Frequency gradients of the basic electrical and mechanical rhythms along the rat intestine

The basic mechanical rhythm (BMR), initiated and maintained by the basic electrical rhythm (BER), ensures the muscular tonus of the intestine during the interdigestive phases. The frequency and amplitude gradient for the BER waves and, correlated with them, the frequency and size gradient of the BMR contraction force have an anatomic determination. The circular muscle layer is discontinuous, consisting of cylindrical segments separated by conjunctive tissue, segments whose size increases starting from the duodenum to the ileocecal valve. The electrical connection between the cylindrical segments formed by the circular muscles is provided by the layer of longitudinal muscle fibres. Each and every segment generates a general voltage which is higher than that of the preceeding segment, so that the slow BER wave becomes amplified along the intestine. In correlation with the electrical phenomena, the BMR contractile waves will become more ample in the terminal region of the intestine, facilitating the progress through peristalsis of the luminal content with greater viscosity.

[Retrograde cholangiopancreatography (ERCP) and endoscopic sphincteropapillotomy (ES) in the diagnosis and treatment of common bile duct (CBD) lithiasis]

The common bile duct (CBD) stones often gives real difficulties of diagnosis and treatment. The ultrasound (US) does not offer in a significant percentage of cases certain diagnostic data, and the unconventional imaging techniques such as computer tomography (CT) are yet less accessible. ERCP appeared in the last period as an optional method for the diagnosis of common bile duct stones, and, moreover, permitted the development of the nonsurgical treatment possibilities. ES and the extraction of stones revealed in this frame as preferable, especially in the high surgical risk cases. This study presents the results of ERCP performed in 547 and the therapeutic value of ES in 284 cases with CBD stones (conclusions of the ERCP and ES used in the clinical practice, in our clinic, in the last three years). In 81.69% cases ES managed the dezobstruction of the CBD, with a frequency of complications of 4.33% and a related mortality rate of 0.78%.

The value of computed tomography for the diagnosis of recurrent patellar subluxation in adolescents

OBJECTIVE

To determine if computed tomography of the patellofemoral joint has any advantage over standard radiologic techniques in the evaluation of recurrent patellar subluxation.

DESIGN

A case series.

SETTING

A tertiary children's hospital out-patient clinic.

PARTICIPANTS

Forty consecutive adolescents with a clinical diagnosis of recurrent patellar subluxation (study group) and 14 volunteers with normal knees (control group).

INTERVENTIONS

A standardized radiologic protocol, including axial views of the patella at 30 degrees of knee flexion, with and without external torsion of the tibia, and computed tomography (CT) of the patella at 15 degrees of knee flexion.

MAIN OUTCOME MEASURES

The lateral patellofemoral angle on the axial views and on the CT scan and patellar centralization on the CT scan.

RESULTS

In the control group, no radiologic evidence of recurrent patellar subluxation was found. In the study group, an abnormal lateral patellofemoral angle was found in 25% of axial views; this rate increased to 42% with external rotation and 86% on the CT scan. Patellar centralization was abnormal in 79% of cases.

CONCLUSIONS

CT of the patellofemoral joint is more sensitive than standard radiographs for the diagnosis of recurrent patellar subluxation. The use of CT is recommended when standard radiographs appear normal.

Changing patterns of scaphoid fractures in adolescents

OBJECTIVE

To determine if the presentation of scaphoid fractures in children has changed.

DESIGN

Case study with a minimum follow-up of 1 year.

SETTING

Outpatient orthopedic clinic in an urban pediatric hospital.

PATIENTS

Twenty-one adolescents (mean age 13.9 years) with scaphoid fractures and an open distal radial growth plate. Fracture healing was assessed at 2-week intervals until union was achieved.

INTERVENTIONS

Immobilization in a short-arm thumb spica cast.

MAIN OUTCOME MEASURES

Fracture union as defined by the absence of pain and obliteration of the fracture line. Active and passive range of motion of wrist as measured with a goniometer.

