Reply to: diagnostic power of fecal calprotectin in inflammatory and functional intestinal disorders

Abstract

Objective. A retrospective clinical audit was carried out to identify whether relaxation of the sphincter of Oddi (SO) by botulinum toxin (BTX) injection can select patients with episodic functional post-cholecystectomy biliary pain who will benefit from endoscopic sphincterotomy. Patients and methods. Sixty-four patients complaining of functional post-cholecystectomy biliary pain with a frequency of at least four episodes per month had 100 units of BTX injected into their SO muscle in four aliquots. After review patients with a pain free interval following BTX injection of at least 4 weeks were offered biliary endoscopic sphincterotomy and their outcome assessed. Results. Of the 64 patients 46 (72%) had at least four pain free weeks after BTX therapy and 44 of these 46 patients (96%) went on to experience pain relief following endoscopic sphincterotomy. Of the 64 patients 41 had sphincter of Oddi manometry prior to BTX injection. Every patient with sphincter of Oddi hypertension defined by manometry and at least 4 weeks' pain relief following BTX (24) had pain relief following sphincterotomy. Fifteen (94%) of the 16 patients who did not undergo manometry but reported at least 4 weeks' pain relief after BTX had pain relief after sphincterotomy. Conclusion. Botulinum toxin relaxation of the SO may be a useful method of predicting the symptom response to endoscopic sphincterotomy in patients who have episodic functional biliary pain.     

Consanguinity and kin level: their relative importance to the helping network of older adults

The purpose of this research was to examine the help received by older rural-transitional adults from seven levels of consanguineous and affinal kin and to determine the correlates of help received according to kin type. The sample consisted of 321 working class adults, aged 65 to 96 years, selected by a compact cluster sampling procedure. The data showed that kin beyond the child, child-in-law levels was of little functional importance in the helping network of older adults. Proximity to kin was the only common denominator of help received across all levels of kin. Results of the study appear to support, in part, the kin-selection theory in that helping behaviors were usually based upon degree of consanguinity (and associated marriage tie) and extent of dependency of older adults as measured by their health status or age.     

Pudendal neuropathy and the importance of EMG evaluation of fecal incontinence

Diseases of the Colon & Rectum - A prospective study was undertaken to evaluate pudendal neuropathy in fecal incontinence. Fifty-two patients (38 women and 14 men) with fecal incontinence...     

The relative importance of factors which influence order of injecting with a shared needle and syringe

Injecting drug users (IDUs) in Adelaide, South Australia, rated the likelihood of first use of a shared needle and syringe by persons who have characteristics which have previously been suggested as influencing order of injecting. This enabled the relative importance of these factors to be assessed. It was found that those who supply their own drug and injecting equipment have the greatest likelihood of using first, but it is also somewhat advantageous if one is able to promote one's needs, has recently been tested for HIV or is at home when the opportunity to inject arises. Older IDUs and regular users may be slightly advantaged, as may those who inject others and those who were denied first use the last time sharing occurred. A model for predicting order of use is proposed.     

Serendipitous rapid detoxification from opiates: the importance of time-dependent processes

Opiate detoxification procedures aim to reduce intensity and duration of withdrawal. Ultra-rapid opiate detoxification (UROD) methods attempt to obtain this goal by administering naltrexone under deep sedation or anaesthesia. We present a case study on accidental ingestion of naltrexone in a methadone maintenance patient, which shows close methodological similarities with UROD procedures. Naltrexone was effective in reducing withdrawal duration, but not as much as UROD studies report. The administration of naloxone after detoxification did not trigger withdrawal symptoms, even in the presence of methadone, as detected by urinalyses. These results suggest the importance of further developing detoxification methods based on protocols of administration of antagonists different from UROD, in absence of anaesthesia.     

The relative importance of thrombin inhibition and factor Xa inhibition to the antithrombotic effects of heparin

The relative importance of antithrombin and anti-factor Xa activities of heparin fractions required to achieve optimal antithrombotic effects is unknown. To study this, we measured the effects of standard heparin, an octasaccharide heparin fraction (anti-factor Xa activity only), and dermatan sulfate (antithrombin activity only) on the prevention of thrombosis and related this to their anticoagulant effects in vivo in rabbits. Thrombosis was measured as the incorporation of 125I- fibrinogen into tissue thromboplastin-induced thrombi using a Wessler- type model. Ex vivo changes in thrombin clotting time (TCT) were used as an index of antithrombin activity, and a chromogenic anti-factor Xa assay was used to measure anti-factor Xa activity. In addition, the ability of the three sulfated polysaccharides to simultaneously inhibit the generation of thrombin activity and to enhance the inactivation of the factor Xa added to initiate thrombin generation in plasma was determined. Standard heparin, in a dose of 10 anti-factor Xa U/kg, inhibited thrombus formation by 90%, prolonged the TCT by two seconds, and resulted in an anti-factor Xa level of 0.32 U/mL. The octasaccharide heparin fraction, in a dose of 10 anti-factor Xa U/kg, inhibited thrombus formation by 41%, had no effect on the TCT, and resulted in an anti-factor Xa level of 0.28 U/mL. Higher doses of the octasaccharide resulted in a further increase in the anti-factor Xa levels but had no further effect on thrombus formation. Dermatan sulfate, in a dose of 500 micrograms/kg, inhibited thrombus formation by 95%, but had no affect on the TCT. These results indicate that the antithrombotic effect achieved by inhibiting factor Xa is limited and that better antithrombotic effects are achieved by heparin or heparin- like substances capable of influencing the inactivation and/or the generation of thrombin.