A comparative evaluation of methods for detecting duodenogastric reflux in patients with peptic ulcer]

The duodenal contents were examined in 81 patients with gastroduodenal ulcer. Bile acid concentrations, alkaline phosphatase activity, and sodium ion concentration were measured for the detection of duodenogastric reflux. Measurements of sodium ion concentration permitted estimation of the immediate volume of the duodenogastric reflux in the gastric contents. No methods for duodenogastric reflux detection should be given preference in examinations of peptic ulcer patients. Multiple-modality studies appear to be the most effective.     

Unilateral congenital elongation of the cervical part of the internal carotid artery with kinking and looping: two case reports and review of the literature

Unilateral and bilateral variation in the course and elongation of the cervical (extracranial) part of the internal carotid artery (ICA) leading to its tortuosity, kinking and coiling or looping is not a rare condition, which could be caused by both embryological and acquired factors. Patients with such variations may be asymptomatic in some cases; in others, they can develop cerebrovascular symptoms due to carotid stenosis affecting cerebral circulation. The risk of transient ischemic attacks in patients with carotid stenosis is high and its surgical correction is indicated for the prevention of ischemic stroke. Detection of developmental variations of the ICA and evaluation of its stenotic areas is very important for surgical interventions and involves specific diagnostic imaging techniques for vascular lesions including contrast arteriography, duplex ultrasonography and magnetic resonance angiography. Examination of obtained images in cases of unusual and complicated variations of vascular pattern of the ICA may lead to confusion in interpretation of data. Awareness about details and topographic anatomy of variations of the ICA may serve as a useful guide for both radiologists and vascular surgeons. It may help to prevent diagnostic errors, influence surgical tactics and interventional procedures and avoid complications during the head and neck surgery. Our present study was conducted with a purpose of updating data about developmental variations of the ICA. Dissections of the main neurovascular bundle of the head and neck were performed on a total 14 human adult cadavers (10 – Africans: 7 males & 3 females and 4 – East Indians: all males). Two cases of unilateral congenital elongation of the cervical part of the ICA with kinking and looping and carotid stenoses were found only in African males. Here we present their detailed case reports with review of the literature.     

Morphologic features of the chemosensory, visual and vestibular pathways of Helix lucorum

The structure of chemosensory, visual and statocyst pathways of the snail Helix lucorum has been studied by means of five histological methods. The chemoreceptors of the optic tentacle bulb, small and large neurons of tentacle ganglion and bipolar cells of olfactory nerve send their processes to the CNS of the mollusc. In the CNS these processes divide into many clusters of branches. All protocerebral cells and the cluster of neurons of the commissural part of metacerebrum send their processes within the olfactory nerve towards the periphery. The axons of eye cells terminate in the enlargement of optic nerve near the eye; so do the CNS cells and neurons of the optic nerve. In the neuropile of pleural part of metacerebrum a region of ramification of cell axons of the visual pathway is found. Hair cells of statocyst send their axons within the static nerve to the cerebral ganglion (CG). Small cells of metacerebrum send their axons towards the statocyst. In the neuropile of ipsilateral CG some processes of statocyst pathway cells divide into many thin branches; others--cross to the contralateral cerebral neuropile via the commissure joining two CG. In the neuropile of contralateral ganglion these processes give off a spray of many branches just as in the ipsilateral ganglion. The axons of the visual pathway cells and statocyst pathway cells ramify in the same region.     

In situ saphenous vein bypass grafts: angiographic evaluation and interventional repair of complications

In situ saphenous vein grafts are being used with increasing frequency for bypass procedures involving the femoral and popliteal arteries. Complications of these procedures include anastomotic stenoses and persistent arteriovenous fistulae that may result in failure of the graft. Balloon angioplasty and embolotherapy with detachable balloons were employed successfully in three or four recent cases of patients with complications from in situ grafts. Tailored angiography is essential for evaluating in situ grafts, and interventional techniques are extremely useful for managing complications.     

Shared care: a review of the literature

This review examines broad issues of concern regarding the primary/secondarycare interface. The main purpose was to identify areas of goodpractice which could be adapted for more general use. One ofthe most fundamental aspects identified was communication, whichis discussed in some detail. Also covered are shared prescribingand disease management. The data suggest that the most effectivesystem(s) of shared care has yet to be established. Furtherqualitative and economic evaluations are required, taking intoaccount patient preferences. Although the literature does describecertain practice exemplars, it is clear that inter- and intra-professionalcommunication continues to be a problem. Whilst informationtechnology may provide some of the solutions, it is concludedthat a culture change, which compels health professionals tomake sharing of patient information a much higher priority,is reauired. Keywords. Shared care, seamless care, hospital, general practice, family practice.     

Localization of a gene for otosclerosis to chromosome 15q25-q26

Among white adults otosclerosis is the single most common cause of hearing impairment. Although the genetics of this disease are controversial, the majority of studies indicate autosomal dominant inheritance with reduced penetrance. We studied a large multi- generational family in which otosclerosis has been inherited in an autosomal dominant pattern. Five of16 affected persons have surgically confirmed otosclerosis; the remaining nine have a conductive hearing loss but have not undergone corrective surgery. To locate the disease- causing gene we completed genetic linkage analysis using short tandem repeat polymorphisms (STRPs) distributed over the entire genome. Multipoint linkage analysis showed that only one genomic region, on chromosome 15q, generated a lod score >2.0. Additional STRPs were typed in this area, resulting in a lod score of 3.4. STRPs FES (centromeric) and D15S657 (telomeric) flank the 14. 5 cM region that contains an otosclerosis gene.