RESULTS

Only 2 of the 21 patients had avulsed fractures. Twelve fractures were located in the middle one-third of the scaphoid. All fractures healed, but two fractures were in a dorsiflexed position. All patients had full, painless range of wrist motion. No arthrosis was present.

CONCLUSIONS

The presentation of scaphoid fractures in adolescents has changed over the years and now resembles the adult pattern. Malunited scaphoid fractures may be seen. Displaced fractures should be reduced.

Congenital glenoid dysplasia: case report in two consecutive generations

Congenital glenoid dysplasia is a rare congenital condition of the shoulder. We report the case of a 6-year-old girl that was referred to our institution for restricted motion of both shoulders. Radiological examination revealed bilateral glenoid dysplasia. At the time of the child's examination, her mother also complained of shoulder stiffness; radiographs of her shoulders were taken and revealed that she too had glenoid dysplasia. Congenital glenoid dysplasia results from failure of development of the inferior ossification center of the glenoid fossa. Shoulder stiffness is the primary resultant disability, although it is variable. Our case is notable because we identified the dysplasia in two successive generations of the same family, although the mother was unaware she had the condition.

Diurnal variation of Cobb angle measurement in adolescent idiopathic scoliosis

To investigate the possible influence of gravity on daily variations of curve magnitude in adolescent idiopathic scoliosis, standardized anteroposterior standing radiographs of the spine were taken at 8:00 AM and repeated in the same conditions at 8:00 PM on the same day, 19 girls with idiopathic scoliosis, aged 10-16 years were included. The Cobb angle of the primary thoracic curve was measured blindly by four skilled orthopaedic surgeons. The mean interobserver variation in measuring Cobb angles on the 38 radiographs was 1.6 degrees. The average Cobb angle on morning radiographs was 60 degrees (range, 42-91 degrees) as compared to 65 degrees (range, 47-89 degrees) in the afternoon, a significant (P < 0.001) difference using a paired two-sided Student t test. It was concluded that there is a statistically and clinically significant daily increase of curve severity in moderate to severe idiopathic scoliosis.

Endoscopic intravascular esophageal pressure measurements in cirrhotic patients: response to metoclopramide

This study reports the effects of metoclopramide (10 mg i.v.) on intravascular esophageal variceal pressure in 12 patients with alcoholic cirrhosis. The esophageal variceal pressure was measured by the direct variceal puncture technique. Metoclopramide caused a reduction in the variceal pressure in 10 out of 12 patients; overall, there was a decrease from 21.5 +/- 5.0 mmHg to 14.0 +/- 3.4 mmHg (p < 0.001). In conclusion, intravenous metoclopramide, which increases lower esophageal sphincter pressure, significantly decreases intravascular variceal pressure in cirrhotic patients.

[Relationship between osteochondromas of the forearm in children and dislocation of the radial head]

Since treatment of a dislocated radial head is difficult in the growing child, we looked for risk factors associated with dislocated radial head in a group of patients with forearm osteochondromas. This is a retrospective study of 21 patients with a mean age of 7.7 years. We measured forearm bone length, size of the osteochondromas, ulnar variance at the wrist, radial articular angle and determined radial head localization. The severity of ulnar shortening was associated with radial head localization (p < 0.005). Ulnar shortening caused by ulnar osteochondromas larger than 0.20 of total ulnar length was associated with radial head dislocation (p < 0.001). Early treatment of ulnar shortening in this group might prevent the radial head from dislocating.

[The value of the echographic exam in the diagnosis of intra-abdominal "textilomas"]

In the absence of radioopaque marker, the diagnosis of textiloma, a rare iatrogenic lesion, is difficult. The wide use of abdominal ultrasonography significantly improved the preoperative diagnosis, the most typical image being that of a echogenic area with a posterior shadow cone. Nine cases of intraabdominal textiloma, in the diagnosis of which ultrasound played the most intra-abdominal textiloma, in the diagnosis of which ultrasound played the most important role, are presented. Although the ultrasound image is not specific, it is nevertheless enough suggestive the diagnosis of textiloma and thus for indicating an early surgery, before complications occur.

