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Distension
Kinds of Distension Selected AbstractsPathogenesis and outcome of extrahepatic biliary obstruction in catsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 6 2002P. D. Mayhew Extrahepatic biliary obstruction (EHBO) was confirmed at surgery or necropsy in 22 cats. Biliary or pancreatic adenocarcinoma was diagnosed by histopathology in six cats and one cat had an undiagnosed mass in the common bile duct. The remaining 15 cats had at least one of a complex of inflammatory diseases including pancreatitis, cholangiohepatitis, cholelithiasis and cholecystitis. The most common clinical signs were jaundice, anorexia, lethargy, weight loss and vomiting. Hyperbilirubinaemia was present in all cases. Distension of the common bile duct and gall bladder was the most commonly observed finding on abdominal ultrasound. Nineteen cats underwent exploratory laparotomy for biliary decompression and diversion. Mortality in cats with underlying neoplasia was 100 per cent and, in those with non-neoplastic lesions, was 40 per cent. Long-term complications, in those that survived, included recurrence of cholangiohepatitis, chronic weight loss and recurrence of obstruction. Based on these findings, the prognosis for EHBO in cats must be considered guarded. [source] Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173 010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipationALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2009A. AGRAWAL Summary Background, A sensation of abdominal swelling (bloating) and actual increase in girth (distension) are troublesome features of irritable bowel syndrome (IBS), which is more common in patients with constipation, especially those with delayed transit. Aim, To establish whether a fermented dairy product containing Bifidobacterium lactis DN-173 010 reduces distension in association with acceleration of gastrointestinal transit and improvement of symptoms in IBS with constipation. Methods, A single centre, randomized, double-blind, controlled, parallel group study in which patients consumed the test product or control product for 4 weeks. Distension, orocaecal and colonic transit and IBS symptoms were assessed on an intention-to-treat population of 34 patients. Results, Compared with control product, the test product resulted in a significant reduction in the percentage change in maximal distension [median difference , 39%, 95% CI (,78, ,5); P = 0.02] and a trend towards reduced mean distension during the day [,1.52 cm (,3.33, 0.39); P = 0.096]. An acceleration of orocaecal [,1.2 h (,2.3,0); P = 0.049] as well as colonic [,12.2 h (,22.8, ,1.6); P = 0.026] transit was observed and overall symptom severity [,0.5 (,1.0, ,0.05); P = 0.032] also improved. Conclusions, This probiotic resulted in improvements in objectively measured abdominal girth and gastrointestinal transit, as well as reduced symptomatology. These data support the concept that accelerating transit is a useful strategy for treating distension. [source] Vascular endothelial growth factor in edematous mouse embryos induced by retinoic acid in uteroCONGENITAL ANOMALIES, Issue 2 2001Yoshiko Yasuda ABSTRACT, Vascular endothelial growth factor (VEGF) is induced by hypoxic environment and contributes to vascular formation in both developing embryos and adults. Exogenous retinoic acid (RA) induces avascular yolk sacs with anemic stunted embryos of day 9 and 10 of gestation when RA is given to pregnant mice on day 6, 6.5 or 7 of pregnancy (Yasuda et al., 1996). We undertook the present studies to find out whether VEGF is activated and plays any role in those RA-exposed embryos. Embryos were obtained from dams given 60 mg/kg of RA on day 6 or 7 of pregnancy and sacrificed three days later. Most RA-exposed embryos showed edematous swelling without prominent vascular nets, but had beating heart tubes on day 9 and day 10 of gestation. Microscopic examination of developing tissue components showed various degrees of degeneration, and distension of the dorsal aorta when the body cavity was dosed. Northern blot analysis revealed expression of VEGF mRNA in the RA-exposed and control embryos. The highest expression of VEGF mRNA was seen in the embryos of day 10 exposed to RA on day 7, and these embryos had a significantly lower ATP content than did the controls (p < 0.01). Immunoreactive VEGF was detectable in both experimental and control embryos; in the former it was especially visible in the distended neuroepithelium, endothelium and membranes. These VEGF-immunoreactive regions also expressed another permeability factor, bradykinin. These findings suggest that VEGF upregulated by hypoxic conditions in edematous embryos induced by RA exposure in utero acts as hyperpermeability. [source] Prostaglandin I2 sensory input into the enteric nervous system during distension-induced colonic chloride secretion in rat colonACTA PHYSIOLOGICA, Issue 3 2010J. D. Schulzke Abstract Aim:, Intestinal pressure differences or experimental distension induce ion secretion via the enteric nervous system, the sensorial origin of which is only poorly understood. This study aimed to investigate sensorial inputs and the role of afferent and interneurones in mechanically activated submucosal secretory reflex circuits. Methods:, Distension-induced rheogenic chloride secretion was measured as increase in short-circuit current 10 min after distension (,ISC10; distension parameters ± 100 ,L, 2 Hz, 20 s) in partially stripped rat distal colon in the Ussing-chamber in vitro. PGE2 and PGI2 were measured by radioimmunoassay. Results:, ,ISC10 was 2.0 ± 0.2 ,mol h,1 cm,2 and could be attenuated by lobeline, mecamylamine and dimethylphenylpiperazine, indicating an influence of nicotinergic interneurones. Additionally, a contribution of afferent neurones was indicated from the short-term potentiation of ,ISC10 by capsaicin (1 ,m). As evidence for its initial event, indomethacin (1 ,m) inhibited distension-induced secretion and the release of PGI2 was directly detected after distension. Furthermore, serotoninergic mediation was confirmed by granisetron (100 ,m) which was functionally localized distally to PGI2 in this reflex circuit, as granisetron inhibited an iloprost-induced ISC, while indomethacin did not affect serotonin-activated ion secretion. Conclusions:, Distension-induced active electrogenic chloride secretion in rat colon is mediated by a neuronal reflex circuit which includes afferent neurones and nicotinergic interneurones. It is initiated by distension-induced PGI2 release from subepithelial cells triggering this reflex via serotoninergic 5-HT3 receptor transmission. Functionally, this mechanism may help to protect against intestinal stasis but could also contribute to luminal fluid loss, e.g. during intestinal obstruction. [source] Contractile activity of skeletal musculature involved in breathing is essential for normal lung cell differentiation, as revealed in Myf5,/,:MyoD,/, embryosDEVELOPMENTAL DYNAMICS, Issue 3 2005Mohammad Reza Inanlou Abstract In the current study, the role of contractile activity of respiratory muscles in fetal lung growth and cell differentiation was examined using Myf5,/,:MyoD,/, mouse embryos. As previously found, Myf5,/,:MyoD,/, mouse embryos had no respiratory musculature. Consequently, they suffered from pulmonary hypoplasia and died shortly after birth. The hypoplastic lung had decreased proliferation and increased apoptotic index as early as embryonic day 14.5. By contrast, only at the last gestational day, the number of lung cells expressing platelet derived growth factor B and insulin growth factor I was decreased, while the gradient of the thyroid transcription factor 1 was not maintained. Type II pneumocytes had a failure in glycogen utilization and surfactant storage and secretion but were able to synthesize the surfactant-associated proteins. Type I pneumocytes were readily detectable using an early differentiation marker (i.e., Gp38). However, the late differentiation of type I pneumocytes never occurred, as revealed by transmission electron microscopy. Together, our findings suggest that pulmonary distension due to fetal breathing-like movements plays an important role not only in lung growth but also in lung cell differentiation. Developmental Dynamics 233:772,782, 2005. © 2005 Wiley-Liss, Inc. [source] Effects of acute hyperglycaemia on anorectal motor and sensory function in diabetes mellitusDIABETIC MEDICINE, Issue 2 2004A. Russo Abstract Aims To determine the effects of acute hyperglycaemia on anorectal motor and sensory function in patients with diabetes mellitus. Methods In eight patients with Type 1, and 10 patients with Type 2 diabetes anorectal motility and sensation were evaluated on separate days while the blood glucose concentration was stabilized at either 5 mmol/l or 12 mmol/l using a glucose clamp technique. Eight healthy subjects were studied under euglycaemic conditions. Anorectal motor and sensory function was evaluated using a sleeve/sidehole catheter, incorporating a barostat bag. Results In diabetic subjects hyperglycaemia was associated with reductions in maximal (P < 0.05) and plateau (P < 0.05) anal squeeze pressures and the rectal pressure/volume relationship (compliance) during barostat distension (P < 0.01). Hyperglycaemia had no effect on the perception of rectal distension. Apart from a reduction in rectal compliance (P < 0.01) and a trend (P = 0.06) for an increased number of spontaneous anal sphincter relaxations, there were no differences between the patients studied during euglycaemia when compared with healthy subjects. Conclusions In patients with diabetes, acute hyperglycaemia inhibits external anal sphincter function and decreases rectal compliance, potentially increasing the risk of faecal incontinence. Diabet. Med. 21, 176,182 (2004) [source] COLLAPSE-SUBMERGENCE METHOD: SIMPLE COLONOSCOPIC TECHNIQUE COMBINING WATER INFUSION WITH COMPLETE AIR REMOVAL FROM THE RECTOSIGMOID COLONDIGESTIVE ENDOSCOPY, Issue 1 2007Takeshi Mizukami Colonoscopy is a difficult examination to conduct for inexperienced examiners. In an attempt to improve the view, there is often a tendency to overinsufflate air, which causes elongation or acute angulations of the colon and makes passage of the scope difficult. Sakai et al. were the first to describe a simple colonoscopic technique using water infusion instead of air insufflation. We have modified this technique to simplify the procedure further by combining water infusion using disposable syringes with complete air suction from the rectum to the descending colon. With the resultant elimination of the boundary lines between water and air, a good view of the lumen is obtained though the transparent water. With the patient in the left lateral position, this procedure allows the water to flow straight down into the descending colon through the ,collapsed' lumen, and the scope to be easily negotiated through the straightened recto-sigmoid colon and sigmoid-descending colon junction with minimum discomfort. Measurements of the patients' abdominal circumference during colonoscopy showed that colonic distension hardly occurred. Under supervision by the author, six complete novices were allowed to insert the colonoscope within 10 min by this method for one patient per week, as long as the patients did not complain of pain. The average trial number for the first cecal intubation within 10 min was 3.3, and the average success rate during the first 3 months was 58.6%. We believe that this ,collapse-submergence method' is easy to master, even for inexperienced examiners. [source] Retroperitoneal perforation of a pancreatic cyst during endoscopic retrograde pancreatographyDIGESTIVE ENDOSCOPY, Issue 2 2003TOMOYUKI KAWAKITA A 70-year-old man was admitted to Ueno Municipal Hospital, Ueno, Japan, for evaluation of abdominal distension. Computed tomography showed a 1 × 1 cm cyst at the pancreas tail. Endoscopic retrograde pancreatography (ERP) showed a normal pancreatic duct after the first gentle injection and an enhanced cyst at the pancreas tail. Extravasation of the contrast medium occurred from the pancreatic duct to the superior-dorsal extrapancreas at the same time of the next low-pressure manual