Fat delays emptying but increases forward and backward antral flow as assessed by flow-sensitive magnetic resonance imaging

Flow has been assessed in the gastric antrum using a velocity-sensitive version of the high-speed magnetic resonance imaging technique, echo planar imaging (EPI). Eight healthy volunteers attended fasted on three separate days and consumed 800 mL of either a 5% glucose (0.2 kcal mL-1), 10% glucose (0.4 kcal mL-1) or an isotonic mixed nutrient meal, Fresubin (1 kcal mL-1, 27.2 g fat). Gastric volumes were obtained at 10-min intervals for 1 h. Flow measurements were performed on a single slice through the antropyloric region 5 and 35 min after meal ingestion. Gastric volumes at 45 min were inversely proportional to the calorie density of the meal with (mean +/- SEM) 89 +/- 10%* of the Fresubin, 64 +/- 5%* of the 10% glucose and 41 +/- 5% of the 5% glucose remaining (*P < 0.005 vs 5% glucose). Substantial forward and backward antral flow was observed after all three meals in the initial 5-min imaging period. AT 35 min flow activity was significantly greater after both the high-calorie meals relative to the 5% meal (total number of flow events: Fresubin = 6.6 +/- 1.7,[symbol: see text] 10% glucose = 9.9 +/- 2.2, [symbol: see text] 5% glucose = 2.5 +/- 0.9,[symbol: see text] P < 0.03,[symbol: see text] P < 0.007 vs 5% glucose, n = 8). Peak forward velocities for the initial phase of emptying tended to be greater for the rapidly emptying 5% meal (5.9 +/- 0.8 cm-1) compared with the Fresubin (3.3 +/- 0.6 cm-1, P < 0.069, n = 8) and the 10% glucose (2.9 +/- 1.0 cm-1, P < 0.068, n = 8) meals. In spite of delayed gastric emptying, high-calorie meals were associated with substantial to and fro movements which may be important for meal tritruration and fat emulsification.     

A Controlled Trial of Misonidazole in the Curative Treatment of Infiltrating Bladder Cancer

Between 1980 and 1983 a total of 89 patients with infiltrating transitional cell carcinoma of the bladder were entered in a multi centre randomised controlled clinical trial with either misonidazole or placebo added to the first 40.00 Gy of radiotherapy. Depending on their referring clinican, patients then completed treatment with either further radiotherapy to a radical dose, or surgery four weeks later. All patients have been followed up for a minimum of three years, and no significant difference has been found in local control, survival, or pathological downstaging of the tumour. The neurotoxicity was considerable, with 43% of patients receiving misonidazole developing a peripheral neuropathy, starting five weeks on average after beginning treatment, and with a mean duration of 27 months. Eighty per cent of patients affected still had peripheral neuropathy at three years or their prior death. There is a suggestion that alcohol may predispose to the neuropathy. This study failed to show any benefit of misonidazole in tumour control and produced unacceptably high levels of toxicity.     

Anaphylactoid reaction to vecuronium followed by systemic reaction to skin testing

An unusual case is presented of a systemic anaphylactoid reaction to tubocurarine and subsequently to vecuronium. Intradermal testing with vecuronium following the latter response was negative at recommended test dose levels but at a higher concentration it initiated a hazardous systemic response. The laboratory investigations and possible mechanisms involved in this unusual case are discussed in detail since they may relate to other patients who experience anaphylactoid responses to anaesthetic drugs and who then undergo intradermal testing.     

APOLIPOPROTEIN E GENOTYPES AND SERUM LIPID LEVELS IN ALZHEIMER'S DISEASE AND MULTI-INFARCT DEMENTIA

Objective. Assessment of apolipoprotein E genotype, serum cholesterol, triglycerides, high density lipoprotein-cholesterol and low density lipoprotein-cholesterol levels in different types of dementia. Subjects. 102 consecutive referrals to an old age psychiatry service based at Manchester were classified according to clinical criteria based on ICD 10. Results. Thirty-seven were considered to have Alzheimer's disease, 16 multi-infarct dementia and 33 to be free from dementia. Sixteen patients, in whom a definitive diagnosis could not be reached or sufficient information was not available, were excluded from the study. There was an increase in the prevalence of the Apo E4 allele in both Alzheimer's disease (χ²=3.82, p<0.05) and multi-infarct dementia (χ²=1.93, p<0.16) by Wald tests compared to individuals without dementia. The increased prevalence of the E4 Allele in multi-infarct dementia was not related to serum lipid levels. Conclusion. The hypothesis that the onset of multi-infarct dementia may be precipitated by E4's mediation of higher serum cholesterol levels is not supported by the present study. © 1997 by John Wiley & Sons, Ltd.     

