To determine the natural history of delayed gastric emptying of solid foods in anorexia nervosa (AN), gastric emptying was assessed by scintigraphy in 20 consecutive inpatients; eight had restrictive AN, ten had both AN and bulimia nervosa (BN), and two BN alone. Initial gastric half-emptying time (HET) exceeded 110 min (the upper limit of normal for the laboratory) in 16; their body mass index ranged from 11.7 to 18.1. HET showed a significant negative correlation with body mass (r = 0.71; p less than 0.001) but not age, duration of illness or use of psychotropic medication. Fourteen patients with prolonged emptying were retested; HET improved in nine of 12 retested at one month (p = 0.0005) but none showed a change in the lag phase of emptying. All four patients retested a further one to two months later achieved a HET less than 110 min. Fourteen patients reached a body mass index of 16.3 during treatment and HET improved to better than 110 min in all but one of these. However, normalisation occurred while body mass was still subnormal (less than 20.3) and with amenorrhea still present. This study shows that delayed gastric emptying in AN improves quite rapidly as feeding recommences; thus the motility disturbance is secondary to restriction in food intake and is not fundamental to the disorder.
The value of positive scans of autologous 'Tc-labelled leucocytes in the detection of intestinal inflammation was assessed in 29 patients with known inflammatory bowel disease and a high probability of intestinal inflammation and 58 with a low probability of intestinal inflammation comprising 37 with intestinal symptoms and 21 with suspected abscess. Autologous leucocytes were labelled with 9mTc using either of the established methods. In patients with inflammatory bowel disease, 3/13 with ileocaecal and 1/11 with colonic accumulation of 99Tc were incorrectly diagnosed in that there was no histological evidence of inflammation in those regions. In the low probability patients, all 26 positive images were false positives: there were 19 in the ileocaecal and 7 in colonic regions and no differences between the two subgroups. False positives were more common in low probabilitythanhigh probabilitypatients (p=0.011). The results were independent of the 'Tc cell labelling technique used. Three false positive patients also had normal scans for "'lInlabelled granulocytes. The time of first detection of 'Tc in the bowel was earlier in true than in false positive patients (92% v 33% within 1 h, p=0.008), the false positive rates in the first hour of imaging being 5% in high and 15% in low probability patients. In -Tc scinti-
Background and Purpose: Elevated middle cerebral erythrocyte velocities and tissue hypoperfusion have been correlated with delayed ischemia after subarachnoid hemorrhage, but few studies have compared serial arterial velocities with cerebral blood flow and neurological deficits.Methods: Serial measurements of middle cerebral velocities, using transcranial Doppler ultrasonography, were performed in 34 patients after subarachnoid hemorrhage and correlated with cerebral blood flow, measured in 20 of the 34 using single-photon emission computed tomography with technetium-99m hexamethylpropylene amine oxime and neurological evidence of delayed ischemia.Results: In 16 patients without delayed ischemia, eight had evidence of vasospasm (>120 cm/sec), but only one of seven had hypoperfusion, suggesting that vasospasm might be more common than hypoperfusion in this group (p=0.1). In 10 patients with delayed ischemia and a lateralizing deficit, both asymmetrical middle cerebral vasospasm (eight of nine with vasospasm) and hypoperfusion (six of six studied) were concordant with the clinically ischemic hemisphere (p<0.05). Vasospasm occurred with nonlateralized delayed ischemia in seven of eight patients and with hypoperfusion in five of six, affecting the anterior cerebral territory in three.Conclusions: Concordant vasospasm and hypoperfusion were most often present in patients with delayed ischemia and lateralizing neurological deficits. Discordant results reflect inherent limitations and the different levels of the circulation monitored by the two techniques. (Stroke 1992;23:492-497) KEY WORDS • blood flow velocity • cerebral blood flow • subarachnoid hemorrhage
The relative efficacy of sodium and calcium heparin in preventing venous thromboembolism and their relative side-effects were studied in 234 high-risk patients in a randomised, double-blind, placebo-controlled trial. The two heparin preparations were from the same batch and in the same concentration, and were given in a dose of 5000 U 12 hourly. Positive leg scans were found in 19% after placebo, 12% after sodium heparin and 8% after calcium heparin. Bruising at the injection site was more common after calcium heparin (66%) than after sodium heparin (53%) or placebo (38%). Pain at the injection site was also more common after calcium heparin (26%) than after sodium heparin (8%) or placebo (6%). Changes in the activated partial thromboplastin time were small and did not correlate with leg scan results or bruising. While there was a tendency for calcium heparin to be possibly more effective, it was followed by significantly more local haematoma and pain.
1. The haemodynamic and volume response to ACTH administration was investigated in six patients with mild, untreated essential hypertension and two patients with Addison's disease on maintenance steroids. Blood pressure, heart rate and weight were recorded daily. Plasma volume (125I-HSA) and cardiac output (thermo-dilution) were measured during the control period and on the 5th day of ACTH treatment. 2. In the hypertensive subjects, mean arterial pressure rose from 94.3 +/- 2.2 to 105.7 +/- 2.8 mmHg on the 5th day of ACTH administration (P less than 0.02). Plasma volume rose from 29.8 +/- 2.2 to 34 +/- 2.2 ml/kg. Cardiac index increased from 2.85 +/- 0.21 to 3.32 +/- 0.14 l/min per m2 (P less than 0.05). Cardiac output rose from 5.81 +/- 0.69 to 6.72 +/- 0.59 l/min. Calculated total peripheral resistance, heart rate and body weight were unchanged. No such changes were seen in patients with Addison's disease. 3. The haemodynamic characteristics of ACTH in patients with mild untreated essential hypertension are similar to those in the experimental model of ACTH induced hypertension in sheep.
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