Motility disorders of the esophagus: diagnosis with barium-rice administration

PURPOSE: To evaluate the role of barium-rice administration for a standardized diagnosis of dysphagia and esophageal motility disorders. MATERIALS AND METHODS: Sixty healthy volunteers and 218 patients with various esophageal disorders (achalasia, scleroderma and other connective tissue diseases, neurologic diseases, esophagitis and others) were examined both by a conventional barium study and by a barium-rice study. The barium-rice meal consisted of barium sulfate and boiled rice, mixed half and half. The time required for esophageal clearance of one sip was measured. RESULTS: Normal esophageal transit time in healthy controls was between 5 and 15 s for both methods. In patients, the conventional barium study revealed a prolonged transit time in only 16.5% (36 of the 218 cases). The barium-rice study was abnormal in 51.8% (113 of 218 cases), independent of the underlying disease. The barium-rice study was pathological in 77 of those 182 patients (42.3%) who had normal barium transit time. In 24 patients the radiologic results was confirmed by endoscopy and manometric measurements. CONCLUSIONS: Esophageal motility abnormalities are detected by a barium-rice study with a high sensitivity. With this simple and low-cost method, quantitative and reproducible results can be obtained. Barium-rice administration is a suitable tool for screening and follow-up of patients with dysphagia and esophageal motility disorders.     

Differential diagnosis in patients with disorders of the patellofemoral joint

Anterior knee complaints are difficult diagnostic problems. It cannot be overstated that the most important information available is to be found in the patient's history. Onset, quality, and quantity of symptoms must be assessed. This information is then synthesized to determine the specific functional disabilities resulting from the patient's anterior knee disorder. Once a history is obtained, a consistent, methodical physical examination can be performed to narrow the differential diagnosis. Radiographic evaluation is used to further hone the differential or to confirm the most likely diagnosis. Ultimately, a specific working diagnosis is selected and treatment is tailored to changing the underlying structural or biomechanical abnormalities that led to the patient's complaints.     

A multimodal approach in the diagnosis of patients with hematopoietic disorders

We previously reported that ethanol elicits an increased protein oxidation in the liver of rats receiving chronic ethanol by continuous intragastric infusion (Tsukamoto-French method). This accumulation of oxidized proteins could result from a decrease in the cytosolic proteolysis, related specifically to alkaline protease and its major components, the proteasomes. Because several studies suggest that intracellular proteolysis depends on the severity of oxidative stress, we investigated the cytosolic proteolytic activity under two chronic ethanol treatment paradigms associated with varying degrees of oxidative stress. For 4 weeks, male rats received chronic ethanol by continuous intragastric infusion or by oral administration (10% ethanol ad libitum as sole drinking fluid). A significant decrease was evident for alkaline protease activity as well as for sodium dodecyl sulfate (SDS)-activated latent 20S proteasome (chymotrypsine-like [ChT-L] and peptidylglutamyl peptide hydrolase [PGPH] activities) in the liver of rats receiving ethanol by continuous intragastric infusion. Free radical production and related processes appeared to be contributing events in proteolysis inhibition, because phenethyl isothiocyanate (PIC), an inhibitor of cytochrome P4502E1 (CYP2E1), reduced the inhibition of the ethanol-related ChT-L activity. Moreover, the lipid peroxidation level was inversely correlated with ChT-L activity. In contrast, no such changes were observed in ChT-L and PGPH activities or in cellular free radical targets following the oral ad libitum consumption of 10% ethanol. It appears, thus, that only the alcohol treatment paradigm associated with an overt oxidative stress produced a significant inhibition of the proteasome activity. The mechanisms of proteasome inhibition could involve the formation of an endogenous inhibitor such as protein aggregates or aldehyde-derivative peptides. Whatever the mechanism, the inhibition of cytosolic proteolysis and the subsequent accumulation of damaged proteins may be involved in the oxidatively challenged alcoholic livers and play a pathogenic role in experimental alcoholic liver disease.     

Radiographic diagnosis of temporomandibular disorders

Although many of the disorders involving the temporomandibular joint and associated structures can be diagnosed clinically on the basis of the history and physical findings, there are others that require the use of various imaging techniques to make an accurate diagnosis or to determine the extent of involvement. To take maximum advantage of the benefits of these procedures, however, it is not only important for the clinician to be able to select the correct methods, but also to understand their limitations as well as their capabilities. In this article the various techniques used for imaging the hard and soft tissues of the temporomandibular joint are reviewed and recommendations are made regarding their appropriate applications.     

