SUMMARYThe gastric emptying of a mixed solid and liquid meal was assessed in 24 normal subjects using a single camera/computer system which allowed continuous monitoring of both solids and liquids. It was shown that variation in tissue attenuation caused by the changing depth of radionuclide within the stomach accounted for large errors in the measurement of gastric emptying (alteration in 50% emptying time of up to 65%). A technique for the correction of attenuation is described which used factors derived from a lateral image of the stomach. In all subjects, solid emptying was slower than liquid emptying and was characterised by a delay (lag period) which was followed by linear emptying. Liquid emptying usually followed a single exponential pattern. The effect of physiological changes induced by increasing the calorie content of the liquid component of the meal was assessed by giving either water, 10% dextrose or 25% dextrose. Liquid emptying was slowed and the lag period of solid was prolonged as the calorie content increased. Reproducibility was assessed in 19 subjects. For the three groups studied (water, 10% dextrose, 25% dextrose) the day-to-day variation in gastric emptying was not significant for any measured parameter, while statistically significant differences were present in solid and liquid emptying between subjects and groups.Radionuclide methods are being used increasingly to study the gastric emptying of both solid and liquid components of a meal and by these means disorders of gastric emptying and of the distribution of solid and liquid components of a meal within the stomach have been shown.
The pattern of gastric emptying has been assessed after gastric bypass surgery using a double isotope technique for measuring solid and liquid emptying with a scintillation camera. Eleven control subjects and 12 patients, 12 months post-gastric bypass, were studied. Stomal and gastric pouch size were assessed at endoscopy. Solid emptying was slower and liquid emptying was more rapid after gastric bypass surgery. Initial rapid emptying of solid occurred in the 4 patients with the smallest pouch diameters. There was no correlation between stomal size and rates of solid or liquid emptying nor between the weight loss produced by the operation and the rates of solid or liquid emptying, stoma or pouch size.
Objective-To investigate a population of elderly people for atrial fibrillation and to determine how many of the cases identified might benefit from treatment with anticoagulants. Methods-From a practice of four primary care physicians, 1422 patients aged 65 years and over were identified, of whom 1207 (85% of the total population) underwent electrocardiographic screening to detect the presence of atrial fibrillation. Patients with the arrhythmia were further evaluated by echocardiography and interview, to stratify their risk of stroke based on echocardiographic and clinical risk factors, their perceived risk from anticoagulation, and their attitude towards this treatment. Their primary care physician was also interviewed to determine the factors influencing the prescription of anticoagulants. Results-The arrhythmia occurred in 65 patients (5.4% overall), its prevalence increasing markedly with age (2.3% in 65 to 69 years age group; 8.1% in those over 85). Warfarin was being prescribed to 21.4% of these patients, although the findings of the study indicate that a further 20% were eligible for this treatment. Symptoms suggestive of cardiac failure were common (32.1%) and coexisting pathology was often identified by cardiac ultrasound in these patients (left ventricular hypertrophy, 32.1%; impaired left ventricular contractility, 21.4%; left atrial dilatation, 80.4%; mitral annular calcification, 42.9%; mitral stenosis, 7.1%; mitral regurgitation, 48.2%; aortic stenosis, 8.9%). In all but one case, the decision to anticoagulate was based on the clinical rather than the echocardiographic findings. Conclusions-Individual risk-benefit assessment in elderly patients with atrial fibrillation suggests that almost half (41.4%) are eligible for full anticoagulation with warfarin, whereas presently only one fifth are receiving this treatment. The decision to anticoagulate can be made on clinical grounds in most cases. If these results are confirmed, a doubling of the current number of patients taking anticoagulants can be anticipated. (Heart 1998;79:50-55)
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