Psychiatric symptoms among patients with acute abdominal pain

Abstract

Background: Abdominal pain is a common cause of visits to emergency facilities. It is related to psychiatric disorders in primary care, but it is unclear if this also holds in emergency departments.

Objective: Is to explore potential differences between diagnostic groups in patients with acute abdominal pain in an emergency ward regarding concurrent somatic-and psychiatric symptoms, ‘Length of stay’ (LOS) and perceived health.

Method: The patients (N?=?137) were divided into three groups; organic dyspepsia, specific abdominal diagnoses, and non-specific abdominal pain. The Prime-MD results for extra gastrointestinal symptoms (outside the gastrointestinal tract), psychiatric symptoms, frequency of symptoms, self-reported health, and LOS within the month before admittance were compared between the diagnostic groups.

Results: There was a significant positive correlation between the number of physical extra gastrointestinal and psychiatric symptoms (p?<?.001), especially regarding anxiety (p?<?.001) and depression (p?=?.002). Patients with organic dyspepsia reported significantly more total (p?=?.016), extragastrointestinal (p?=?.026) (chest pain; p?=?.017, dizziness; p?=?.004, palpitations; p?=?.005, insomnia; p?=?.005 and worries; p?=?.001), and summarized anxiety and depression symptoms (p?=?.001–0.002) besides poorer general health (p?<?.001) compared to other abdominal conditions. Also, organic dyspepsia patients needed longer hospital stay than the non-specific abdominal group (p?=?.002) but similar to the specific abdominal disorders group.

Conclusion: Organic dyspepsia is accompanied by more co-occurring physical, anxiety and depression symptoms as well as poorer perceived health than other abdominal pain conditions and comparably increased LOS. This suggests that psychiatric consultations might be beneficial for diagnosing and treating psychiatric comorbidity in emergency care.     

Does nicotine administration influence intragastric acidity?

Smokers have an increased incidence of duodenal ulcer with a high relapse rate whether they receive maintenance therapy with H2-receptor antagonists or not. They also tend to be slow healers. The etiology behind this is still unknown, and there is general disagreement as to whether smoking affects gastric secretion. In an earlier study we found a small but significant decrease in intragastric pH a short time after smoking a cigarette. The aim of the present investigation was to study whether intragastric pH changed during nicotine administration per se. Nicotine was given as a nasal spray to eight healthy smokers. Nicotine did not induce any acute detectable changes in gastric acidity when the 5-min period before spraying was compared with the 35-min period after spraying (median pH, 1.47 (25-75 percentiles, 1.40-2.32) and 1.55 (25-75 percentiles, 1.42-2.06), respectively). When different time periods during a day with hourly nicotine administration were analyzed, and the results compared with those of a similar day when placebo was given, nicotine was found to impair postprandial gastric neutralization. Median pH during the lunch hour was 1.93 (25-75 percentiles, 1.80-2.37) after nicotine and 2.86 (25-75 percentiles, 2.37-3.70) after placebo; p less than 0.025. Possible explanations for this might be nicotine-mediated effects on gastric motility or gastrin release.     

Stability of faecal hepatocyte growth factor determination

In order to evaluate the accuracy and reproducibility of determination of hepatocyte growth factor (HGF) levels in faeces, the stability of HGF in samples processed in different ways was investigated. An ELISA method was used for determination of HGF concentrations. Faeces samples from healthy controls and patients with infectious diarrhoea were studied. It was found that faeces HGF concentration remained stable irrespective of whether samples were freeze-thawed several times, kept for 6, 12 or 24 h at room temperature or refrigerated for 6, 12, 24 or 36 h; the levels of HGF did not change significantly when samples were freeze-dried. Adding protease inhibitor to the faeces samples did not affect the HGF levels. There were no significant differences between HGF levels using phosphate buffered saline (PBS) (pH 7.4) or NaCL as buffer, but it was observed that levels of HGF were significantly lower in the samples that were diluted in distilled water. Although both HGF and albumin through various mechanisms may increase in faeces during infectious diarrhoea, there was no significant correlation between faeces HGF levels and albumin levels, which might indicate local production of HGF in the bowel in response to infection. It is concluded that determination of faeces HGF levels is feasible with a high degree of stability. Increased HGF levels in faeces might represent a local production of HGF during bowel injury and might be of use as a diagnostic and monitoring assay.     

Clinical impact of real-time evaluation of the biological activity and degradation of hepatocyte growth factor

Hepatocyte growth factor (HGF) is essential for injury repair. Despite high HGF levels in chronic ulcers, up-regulation of HGF receptor in ulcer tissue and decreased biological activity of HGF in ulcer secretions have been observed. With a surface plasmon resonance-based method, we assessed the binding of HGF to antibodies, receptors, and the basement membrane and identified binding interactions that are indispensable for the biological activity of HGF. Recombinant HGF (rHGF) lots were tested for activity, structural integrity, and degradation, and the results were verified in an in vitro model of cell injury. Biologically active rHGF, as well as plasma from healthy volunteers, bound to heparan sulphate proteoglycan (HSPG) and to anti-HGF antibodies. Decreased binding to HSPG was the first event in rHGF degradation. This study established the feasibility of identifying patients with chronic inflammation who need exogenous HGF and of using ligand-binding assessment to evaluate rHGF lots for biological activity.     