The O'Brien filter test in the differential diagnosis of disorders with high-grade thrombocytosis

In the differential diagnosis of primary and secondary thrombocytosis, platelet function test can be used. We have examined the possible role of O'Brien's filter test in the differentiation of primary and secondary thrombocytosis in 53 patients with myeloproliferative diseases with primary thrombocytosis and in 21 patients with other disorders complicated by secondary thrombocytosis. By using heparin as an anticoagulant, the sensitivity of O'Brien's filter test proved to be 75%, and it's specificity was 85.7%. In blood samples anticoagulated with citrate, the sensitivity was 100% and specificity 83.3%. Based on these studies we suggest the use of O'Brien's filterometer as a screening test in the differential diagnosis in patients with elevated (> 400 x 10(9)/L) platelet count. In case of normal results, the causes of reactive thrombocytosis should be cleared first, while with pathologic results, haematological examination of the patients should be performed.     

Videoendoscopic diagnosis of esophageal motility disorders

PURPOSE: Looking for a valid, reliable, and feasible method to collect data on the performances of practicing family physicians, the authors compare the measurement characteristics of a multiple-station examination (MSE) using standardized patients with those of a video assessment of regular consultations in daily practice (practice video assessment, PVA). METHOD: In a cross-sectional study, consultations of 90 family physicians were videotaped both in an MSE and in their daily practices. Peer-observers used a validated instrument (MAAS-Global) to assess the physicians' communication with patients and their medical performances. The physicians were randomly divided into two groups, comparable for demographic characteristics, and half underwent the assessments in reverse order to test for time-order effects. Content validity, criterion validity, reliability, and feasibility of the two methods were compared. RESULTS: Content validity of the PVA was superior to that of the MSE, since the domain of general family practice care was better covered. Observed participants judged the videotaped practice consultations to be "natural," whereas hardly any family physician, after reviewing the videotaped consultations of the MSE, recognized his or her usual working style. Specific criteria made it possible to standardize real practice. Concerning criterion validity, only the medical-performance components of the two methods correlated. No correlation was found for the communication components. Real-practice performance proved to be less influenced by observation than was performance during the MSE. The reliabilities of the two methods, expected to be better in the controlled MSE, were comparable. The administration of the PVA was more flexible, less costly, and better accepted by the family physicians than was that of the MSE. CONCLUSION: Assessment for quality improvement of family physicians' practices by video observation in daily practice is superior to video assessment in a simulated setting using standardized patients.     

Motility of the canine pyloric ring following a pylorus-preserving pancreatoduodenectomy

Recently, function-preserving operations have become popular, and pylorus-preserving pancreatoduodenectomy (PPPD) is frequently performed for diseases of the head of the pancreas. However, there are only a few basic studies on the pyloric function after PPPD. Using strain gauge force transducers (SGTs), we studied the pyloric motility of normal and PPPD dogs. We prepared three normal and three PPPD dogs in which the SGTs were implanted onto the antrum and pyloric ring, etc. In conscious dogs, the spontaneous gastrointestinal motility was recorded, and the plasma motilin concentration was measured during the interdigestive state. Following the administration of exogenous Leu13-motilin, the motility was again recorded. The relaxation and opening of the pyloric ring was observed synchronously with intense contractions of the antrum during the phase III of normal dogs. Phase III-like motility was recorded in the PPPD dogs, which was not a typical periodic motility. The plasma motilin concentration of one PPPD dog could be measured, and the motilin levels during the phase III-like motility were higher than during phase I. The phase III-like motility was induced by Leu13-motilin in both normal and PPPD dogs. The phase III-like motility recorded in the PPPD dogs was not a typical periodic one, and this aberrant motility was considered to be one of the causes of delayed gastric emptying. Phase III-like motility was induced by the administration of Leu13-motilin; therefore, it is possible that Leu13-motilin improved the motility of the pyloric ring after PPPD.     

Sleep disorders: diagnosis and treatment

Disturbed or inadequate sleep is a frequent complaint with a great impact on daily functions and an often chronic course requiring adequate treatment. To choose an appropriate therapy it is necessary to develop a useful, reliable, valid and specific diagnostic procedure. Primary care physicians can recognize and treat most sleep disorders. For special diagnostic cases sleep centers are recommended. Sleep disorders may be managed by adequate pharmacological as well as nonpharmacological treatment. Besides specific pharmacological means, education in sleep/wake physiology and hygiene and several psychotherapeutic strategies may be valuable.     

Advances in the diagnosis and treatment of childhood disorders.