injection. Computed tomography showed extravasation of the contrast medium from the pancreas cyst to the retroperitoneal space after ERP. It was considered that the cyst wall weakness, in addition to slight elevated pancreatic duct pressure, caused the disruption of the cyst wall. [source] Excessive belching and aerophagia: two different disordersDISEASES OF THE ESOPHAGUS, Issue 4 2010Albert J. Bredenoord SUMMARY Belching is physiological venting of excessive gastric air. Excessive and bothersome belching is a common symptom, which is often seen in patients with functional dyspepsia and gastroesophageal reflux disease. Other symptoms are usually predominant. However, a small group of patients complain of isolated excessive belching, with a frequency of several belches per minute. In these patients, the eructated air does not originate from the stomach but is sucked or injected in the esophagus from the pharynx and expelled immediately afterward in oral direction. This behavior is called supragastric belching because the air does not originate from the stomach and does not reach the stomach either. Excessive belching can be treated by speech therapy or behavior therapy. The term aerophagia should be reserved for those patients where there is evidence that they swallow air too frequently and in too large quantities. These patients have excessive amounts of intestinal gas visualized on a plain abdominal radiogram and their primary symptoms are bloating and abdominal distension and they belch only to a lesser degree. Aerophagia and excessive supragastric belching are thus two distinct disorders. [source] A Comparison of Echocardiographic Techniques in Determination of Arterial Elasticity in the Pediatric PopulationECHOCARDIOGRAPHY, Issue 5 2009Michael Fahey M.D. Background: Many methods are used to measure arterial elasticity in children using echocardiography. There is no data to support the equivalence of the different techniques. The goal of this study was to evaluate the reproducibility of several techniques used to measure arterial elasticity using echocardiography. Methods: Aortic distension in two different sites (arterial distension) through the cardiac cycle was measured by (four) two-dimensional (2D) and M-mode echocardiographic techniques in 20 children without significant structural heart disease. These measurements combined with noninvasive blood pressure measurements were used to calculate arterial elastic indices. Arterial elasticity was expressed in terms of distensibility and stiffness. Data were collected by two sonographers and interpreted by two reviewers. Paired Student's t-test and Pitman's test for equality of variance for correlated observations were used to detect differences between different sonographers, different reviewers, and different techniques. Results: No significant difference in the measured elasticity between sonographers or reviewers was observed. There was a somewhat increased variance in two of the four techniques evaluated. There was no significant difference in elasticity measured using different techniques to evaluate the same arterial site, although a significantly decreased elasticity was noted from measurements taken in the proximal ascending aorta as compared with the distal ascending aorta. Conclusions: Many echocardiographic techniques produce reproducible measurements of arterial elasticity. There may be intrinsic differences in arterial elasticity between different segments of the ascending aorta, which have not been previously described in children with normal cardiac anatomy. Comparisons of data from separate studies must take these differences into account. [source] Vagus Nerve Stimulation Therapy Induces Changes in Heart Rate of Children during SleepEPILEPSIA, Issue 5 2007Boubker Zaaimi Summary:,Purpose: This study analyzed changes in the heart rates of children receiving vagus nerve stimulation (VNS) therapy for pharmacoresistant epilepsy. Methods: Changes in the heart rates of ten children receiving VNS therapy for pharmacoresistant epilepsy were evaluated with polysomnographic recordings, including electrocardiogram (ECG), EEG, thoraco-abdominal distension, nasal airflow, and VNS artifacts. Measurements during stimulation were compared with those at baseline for each patient. Result: While the VNS therapy pulse generator was delivering stimulation, the heart rates of four children increased significantly (p < 0.01), decreased for one child, and increased at the end of the stimulation for one child. The heart rates of four children did not change. Changes in heart rate varied during VNS, within stimulation cycles for individual children and from one child to another. Changes in heart rate differed between rapid eye movement (REM) and non-REM (NREM) sleep states. Respiratory changes (increases in frequency and decreases in amplitude) were concomitant with the changes in heart rate. Conclusion: In this case series of children with pharmacoresistant epilepsy, cardiorespiratory variations occurred while the VNS therapy pulse generator was delivering stimulation. Understanding these variations may allow further optimization of VNS parameters. [source] Recurrent colics in a 9-year-old Arabian stallion due to several congenital anomaliesEQUINE VETERINARY EDUCATION, Issue 11 2008M. P. Robert Summary A 9-year-old Arabian stallion was presented for evaluation of recurrent colic problems of 2 years' duration. These colic episodes were associated with a right sided abdominal distension. An exploratory laparotomy revealed a colonic diverticulum that was resected en bloc. Two days later, following signs of acute colic, a second laparotomy showed incarceration of the distal jejunum into a mesodiverticular band combined with haemorrhage of a mesenteric arterial branch. In addition, an abnormally short jejunum (10 m) was also observed. An end-to-end jejunojejunostomy was performed. Following surgery the horse developed septic peritonitis, ptyalism and became dysphagic. Ten days after the second surgery, an infected oesophageal diverticulum causing regional inflammation was diagnosed endoscopically and euthanasia