[The bronchial asthma-gastroesophageal reflux association]

The gastroesophageal reflux acts as a trigger mechanism in the induction of a asthmatic attack, either as an aggravating or a releasing factor. Our study was underwent on 15 out of 100 followed up asthmatic patients who did not respond to the usual treatments and demonstrated the usual treatments and demonstrated the intervention of the gastroesophageal reflux. Its presence was suggested clinically by the symptoms (pyrosis, dysphagia, acid regurgitations) and confirmed in 5 patients by the barium examination in Trendelenburg and in the remainder of 10 by the esophageal pH, determination of gastroesophageal motility and endoscopic examination. Excepting the known allergenic conditions, the attacks were recorded during night or postprandially, being usually preceded by the above mentioned symptoms. The antispastic and antisecretory treatment improved the respiratory symptoms. The recognition of this association, i.e. bronchial asthma-gastroesophageal reflux, has a practical importance, the intervention of the esophageal component leading to the termination of the attacks.

[A case of Nonne-Milroy-Meige syndrome]

A case of Nonne-Milroy-Meige syndrome with onset at puberty is presented. The syndrome is characterized by the association of trophic edema of the limbs with endocrine disturbances and malformations of some genes.

["Biloma": its diagnosis and treatment by percutaneous echo-guided evacuation]

The term "biloma" describes an intra-abdominal bile collection secondary to traumatic or iatrogenic injury of the biliary tree. We present a case of biloma treated by guided percutaneous needle aspiration.

[Chronic nonspecific duodenitis: myth or reality?]

There is much controversy regarding the chronic nonspecific duodenitis as autonomous clinical entity. We have studied 36 patients (16 women, 20 men), aged 24-59 years (mean age 37.8 years), with biliary dyspepsia and endoscopic changes suggesting "duodenitis"; in all patients the following investigations were carried out: gastric secretion, barium X-ray and histological examination of the duodenal mucosa specimens obtained by endoscopic biopsy. There was no significant difference between the patients with duodenitis and normal subjects regarding the maximal acid output. Unspecific radiological changes were noticed in 55.5% of patients with chronic duodenitis. Endoscopy showed varied changes of duodenal mucosa including edema, erythema, erosions and hypertrophic folds. Histology confirmed the presence of inflammation. The patients have been followed-up for three years and none of them developed duodenal ulcer. We conclude that chronic nonspecific duodenitis is an autonomous clinical entity.

[Megaduodenum due to aortomesenteric shunt]

Two new cases of megaduodenum by aortomesenteric shunt in young adults are presented. The role of some risk factors, the diagnostic and therapeutical elements are discussed, the importance of a thorough investigation of each case in view of individualizing the therapeutical management being underlined.

[Bacterial liver abscess cured by nonsurgical treatment. Comments on 8 cases]

Eight cases (3 children aged 7-15 years and 5 adults aged 16-46 years) of hepatic abscess in whom a cure was obtained by medical therapy are presented. The abscess occurred during septicemia (2 cases), cutaneous staphylococcosis (2 cases) and pyocholecystitis (1 case). In 3 patients the abscess remained cryptogenic. The clinical diagnosis was confirmed by scintigraphy, ultrasonography and in one case by radiography with contrast substance in the abscess. The microorganisms, isolated in 3 patients from the abscess and in one patient from hemoculture, were S. aureus (3 cases) and gram negative bacilli (1 case). The systemic antibiotic therapy consisted in the administration of gentamicin and oxacillin or rifampicin in 4 cases and gentamicin and chloramphenicol or ampicillin and metronidazole in other 4 cases for an average interval of 39 days. The associated local therapy (3 cases) consisted in one or more punctures, followed by the injection of gentamicin.

