Rundles (1945), who, in discussing the oesophageal changes, considered that the whole problem was a challenge. Mandelstam and Leiber (1967) concluded that the oesophageal motor dysfunction was a common finding in diabetic neuropathy-gastroenteropathy, and that on occasion it results in dysphagia. In their group 12 had oesophageal dysfunction but only three had symptoms, while their control group had no changes at all.The present study indicated that abnormal oesophageal function was not limited to one group and therefore that the abnormality is not specific or exclusive to the diabetic neuropathy group. The chief finding was an incoordination of the primary peristalsis in the body of the oesophagus. In each group there were cases of sliding hiatal herniae associated with both normal and abnormal sphincteric action and peristalsis. With the exception of the non-diabetic symptomatic group, however, there was no correlation between the clinical picture and the cineradiographic motility studies. Similar findings of oesophageal dysfunction were reported in alcoholic neuropathy and normals (Winship et al., 1968).Furthermore, there is no explanation of the pathogenesis which could account for these changes occurring in all the groups at all ages. Vagal degeneration and myopathy of the oesophageal muscle have been incriminated, but with no absolute proof. Recently it has been considered that diabetic neuropathy is a metabolic defect predominantly affecting fat metabolism within the cell which is associated with hyperplasia of the basement membrane (Bischoff, 1968). This latter investigation was carried out on peripheral nerves, and not on the oesophagus or on the rest of the gastrointestinal tract.The conclusion therefore drawn from the present study is that identical cineradiographic and manometric evidence of oesophageal dysfunction can occur in all four groups investigated and not only in those affected by diabetes, with or without neuropathy. British Medical Yournal, 1967, 4, 311. Mandelstam, P., and Leiber, A. (1967 Journal, 1969, 3, 690-693 Summary: The results of surgical treatment for duodenal ulcer were compared in two groups of patients -51 who had undergone selective vagotomy without drainage and 17 who had had selective vagotomy and pyloroplasty. It is suggested that in the absence of organic pyloric or duodenal stenosis the former method seems both preferable and desirable, since postoperatively dumping does not occur and there is a steady improvement in gastric emptying.
Constant intravenous infusion of epinephrine has no effect on the pulmonary vascular resistance (P.V.R.) of the cat under chloralose anesthesia, either when the chest is opened and artificial ventilation is used, or when the animal is respiring naturally. The same dose of epinephrine given after removal of the stellate ganglia and upper 4 to 5 thoracic sympathetic ganglia, can cause an increase of P.V.R. Removal of such ganglia causes a decrease of P.V.R. Electrical stimulation of the cardiac branches from both stellate ganglia causes either an increase or a decrease of P.V.R. Increases of P.V.R. have been produced by intravenous infusion of norepinephrine.
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