Factor analysis of bowel symptoms in US and Italian populations

BACKGROUND AND AIMS: Functional gastrointestinal disorders are diagnosed by the presence of a characteristic set of symptoms. Aims of this study were to validate the Rome symptom criteria by factor analysis and to determine whether symptoms cluster in the same way in different cultures. METHODS: One thousand forty-one gastroenterology clinic patients in the US (response rate 53%) and 228 family members accompanying clinic patients in Italy (84%) completed a previously validated symptom questionnaire. Factor analysis identified clusters of symptoms which are highly correlated with each other, and these were compared to the Rome diagnostic criteria. RESULTS: In the US, 13 factors were identified. The irritable bowel factor was composed of three core symptoms corresponding to the Rome II classification system. Two dyspepsia factors were identified which correspond to the ulcer- and motility-like subtypes proposed in the Rome I classification system. All symptoms of constipation formed a single cluster as proposed in the Rome II classification system. Symptom clusters in the US agreed well with symptom clusters identified in Italian subjects. CONCLUSIONS: Empirically derived symptom clusters agree in most respects with the Rome II classification system and support their validity. These symptom clusters are independent of cultural differences in diet and behaviour.     

Sclerosed liver hemangioma mimicking malignant tumor at MR imaging: Pathologic correlation

This case report illustrates atypical magnetic resonance (MR) imaging findings in a liver hemangioma mimicking a malignant lesion—lower signal intensity than cerebrospinal fluid on T2-weighted spin-echo images and lack of early enhancement on dynamic contrast material—enhanced gradient-echo images. Pathologic analysis demonstrated nearly total replacement of the vascular cavities by dense fibrous tissue. In this rare, sclerosed form, this lesion could not be defined as a hemangioma with MR imaging.     

Adhesins of uropathogenic bacteria: Properties,identification and use for new antibacterial strategies

Adherence is a major virulence factor in the complex pathogenesis of urinary tract infections (UTI). Colonization of the urinary tract and subsequent spread of infection ascending to the kidneys depends not only on the expression of adhesins by bacteria but also on the presence of host factors which may either contribute to or inhibit infection. The presence of certain types of adhesins expressed by the bacteria and their interactions with epithelial cells play a role in determining where bacteria localize in the urinary tract, the kind and severity of symptoms and how the disease progresses. The knowledge of the molecular mechanisms underlying adherence may be useful for epidemiological research in the pathogenesis of UTI, for the diagnosis of different types of UTI and, in some cases, for prognosis. Furthermore, attachment to epithelia is a promising target for developing new methods in prophylaxis and therapy.     

磁共振尿路成像对泌尿系疾病的诊断价值

目的评价磁共振尿路成像(Magneticresonanceurography,MRU)对泌尿系疾病的诊断价值。方法对36例泌尿系疾病患者进行MRU检查,并结合临床手术、病理资料和其他影像学资料进行回顾性分析。结果36例患者中,均有MRU阳性结果,3例肾盂、肾盏癌,4例前列腺癌,8例前列腺增生症,2例输尿管癌定性、定位明确;9例肾盂、输尿管移行段梗阻定位明确,定性有帮助;10例输尿管下段梗阻中6例诊断明确,4例未能确诊。结论MRU在泌尿系疾病的诊断中,对肿瘤的定位、定性参考价值较高,对尿路梗阻定位诊断有价值,对定性诊断帮助有其局限性。     

Measurement of degraded fecal hemoglobin-heme to estimate gastrointestinal site of occult bleeding appraisal of its clinical utility

Hemoglobin-heme is variably converted to porphyrin during enterocolic transit. This intestinal converted fraction, as measured by HemoQuant, was elevated as a predictor of the occult bleeding site in 152 patients with discrete lesions. The intestinal converted fraction, expressed as the percentage of total fecal hemoglobin, was similar with upper gastrointestinal and proximal colon lesions. Within the colon, values trended downward with more distal location: means ± standard deviations were 18±14 proximal colon, 16 ±15 sigmoid, and 10±10 rectum. The amount of fecal blood also affected the intestinal converted fraction; correcting for hemoglobin concentration improved separation by site. Corrected intestinal converted fraction values were significantly lower with rectal (P< 0.0005) and sigmoid (P<0.02) lesions than with proximal colon lesions. Unfortunately, large within-site variation caused considerable overlap between sites. We conclude that the intestinal converted fraction is influenced by the site and amount of bleeding. However, its clinical utility is compromised by substantial individual differences in luminal hemoglobin metabolism.Presented in part at the Annual meeting of the American Gastroenterological Association in San Francisco in May of 1986 (Gastroenterology 90:1431, 1986).Supported by the Mayo Foundation.     

