Acute Myocarditis

ABSTRACT In a prospective study, 57 patients with a preliminary diagnosis of myocarditis were investigated. Twenty-four patients were considered to have an acute myocarditis, 14 had a suspected myocarditis, while in 19 patients myocarditis was excluded. Episodes of frequent supraventricular and/or ventricular extrasystoles during hospital stay were seen in 8/24 cases (33%) with myocarditis and in 1/19 cases (5%) without myocarditis. On follow-up 1 month later, no supraventricular extrasystoles were observed in either group. Echocardiographic signs consistent with left ventricular insufficiency were noted in 7/24 cases (29%) with myocarditis, in 1/14 cases (7%) with suspected myocarditis and in no case without myocarditis. With a “routine” serologic test battery covering influenza viruses A and B, adenovirus, Coxsackie virus group B, ECHO viruses, Chlamydia psittaci, Mycoplasma pneumoniae and hemolytic streptococci group A, a possible etiology could be documented in 9/24 cases (38%) with myocarditis and in 4/19 cases (21%) without myocarditis. Enterovirus-specific IgM was detected with solid-phase reverse immunosorbent test (SPRIST) in 12/23 (48%) cases with myocarditis and in 3/16 cases (19%) without myocarditis. In SPRIST-IgM-positive cases, IgM antibodies were detected in 15/20 (75%) of the sera taken on admission. The overall serological results indicated a recent infection in 16/24 cases (67%) with myocarditis and in 5/19 cases (26%) without myocarditis (p < 0.05).     

Effect of meal volume on gastric emptying

Abstract While the volume of a liquid meal has been identified as the principal accelerator of gastric emptying of liquids, the relationship between meal volume and gastric emptying of solids has been controversial. With solid foods, the need to reduce solid foods into small particles (trituration) before passage might obscure the effect of meal volume on solid propulsion. To distinguish trituration from driving force as the rate-limiting factor for emptying, 75 (1.6 mm) nylon spheres were fed along with different amounts of steak meals (150, 300 and 600 g), or alternatively, 50, 100 or 200 (1.6 mm) nylon spheres were fed to six dogs with 300 g steak meals. To examine the effect of meal volume on gastric emptying, we studied the effect of different meal volumes on the speed of gastric emptying of liquids (150, 300, 600 and 1200 ml of phosphate buffer) and solids (150, 300 and 600 g of cooked beef steak) in five dogs with duodenal fistulas. Intestinal inhibition was eliminated by diverting all chyme through the fistulas. In the absence of intestinal feedback, we found that gastric emptying of steak and spheres were different in that steak emptying was independent of meal volume (g min^-1 was constant across 150–600 g) while sphere emptying was affected by the number of spheres in the stomach and that liquid emptying was dependent on the meal volume (ml min^-1 increased across 150–1200 ml). Thus, meal volume accelerated gastric emptying provided the process is not rate-limited by trituration.     

原发性胃肠道粘膜相关淋巴组织淋巴瘤47例临床病理分析

目的 探讨原发性胃肠道粘膜相关淋巴组织淋巴瘤(GIL-MALT)的临床病理特点。方法 回顾性分析1990～2000年我院经手术及病理证实的47例胃肠道MALT患者临床病理资料。结果 47例患者平均年龄57．2岁，男女比例2．1：1。以腹痛和发热为主。病变分布为胃32例，小肠4例，回盲部及盲肠5例，大肠6例。内窥镜下息内型15例，溃疡型25例，弥漫型7例。除1例为T细胞淋巴瘤，其余均为B细胞淋巴瘤。结论 胃肠道粘膜相关淋巴瘤以中老年为主，男性居多，临床误诊率较高。内窥镜下多次多点活检、深凿活检可提高本病的确诊率。     

INVASIVE MUCORMYCOSIS WITH GASTRIC INVOLVEMENT IN A PATIENT WITH SEVERE ATHEROMATOUS VASCULAR DISEASE

Gastric mucormycosis involvement is a rare condition that usually occurs in inmunocompromised patients and frequently has a fatal outcome. We report the case of a 73‐year‐old woman admitted to the intensive care unit with severe bleeding after an acute pulmonary disease. Upper endoscopy disclosed wide and deep necrotic ulcers in the body and fundus of the stomach and greenish exudates with the antrum and the duodenum undamaged. Autopsy revealed an invasive mucormycosis and a severe atheromatosis. Several predisposing factors for mucormycosis infection have been reported until now. We postulate that ischemic gastritis could be a predisposing factor for colonization of zygomycete.     