was performed. Post mortem examination showed a 40 cm long diverticulum lateral to the oesophagus. Histology suggested a congenital nature of the colonic and oesophageal diverticuli. [source] Red Cell Pulmonary Transit Times Through the Healthy Human LungEXPERIMENTAL PHYSIOLOGY, Issue 2 2003G. S. Zavorsky It has previously been postulated that rapid red cell capillary transit through the human lung plays a role in the mechanism of diffusion limitation in some endurance athletes. Methodological limitations currently prevent researchers from directly measuring pulmonary capillary transit times in humans during exercise; however, first pass radionuclide cardiography allows direct measurement of red blood cell (RBC) transit times through the whole lung at various exercise intensities. We examined the relationship between mean whole lung red cell pulmonary transit times (cardiopulmonary transit times or CPTT) and different levels of flow in 88 healthy humans (76 males, 12 females) from several studies (mean age 31 years). The pooled data suggest that the relationship between CPTT and cardiac index (CI), beginning at rest and progressing through to maximum exercise demonstrates that CPTT reaches its minimum value when CI is about 8.1 l m2 min,1 (2.5-3 times the CI value at rest), and does not significantly change with further increases in CI. Cardiopulmonary blood volume (CPBV) index also does not change significantly until CI reaches 2.5 to 3 times the CI value at rest and then increases roughly linearly after that point. Consequently, the systematic increase in CPBV index with increasing pulmonary blood flow between 8.1 and 20 l m2 min,1 displays an adaptive response of the cardiopulmonary system by augmenting CPBV (and perhaps pulmonary capillary blood volume through distension and recruitment) to offset the reduction in CPTT, as no significant difference in mean CPTT is observed between these levels of flow (P > 0.05). Therefore, these data demonstrate that CPBV does not reach maximum capacity during strenuous or maximum exercise. This does not support the principle of quarter-power allometric scaling for flow when explaining modifications during exercise. Therefore, we speculate that the observed relationships between CPTT, CBPV index and flow may prevent mean CPTT (and perhaps mean pulmonary capillary transit times) from decreasing below the threshold time required for oxygenation. [source] Acute gastric dilatation causing bacterial cerebral aneurysm,Case reportINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 4 2008Takeshi Matsuyama MD Abstract Objective: Acute gastric dilatation (AGD) is a very rare entity which can sometimes be life-threatening. We report a case of a patient presenting with a rupture of a BCA during the treatment of AGD. Method: A 24-year-old woman, who had a history of bulimia and vomiting episodes, was transferred in shock with marked abdominal distension. A large nasogastric tube was inserted, and 9 liters of viscous gastric contents were drained out. Her circulation became stable. Results: About 3 months after admission, she became drowsy and presented with a right hemiparesis and aphasia. Computed tomography of the head showed a diffuse thick subarachnoid hemorrhage. Left carotid angiograms revealed an obscurely-shaped aneurysm in the left middle cerebral artery. Conclusion: Trapping of the aneurysm was performed. Thirty-four days after admission, the patient had a residual right hemiparesis and motor aphasia, and was discharged. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2008 [source] Contribution of Nitric Oxide Synthase to Improved Early Graft Patency in Human Saphenous Vein Graft Harvested by a Novel ,No-Touch' TechniqueJOURNAL OF CARDIAC SURGERY, Issue 6 2002JCS Tsui Aim: Saphenous vein (SV) is the most commonly used conduit in bypass procedures but has a one-year occlusion rate of 15-30%. A new ,no-touch' technique where the SV is harvested with a cushion of surrounding tissue with no distension has led to improved early patency rates of 5% at 18-months. Nitric oxide (NO), synthesised by nitric oxide synthase (NOS) has properties beneficial to graft patency. Our aim was to study the distribution of NOS in SV harvested by this technique and the effect of distension and removal of perivascular tissue on NOS content of SV. Methods: Following ethical committee approval and patients' informed consent, SVs were harvested from ten patients undergoing coronary artery bypass grafting. A segment of vein was harvested by the conventional technique (surrounding tissue stripped and vein distended with saline); another part was stripped but not distended (,control') and the remaining parts harvested by the ,no-touch' technique. Samples of each segment were taken and transverse sections prepared for NOS identification using 3[H]L-NG nitroarginine (NO Arg) autoradiography and NADPH-diaphorase histochemistry. NOS isoforms were studied using standard immunohistochemistry. Endothelial cells and nerves were also identified using immunohistochemistry with CD31 and NF200 respecitvely, to confirm sources of NOS. Morphometric analysis of NADPH-diaphorase staining was carried out to study tissue NOS content. Results: NO Arg binding representing NOS was preserved on the lumen of ,no-touch' vessels whilst that on conventional and control vessels was reduced. NOS was also localised to the medial smooth muscle cells of all vein segments and to the intact adventitia of ,no-touch' segments. This was confirmed by NADPH-diaphorase staining, which revealed a mean reduction of NOS by 19.5% (p < 0.05, ANOVA) in control segments due to stripping of surrounding tissue alone and a reduction of 35.5% (p < 0.01, AVNOVA) in conventional segments due to stripping and distension, compared to ,no-touch' segments. Adventitial NOS sources in ,no-touch' vessels corresponded to vasa vasorum and paravascular nerves. All three NOS isoforms contributed to the preserved NOS in ,no-touch' vessels. Conclusions: Apart from preserved lumenal NOS, NOS sources are also located in the media and adventitia of SV grafts. These are reduced by both adventitial damage and