[Hepatic abscesses]

The authors analyse 16 cases of hepatic abscesses recorded in a 10-year interval. The difficulties in assessing the etiology and diagnosis, as well as in indicating an effective treatment are discussed. The clinical aspects and investigation methods, among which scintigraphy, arteriography and especially echotomography are extremely useful in making the diagnosis and in localizing the collection, are reviewed. The bacteriological examination revealed the presence of various organisms in 14 patients, the examined specimen of pus being negative in the remainder of 2 cases. The treatment was surgical in most of the cases (15) consisting in an abdominal approach or posterolateral with rib resection (1 case) and drainage. In 3 cases the intervention was extended to cholelithiasis which was the underlying cause of the abscess. The ultrasound-guided transparietohepatic drainage was performed in 2 cases. No death was recorded.

Effects of ceruletide on post-operative intestinal atony: a manometric study

The effects of ceruletide on jejunal motor activity were studied in seven patients with postoperative intestinal atony. Jejunal pressures were recorded by three perfused catheters with orifices spaced 5 cm apart, the proximal one being positioned 10 cm beyond the ligament of Treitz. Ceruletide (0.05 microgram/Kg i.v.) significantly (p less than 0.0001) increased the number and amplitude of jejunal contractions. The action of ceruletide was most obvious the first 15-minutes after administration, then its effect diminished progressively and ceased after 65-75 minutes. The adverse reactions of ceruletide were minimal and self-limiting.

[Clinical and therapeutic aspects of some rare forms of pancreatic tumors]

A total of 198 tumours of the pancreas have been hospitalized between 1972 and 1987 in the 1st Surgical Clinic from Jassy. Only 10 of these tumours were benign, and these included: 2 gastrinomas, 2 insulinomas, 2 cystadenomas, one fibrolipoma, 1 lymphangioma, one hydatic cyst and a Wermer's syndrome. The particularities are analysed, of these 10 cases of benign tumours of the pancreas, and it is stressed that most of the clinical and therapeutic problems are determined by tumours of the endocrine pancreas, and especially those which are hormonally active. Thus the symptomatology of these last tumours which is difficult to evaluate, especially at the onset of the symptoms will determine a considerable delay in the surgical diagnosis, many of the patients being hospitalized in other departments before reaching the surgeon. Present possibilities for diagnosis and treatment have kept pace with progresses achieved in the field of investigations, which provide useful data from the morphological and functional viewpoints. All the 10 cases mentioned above have benefited from the surgical treatment, that was adapted according to particularities of each patient. The authors stress the importance of the extemporaneous morpho-histologic examination (with serial slides) and when the tumours are difficult to identify by direct macroscopic examination they recommend intraoperative echography and direct hormonal dosages on samples obtained from the portal circulation before and during surgery.

De-Nol in the treatment of reflux esophagitis

Twenty-eight patients with histologically proven reflux esophagitis were randomly allocated to receive either De-Nol (tripotassium dicitrate bismuthate) or placebo for three weeks. Significant decreases in symptoms frequency and severity were noted in De-Nol group comparing with placebo group (p less than 0.01). Objective improvement in esophageal endoscopic appearance was obtained in 78.5% of the patients treated with De-Nol and only in 14.2% of those receiving placebo. De-Nol appears to be an effective drug in the treatment of reflux esophagitis, but this should be confirmed by further studies.

Continuous electrocardiographic monitoring during balloon dilatation in achalasia

Electrocardiographic (ECG) changes in nine patients under continuous ECG monitoring before, during and after balloon dilatation for achalasia were followed; of these, three had ischaemic heart disease (IHD). One or several abnormalities including sinus tachycardia, supraventricular or ventricular ectopic beats, S-T segment depression and T-wave flattening appeared during the procedure; these were more commonly found in patients with IHD. Despite the high incidence of recorded ECG abnormalities, these were transient, and no treatment was needed. However, it seems advisable to have resuscitation equipment and emergency drugs available during balloon dilatation for achalasia, particularly when this procedure is performed in patients with IHD.