereas seven echo layers were seen in the fluidfilled esophagus. These seven layers correspond to the following histologic structures: first hyperechoic layer-mucosa (including squamous epithelium and O ver the past several years, flexible ultrasound transducer-containing catheters (4.8 to 9 Fr), which were originally designed for intravascular sonographic application, have become available. 1 • 2 During the past 3 years, these miniature catheter-based transducers have been used to evalu- ABBREVIA nONSFr, French