Relationships between gastric emptying, intragastric meal distribution and blood glucose concentrations in diabetes mellitus

The aim of this study was to evaluate the prevalence of disordered intragastric meal distribution and the relationships between gastric emptying, intragastric distribution, glycemic control and gastrointestinal symptoms in diabetes mellitus. METHODS: Eighty-six patients with diabetes mellitus had measurements of gastric emptying and intragastric distribution of a radioisotopically labeled solid/liquid meal (100 g beef and 150 ml 10% dextrose), glycemic control (plasma glucose concentrations), upper gastrointestinal symptoms (questionnaire) and autonomic nerve function (cardiovascular reflexes). Results were compared to those obtained in 20 normal volunteers. RESULTS: Solid and liquid gastric emptying were delayed in the diabetic patients and correlated weakly. Intragastric meal distribution was also often abnormal, with increased retention of both solid and liquid in the proximal stomach and increased retention of solid but not liquid in the distal stomach. In all patients with increased retention of solid in the proximal stomach, emptying from the total stomach was delayed. Gastric emptying of liquid was slower in those subjects who had a mean plasma glucose > 15 mmol/liter during the gastric emptying measurement, when compared to the remainder of the group. CONCLUSION: In patients with diabetes mellitus, there is poor relationship between solid and liquid gastric emptying and intragastric meal distribution is frequently abnormal. Interpretation of the results of gastric emptying measurements should consider meal composition and plasma glucose concentrations.     

Clinical evaluation--continuous real-time intra-arterial blood gas monitoring during anesthesia and surgery by fiber optic sensor

A clinical evaluation of the clinical utility, techniques of use, durability, accuracy, and potential complications of a newly available system for the continuous real-time, intra-arterial monitoring of arterial blood gas and acid base status (ABG) has been studied (Optex BioSentry System, Optex Biomedical, Incorporated, The Woodlands, Texas, U.S.A.). The system consists of three separate fiber optic channels with contained fluorescent and absorbant chemical analytes imbedded in a single probe and capable of insertion inside of a twenty gauge indwelling arterial catheter (The Optex Optode Sensor), along with an external monitor. The system was utilized during anesthesia and surgery in the care of five informed patients. Constant trend monitoring of all three variables was deemed satisfactory in four of the patients. The fifth sensor was damaged by a surgical assistant while in place and ceased to function. Comparison of Optode sensor readings with standard clinical laboratory ABG analysis was excellent in three uncomplicated patients (pH: bias -0.0183 pH units, precision: 0.0237 pH units; PCO2: bias 3.22 mmHg, precision 2.04 mmHg; PO2: bias -5.94 mmHg, precision 11.74 mmHg). Postoperative study suggested that discrepancies in a fourth patient may have been due to an incorrect 'offset' applied to the Optode sensor yielding a constant error.     

Mesenteric ischemia secondary to cocaine abuse: case reports and literature review

In summary, we report two cases of mesenteric ischemia following cocaine abuse in young women. In such cases it is always difficult to prove a direct causal relationship between the abuse of cocaine and mesenteric ischemia. Both our patients were relatively young (in their thirties) and did not have any history of atherosclerosis, and their urine toxicity screens were positive for the use of cocaine. Cocaine-related hospital visits are on the increase. Mesenteric ischemia should be considered in the differential diagnosis when evaluating a young patient with a history of cocaine abuse presenting with an acute abdomen.     

Human immunodeficiency virus type 1 and 2 envelope glycoproteins oligomerize through conserved sequences

Hetero-oligomerization between human immunodeficiency virus type 2 (HIV-2) envelope glycoprotein (Env) truncation mutants and epitope-tagged gp160 is dependent on the presence of gp41 transmembrane protein (TM) amino acids 552 to 589, a putative amphipathic alpha-helical sequence. HIV-2 Env truncation mutants containing this sequence were also able to form cross-type hetero-oligomers with HIV-1 Env. HIV-2/HIV-1 hetero-oligomerization was, however, more sensitive to disruption by mutagenesis or increased temperature. The conservation of the Env oligomerization function of the HIV-1 and HIV-2 alpha-helical sequences suggests that retroviral TM alpha-helical motifs may have a universal role in oligomerization.     

Health promotion, health protection, and preventive services

Health promotion, health protection, and preventive services reflect the 21 priority areas of Healthy People 2000. This article focuses on the cost-effectiveness of health promotion and the role that primary care physicians can play in this initiative.     

Concurrence of Graves'' disease and dysplastic cerebral blood vessels of the moyamoya variety

A recent observation that (+)-7-deaza-5'-noraristeromycin (1), as an L-like analogue of aristeromycin, possessed meaningful anti-trypanosomal properties has prompted a search of other 7-deazapurines with similar or improved anti-trypanosomal responses. In that direction a series of pyrazolo[3,4-d]pyrimidines (that is, 8-aza-7-deaza-5'-noraristeromycin derivatives, 2-11) related to 1 have been prepared. These derivatives were evaluated against bloodstream forms of Trypanosoma brucei brucei and Trypanosoma brucei rhodesiense grown in vitro. Of these compounds, the parent L-like derivative 2 was less potent (IC50 40-70 microM) than 1 (IC50 0.165-5.3 microM) whereas the D-like analogue 3 was inactive, which is the same trend observed previously with 7-deaza-5'-noraristeromycin. Interestingly, some moderate activity (IC50 12.2-16.8 microM) was seen in the D-like 4'-methyl derivative 7 while its L-like partner was inactive.     

The cognitive mediation of obsessive-compulsive handwashing

The potential mediating roles of danger expectancies, responsibility, perfectionism, anticipated anxiety and self-efficacy on obsessive-compulsive handwashing were examined. Ratings were obtained from 27 obsessive-compulsive patients before and during a behavioural avoidance test involving a compound stimulus of potting soil, animal hair, food scraps and raw meat. Correlation and partial correlation analyses were conducted to examine the relationships between the cognitive predictor variables and anxiety, urge to wash, time in task and duration of post-test washing. Large and significant relationships between danger expectancies and the dependent measures were obtained, even when alternative mediators were held constant. No other variable remained significantly related to any of the dependent measures when severity of disease ratings were held constant. Results suggest that of the cognitive variables examined, danger expectancies are the most likely mediator of washing-related behaviour in obsessive-compulsive disorder.     

Individual perceptions of stress by dentists

This paper is concerned with individual responses of four dental practitioners to stress. The subjects were chosen on the basis of age, sex, length of time in practice and whether or not they practised solo or in a group. Responses were measured against ten stressor variables that were previously found to have occurred commonly among dentists. From these responses stressor ratings of the four subjects were obtained and compared. These ratings, which seem to be idiosyncratic and unpredictable, reflect wide differences between the respondents. The findings suggest the possibility that these differences may be attributable to personality factors and differences in coping styles, and tend to support the hypothesis that stress is a unique, perceptual and experimental phenomenon.