Attempts have long been made to use the prostigmine-morphine provocation test for the selection of postcholecystectomy patients suffering from sphincter of Oddi (SO) dyskinesia. Since the whole procedure is based upon the evaluation of subjective complaints, this test has frequently been criticized. To improve the diagnostic value of this method, we have visualized SO spasms during prostigmine-morphine provocation by means of quantitative hepatobiliary scintigraphy (QHBS). Twenty-two cholecystectomized patients with typical postprandial biliary pain were included in this study. In the first series of studies, QHBS with technetium-99m 2,6-diethylphenylcarbamoylmethyl-diacetic acid was performed in each patient 2 days before prostigmine-morphine provocation. The time to peak activity (Tmax) and the half-time of excretion (T1/2) over the liver parenchyma (LP), hepatic hilum (HH) and common bile duct (CBD), and the duodenum appearance time (DAT), were determined and served as control values. In the second series of experiments, sphincter spasms were evoked by prostigmine-morphine administration and visualized by means of QHBS. The same parameters were evaluated and serum levels of aspartate aminotransferase (AST) were determined simultaneously at regular intervals. In 12 patients who responded to prostigmine-morphine provocation with typical biliary pain and a significant AST elevation (Nardi positive group) the hepatobiliary scintigram demonstrated a marked biliary obstruction. Tmax and T1/2 over the LP, HH and CBD were significantly increased, while DAT was significantly longer relative to the corresponding data obtained without provocation. Four of the remaining ten patients indicated atypical abdominal pain during prostigmine-morphine provocation, but the AST level remained unchanged in all ten (Nardi negative group).(ABSTRACT TRUNCATED AT 250 WORDS)
In this case report, we describe the rare situation of a patient with nonvariceal upper gastrointestinal bleeding induced by gastric and duodenal involvement of Schistosoma mansoni infection. In this unique case severe, recurrent upper gastrointestinal bleeding was induced by central ulcerations of gastric pseudopolypoid and duodenal polypoid lesions. However, very atypically, there were no signs of portal hypertension, coagulopathy, or variceal bleeding, and no macroscopic evidence of lower gastrointestinal tract involvement. Neither anti-ulcer therapy nor endoscopic hemostasis methods were effective in preventing recurrent bleeding episodes. Finally, typical histological and serological tests (positive for S. mansoni hemagglutination) led to the correct diagnosis, and the patient was completely cured by specific antischistosomal therapy.
Bittera' 1ntr: by D . Boda . Paediatric ~e~a r t m e s , UiiGZEi& of Szeged, Hu&ry.It has frequentelg been suggested that MV gene carriers are notcompletely healthy, and that cages owcur among them axhibiting clinical symptoms oP MV of variable severity. Without an appropriate examination method, this could not be proved so far. We recently found that the bromide index is suitable for demonstration of W heterozygous state. With some modification, the blood: sweat bromide ratio after per os NaBr administration is determined with an ion-selective electrode. With this method, hZV gene carrying was confirmed in 24 children with chronic diseases of the respiratory tract. Such Hbngary .It has been shown earlier by the authors that the glomerular filtration ?ate /GFR/ and the penicillin clearence are increased in short-term cllildhood diabetes. Recently, GFR and carbenicillin half-life /T/2/ were determined in insulin-treated children with a diabetes duration of 1-5 years, and in a healthy control group. A n inverse relationship, between carbenicillin T/2 and GFR was found in,both groups. The GFR was significantly higher, and the carbenicillin T/2 significantly lower in diabetic cililaren than in healthy controls. There was no correlation to blood sugar levels. It is suggested that the accelerated elimination of penicillin and carbenicillin in early diabetes necessitates lligher dosages of these drugs for an adequate therapeutic effect. Clinical and laboratory data are reported on metachromatic leukodystrophy of delayed infantile type in a five and a half years old female child from a marriage between cousins of first degree. TvIetachromatic staining eulphati.de excreted in the urine was confirmed by cresyl violet staining urinary sediment. There was no arylsulphatase activity in the urine. Quantitative glycolipid thin-layer chromatography of the urine showed the characteristic sulphatide accumulation. Metachromatic granules were detected in fibroblast cultures. Lysosomal arylsulphatase-A was determined on serum and wbc homogenizates. The enzymatic activity of the leukocyte homogenizate of the patient was 8.9% of the normal value /homozygote/; corresponding values in the mother and father were 47.7%, and in the paternal grandfather 27.7% /all three heterozygote/. The course of the heredity of the disease could be well followed by examination of the specific enzymatic activity of the family members. Lysosomal arylsulphatase-A examinations are of great importance in the diagnosis of demyelinization syndromes. STUDY OF ARYLSULPHATASE - VISUAL OBSERVATION AND ELECTRONIC MONITORING OF MOTOR ACTIVITY IN NEI~ORN INFANTSLars-Eric Brattebx Perinatal Research Unit, University hospital, Uppsala, Sweden.The spontaneous motor activity of newborn infants was electronically monitored using a sensing unit, placed in the bed or incubator. The sensor is an inductive-capacitive circuit, which allows monitoring of motor activity without attachment of cables or electrodes to the infant. The signal from the instrument and the coded visua...
Recurrent biliary pain after cholecystectomy is presumably due to sphincter of Oddi dysfunction (SOD). There is no ideal non-invasive test for SOD, and the diagnosis often relies on invasive procedures such as sphincter of Oddi (SO) manometry. Amyl nitrite-augmented quantitative hepatobiliary scintigraphy (QHBS) was performed on nine asymptomatic volunteers and 22 patients with SOD of biliary types I and II. Normal QHBS parameters were established in the asymptomatic volunteers. QHBS revealed a partial obstructive pattern in nine patients in whom SO stenosis was suspected and in 13 patients in whom SO dyskinesia was suspected. This obstructive pattern remained unchanged in the former group, but was completely relieved in the latter group of patients on amyl nitrite administration. In conclusion, amyl nitrite-augmented QHBS proved to be a useful non-invasive method in the diagnosis of SOD of biliary types I and II and permitted differentiation between organic stenosis and functional motor abnormalities of the SO.
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