Augmented histamine test,ewald test meal,and diagnex test

Summary and conclusions The augmented histamine test, the Ewald test meal, and the Diagnex tests have been compared in a series of 130 patients. The results indicate that although the results of these tests follow the same trend in a group of patients, no one test can be used to predict satisfactorily the results of the other two tests in the majority of individual patients.Although the Ewald test is as informative as the augmented histamine test in supporting a clinical diagnosis of duodenal ulcer, the latter shows most clearly the wide variations in the degree of hypersecretion in different patients with duodenal ulcer and is the most reliable test for establishing the presence of achlorhydria. The augmented histamine test is virtually free of any serious side effects and, furthermore, provides a reliable index of the parietal-cell mass. The augmented histamine test would thus appear to be of particular value as a guide to the nature and extent of surgery necessary for the satisfactory reduction of acid secretion in patients with peptic ulcer.Our findings support the claims made by previous workers regarding the value of the Diagnex test in the screening of large numbers of patients for achlorhydria or marked hypochlorhydria. Apart from its usefulness as an initial screening test in cancer detection programs, the test has a limited place in excluding a diagnosis of pericious anemia or duodenal ulcer.We wish to record our deep obligation to E. R. Squibb and Sons, New York, for supplies of Diagnex Blue and Diagnex reagent, and to Merck Sharp and Dohme, West Point, Pa. for supplies of Neo-Antergan maleate.     

A quantitative test for xerostomia. The Saxon test, an oral equivalent of the Schirmer test

We describe a simple, reproducible, and low-cost test for xerostomia, which involves chewing on a folded sterile sponge for 2 minutes. Saliva production is quantitated by weighing the sponge before and after chewing. Normal control subjects produced greater than or equal to 2.75 gm of saliva in 2 minutes. Three of 32 consecutive, unselected outpatients in allergy-immunology clinics and 9 of 38 patients in rheumatology clinics had decreased saliva production, which was significantly different compared with controls (P less than 0.01). The presence of sicca symptoms was highly correlated with quantitatively abnormal tear and saliva production, according to the results of the Saxon and Schirmer's tests.     

Delayed gastric emptying: Whom to test, how to test, and what to do

Opinion statement Gastroparesis, or delayed gastric emptying, is a common cause of chronic nausea and vomiting as seen in a gastroenterology practice. Diabetic, postsurgical, and idiopathic causes remain the three most common forms of gastroparesis. In addition to nausea and vomiting, symptoms of gastroparesis may include early satiety, postprandial fullness, and abdominal pain. Physiologic changes that may explain symptoms in patients with gastroparesis, in addition to delayed gastric emptying, include impaired fundic accommodation, antral hypomotility, gastric dysrhythmias, pylorospasm, and perhaps visceral hypersensitivity. Diagnosis of gastroparesis is best determined using a radioisotope-labeled solid meal with scintigraphic imaging for at least 2 hours, and preferably 4 hours, postprandially. Most commonly, a 99mTc sulfur colloid-labeled egg sandwich with imaging at 0, 1, 2, and 4 hours is used. Extension of the gastric emptying test to 4 hours improves the accuracy of the test, but unfortunately, this is not commonly performed at many centers. Emptying of liquids remains normal until the late stages of gastroparesis and is less useful. The aims of treatment should be to control symptoms and maintain adequate nutrition and hydration. Patients should be advised to eat small meals and to limit their intake of fat and fiber. Additional dietary recommendations may include increasing caloric intake in the form of liquids. For diabetic patients, control of blood glucose levels is important, as symptom exacerbation is frequently associated with poor glycemic control. Specific treatment often begins with metoclopramide, 10 mg, up to four times daily, after a discussion of possible side effects with the patient. An antiemetic agent, such as prochlorperazine, 5 to 10 mg orally or 25 mg by suppository, can be added on an as-needed basis every 4 to 6 hours to control nausea. If these antiemetic medications are not effective, or if side effects develop, orally dissolving ondansetron, 8 mg every 8 to 12 hours, can be tried on an as-needed basis. If this regimen is unsuccessful, then alternative prokinetic agents—erythromycin, 125 mg, or tegaserod, 6 mg, prior to meals—can be tried. For cases refractory to these treatments, referral to a center with US Food and Drug Administration permission to use domperidone should be considered. Alternatively, symptom modulators such as low-dose tricyclic antidepressants can be tried to reduce symptoms, but these do not improve gastric emptying. In patients for whom all medical therapy fails, other options that are tried at experienced centers include the injection of botulinum toxin into the pylorus, placement of a feeding jejunostomy, and/or placement of a gastric electrical stimulator.     

Resistance test welcomed, with caution

Murex Technologies has launched an HIV drug resistance test, LiPA HIV-1 RT, that is causing both confusion and excitement. Researchers warn that resistance testing is still in its infancy and urge that the test be used with caution. Researchers are concerned with the number of patients who are failing drug therapy after only one year. Drug failure can be caused by a number of reasons, including patient noncompliance and the ineffectiveness of the treatment. Resistance tests are being developed for both genotypic and phenotypic resistance. The mechanisms of how resistance develops, and the benefits and advantages of each type of test are discussed.     

The single-breath nitrogen test, mortality, and cancer

The relationship between indices of the single-breath nitrogen test and mortality, overall cancer incidence, and respiratory cancer incidence was examined in a cohort of 876 men, 46 to 69 yr of age, examined in 1974 and followed until June 1985. Closing volume, closing capacity, and slope of phase III were not related to mortality or cancer. In contrast, FEV1 was related to mortality, with an estimated relative mortality risk of 1.37 (95% confidence interval, 1.11 to 1.70) per liter under the expected FEV1, given height, age, and smoking, but FEV1 was not related to cancer. Inability to perform acceptable single-breath nitrogen test tracings was related to mortality with a relative mortality risk of 2.03 (1.45 to 2.85), but not to cancer. We conclude that indices of the single-breath nitrogen test have no predictive value concerning overall mortality and cancer incidence.     