Response of lower esophageal contractility to changing concentrations of halothane or isoflurane: A multicenter study

A multiple-center study was performed to determine the relationship between lower esophageal contractility, clinical signs, and anesthetic concentration as expressed by minimum alveolar concentration (MAC). One hundred four American Society of Anesthesiologists Class I through III patients were exposed to isoflurane (with and without nitrous oxide) or halothane in concentrations of 0.5, 1.0, and 1.5 MAC. Heart rate and systolic blood pressure were continuously monitored. Both the amplitude and frequency of spontaneous and provoked lower esophageal contractions were measured in situ by using a 24-F probe equipped with provoking and measuring balloons. Combined results demonstrated statistically significant correlations (P<0.001) between lower esophageal contractility and MAC. Spontaneous lower esophageal contractions decreased from 1.10±0.12 (SEM) contractions per minute (0.5 MAC) to 0.42±0.05 (1 MAC) to 0.18±0.05 (1.5 MAC). Provoked lower esophageal contractility values decreased from 45±4 mm Hg (0.5 MAC) to 29±3 (1 MAC) to 19±2 (1.5 MAC). Heart rate changes did not correlate with MAC, and systolic blood pressure correlated in only one of three centers. Intracenter and intercenter analyses failed to demonstrate a significant relationship between lower esophageal contractility and heart rate or systolic blood pressure. No intracenter differences in either amplitude or frequency of lower esophageal contractions were observed, despite differences in volatile agents, induction techniques and agents, patient populations, and duration of anesthesia. Our studies indicate that lower esophageal contractility may be an indicator of anesthetic depth as reflected by MAC, but further studies are needed to quantify the effects of surgical stimulus, intravenous anesthetics, vasodilators, anticholinergics, calcium channel blockers, beta-adrenergic agonists, and the presence of a nasogastric tube.     

泌尿生殖道炎症患者沙眼衣原体感染的临床研究

目的　探讨在泌尿生殖道有炎症表现的情况下沙眼衣原体 (CT)感染的状况。方法　采用C -C快速法。结果　CT在泌尿生殖道炎症时的阳性率显著高于无炎症表现者 (P <0 .0 5) ;男性在有无炎症表现情况下的CT阳性率差异有显著性 (P <0 .0 5) ,而女性差异无显著性 (P >0 .0 5) ;2 1～ 50岁为高发年龄段。结论　CT感染症状隐匿 ,临床无症状者也应注意CT的检测 ,尤其是女性和高危人群。     

白术茯苓汤及其配伍对脾虚大鼠胃肠激素的影响

目的：探讨益气健脾方剂治疗脾虚证的配伍规律。方法：采用苦寒泻下法复制大鼠脾虚模型，运用放射免疫分析法（RIA）检测白术茯苓汤及其与补气药。行气药及除湿药的不同配伍对脾虚大鼠胃泌素（GAS）、胃动素（MTL）及血管活性肠肽（VIP）的含量影响。结果：与正常对照组比较，脾虚模型大鼠GAS、MTL降低（P＜0．01），VIP升高（P＜0．01）；与自然恢复组比较，各治疗组以上部分或全部指标均有不同程度的改善，其中，以综合配伍组改善作用最优。结论：白术茯苓汤的脾虚大鼠胃肠激素的紊乱的某些指标，有一定的改善作用，综合配合组以上指标的改善，优于白术茯苓汤组及其余各配伍组，说明中医关于复方配伍的理论与实践，有其科学价值。     

Increased carbon monoxide levels in the nasal airways of subjects with a history of seasonal allergic rhinitis and in patients with upper respiratory tract infection

BACKGROUND: Carbon monoxide (CO) has emerged as an endogenously produced gaseous mediator known to be involved in bronchial smooth muscle regulation. Increased amounts of CO have been found in exhaled air during asthma and lower airway inflammation. Recently CO has been shown to be produced in the nasal airways, but there are no reports of altered CO levels in nasal airways during inflammation. OBJECTIVE: This study was designed to investigate if CO levels increase in the human nasal airways during inflammatory conditions, such as allergy and upper airway respiratory tract infection (URTI). METHODS: CO was sampled separately from the upper and lower airways of 13 healthy control subjects, six patients with a history of allergic rhinitis and six patients with URTI. RESULTS: Nasal CO levels were increased in subjects with allergic rhinitis, compared to healthy controls (2.07 +/- 0.15 ppm, n = 6 and 1.62 +/- 0.08 ppm, n = 13, respectively, P < 0.01). CO levels were also increased in patients with URTI, compared to the same controls (1.92 +/- 0.09 ppm, n = 6, P < 0.05). Normal levels of CO were found in air from the lower airways among subjects with allergic rhinitis, whereas corresponding levels in the URTI patients were increased. CONCLUSION: The present data demonstrates that upper airway CO levels increase in parallel with different inflammatory stimuli, such as allergy and infection, suggesting a role for CO as marker or mediator of nasal inflammation.     

Characteristic modifications of the breathing pattern of mice to evaluate the effects of airborne chemicals on the respiratory tract

A system was developed for exposure of unanesthetized mice to airborne chemicals and for continuous measurement of their breathing pattern prior to, during and following exposure. By measuring inspiratory and expiratory airflows (VI and VE), and integration with time to yield tidal volume (VT), we obtained characteristic modifications to the normal breathing pattern. These permitted recognition that a specific portion of the respiratory tract was affected by the selected airborne chemicals. Following recognition, we also quantitated the degree of effect using one specific measurement in each case. An effect on the upper respiratory tract, induced by the sensory irritant, 2-chlorobenzylchloride, was quantitated by measuring a decrease in respiratory frequency. An effect on the conducting airways, induced by the airway constrictor, carbamylcholine, was quantitated by a decrease in VE at the mid-point of VT. An effect at the alveolar level, induced either by the vagal nerve ending stimulant, propranolol, or by the pulmonary irritant, machining fluid G, was quantitated by an increase in the length of a pause induced at the end of expiration. The system is easy to construct and operate and can be used to rapidly evaluate the effects of airborne chemicals on the respiratory tract.