vein distension during conventional vein harvesting. The ,no-touch' technique avoids these procedures, preserving NOS sources. This may result in improved NO availability in SV harvested by this technique, contributing to the improved patency rates reported. [source] Multicenter randomized controlled trial of heat-killed Lactobacillus acidophilus LB in patients with chronic diarrheaJOURNAL OF DIGESTIVE DISEASES, Issue 4 2002Shu Dong XIAO OBJECTIVE: Chronic diarrhea is a common bowel disorder, and disturbance of intestinal microorganisms may play a role in its pathogenesis. The aim of this study was to assess the clinical efficacy of lyophilized heat-killed Lactobacillus acidophilus LB compared with living lactobacilli in the treatment of chronic diarrhea. METHODS: One hundred and thirty-seven patients with chronic diarrhea were randomly allocated to receive either a 4-week course of two capsules of Lacteol Fort twice a day as the Lacteol group (69 patients completed the course) or a 4-week course of five chewable tablets of Lacidophilin three times a day as the Lacidophilin group (64 patients completed the course). The frequency of stools was recorded quantitatively and the semiquantitative parameters such as stool consistency, abdominal pain, distension and feeling of incomplete evacuation were evaluated. RESULTS: At the second and fourth week of the treatment, the mean bowel frequency was significantly lower in the Lacteol group than in the Lacidophilin group (1.88 ± 1.24 vs 2.64 ± 1.12, 1.39 ± 0.92 vs 2.19 ± 1.05, respectively; P < 0.05). At the end of the treatment, the clinical symptoms were markedly improved in the Lacteol group. CONCLUSIONS: Lactobacillus acidophilus LB is more effective than living lactobacilli in the treatment of chronic diarrhea. [source] Intussusception: Trends in clinical presentation and managementJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 5 2006FRANCES A JUSTICE Abstract Background:, The association of a rotavirus vaccine and intussusception has renewed interest in understanding the incidence, clinical presentation and outcome of intussusception. Methods:, A retrospective chart review of all patients diagnosed with intussusception at Royal Children's Hospital, Melbourne over a 6.5-year period (1 January 1995,30 June 2001) was conducted using patients identified by a medical record database (ICD-9-CM code 560.0 1993,1997; ICD-10-CM code 56.1 1998,2001). Patient profile, clinical presentation, diagnosis methods, treatment and outcome were analyzed and compared to data previously reported on children with intussusception at the same hospital during 1962,1968. Results:, The hospitalization rate for primary idiopathic intussusception increased marginally from 0.19 to 0.27 per 1000 live births during the period 1962,1968 to 1995,2001. Most patients (80%) were <12 months of age (median age 7 months, range 2,72 months). The combination of abdominal pain, lethargy and vomiting was reported in 78% of infants. Air enema confirmed the diagnosis of intussusception in 186 of 191 cases (97%) and air reduction was successful in most cases (82%). Factors associated with increased risk of intestinal resection included abdominal distension (32%), bowel obstruction on abdominal X-ray (27%) and hypovolemic shock (40%). No mortality was observed in the present study. Conclusions:, Over the past 40 years at Royal Children's Hospital, Melbourne the hospitalization rate due to primary idiopathic intussusception has marginally increased from 0.19 to 0.27 per 1000 live births. Diagnosis and treatment using air enema has been highly successful, resulting in a reduction in patients requiring surgery and reduced hospital stays. [source] Gastrointestinal symptoms in intensive care patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009A. REINTAM Background: Gastrointestinal (GI) problems are not uniformly assessed in intensive care unit (ICU) patients and respective data in available literature are insufficient. We aimed to describe the prevalence, risk factors and importance of different GI symptoms. Methods: We prospectively studied all patients hospitalized to the General ICU of Tartu University Hospital in 2004,2007. Results: Of 1374 patients, 62 were excluded due to missing data. Seven hundred and seventy-five (59.1%) patients had at least one GI symptom at least during 1 day of their stay, while 475 (36.2%) suffered from more than one symptom. Absent or abnormal bowel sounds were documented in 542 patients (41.3%), vomiting/regurgitation in 501 (38.2%), high gastric aspirate volume in 298 (22.7%), diarrhoea in 184 (14.0%), bowel distension in 139 (10.6%) and GI bleeding in 97 (7.4%) patients during their ICU stay. Absent or abnormal bowel sounds and GI bleeding were associated with significantly higher mortality. The number of simultaneous GI symptoms was an independent risk factor for ICU mortality. The ICU length of stay and mortality of patients who had two or more GI symptoms simultaneously were significantly higher than in patients with a maximum of one GI symptom. Conclusion:, GI symptoms occur frequently in ICU patients. Absence of bowel sounds and GI bleeding are associated with impaired outcome. Prevalence of GI symptoms at the first day in ICU predicts the mortality of the patients. [source] MR colonography for the assessment of colonic anastomosesJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 1 2006Waleed Ajaj MD Abstract Purpose To assess colonic anastomoses in patients after surgical treatment by means of MR colonography (MRC) in comparison with conventional colonoscopy (CC). Materials and Methods A total of 39 patients who had previously undergone colonic resection and end-to-end-anastomosis were included in the study. MRI was based on a dark-lumen approach. Contrast-enhanced T1-weighted (T1w) three-dimensional (3D) images were collected following the rectal administration of water for colonic distension. The MRC data were evaluated by two radiologists. The criteria employed to evaluate the anastomoses included bowel wall thickening and increased contrast uptake in this region. Furthermore, all other colonic