Background :Measuring colonic transit time (CTT) by the radio-opaque marker method is simple, widely available and important for the diagnosis of slow transit constipation. Moreover, the effects of gender and menstrual cycle on CTT remain controversial. Thus, in this study, we examined the effects of gender and menstrual cycle on CTT in healthy subjects.Methods :We measured CTT in 42 healthy subjects (21M, 21F) by using a radio-opaque marker, Kolomark™. Two simple abdominal radiographs were taken on the 4th and 7th days. Average daily intake of dietary fiber and menstrual history were surveyed.Results :The mean CTT of the 42 healthy subjects was 26.5±19.4 hours. The mean CTT was not significantly different between the male and female subjects (22.3±16.1 h vs. 30.1±21.4 h, p>0.05). However, the mean CTT of 11 female subjects in the luteal phase was significantly longer than that of 10 female subjects in the follicular phase (40.9±19.0 h vs. 20.6±19.2 h, p<0.05). Serum progesterone level, age, BMI, and the average daily intake of dietary fiber did not correlate with CTT.Conclusion :The effects of the menstrual cycle should be considered in interpreting CTT in young women.
Our data suggest that obesity increases the risk of colonic adenoma in relatively young people and in premenopausal women subject to estrogen effects.
Constipation and the use of laxatives are relatively common in patients with diabetes mellitus. However, the mechanisms responsible for the constipation are unclear. Even though autonomic neuropathy is regarded as one of the important mechanisms of constipation, it requires further clarification. In addition, the colonic function in diabetic patients requires further investigation. The aim of this study was to compare the colonic transit time between patients with diabetes mellitus and healthy subjects, and correlate it to the presence of cardiovascular autonomic neuropathy. The colonic transit time was measured by a noninvasive, radio-opaque marker method, and the presence of cardiovascular autonomic neuropathy was evaluated by the beat-to-beat variation and the orthostatic hypotension. Constipation was defined by the Rome II criteria. The mean total colonic transit time of the 28 diabetic patients (34.9 +/- 29.6 h, mean +/- S.D.) was significantly longer than that of the 28 healthy subjects (20.4 +/- 15.6 h, p < 0.05). Among the diabetic patients, 9/28 (32%) had constipation and 14/28 (50%) had cardiovascular autonomic neuropathy. The diabetic patients with constipation showed longer total, left and recto-sigmoid colonic transit times than those without constipation. However, the mean colonic transit time of diabetic patients with and those without cardiovascular autonomic neuropathy was similar. In conclusion, other mechanisms than the mere presence of cardiovascular autonomic neuropathy might be more relevant to the development of constipation in patients with diabetes mellitus.
Vaccination against hepatitis A virus (HAV) is recommended for patients with chronic liver disease (CLD), but this has been deemed unnecessary in Korea since the immunity against HAV was almost universal in adults. However, this practice has never been reevaluated with respect to the changing incidence of adult acute hepatitis A. We retrospectively reviewed the medical records of 278 patients with acute hepatitis A diagnosed from January 1995 to November 2005 and prospectively tested 419 consecutive CLD patients from July to December 2005 for the presence of IgG anti-HAV. The number of patients with acute hepatitis A has markedly increased recently, and the proportion of adult patients older than 30 yr has been growing from 15.2% during 1995-1999, to 28.4% during 2000-2005 (p=0.019). Among 419 CLD patients, the seroprevalences of IgG anti-HAV were 23.1% for those between 26 and 30 yr, 64% between 31 and 35 yr, and 85.0% between 36 and 40 yr. These data demonstrate that immunity against HAV is no more universal in adult and substantial proportion of adult CLD patients are now at risk of HAV infection in Korea. Therefore, further study on seeking proper strategy of active immunization against HAV is warranted in these populations.
Progenitor cells in bone marrow have been explored for the treatment of liver injury. Stem cell homing to the injured tissue is regulated through stromal cell derived factor-1 (SDF-1) and its receptor CXCR4. We hypothesized that syngenic bone marrow cells (BMCs) would restore hepatic function in the injured liver through the regulation by SDF-1/CXCR4 system. After injecting carbon tetrachloride (CCl(4)), the mice were injected with syngenic BMCs or normal saline. Morphological and functional analysis of the liver was performed. Flow cytometry for the stem cell markers and CXCR4 was done with the liver, BM, and spleen cells from each group. Carboxyfluorescein diacetate succinimidyl ester was used to trace the homing of transplanted BMCs. The SDF-1 expression of the liver was assessed by immunohistochemistry. Hepatosplenomegaly and necrosis of the CCl(4)-injected mouse liver were improved after BMCs transplantation The hepatic enzymes were increased after injury and then decreased after BMCs transplantation. The expression of stem cell markers and CXCR4 was exclusively increased in the damaged liver compared to the BM and spleen, and even more elevated after BMCs transplantation. SDF-1 expression in the liver was observed after CCl(4) injection and it was elevated after BMCs transplantation. The intrinsic and extrinsic BMCs migrate specifically to the injured liver rather than BM or spleen, and the transplanted BMCs contribute to the repair of the damaged liver. SDF-1/CXCR-4 interaction plays a role in stem cell homing toward the damaged organ, and transplanted BMCs are involved in the up-regulated SDF-1 expression seen in the injured liver.
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