LONG‐TERM OUTCOME OF ENDOSCOPIC BALLOON DILATION IN OBSTRUCTIVE GASTROINTESTINAL CROHN's DISEASE

Background: Gastrointestinal strictures are the most often and serious complication in Crohn's disease. Because of the frequent postoperative recurrence in Crohn's disease, endoscopic therapy of gastrointestinal stricture is one of the best therapeutic options. Method: The present study sets out the results from a prospective study of endoscopic dilation therapy on 48 Crohn's disease patients with severe gastrointestinal stenoses. All patients who could not undergo endoscopic balloon dilation therapy (EBD) were operated on. Results: Long‐term success was attained in 32 of the 48 patients; cumulative avoidance of surgery after EBD was 86% at one year and 71% at three. Second, the most hazardous factor was recurrent inflammation causing restenosis. Patients who had strictures with oral luminal dilatation and patients with frequent recurrence had a tendency to be operated on. As a complication, perforation occurred in two cases (3.3%). Conclusions: EBD therapy for Crohn's stricture in the gastrointestinal tract is recommended before surgical intervention.     

Endoscopic laser pancreatic cystogastrostomy

Traditionally the drainage of pancreatic pseudocysts has been carried out operatively, forming a cystenterostomy. A simple endoscopic method of forming a pancreatic cystogastrostomy with laser is presented. This procedure does not require a general anesthetic, is safe, and allows resolution of symptoms.     

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.     

小儿与成人喉内肌肌纤维型的差异与喉功能的关系

通过对１０例小儿及２３例成年人的喉内肌进行的ｍｙｏｓｉｎ－ＡＴＰａｓｅ等染色观察，得到小儿和成人各喉内肌不同的肌纤维构成比。成人ＰＣＡⅠ型纤维最多，ＬＣＡ、ＩＮＡ及ＣＴ次之，ＴＡ最少。小儿的各喉内肌也有类似比例。表明不论小儿或成人，ＰＣＡ均具有较强的抗疲劳性，适应呼吸作用的需要；ＴＡ具有较快的收缩速度，以适应发声及呼吸道保护作用。从纤维构成上看，小儿与成人相比，各喉内肌Ⅰ型纤维较为匮乏，表明小儿的喉在发声及呼吸道保护等功能方面尚不够完善。     

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.     

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.     

Thrombophilic risk factors and unusual clinical features in three Italian CADASIL patients

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a genetically transmitted cerebrovascular disease. Typically, the first clinical manifestation is migraine and the full clinical spectrum of the disease with recurrent strokes of the subcortical type, cognitive, and mood disorders is seen during the fourth and fifth decades of life. Vascular risk factors are usually absent in CADASIL patients and the diagnosis of the disease is particularly suspected in young adults with cerebrovascular events of unknown cause, diffuse leukoencephalopathy on computed tomography or magnetic resonance imaging, and a history of cerebrovascular diseases or dementia in many family members. We describe three Italian CADASIL patients who presented to medical attention for cerebrovascular events occurred after the age of 55 and had, in addition to hypertension and hyperlipidemia, thrombophilic risk factors such as hyperhomocysteinemia, elevated levels of lipoprotein(a), and antiphospholipid antibodies. Symptoms possibly related to cortical involvement, such as dysphasia and visual field deficits, were reported by two of these patients. We conclude that a diagnosis of CADASIL should not be disregarded in patients with vascular risk factors and presenting with symptoms not immediately referable to subcortical damage at ages more advanced than commonly reported.     

Executive functions processed in the frontal and lateral temporal cortices: Intracerebral study

OBJECTIVE: The study was designed to investigate the neurocognitive network in the frontal and lateral temporal cortices that is activated by the complex cognitive visuomotor tasks of letter writing. METHODS: Eight epilepsy surgery candidates with implanted intracerebral depth electrodes performed two tasks involving the writing of single letters. The first task consisted of copying letters. In the second task, the patients were requested to write any other letter. The cognitive load of the second task was increased mainly by larger involvement of the executive functions. The task-related ERD/ERS of the alpha, beta and gamma rhythms was studied. RESULTS: The alpha and beta ERD as the activational correlate of writing of single letters was found in the sensorimotor cortex, anterior cingulate, premotor, parietal cortices, SMA and the temporal pole. The alpha and beta ERD linked to the increased cognitive load was present moreover in the dorsolateral and ventrolateral prefrontal cortex, orbitofrontal cortex and surprisingly also the temporal neocortex. Gamma ERS was detected mostly in the left motor cortex. CONCLUSIONS: Particularly the temporal neocortex was activated by the increased cognitive load. SIGNIFICANCE: The lateral temporal cortex together with frontal areas forms a cognitive network processing executive functions.     

佛山地区1991～2000年小儿消化道出血病因研究

【目的】探讨佛山地区小儿消化道出血的临床特点，了解小儿消化道出血的病因。【方法】采用回顾性调查方法对1363例消化道出血患儿进行病因分析。【结果】1363例消化道出血患儿除全身疾病引起出血的146例外，消化道局部病变引起出血者1217例；属上消化道出血395例，确诊为溃疡病232例(57．3％)，各种类型胃炎及十二指肠球炎共123例(30．4％)，其次为食管静脉曲张、胃粘膜脱垂、食管贲门撕裂症、食管裂孔疝、十二指肠息肉等，明确病因372例(94．2％)。属下消化道出血822例，确诊为肠息肉526例(54．9％)，结肠炎121例(12．6％)，其次为溃疡性结肠炎、肠套叠、美克尔憩室、阿米巴结肠炎、小肠血管瘤、血管畸形、肠结核等，明确病因800例(97．3%)。【结论】小儿消化道出血应根据不同年龄、不同出血部位选择有效诊断方法，以提高病因诊断率，减少对患儿生长发育及身心健康的影响。     

Effects of Spascupreel versus hyoscine butylbromide for gastrointestinal cramps in children

BACKGROUND: Gastrointestinal spasms and cramps are common in children as well as in adults. Alternative medical practices such as chiropractice and homeopathy are becoming increasingly popular in Europe and the USA. The effectiveness and tolerability of the homeopathic preparation Spascupreel was compared with that of hyoscine butylbromide treatment in children <12 years of age. METHODS: An observational cohort study in 204 children <12 years was conducted over a 1 week treatment period. The efficacy of the respective therapies were evaluated on the effect on severity of spasms and clinical symptoms (pain/cramps, sleep disturbances, distress, eating or drinking difficulties and frequent crying). Compliance was evaluated on a four-point scale from 'very good' to 'low'. Evaluation was done by the practitioner based on information given by the patient or minder. RESULTS: The analysis showed comparative improvements with the homeopathic preparation and hyoscine butylbromide therapy on severity of spasms, pain/cramps, sleep disturbances, eating or drinking difficulties, and frequent crying, all as evaluated by the practitioner. Both treatments were very well tolerated. CONCLUSIONS: For patients opting for a homeopathic therapy, Spascupreel seems to be an effective and well tolerated alternative to conventional therapies in children suffering from gastrointestinal spasms.