segments were assessed for the presence of pathologies. Results In 23 and 20 patients the anastomosis was rated to be normal by MRC and CC, respectively. In three patients CC revealed a slight inflammation of the anastomosis that was missed by MRI. A moderate stenosis of the anastomosis without inflammation was detected by MRC in five patients, which was confirmed by CC. In the remaining 11 patients a relevant pathology of the anastomosis was diagnosed by both MRC and CC. Recurrent tumor was diagnosed in two patients with a history of colorectal carcinoma. In the other nine patients inflammation of the anastomosis was seen in seven with Crohn's disease (CD) and two with ulcerative colitis. MRC did not yield any false-positive findings, resulting in an overall sensitivity/specificity for the assessment of the anastomosis of 84%/100%. Conclusion MRC represents a promising alternative to CC for the assessment of colonic anastomoses in patients with previous colonic resection. J. Magn. Reson. Imaging 2006. © 2006 Wiley-Liss, Inc. [source] Small bowel hydro-MR imaging for optimized ileocecal distension in Crohn's disease: Should an additional rectal enema filling be performed?JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 1 2005Waleed Ajaj MD Abstract Purpose To assess the impact of an additional rectal enema filling in small bowel hydro-MRI in patients with Crohn's disease. Materials and Methods A total of 40 patients with known Crohn's disease were analyzed retrospectively: 20 patients only ingested an oral contrast agent (group A), the other 20 subjects obtained an additional rectal water enema (group B). For small bowel distension, a solution containing 0.2% locust bean gum (LBG) and 2.5% mannitol was used. In all patients, a breathhold contrast-enhanced T1w three-dimensional volumetric interpolated breathhold examination (VIBE) sequence was acquired. Comparative analysis was based on image quality and bowel distension as well as signal-to-noise ratio (SNR) measurements. MR findings were compared with those of conventional colonoscopy, as available (N = 25). Results The terminal ileum and rectum showed a significantly higher distension following the rectal administration of water. Furthermore, fewer artifacts were seen within group B. This resulted in a higher reader confidence for the diagnosis of bowel disease, not only in the colon, but also in the ileocecal region. Diagnostic accuracy in diagnosing inflammation of the terminal ileum was 100% in group B; in the nonenema group there were three false-negative diagnoses of terminal ileitis. Conclusion Our data show that the additional administration of a rectal enema is useful in small bowel MRI for the visualization of the terminal ileum. The additional time needed for the enema administration was minimal, and small and large bowel pathologies could be diagnosed with high accuracy. Thus, we suggest that a rectal enema in small bowel MR imaging be considered. J. Magn. Reson. Imaging 2005;22:92,100. © 2005 Wiley-Liss, Inc. [source] Comparison between three-dimensional volume-selective turbo spin-echo imaging and two-dimensional ultrasound for assessing carotid artery structure and functionJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 3 2005Lindsey A. Crowe PhD Abstract Purpose To compare a volume-selective three-dimensional turbo spin echo (TSE) technique with ultrasound (US) for assessing carotid artery wall structure and function. Materials and Methods A three-dimensional volume-selective TSE technique was used to image the carotid artery in 10 healthy subjects and five hypertensive subjects (each of whom were scanned three times while they received different hypertension treatments). Lumen and wall area were measured on MR images. Two-dimensional US measurements of the intima-media thickness (IMT) and lumen diameter were taken in three orientations through a single cross section. The lumen area change over the cardiac cycle was used to determine distension. For validation, a Bland-Altman analysis was used to compare the vessel wall and lumen areas measured by three-dimensional MRI volumes with those obtained by US scans. Results Agreement between the two methods was found. The mean difference in distension between US and MRI was 1.2% (±5.1%). For the wall area measurements, good agreement was shown, but there was a systematic difference due to the visualization of the adventitia by MRI. Both techniques offer an easy way to objectively measure lumen indices. MRI can provide the complete circumference over the length of a vessel, while US is flexible and relatively inexpensive. The application of US is limited, however, when subjects are poorly echogenic. A difference between hypertensive and healthy subjects was found. Conclusion There was a good agreement between MRI and the clinically established two-dimensional US method. The MRI method has the advantage of providing increased vessel coverage, which permits one to assess localized abnormalities without assuming vessel uniformity. J. Magn. Reson. Imaging 2005;21:282,289. © 2005 Wiley-Liss, Inc. [source] Comparison of viral load and duration of virus shedding in symptomatic and asymptomatic neonatal rotavirus infectionsJOURNAL OF MEDICAL VIROLOGY, Issue 10 2010Sasirekha Ramani Abstract A single rotavirus strain causing asymptomatic infections as well as severe gastrointestinal disease has been described in the neonatal nurseries of the Christian Medical College, Vellore. In this study, quantitative real-time RT-PCR was used to determine the association of viral load with the presence of gastrointestinal symptoms in neonates. Viral load was estimated in terms of the crossing point [C(t) value] at which the amplicon could be detected in the real-time PCR assay. The study was carried out on 103 neonates, including 33 asymptomatic neonates and 70 neonates with different gastrointestinal symptoms. The duration of virus shedding was also compared between five symptomatic and four asymptomatic neonates using real-time RT-PCR. There was no significant difference in viral load between symptomatic and asymptomatic neonates (P,=,0.087). Among neonates with different gastrointestinal symptoms, those presenting with feed intolerance and abdominal distension had a significantly higher viral load than those with other gastrointestinal symptoms (P,=,0.02). For the study on virus shedding, nine neonates were followed up for a median duration of 53 days, with a median of 31 samples tested per child. Extended shedding of low copies of rotavirus was found, with no significant differences in pattern of shedding between symptomatic and asymptomatic neonates. The lack of correlation between viral load and gastrointestinal disease demonstrates yet another difference between neonatal rotavirus infection and infection in older children where higher viral load correlates with severe disease. J. Med. Virol. 