Activation of complement—a mechanism for the inflammation in acne

An immunofluorescence investigation of thirty-six non-inflamed and thirty-four inflamed acne lesions has been carried out. Fluorescence for C3, unaccompanied by fluorescence for immunoglobulins, was found in the walls of dermal blood vessels or at the basement membrane zone of the comedo or at both these sites in fifty-seven lesions. Fluorescence for C3 accompanied by fluorescence for immunoglobulins was found in nine lesions. In two papules and three nodules the comedo was surrounded or replaced by a mononuclear cell infiltrate. These findings have been taken to indicate that cellular immune mechanisms are a late event and activation of complement is an early event in the pathogenesis of inflammation in acne. The mechanism of complement activation remains uncertain.     

Cellular immunity to P. acnes in the normal population and patients with acne vulgaris

Patients with varying degrees of acne, acne-free adult controls and samples of cord blood were investigated for cell mediated immunity to P. acnes using a leukocyte migration inhibition test. Despite the fact that the mean migration index tended to decrease with acne severity, only the patients with severe acne showed cell-mediated immunity. It is suggested that when cellular immunity arises it is a late event which may contribute to inflammation but is probably not a factor in its initiation.     

OM-89 MODULATION OF CHRONIC INFLAMMATION: RELEVANCE TO CLINICAL USE

The modulatory effects of a glycoprotein-rich endotoxin-freeextract of Escherichia coli (OM-89) have been studied usingthe cotton pellet model of chronic inflammation in the maleWistar rat. OM-89 had a suppressive effect on the size of granulomasurrounding implanted cotton pellets at both 4 and 40 mg/kggiven three times weekly. The lower dosage of 4 mg was effectivethroughout and there was little to be gained by increasing thedose as further reduction of granuloma size was not obtained.Whether given prior to, at the same time as, or after an inflammatorystimulus, OM-89 had suppressive effects. However, if given before,animals at first went through a phase of ‘sensitization’before suppressive effects were seen on further exposure toOM-89 antigens, a phenomenon which might have bearing on clinicalfindings in rheumatoid arthritis. In animals presensitized toa cotton pellet, OM-89 was statistically as effective as indomethacinin suppressing a second granuloma. OM-89 combined with indomethacinshowed additive effects and was highly effective. The resultsindicate that OM-89 could be efficacious in the treatment ofchronic inflammatory conditions and there is the possibilitythat in appropriate circumstances OM-89 might replace some drugscurrently used and in others reduce their dosage. KEY WORDS: OM-89, Chronic inflammation     

Antibodies to P. acnes and P. acnes exocellular enzymes in the normal population at various ages and in patients with acne vulgaris

Total serum IgM and IgG agglutinins to P. acnes and neutralizing antibodies to P. acnes lipase, hyaluronate lyase and acid phosphatase were measured in normal individuals of different age groups. Agglutinins to P. acnes were detected in infants at 4 months of age and were present at a high level throughout life. A switch from predominantly IgM agglutinins in children, to IgG agglutinins in adults, occurred during adolescence. Anti-P. acnes lipase antibodies were present in 20% of teenagers and 17-42% of adults. Anti-P. acnes hyaluronate lyase antibodies were found in adults only (4-17%). Antibodies to acid phosphatase were not detected. Agglutinins to P. acnes were measured in individuals with mild, moderate and severe acne, and in normal controls. Only patients with severe acne had significantly higher titres than the controls. IgM and IgG agglutinins were determined in 13-14-year-olds with mild, moderate and severe acne, and in normal controls. Thirty-three per cent, 60% and 100% of the acne patients, respectively, but none of the normal controls, had predominantly IgG agglutinins. No difference in the prevalence or titre of antibodies to P. acnes exocellular enzymes was observed when patients with severe acne were compared with normal controls. There was no evidence to suggest a role for antibodies to P. acnes exocellular enzymes in the initiation of inflammatory acne.     

Validation of antroduodenal motility measurements made by echo-planar magnetic resonance imaging

Echo planar imaging, a development of magnetic resonance imaging, can produce snapshot images of the stomach and antroduodenal segment in as little as 64 msec and can be more useful than conventional techniques when assessing motility. The aim of this study was to compare antroduodenal motility measured by simultaneous perfused tube manometry and echo planar imaging. Ten volunteers were studied following the ingestion of 500 mL water or 500 mL porridge. Antroduodenal images, with acquisition times of 130 msec, were taken at 3-sec intervals, synchronized with motility traces and presented as a split-screen video. This allowed direct visual comparison of gastric wall movement and motility to be made. Contractions were confined to either the stomach or the duodenum or propagated across the antroduodenal segment. Over 4550 images were available for analysis. A larger number of propagated contractions were recorded with echo planar imaging in both water (P = 0.03) and food (P = 0.02) groups, whereas manometry detected a greater number of isolated duodenal pressure waves (P = 0.005). The contraction rate for water and food studies was similar, but direct visualization indicated that the manometric technique under-detected propagated events. The ability of echo planar imaging to record antroduodenal contractile activity provides a new insight into the role of occlusive and nonocclusive contractions during gastric emptying.