Effect of adding albumin to solutions of somatostatin on inhibiting pentagastrin-stimulated acid secretion in dogs

In five conscious dogs with chronic gastric fistulas we studied the effect of somatostatin solutions on pentagastrin-stimulated acid secretion. Somatostatin was dissolved in 0.154 M NaCl alone or in the same amount of saline to which dog albumin had been added to give a 0.5% solution. Somatostatin produced a dose-dependent inhibition of pentagastrin-stimulated gastric secretion. However, the inhibition was significantly less when somatostatin was dissolved in saline as compared to saline plus albumin. This study suggests that albumin should be added to somatostatin solutions to preserve biological activity, and it confirms previous reports indicating that, without albumin, basic peptides have a tendency to stick to infusion systems.     

Pilot Project to Ascertain the Utility of Tower of London Test to Assess Outcomes of Neurofeedback in Clients with Asperger's Syndrome

Introduction. Behavioral and cognitive improvements in clients with Asperger's Syndrome (AS), employing continuous performance tests (CPTs), intelligence and academic measures, and electroencephalographic data, have been reported following 40 sessions of neurofeedback (NFB) training combined with coaching in metacognitive strategies. However, measures of executive functions (EFs) in this population have not been commonly employed and NFB is still not commonly used as a treatment for AS. Therefore, this pilot project used Tower of London – Drexel University (ToL^DX), an individually administered test of EFs, in addition to the previously mentioned measures. The goal of the current study was to investigate the utility of ToL^DX as an assessment tool for clients with AS as well as further study the effects of NFB and training in metacognitive strategies on executive functioning in clients with AS.

Method. Nineteen consecutive clients at the ADD Centre, Toronto, Canada (M age = 12 years 0 months) recruited over a 2½-year period all had full clinical assessment, completed age appropriate questionnaires, and were tested pre- and post-40 NFB sessions.

Results. Following the training, clients with AS were able to plan more efficiently, inhibit premature responses, and shift set with greater ease, as well as solve problems more quickly as measured by their ToL^DX scores. On CPTs, clients with AS showed a trend toward less impulsivity. Finally, improvement in their scores on ToL^DX was not affected by age or IQ.

Conclusion. These data are important because they provide an extension of results of previous studies (Reid, 2005), demonstrate the utility of tests of executive functions in a clinical setting with clients with AS, and suggest directions for further controlled research in this area.     

Tripolar Spinal Cord Stimulation for the Treatment of Abdominal Pain Associated With Irritable Bowel Syndrome

Objectives: The objective of this case report is to describe the use of transverse tripolar dorsal column stimulation in a patient with a history of irritable bowel syndrome (IBS) associated with abdominal pain resistant to conservative treatments. Method: We report a 36‐year‐old man who presented to the pain clinic with an eight‐year history of IBS (constipation predominant with occasional diarrheal episodes), with “crampy and sharp” abdominal pain. He also had nonradicular thoracic spine pain due to thoracic scoliosis. Both pains were affecting his ability to function as an attorney. Prior conservative therapy, including psychologic treatment, antidepressants, and opioids, was without any benefits. Results: The use of a spinal cord stimulator (SCS) was discussed with the patient. The procedure was performed after Institutional Review Board approval. A tripolar SCS was implanted at the T8 level using one‐eight contact and two‐four contact percutaneous leads based on paresthesia reproduction of patient's areas of discomfort. This tripolar spinal cord stimulation provided relief of abdominal and thoracic pain, and better management of gastrointestinal symptoms. The patient was followed‐up for one year, and his quality of life also was improved via the IBS‐Severity Scoring System quality of life tool. Conclusions: The use of the tripolar SCS in this patient provided relief of abdominal and thoracic spine pain, regulated bowel habits, and improved the patient's quality of life. We believe that the use of SCS should be considered as a treatment option in patients with IBS when all conservative treatments failed.     

EUS mini probes in diagnosis of cystic dystrophy of duodenal wall in heterotopic pancreas： A case report

Cystic dystrophy of the duodenal wall is a rare condition characterized by the development of cysts in heterotopic pancreatic tissue localized in the duodenal wall. A 38-year-old man was admitted to the hospital for abdominal pain and vomiting after food intake. The diagnosis of acute pancreatitis was initially suspected. Abdominal ultrasound examination revealed thickening of the second portion of duodenal wall within which, small cysts (diameter, less than 1 cm) were present in the vicinity of pancreatic head.The head of pancreas appeared enlarged (63 mm×42 mm)and hypoechoic. Upper endoscopy and barium X-ray series were performed revealing a severe circumferential deformation, as well as 4 cm long stenosis of the second portion of the duodenum. CT examination revealed multiple cysts located in an enlarged, thickened duodenal wall with moderate to strong post-contrast enhancement. We suspected that patient had cystic dystrophy of duodenal wall developed in the heterotopic pancreas and diagnosis was confirmed by endoscopic ultrasound (EUS). Endoscopi cutrasound (EUS) revealed drcular stenosis from the duodenal bulb onwards. A twenty megaHertz mini-probe examination further showed diffuse (intramural) infiltration of duodenal wall limited to the submucosa and muscularis propria of the second portion of duodenum with multiple microcysts within the thickened mucosa and submucosa, a. Patient was successfully surgically treated and pancreatoduodenectomy was performed. The pathological examination confirmed a diagnosis of cystic dystrophy of a heterotopic pancreas.Endoscopic ultrasonography features allow preoperative diagnosis of cystic dystrophy of a heterotopic pancreas in duodenal wall, with inb‘alumina120 MHz mini probe sonography being more efficient in cases of luminal stenosis.     

The use of outcome measures relating to the knee

Accurate outcomes assessment is one of the fundamental aspects of any reliable research. There are a vast number of outcome instruments currently available in orthopaedics. This plethora and diversity can lead to frustration when it comes to choosing the appropriate option. In this article we address the essential properties an outcome measure must possess, aiming to allow an informed selection of the most suitable instrument. We describe and illustrate key psychometric properties that are to be assessed when judging suitability of an instrument, such as validity, reliability and responsiveness. We also review some of the most commonly used and recommended outcome measures available in regard to different knee pathologies. With no intention of recommending a specific option, we briefly outline advances and shortcomings of named instruments.