82:1803,1807, 2010. © 2010 Wiley-Liss, Inc. [source] Randomized controlled trial of oral versus intravenous fluid supplementation on serum bilirubin level during phototherapy of term infants with severe hyperbilirubinaemiaJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 2 2002N-Y Boo Objective: To compare the rates of decrease in serum bilirubin levels in severely jaundiced healthy term infants given oral or intravenous fluid supplementation during phototherapy. Methods: A randomized controlled study was carried out in the neonatal intensive care unit (NICU) of Hospital Universiti Kebangsaan Malaysia over a 12-month period. Fifty-four healthy term infants with severe hyperbilirubinemia were randomized to receive either solely enteral feeds (n = 27) or both enteral and intravenous (n = 27) fluid during phototherapy. Results: There were no significant differences in the mean birthweight, mean gestational age, ethnic distribution, gender distribution, modes of delivery and types of feeding between the two groups. Similarly, there was no significant difference in the mean indirect serum bilirubin (iSB) level at the time of admission to the NICU between the enteral (359 ± 69 ,mol/L [mean ± SD]) and intravenous group (372 ± 59 ,mol/L; P = 0.4). The mean rates of decrease in iSB during the first 4 h of phototherapy were also not significantly different between the enteral group (10.4 ± 4.9 ,mol/L per h) and intravenous group (11.2 ± 7.4 ,mol/L per h; P = 0.6). There was no significant difference in the proportion of infants requiring exchange transfusion (P = 0.3) nor in the median duration of hospitalization (P = 0.7) between the two groups. No infant developed vomiting or abdominal distension during the study period. Conclusion: Severely jaundiced healthy term infants had similar rates of decrease in iSB levels during the first 4 h of intensive phototherapy, irrespective of whether they received oral or intravenous fluid supplementation. However, using the oral route avoided the need for intravenous cannulae and their attendant complications. [source] First report of canine African trypanosomosis in the UKJOURNAL OF SMALL ANIMAL PRACTICE, Issue 11 2007A. G. Gow A six-year-old neutered male Jack Russell terrier was presented two years after importation into the UK from southern Africa with severe anaemia and abdominal distension. Abdominal ultrasonography revealed the presence of hepato-splenomegaly and ascites. A diagnosis of trypanosomosis was made by blood smear examination. Shortly after admission the dog collapsed and died. PCR analysis revealed a single infection with Trypanosoma congolense savannah type. This is the first reported case of canine African trypanosomosis in Europe and suggests that chronic trypanosomosis may allow importation of the disease in apparently asymptomatic animals, even with extended quarantine periods. [source] Acquired urinary bladder diverticulum in a dogJOURNAL OF SMALL ANIMAL PRACTICE, Issue 12 2005E. T. F. Scheepens A neutered female chow chow aged six years and five months was evaluated for dysuria. An initial diagnosis of bladder distension and atony was made following physical, ultrasonographic and radiographic examinations. The problems did not resolve with medical management and exploratory surgery revealed a large bladder diverticulum. This report describes the radiographic findings and surgical repair of the acquired bladder diverticulum. The literature available on this condition is also reviewed. [source] Intra-abdominal metastases from soft tissue sarcomaJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2004FRCS (Ed.), FRCS (Glas.), Kasim A. Behranwala MS Abstract Objective To define the clinical features and prognosis of patients with abdominal metastasis from primary soft tissue sarcoma (STS) at other sites. Methods All patients with abdominal metastasis from STS were identified from the Royal Marsden Hospital Sarcoma Unit prospective database from January 1990 to July 2001. Results Nineteen patients developed abdominal metastasis out of a cohort of 2127 patients (0.9%) evaluated during the study interval. The median age was 49 (19,71) years. The median time to abdominal metastasis from diagnosis of the primary was 27 (8,91) months. The presenting complaints were incomplete intestinal obstruction (n,=,5), abdominal pain (n,=,4), mass (n,=,2), gastrointestinal bleed (n,=,2), urinary obstruction (n,=,2), anorexia (n,=,1), and abdominal distension (n,=,1). Emergency laparotomy was done for perforative peritonitis (n,=,2), intussusception (n,=,2), and bleed in spleen (n,=,1). Two patients were asymptomatic. The common histologies were myxoid liposarcoma (n,=,6) and leiomyosarcoma (n,=,4). The median follow-up of survivors post metastasis was 12 months. Abdominal metastatectomy was performed in 16 patients, 3 of these patients had abdominal recurrences. The 1- and 2-year overall disease specific survival for the 19 patients was 66% (SE,=,11%) and 43% (SE,=,13%) with a median survival of 13 months (95% CI,=,11.8,14.7). Metastasectomy was associated with slight improved median post-metastasis survival (33 months vs. 8 months for unresected patients). Conclusions Although abdominal metastasis is rare, vigilance is warranted. Symptomatic patients should be examined and investigated thoroughly for metastases. Surgery is the treatment of choice for patients with an acute presentation; however, survival is dismal. J. Surg. Oncol. 