Regional structure-function correlations in chronic obstructive lung disease measured with positron emission tomography.

BACKGROUND: Positron emission tomography, performed with isotopes of very short half life, can be used to relate local lung tissue density to local ventilation and to the ventilation:perfusion ratio. This method has been used in 10 patients with severe chronic airflow obstruction and differing values for carbon monoxide transfer factor (TLCO) and transfer coefficient (KCO). METHODS: Ventilation (VA) and the ventilation:perfusion ratio (V/Q), lung density, and blood volume were measured regionally in a single transaxial section at mid-heart level with the patients in a supine position. Alveolar volume, extravascular tissue lung density, and perfusion (Q) were derived. Twenty five regions with abnormalities in the ventilation images were analysed. RESULTS: Tissue density showed a negative correlation with the ratio V/Q (r = 0.55) and a positive correlation with Q (r = 0.59) and blood volume (r = 0.65). In four patients with a low carbon monoxide transfer factor (TLCO) and transfer coefficient (KCO) < 50% predicted many regions with low VA had low tissue density and normal or high V/Q. On the other hand, in four patients with TLCO and KCO > 50% predicted many regions with low VA had normal or high tissue density and low values of V/Q. The other two patients had patterns between these two extremes. Individual ratios between mean values of tissue density and V/Q had a positive correlation with KCO (% pred; r = 0.79). CONCLUSIONS: These findings link structural differences with distinctive functional patterns; they reinforce the view that bronchial inflammation or oedema predominate in some patients with chronic airflow obstruction, whereas alveolar destruction is the major feature in others.     

Do health care professionals underestimate severe pain more often than mild pain? Statistical pitfalls using a data simulation model

RATIONALE: When comparing patients' pain ratings with the health care professional's conception of pain assessed by Visual Analogue Scales (VAS) ratings, statistical problems arise. METHOD AND RESULT: In this data simulation study we have shown that the tendency for health care professionals to underestimate severe pain compared with mild pain is probably not attributed to difficulties in judging severe pain more often than mild but the result of professionals having a different and often narrower distribution of their ratings compared with patients.     

Hepatocyte growth factor may act as an early therapeutic predictor in pneumonia

High serum levels of hepatocyte growth factor (HGF) may reflect the regenerative effect and enhanced local and systemic production of this cytokine after organ injuries. The possibility of using serial serum HGF values in order to predict the results of therapy for pneumonia was investigated in this study. In a prospective multicenter study we investigated the serum levels of HGF and CRP before and within 48 h after treatment in 70 patients with pneumonia. Serum levels of HGF before treatment were significantly higher than the HGF levels of a normal population (p < 0.0001). Within 48 h serum HGF levels had decreased significantly in those patients who ultimately responded to the initial antibiotic therapy (p < 0.0001). Serum HGF levels at 48 h were unchanged or increased in cases in whom the initial therapy was ineffective and had to be changed. CRP and HGF levels were significantly correlated. Using multivariate logistic regression analysis it was found that individual changes in acute serum HGF levels and serum HGF levels obtained within 48 h could predict the results of therapy at least as significantly (p < 0.003) as CRP (p = 0.05), although CRP levels were known and used by the physician to decide whether or not to change the initial therapy. We conclude that serial control of serum HGF levels can be used as an early indicator to predict the results of therapy during treatment of pneumonia.     

Is scintigraphy of value in the diagnosis of gastrooesophageal reflux disease?

One hundred and ten patients with suspected oesophageal symptoms were investigated by means of oesophageal endoscopy (OE), 24-h pH-metry, and oesophageal scintigraphy (ES). When 24-h pH-metry formed the basis for diagnosis of gastrooesophageal reflux disease (GERD), the sensitivity for ES at abdominal compression was 64%, but no statistically significant differences were found among erect refluxers (ER), supine refluxers (SR), and combined refluxers (CR). Only 4% of the GERD patients had pathologic oesophageal clearing at ES. The more severe the macroscopic oesophagitis found by OE, the more pronounced were the abnormal findings at 24-h pH-metry and at ES with abdominal compression. Increased postprandial reflux was associated with gastro-oesophageal reflux and hiatal hernia at ES with abdominal compression and the most severe form of oesophagitis, respectively. It was concluded that ES had too low sensitivity to be recommended as a screening test for GERD. Nevertheless, the specificity of 76% can to some extent help us to rule out GERD in patients.