Electrical activity of the ovine jejunum and changes due to disturbances

Spike potential activity of the jejunum was recorded from chronically implanted electrodes in conscious sheep. The activity was summed at 20-sec intervals before, during, and after induction of diarrhea, small-bowel obstruction, and after nerve section. Sheep on a normal diet regimen exhibited migrating myoelectric complexes at a frequency of 18/24 hr. These complexes displayed irregular and regular activities which occupied 67% of the recording time. A common pattern observed during the manipulations was disorganization of the motor profile. The normal pattern was replaced by continuous spiking activity followed in many cases by total quiescence. After vagotomy the complexes still occurred but the duration of irregular spiking activity was decreased. These experiments suggest that the migrating myoelectric complex acts as a regulating factor and suggests that the ratio of irregular to regular activity is dependent on the influence of extrinsic nerves.     

Bradykinesia in minimal hepatic encephalopathy is due to disturbances in movement initiation

BACKGROUND: One of the predominant symptoms of early stages of hepatic encephalopathy (HE) is bradykinesia. AIMS: To further analyze the pathophysiology of bradykinesia in HE. METHODS: A three-dimensional computer-assisted movement analysis was performed in 36 cirrhotics with grade 0-I HE compared to 18 controls selected with regard to sex and age and 16 patients with Parkinson's disease (PD). Four types of movement were studied: finger tapping, hand tapping, pronation/supination of the forearm and flexion/extension in the hip joint. RESULTS: The patients with PD presented with a decrease of the maximal movement velocity (VMAX) and a prolongation of the time needed to reach VMAX (VTIME). In patients with minimal or grade I HE, the VMAX of all movements was unchanged compared to controls while the VTIME was significantly prolonged. This was caused by a delay before the beginning of each new part of the diadochokinetic movement cycle. CONCLUSIONS: The data suggest an impairment of movement initiation as main cause of bradykinesia in early HE.     

Orgotein efficacy in ameliorating side effects due to radiation therapy

Orgotein efficacy in minimizing the local side effects induced by radiotherapy, administered to patients suffering from bladder or prostate cancer, was studied in 3 double-blind clinical trials. Assessment parameters such as efficacy, signs and symptoms of bladder disease were chosen as follows: incontinence, pain, dysuria, cystoscopic picture, maximal voiding volume, voiding frequency (day and night), diarrhoea, amount of anti-diarrhoea preparations consumed. In the first study orgotein was administered in a dose of 4 mg, 15-30 minutes after radiotherapy. Orgotein was found to be statistically significant superior to placebo when assessed according to the above mentioned criteria. Side effects that would have compelled stopping the orgotein therapy did not develop. In the second trial 50 patients suffering from prostatic carcinoma received after each radiotherapy (5,400 rad during 6 weeks) 8 mg orgotein or placebo. The radiotherapy-induced side effects were less common in the orgotein group than in the placebo group. The third clinical trial was conducted according to the same protocol as the two previous ones. Fifty patients with either prostate or bladder cancer were given orgotein or placebo in conjunction with radio-therapy. Only data of 26 out of 50 are yet available. These data show in agreement with two previous mentioned trials a significant superiority of orgotein compared to placebo.     

Pulmonary insults due to transfusions, radiation, and hyperoxia

Pulmonary insults caused by transfusion, radiation, and hyperoxia share many clinical features with insults caused by serious pulmonary infections. The major objective in evaluating these patients is to establish the diagnosis with as much certainty as possible. Unfortunately, there are no clinical aspects or laboratory tests that are pathognomonic for these diseases; therefore, it is often necessary to rely on a knowledge of those features which help to distinguish these disorders from infectious etiologies. For example, patients suffering from transfusion-related acute lung injury (TRALI) experience onset of insult within 6 hours of a transfusion and have the presence of leukoagglutinins in their serum. Patients with radiation injuries frequently have roentgenographic infiltrates that conform to the ports of radiation. Despite extensive animal and human studies, factors distinguishing hyperoxic injury from infectious disorders remain poorly defined. These clinical features and others are reviewed to identify the essential components in the diagnosis of TRALI, acute radiation pneumonitis, and hyperoxic pneumonitis.     

Effect of radiation therapy on bronchial obstruction due to bronchogenic carcinoma

We evaluated the effect of radiation therapy in 57 patients with obstruction of a large bronchus with NSCC. Response with aeration of the atelectatic lung was seen in 12 patients (21 percent). Three patients (5 percent) showed partial response with persistent partial atelectasis, and nine patients (16 percent) showed good response with complete aeration of the atelectatic lung. In these patients the response appeared to be related to the dose of radiation. All of the patients who responded received more than 50 Gy. The difference in the response rate related to the dose of radiation was statistically significant (p less than 0.05). The rates were similar with all histologic types of NSCC. Regardless of the clinical response observed, bronchoscopy performed two to four months after completion of radiation therapy in 14 patients revealed persistent endobronchial tumor. There was no significant relationship between the persistence of endobronchial tumor, the dose of radiation therapy, and the tumor's histologic type. Of the 12 patients with radiographic improvement in atelectasis, fibrotic changes developed in four (33 percent) patients and pneumonitis in two (17 percent). Progression of disease with distant metastases occurred in 58 percent (seven) of the 12 patients who showed a clinical response of their bronchial obstruction. The median time to survival was nearly identical in responders and nonresponders.     

Determination of physiologic disturbances due to rotating shift schedules using ambulatory measurement of the arterial pressure

Technological progress has led to the creation of jobs requiring minimal physical labor, high mental concentration, and rotating shift schedules. This study evaluates the physiological effects of rotating shift work on the cardiovascular system. Methods: blood pressure (BP) and heart rate were recorded automatically (Spacelabs) under ambulatory conditions over a 24 h period in 15 quality control technicians at a chemical factory, during each one of their 3 shifts: morning (4 am-12 noon), afternoon (12 noon to 8 pm) and night (8 pm to 4 am). Results: mean Bp and HR did not differ significantly between the 3 shifts when the work period was taken into account. (table; see text) Activity appears to prevail over circadian rythm and to determine BP and HR levels. Techniques using chronological series analysis which take BP variability into account (Fourier harmonic transformations) show that night work considerably modifies the modes of BP and HR variation (going to sleep, waking-up, variability at work). Conclusion: BP and HR measurement provide a pratical approach to the analysis of physiological disturbances induced by rotating shift work in employees with mentally demanding jobs.     

Previously unknown stricture due to radiation therapy diagnosed by capsule endoscopy.

Radiation enteritis is a complex clinical entity secondary to the affectation of intestinal epithelial cells as a result of radiation in the management of pelvic malignancies that may occasionally cause intestinal strictures. We present the case of a 60 year-old woman who had been diagnosed ten years before with endometrial adenocarcinoma, and who underwent hysterectomy with double adnexectomy and subsequent radiation therapy. The patient consulted for abdominal pain and ferropenic anemia of several years standing, and had negative results following radiographic and endoscopic conventional techniques, reason why she was subjected to a capsule endoscopy study that revealed the presence of an ulcerated ileal stricture, which caused the asymptomatic retention of the capsule within the ileum. A laparotomy was subsequently performed--the strictured segment was resected and the capsule retrieved. The histologic examination of the resected segment confirmed the capsule endoscopy-raised suspicion of radiation enteritis. This case shows the role capsule endoscopy may play in the diagnosis of this condition.