Comparison of a multiple puncture tuberculin test, 'Imotest', and the Mantoux test in an Australian population

The new multiple puncture tuberculin testing device, 'Imotest', was compared to the Mantoux test (10 I.U.) in an Australian population. The tests were applied simultaneously to opposite forearms of 105 volunteers. Sixty-eight per cent of the Mantoux tests were positive compared to 39% of the 'Imotests', resulting in a false negative rate of 44% and the difference was highly significant. A further 30 volunteers were tested with a different batch of 'Imotest' and similar results were obtained. When multiple 'Imotests' were applied simultaneously to each of two subjects in a separate study, there was a wide variation of response within each subject, and positive and negative reactions occurred side by side. These results indicate that the 'Imotest' is significantly less sensitive than the Mantoux test and is unsuitable for use as a diagnostic or screening test.     

Value of the treadmill test, bicycle ergometry test and the isometric test in evaluating the severity of coronary insufficiency

Possibilities of the treadmill test, bicycle ergometry and the isometric test are reviewed with respect to the diagnosis and assessment of the severity of coronary heart disease (CHD). A study of 40 normal males and 95 coronary patients (including 57 aneurysm-free ones and 38 with left ventricular postinfarction aneurysm) demonstrated low diagnostic value of standard dynamic load programs for the assessment of coronary insufficiency. An original treadmill test program has been developed where each new step carries a 1 MET increment of the load, allowing to assess the severity of CHD within a wide range of clinical manifestations, and group patients according to the involvement of 1 or 2 coronary arteries. The isometric test is of little value for the diagnosis of CHD, yet it can be useful in the assessment of the severity of coronary insufficiency and identification of patients with the involvement of 2 and 3 coronary arteries.     

Rapid HIV test yields counseling, referrals. Clients report satisfaction with rapid test

Recent studies of the rapid HIV test's use among at-risk populations show that the test can be a valuable tool when combined with counseling in intervention programs because the percentage of people who stay to receive their test results is very high.     

Prospective evaluation of a new stool antigen test for the detection of Helicobacter pylori, in comparison with histology, rapid urease test, (13)C-urea breath test, and serology

Background and Aims: This study aimed to evaluate the efficacy of a new polyclonal enzyme immunoassay for the detection of Helicobacter pylori (H. pylori) antigen in stool by determination of the optimal cut‐off value in the screening population. Methods: A consecutive 515 patients undergoing a routine health check‐up were prospectively enrolled. H. pylori infection was defined if at least two of four tests (histology, rapid urease test, ¹³C‐urea breath test, and serology) were positive. A stool antigen test (EZ‐STEP H. pylori) was performed for the detection of H. pylori. The optimal cut‐off value was determined by the receiver–operator characteristic curve. The diagnostic performance of each test was evaluated with regard to the histological diagnosis of atrophic gastritis (AG)/intestinal metaplasia (IM), degree of AG/IM, and old age. Results: Sensitivity, specificity, positive and negative predictive values, and accuracy of the stool antigen test were 93.1%, 94.6%, 95.1%, 92.3%, and 93.8%, respectively. The sensitivity of histology, rapid urease test, and the ¹³C‐urea breath test ranged from 89.1% to 97.6%, and their specificity was > 98%, while serology had high sensitivity, but low specificity. The accuracy of the stool antigen test was comparable to that of other methods (93.6–95.9%), whereas it was higher than that of serology. The stool antigen test still showed good diagnostic performance in the setting of progression of AG/IM and in patients over 40 years. Conclusions: The performance of a new stool antigen test was comparable to that of other methods in the diagnosis of H. pylori infection for the screening population, even with the presence of AG/IM.     

Comparison of acidified glycerol lysis test, Pink test and osmotic fragility test in hereditary spherocytosis: effect of incubation

In this study we compared the results of the acidified glycerol lysis test, the Pink test and the osmotic fragility test in 38 patients with hereditary spherocytosis and in healthy controls. The sensitivity of the acidified glycerol lysis test was 81.6% when performed within 3 h after blood collection. After incubating for 24 h, the sensitivity increased to 100% whereas the specificity remained maximal. Similar incubation did not improve the diagnostic utility of the Pink test. All patients, but none of the controls, showed a positive osmotic fragility test. It is concluded, because of sensitivity and specificity in this study, that the acidified glycerol lysis test after incubation and the osmotic fragility test are superior to the Pink test in detecting spherocytosis.     

Holter monitoring, exercise test and atropine test in isolated congenital atrioventricular block in children

Twenty-four patients with isolated congenital heart block were investigated by 24-hour Holter monitoring at an average age of 9.3 +/- 5.5 years. Six patients were symptomatic and 18 were asymptomatic. Eight asymptomatic patients underwent exercise stress tests and an atropine test was performed in 10 asymptomatic patients to evaluate the capacity to accelerate the heart rate. The symptomatic patients were older than the asymptomatic patients. None of the parameters which analyse ventricular rate were significantly different in the two groups of patients. Significant ventricular arrhythmias (Lown Grade 2 or over) were recorded in 1 symptomatic and 3 asymptomatic patients. The incidence of these ventricular arrhythmias increased with age and degree of bradycardia. The percentage increase in ventricular rate after atropine correlated with what was observed on effort (r = 0.95, p = 0.01) but there was no relationship between the ventricular rates during these two tests and those recorded on Holter monitoring. The results of this series of children with isolated congenital heart block show the Holter parameters cannot distinguish symptomatic from asymptomatic patients. The exercise stress and atropine tests gave very similar results but their prognostic value has not yet been established.