Clinicians today face difficulties in appropriately assisting children with mood disorders, whose parents may challenge diagnostic and treatment decisions based on potentially faulty information obtained from unregulated sources (e.g., the Internet, commercial books, other media). In light of this problem, as well as the U.S. Surgeon General's recent call for increases in evidence-based diagnosis and treatment of childhood disorders, it is important that psychologists educate themselves and their clients about evidence-based practices. Evidence-based assessment and psychosocial and psychopharmacological treatment procedures for childhood unipolar and bipolar mood disorders are reviewed, and specific practice recommendations are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Oculomotor testing in the differential diagnosis of degenerative ataxic disorders

BACKGROUND: Oculomotor abnormalities have been reported in patients with degenerative ataxic disorders. OBJECTIVE: To assess the diagnostic sensitivity and specificity of oculomotor deficits in patients with Friedreich ataxia (FA), cerebellar atrophy (CA), and olivopontocerebellar atrophy (OPCA). SETTING: Neurology clinic at a university hospital in Lübeck, Germany. PATIENTS: Seven patients with FA, 9 with CA, and 10 with OPCA were studied. These patients were selected from an ongoing follow-up study. MAIN OUTCOME MEASURES: Eye movements were recorded by electro-oculography; an extensive battery of quantitative tests was used. RESULTS: A proven CAG repeat expansion on chromosome 6 or 14 was significantly associated with reduced saccadic eye velocity and vertical gaze palsy (P<.001, Mann-Whitney U test). All 6 patients with OPCA and slow saccades had an autosomal-dominant inheritance; 4 of them were proved to have spinocerebellar atrophy type 1. In 9 of these patients (4 with FA, 1 with CA, and 4 with OPCA), the genetic defect could not be identified. Saccadic dysmetria, impairment of smooth pursuit and optokinetic nystagmus, deficient suppression of the vestibulo-ocular reflex by either visual or otolith input, and pathological nystagmus were attributed to degenerative lesions in different parts of the cerebellum. However, these symptoms failed to clearly distinguish between the different groups of patients, whereas decreased vestibulo-ocular reflex gain, slow saccades, and vertical gaze palsy pointed to an extracerebellar manifestation of the degenerative disease, occurring only in patients with OPCA and FA. CONCLUSIONS: In this prospective study, oculomotor disturbances were mainly related to cerebellar dysfunction. Only a few of them were caused by extracerebellar manifestations of the disease, such as slowing of saccades, which was characteristic for patients with OPCA of autosomal-dominant inheritance.     

Symptom check-lists in the diagnosis and epidemiology of neurotic disorders

Epidemiological studies related to the occurrence of neurotic disorders commonly use symptom check-lists. The results of such studies depend on, amongst others, the construction of the questionnaire and especially on the specification of the value of the questionnaire (GSI) which is determined as the boundary between the "psychophysiological" or organic symptoms and neurotic symptoms. A control study was carried out on the norms of two symptom checklists which have been used for many years in Poland: SCL-"S" (73 symptoms), most often diagnosed in neurotic patients, at the time of constructing the questionnaire and the SCL-"O" (the same 73 + 62 other symptoms). The criterion population was made up of 843 untreated subjects and 2026 patients of day-hospitals. The norms specified by the method of finding the "optimal cut-off point" were approx. 5% in the SCL-"S" and 3% in the SCL-"O" higher for the cohort of women than for men. According to those norms, about 30% of the untreated population gains the same result of Global Severity Index (GSI) as about 90% of patients treated for neurotic disorders and could be diagnosed as neurotic disorders. The GSI norms for the SCL-"S" more often indicated the existence of these disorders in the group of untreated women than in the men's group, while the norms of SCL-"O" indicate a similar frequency of the disease independently of the gender. The symptom frequency analysis presenting differences in the women (1165 ss.) and men (861 ss.) patient groups and lead also to the hypothesis on the dependency of such epidemiological data on the construction of the symptom check-lists--especially the number of variables concerning symptoms more frequent in the female and/or in the male populations.     

On consumer advocacy and the diagnosis of mental disorders.

This article provides a brief overview of the development of consumer and family advocacy activity during the past 40 years, mentioning the involvement of these groups in the treatment and research arenas and describing a dearth of such activities related to matters of diagnosis. In an attempt to address this relative inattention to diagnostic issues, the article continues by proffering a relative personal account and then reporting the results of a quasi-qualitative study that collected opinions about the diagnostic process from a selected sample of consumers. The results of the latter process indicate that these consumers' opinions primarily focus on issues of billing and insurance, labeling and stigma, axis issues, and multiple and/or changing diagnoses. The article concludes with guarded recommendations as to how mental health professionals can possibly improve the process of diagnosing persons with mental illnesses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Instrumental non invasive diagnosis of arterial circulation disorders of the extremities

1 In citrated platelet-rich plasma, freshly prepared from rabbit blood, the velocity of platelet aggregation was within limits proportional to the log of the concentration of added adenosine diphosphate (ADP). 2 Addition of either adenosine triphosphate (ATP) or its beta,y-methylene analogue inhibited aggregation similarly except that the analogue was about half as potent as ATP. beta,y-Methylene ATP also reversed the optical effects associated with the shape change of platelets very similarly to ATP itself. 3 As beta,y-methylene ATP is not a substrate for nucleoside diphosphokinase, these observations do not support the proposition that inhibition of aggregation by added ATP is due to its utilization by the nucleoside diphosphokinase of platelets.