Major depression and irritable bowel syndrome: is there a relationship?

BACKGROUND: Irritable bowel syndrome (IBS) has been reported in 10% to 22% of adults. Seventy percent to 90% of patients with IBS who seek medical attention have psychiatric comorbidity, most commonly major depression. In contrast, few studies have looked at the prevalence of IBS among psychiatric patients. METHOD: Using a semistructured clinical interview to study the prevalence of IBS, we compared 56 patients seeking treatment for major depression in an outpatient setting to an age- and sex-matched control group of patients (N = 40) who were seeking treatment in a general physician's office for other medical illnesses. The control group had no Axis I disorders. IBS was diagnosed according to the criteria of Drossman et al. RESULTS: Twenty-seven percent (N = 15) of patients with major depression met criteria for IBS in contrast to 2.5% (N = 1) of the control group (p = .0005). Patients with major depression and IBS were more likely to report symptoms of back pain, weakness, heartburn, and nocturnal bowel movements as well as a personal or family history of bowel disease compared with patients with major depression but without IBS. CONCLUSION: IBS is fairly common in patients seeking treatment for major depression. Prospective studies should address the question whether treatment of major depression leads to an improvement or resolution of the symptoms of IBS.     

Tumor imaging with a macromolecular paramagnetic contrast agent: gadopentetate dimeglumine-polylysine

RATIONALE AND OBJECTIVES: We evaluated magnetic resonance (MR) contrast enhancement of tumor tissue following injection of the macromolecular conjugate, gadopentetate dimeglumine-polylysine. METHODS: T1-weighted MR imaging scans were performed on female Fisher-344 rats with subcutaneously implanted mammary adenocarcinoma tumors. Following the baseline scan, gadopentetate dimeglumine-polylysine or gadopentetate dimeglumine was injected at a dose of 0.1 mmol gadolinium per kilogram. RESULTS: Gadopentetate dimeglumine-polylysine injection resulted in a maximum enhancement of tumor contrast of 310 +/- 60% (n = 7). Tumor tissue remained enhanced and well defined for several days after gadopentetate dimeglumine-polylysine injection. Gadopentetate dimeglumine injection at the same dose resulted in a 70 +/- 25% (n = 4) maximal tumor enhancement and a corresponding 25 +/- 4% muscle enhancement. CONCLUSION: Gadopentetate dimeglumine-polylysine provides higher, more sustained tumor contrast than does gadopentetate dimeglumine for the same dosage of gadolinium.     

Perioperative blood transfusion does not prevent recurrence in Crohn's disease. A pooled analysis

The effect of perioperative blood transfusion on the recurrence of Crohn's disease is controversial. Various studies have suggested that perioperative blood transfusions reduce the risk of recurrence; others have failed to find a protective effect. Since all the studies are based on relatively small numbers, we performed a pooled analysis. We contacted the senior authors of seven previously published studies and asked for the original data. Four authors provided their data. The pooled database included 622 patients with a primary and complete resection of macroscopic disease. Recurrence was defined as the need for repeat surgery for disease control. Kaplan-Meier life table analysis was performed. Of the study sample, 366 cases (59%) were female. Disease distribution was as follows: small bowel (47%), small/large bowel (35%), and large bowel only (18%). Three hundred thirty-one patients (53%) received blood in the perioperative period. Mean follow-up was 72.8 months. For the overall sample, the 5-year recurrence rates were 26.9% for the transfused group and 25.2% for the nontransfused (p = 0.456). When the data were stratified by age, gender, disease location, and length of resection, no difference in 5-year recurrence rates between transfused and nontransfused cases could be detected. In this pooled analysis of four retrospective studies on the effect of blood transfusions on the risk of recurrence in Crohn's disease, we were unable to document a protective effect.     

Clavicular Auscultation. Preferential clavicular transmission and amplification of aortic valve murmurs

1. A diet based on soybean meal and wheat contained insufficient chloride to support normal growth in chicks. 2. Ammonium chloride and sodium chloride were equally good sources of supplementary chloride for the chick. 3. When seven diets providing increasing proportions of chloride from 608 to 1808 mg/kg, were fed to chicks, maximal growth at 21 d was obtained at about 1200 mg chloride/kg diet.     

Iron deficiency in the rat. Physiological and biochemical studies of muscle dysfunction

Work performance on a treadmill has been evaluated in normal and iron-deficient rats. Anemia was removed as a variable by adjusting the hemoglobin of all animals to the same concentration. At a hemoglobin compatible with normal work performance, iron-deficient animals showed a marked impairment of running ability as compared to control animals. Iron therapy corrected the disability within 4 days. Concentrations of the cytochrome pigments and myoglobin, and rates of oxidative phosphorylation with pyruvate-malate, succinate, and alpha-glycerophosphate as substrates were all reduced in mitochondrial preparations from skeletal muscle of iron-deficient rats, but only the rate of phosphorylation with alpha-glycerophosphate as substrate increased significantly and in parallel with the recovery in work performance of the iron-deficient rats treated with iron dextran.     

Sugar absorption by small bowel biopsy samples from patients with primary lactase deficiency and with adult celiac disease

The present study was undertaken to compare the 3-O-methyl-D-glucose (3MG) absorption by jejunal biopsies from normal human subjects (N = 3) with that by the jejunum of the rat (N = 8) and of the hamster (N = 8), and to examine whether jejunal biopsies from normal subjects (N = 3), patients with primary lactase deficiency (N = 5) and from patients with celiac sprue (N = 5) follow the same pattern of sugar absorption as usually observed in vivo. The results indicate that under the conditions of our experiments the estimated affinity of carrier for 3MG (ie, apparent Km) in the biopsies from normal subjects did not differ significantly from that in rat or hamster jejunum. The estimated capacity of carriers for 3MG absorption (ie, Vmax) appeared to be similar in biopsies from normal subjects and in hamster jejunum, but significantly lower in rat jejunum. There was no difference in apparent Km between the biopsies from normal subjects and those from the patients with lactase deficiency. Although the Vmax for the lactase deficient patients was substantially higher than that for the normal subjects, the difference was not statistically significant. The absorption of 3MG by the biopsies from patients with celiac sprue did not follow Michaelis-Menten kinetics and was compatible with that of passive diffusion or low saturation conditions. Since the intracellular concentration of 3MG in all biopsies from celiac patients exceeded the concentration of the media, sugar transport could not have occurred by diffusion, and it is concluded that the absence of Michaelis-Menten kinetics was the result of low saturation conditions. This active transport with low saturation kinetics in patients with celiac disease suggests that in these patients not only the number of functioning carrier molecules is diminished but also the affinity of the existing carrier for sugar molecule is reduced. This situation, at least in some patients, seems to improve after treatment with gluten-free diet.