2004;87:116,120. © 2004 Wiley-Liss, Inc. [source] Endocannabinoid control of gastric sensorimotor function in manALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2010K. AMELOOT Aliment Pharmacol Ther,31, 1123,1131 Summary Background, Little is known about the physiological role of the endocannabinoid system in the regulation of the motility and the sensitivity of the stomach. Endocannabinoid system dysfunction has been hypothesized to contribute to the control of food intake and the pathogenesis of functional dyspepsia. Aim, To study the influence of rimonabant, the endocannabinoid 1 (CB1) receptor antagonist, on gastric sensorimotor function in healthy controls. Methods, After 4 days of pre-treatment with rimonabant 20 mg/day or placebo, 12 healthy volunteers (mean age 34 ± 12 years, six men) participated in a placebo-controlled, double-blind, randomized, crossover study with a gastric barostat assessment of gastric sensitivity to distension, gastric compliance, gastric accommodation and phasic motility on day 3 and a liquid nutrient challenge test on day 4. Results, Rimonabant did not influence gastric compliance and sensitivity to distension. The meal-induced gastric accommodation reflex was significantly inhibited by rimonabant (154.3 ± 30.9 vs. 64.3 ± 32.4 mL, P = 0.02). Rimonabant did not affect maximal nutrient tolerance or meal-related symptoms during the satiety drinking test. Conclusion, Endocannabinoids acting on the CB1 receptor are involved in the control of gastric accommodation in man. [source] Clinical trial: renzapride treatment of women with irritable bowel syndrome and constipation , a double-blind, randomized, placebo-controlled, studyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2010A. J. LEMBO Aliment Pharmacol Ther,31, 979,990 Summary Background, Renzapride, a 5-hydroxytryptamine type-4 (5-HT4) receptor agonist and 5-HT3 receptor antagonist, has been proposed as a new treatment of irritable bowel syndrome with constipation (IBS-C). Aim, To assess the efficacy and safety of renzapride in women with IBS-C. Methods, Women with IBS-C were randomized to renzapride 4 mg daily, 2 mg b.d. or placebo for 12 weeks. The primary outcome measure was global relief of IBS symptoms. A subset of patients were enrolled in a 12-month, open-label study of renzapride 4 mg daily. Results, A total of 1798 patients were included in the efficacy analysis and 971 patients entered the long-term study. The mean (S.E.M.) number of months with relief of overall IBS symptoms was 0.55 (0.04), 0.60 (0.04) and 0.44 (0.04) in the renzapride 4 mg daily, 2 mg b.d. and placebo groups (P = 0.027 and P = 0.004 respectively). Small yet statistically significant differences in favour of renzapride were observed on stool consistency and frequency, and bloating/abdominal distension scores. Renzapride was generally well tolerated; however, three episodes of ischaemic colitis were reported in the long-term study. Conclusion, Given the limited increase in efficacy over placebo and the incidence of ischaemic colitis observed, our data suggest that the benefit/risk ratio of renzapride is not sufficient to warrant further study in IBS-C. [source] Measuring irritable bowel syndrome patient-reported outcomes with an abdominal pain numeric rating scaleALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11-12 2009B. SPIEGEL Summary Background, Controversy exists on how to measure patient-reported outcomes in irritable bowel syndrome (IBS) clinical trials effectively. Pain numeric rating scales (NRS) are widely used in the non-IBS pain literature. The Food and Drug Administration has proposed using the NRS in IBS. Aim, To test the psychometrics of an abdominal pain NRS in IBS. Methods, We analysed data from a longitudinal cohort of Rome III IBS subjects. At entry, subjects completed a 10-point NRS, bowel symptoms, IBS severity measurements (IBS-SSS, FBDSI), health-related quality of life indices (IBS-QOL, EQ5D), and the Worker Productivity Activity Index (WPAI). We repeated assessments at 3 months along with a response scale to calculate the minimal clinically important difference. Results, There were 277 subjects (82% women; age = 42 ± 15) at baseline and 90 at 3 months. The NRS correlated cross-sectionally with IBS-SSS (r = 0.60; P < 0.0011), FBDSI (r = 0.49; P < 0.0001), IBS-QOL (r = 0.43; P < 0.0001), EQ5D (r = 0.48; P < 0.0001), presenteeism (r = 0.39; P < 0.0001), absenteeism (r = 0.17; P = 0.04) and distension (r = 0.46; P < 0.0001), but not stool frequency or form. The minimal clinically important difference was 2.2 points, correlating with a 29.5% reduction over time. Conclusions, An abdominal pain NRS exhibits excellent validity and can be readily interpreted with a minimal clinically important difference in patients with IBS. These data support the use of the NRS in IBS clinical trials. [source] Budd,Chiari-like syndrome in a dog with a chondrosarcoma of the thoracic wallJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2007Megan F. Whelan DVM Abstract Objective: To describe a dog with Budd,Chiari-like syndrome secondary to caudal vena cava compression from a thoracic wall chondrosarcoma. Case summary: A 9-year-old spayed female Shetland Sheepdog cross with a recent history of non-productive cough developed severe abdominal distension and dyspnea. Marked ascites and enlarged hepatic veins were identified with ultrasonography. At surgery, a right thoracic wall mass was found to be compressing the caudal vena cava. Fluid analysis of the ascites revealed a modified transudate with elevated protein concentration, consistent with Budd,Chiari-like syndrome. Clinical signs resolved following thoracotomy and complete resection of the mass. New or unique information provided: Obstruction of venous blood flow can result from compression exerted by a space-occupying thoracic wall mass on the caudal vena cava. Clinical resolution can be achieved with return of adequate venous circulation by removal of the mass and alleviation of the external pressure. [source] | |||||||||||||||||||||||||||||||||||||