功能性便秘患儿胃肠传输时间的测定

目的 :采用不透X线标志物测定功能性便秘患儿和正常儿童全胃肠传输时间口 盲传输时间 ,结肠传输时间及分段结肠传输时间的正常值 .方法 :通过口服不透X线标志物 ,用X线拍片法分别于 12 ,2 4和 4 8h摄腹部平片 ,测定 6 8名正常儿童全胃肠传输时间 (totalgastrointestinaltransittime,TGITT)、口 盲时间 (mouth intestinetransittime ,M ITT)和结肠传输时间 (colonictransittime ,CTT) .结果 :正常儿童及FC患儿的 5 0 %全胃肠、口 盲、全结肠传输时间分别为 (2 3.6± 1.6 )h ,(9.9± 1.4 )h ,(14 .8± 1.8)和 (80 .4± 2 .1)h ,(2 0 .7± 0 .6 )h ,(5 9.9± 2 .3)h .节段性结肠传输时间包括 :右半结肠传输时间 (rightcolonictransittime,RCTT) ;左半结肠传输时间 (leftcolonictransittime ,LCTT)和直肠乙状结肠传输时间 (rectosigmoidcolonictransittime,RSTT)分别为 (7.3± 1.1)h ,(3.4± 0 .8)h ,(4 .1± 1.2 )和 (2 0 .3± 1.2 )h ,(12 .8± 1.7)h ,(2 6 .8± 1.4 )h .结论 :正常儿童胃肠传输时间与正常成人和功能性便秘患儿比较有显著差异 (P <0 .0 1) .胃肠传输时间测定可了解全胃肠及各段的动力情况 ,对功能性便秘的诊断及评估治疗效果有实用意义     

主观症状及实验检查诊断早期干眼症

目的 分析主观症状及实验检查对早期干眼症患者诊断的意义。方法 对55例（109眼）已确诊的早期干眼症患者（无或仅伴有轻微体征）的临床症状及实验检查进行回顾性分析及比较。结果 患者中主观症状所占比率：干涩感94％，视疲劳感82％，异物感74％，明显高于其他症状（P〈0．05）。实验检查的阳性率：基础泪液分泌试验（Schirmer I test，SIt）35％，泪膜破裂时间检查（break-up time，BUT）85％，角结膜荧光素（fluorescent，FL）染色60％，其中BUT阳性率明显高于SIt和FL（P〈0．05）。结论 主观症状及实验检查可为早期干眼症诊断提供有利依据。     

马来西亚寒邪致病及其证治初探

根据第一作者在马来西亚从事中医临床工作50余年的经验,以中医理论为指导,探讨了在炎热的马来西亚,寒邪致病的可能性、客观性以及寒邪致病的病因、病机、临床表现特征及其治疗方法。     

No difference in symptoms of irritable bowel syndrome between healthy subjects and patients with recurrent depression in remission

There is bidirectional comorbidity between anxiety/depression and irritable bowel syndrome (IBS). To investigate the prevalence of IBS symptoms, and factors associated with gastrointestinal symptoms in patients with recurrent depressive disorder. Patients (n = 95) with recurrent type of major depression according to DSM-IV criteria and sex- and age-matched controls (n = 190) were sent questionnaires investigating symptoms of IBS [Gastrointestinal Symptom Rating Scale (GSRS)-IBS] and symptoms of anxiety and depression [Hospital Anxiety and Depression Scale (HADS)]. Medical records were checked over a 10-year period for chronic somatic symptoms or diseases. Seventy-three patients with unipolar disorder (mean age 63.6 years SD 13.8; range 23-86 years) and 156 controls (mean age 59.2 years SD 11.6, range 21-85 years) responded. Patients with recurrent depression had higher GSRS-IBS scores and showed a strong correlation between symptoms of IBS and anxiety-depression (r(s) = 0.54; P < 0.001). IBS symptoms were also associated with multiple pain symptoms, higher health-seeking behaviour and selective-serotonin-reuptake inhibitor intake. However, patients with recurrent depression (n = 46) in remission (HADS-Depression score <8) did not have more symptoms of IBS than controls (GSRS-IBS median score 6.0 vs 6.5; P = 0.46). There is a strong association between symptoms of IBS and symptoms of anxiety and depression, whereas depressive patients in remission do not have more IBS symptoms than controls.     

Impact of gastrointestinal endoscopy on HIV‐infected children

Objective: To evaluate the role of gastrointestinal (GI) endoscopy in human immunodeficiency virus (HIV)‐infected children with GI problems. Methods: From 1998 to 2002, we retrospectively reviewed all cases of HIV‐infected children presenting with GI problems in which an upper or lower GI endoscopy was indicated. The initial diagnostic endoscopic examination and any repeat endoscopic session leading to a new diagnosis were used in the data analysis. Tissue biopsies were obtained from all abnormal lesions and representative sites of normal‐appearancing GI mucosa. Results: Fourteen patients (median age: 22.5 months) underwent 23 sessions of GI endoscopy, including 10 esophagogastroduodenoscopy, nine colonoscopy and four flexible sigmoidoscopy. Chronic diarrhea was the most common indication, followed by lower GI bleeding, abdominal/retrosternal pain, dysphagia/odynophagia, and upper GI bleeding. Gross endoscopic abnormalities were observed in 78.3%; whereas histological inflammation and opportunistic pathogens were identified in 87% and 43.5%, respectively. Cytomegalovirus was the most common identified pathogen. Abnormal gross findings were significantly associated with histological inflammation and identification of pathogens (P = 0.006 and 0.046, respectively). Specific changes in medical management were made in 50% of cases as a result of endoscopic investigation. Conclusion: If non‐invasive investigations for HIV‐infected children with GI symptoms fail to establish a diagnosis, gastrointestinal endoscopy should be performed and often yields a positive result leading to changes in medical management.