Esophageal Function in Diabetes Mellitus with Special Reference to Acid Studies and Relationship to Peripheral Neuropathy

Esophageal function in 20 subjects with diabetes mellitus was assessed using esophageal manometry, 24-hr ambulatory esophageal pH monitoring, and esophageal scintigraphy. Seven patients had abnormal esophageal manometric studies, and this abnormality was significantly associated with peripheral neuropathy. Almost half of the subjects studied demonstrated excessive gastroesophageal acid reflux, but there was no correlation between the likelihood of abnormal reflux and the presence of peripheral neuropathy. Esophageal scintigraphy was relatively insensitive in the detection of abnormal esophageal function in diabetics.     

Prevalence of high Epworth Sleepiness Scale scores in a rural population

BACKGROUND:

Increased daytime sleepiness is an important symptom of obstructive sleep apnea (OSA). OSA is frequently underdiagnosed, and the Epworth Sleepiness Scale (ESS) can be a useful tool in alerting physicians to a potential problem involving OSA.

OBJECTIVE:

To measure the prevalence and determinants of daytime sleepiness measured using the ESS in a rural community population.

METHODS:

A community survey was conducted to examine the risk factors associated with ESS in a rural population in 154 households comprising 283 adults. Questionnaire information was obtained regarding physical factors, social factors, general medical history, family medical history, ESS score, and self-reported height and weight. Multivariable binary logistic regression analysis based on the generalized estimating equations approach to account for clustering within households was used to predict the relationship between a binary ESS score outcome (normal or abnormal) and a set of explanatory variables.

RESULTS:

The population included 140 men (49.5%) and 143 women (50.5%) with an age range of 18 to 97 years (mean [± SD] 52.0±14.9 years). The data showed that 79.2% of the study participants had an ESS score in the normal range (0 to 10) and 20.8% had an ESS score >10, which is considered to be abnormal or high sleepiness. Multivariable regression analysis revealed that obesity was significantly associated with an abnormal or high sleepiness score on the ESS (OR 3.40 [95% CI 1.31 to 8.80).

CONCLUSION:

High levels of sleepiness in this population were common. Obesity was an important risk factor for high ESS score.     

Left ventricular function evaluation using radionuclide methods in the intensive coronary care unit

We describe an adapted first-transit (FT) technique to perform left ventricular ejection fraction (LVEF) measurements on patients with Swan-Ganz catheters in the intensive cardiac care unit (ICCU). The radionuclide is introduced directly into the right pulmonary artery through the catheter. High-quality images of the left ventricle are obtained owing to minimal activity in the right ventricle and left lung. LVEF measurements obtained by FT compared well with measurements obtained from gated blood pool studies (r = 0.91) but gave consistently lower values. The adapted FT method improves LVEF determination and left-ventricular wall motion evaluation in the ICCU patient.     

Sclerosing Cholangitis Associated with Autoimmune Hemolytic Anemia and Hyperthyroidism

A patient presented with autoimmune hemolytic anemia and sclerosing cholangitis. Six years later he was found to be hyperthyroid. Although sclerosing cholangitis has been associated with other autoimmune disorders, it has not been reported in association with either autoimmune hemolytic anemia or hyperthyroidism. Sclerosing cholangitis is a chronic fibrosing inflammatory disease process which may include parts or all of the biliary tree including the gallbladder. Although this disorder has been reported to occur with a variety of autoimmune disorders, it has not been previously associated with autoimmune hemolytic anemia and hyperthyroidism.     

Normal High-Resolution Karyotypes in 26 Unrelated Individuals with Hereditary Colorectal Neoplasia

High-resolution karyotype analysis was performed on peripheral blood cultures from 26 patients with hereditary colorectal neoplasia. The aims of this study were: first, to determine the frequency of cytogenetically visible chromosome 5q deletions in familial adenomatous polyposis and, thus, whether routine karyotype analysis should be included in screening regimens for affected families; and, second, to search for chromosomal abnormalities in hereditary nonpolyposis colorectal cancer that might assist in localizing the gene or genes responsible. No cytogenetic abnormalities were detected among 21 unrelated patients with familial adenomatous polyposis and five with hereditary nonpolyposis colorectal cancer. We conclude that cytogenetic analysis is of no value in the management of families with typical familial adenomatous polyposis or Gardner's syndrome, and should be confined to those families with atypical features such as mental retardation or facial dysmorphism.