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BACKGROUND/AIMS: Functional dyspepsia (FD) is one of the commonest diseases in the field of Internal Medicine. The Japanese Society of Gastroenterology (JSGE) has been enlightening the term and concept of FD. Aim of this survey was to elucidate the understanding status of FD and Rome criteria and attitude toward FD among Japanese internists. METHODS: Data were collected at the time of lifelong education course for certified members of Japanese Society of Internal Medicine. Self-administered questionnaires were delivered to the medical doctors prior to the lectures. RESULTS: Analysis subjects were 1,623 (24-90 years old) internists among 1,660 medical doctors out of 4,264 attendees. The terms related to FD were known in 62.0-68.9% of internists, whereas 95.5% understood chronic gastritis. Internists who had been taking care of FD patients informed them as chronic gastritis (50.0%), FD in Japanese Kanji character (50.8%) and FD in Kanji and Katakana (18.6%). Logistic linear regression analysis revealed that positive factors for the understanding of FD and intensive care for FD patients were practitioner, caring many patients and certified physician by JSGE. Existence of Rome criteria was known in 39.9% of internists, and 31.8% out of them put it to practical use. The certified physician by JSGE was a positive factor for awareness, but not for utilization. CONCLUSIONS: The results suggest the needs of enlightening the medical term FD in Japan and revision of Rome criteria for routine clinical practice. Precise recognition of FD may enhance efficient patient-based clinical practice.
Subject(s)
Humans , Asian People , Dyspepsia , Education , Gastritis , Gastroenterology , Critical Care , Internal Medicine , Japan , Lecture , Linear Models , Surveys and QuestionnairesABSTRACT
The gastric barostat study is the gold standard method for evaluating gastric perception and accommodation. This technique has serious drawbacks, such as expense and invasiveness. Several drinking tests have been developed as noninvasive methods. Such tests are easily performed without special instruments and are well tolerated. We have reported that (1) a threshold volume inducing mild bloating in the slow nutrient drinking test might be an alternative parameter of gastric accommodation volume as determined by the barostat method and (2) the maximum satiety volume in the drinking test correlated positively with the pressure to induce severe discomfort in healthy volunteers, indicating that the slow nutrient drinking test may be useful for evaluating accommodation volume and the threshold to induce severe discomfort. However, the correlation between the maximum satiety drinking volume and accommodation volume as measured by the barostat study has been controversial. Therefore, validation of a certain nutrient drink test for measuring gastroduodenal function might be recommended in each institution.
Subject(s)
DrinkingABSTRACT
Objective: To develop an effective and safe therapeutic strategy, we studied the effect of the clinical characteristics of patients with acute drug intoxication on the duration of hospitalization. <br>Subjects and Methods: The subjects were 89 patients hospitalized for acute drug intoxication. They were divided into two subgroups; the short hospitalization group (duration of hospitalization < 7 days) and the long hospitalization group (duration of hospitalization ≥ 7 days). We compared age, sex, vital signs, drugs, and therapy between the two groups. <br>Results: There were no significant differences in sex or severity of consciousness disturbance between the short- and long-hospitalization groups. Age in the latter group was higher than that in the former, and age was significantly and positively correlated with the duration of hospitalization. Prolongation of hospitalization in patients with Japan Coma Scale (JCS) I or II is associated with psychiatric disease, and in patients with JCSIII, with physical disease. We used direct hemoperfusion (DHP) to treat patients with severe acute drug intoxication. The duration of hospitalization in patients treated by DHP tended to be shorter than those not so treated. <br>Conclusions: The present results suggest that aging is associated with prolongation of hospitalization and the onset of physical disease among patients with acute drug intoxication. When elderly patients with acute drug intoxication are treated in a primary-care setting, the question of whether or not physical diseases are present as complications should be considered. The appropriate use of DHP for the treatment of patients with severe acute drug intoxication requires further study.
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The purpose of this research was to study the effects of Tu-Chung extract (Eucommia ulmoides OLIV.) administration on serum testosterone and the possible mechanisms in hindlimb- suspended rats. 25 five-week old male Wistar rats were used. All rats were randomly divided into two groups : those treated with Tu-Chung extract (Tu-Chung G, n=suspended for 37 days in hindlimb. 1 mg/ml Tu-Chung extract was administered orally once daily at a dose of 1 ml/100 g body weight. Distilled water was administered in a similar way to the control group. The following results were observed :<BR>1. Serum testosterone concentration in Tu-Chung G was significantly higher than in Cont. G (P<0.001) .<BR>2. There was no significant difference between Tu-Chung G and Cont. G in serum LB concentrations.<BR>3. The Testicular cAMP level in Tu-Chung G was significantly higher than that in Cont. G (P<0.01) .<BR>4. 24-h urinary excretion of 17-ketosteroid in Tu-Chung G was significantly higher than that in Cont. G (P<0.001) .<BR>5. There were no significant differences between the two groups in the weights per body weight of the kidneys, adrenal grand and testes. These results suggest that the adininstration of Tu-Chung extract inducing high serum testosterone concentrations in hindlimb-suspended rats might be due to enhanced testicular and adrenal functions, not pituitary.
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A 67-year-old man receiving treatment for choledocholithiasis was found to have an abdominal aortic aneurysm on CT. The maximum diameter of the aneurysm was 60mm, and the isthmus of a horseshoe kidney was also observed. A total of four renal arteries, two each on the right and left sides, was detected by angiography and helical CT. Two of four arteries bifurcated from the aneurysm. Laparotomy confirmed the presence of a fifth renal artery, which extended from the left common iliac artery to the isthmus. It was not difficult to free the isthmus from the aneurysm. A Y-shaped prosthesis was placed between the normal portion of the aorta and the common iliac arteries without severing the isthmus. The left renal artery arose from the aneurysm and was reconstructed with 6mm knitted Dacron. The right renal artery, which was located below the isthmus, was ligated. The absence of postoperative renal dysfunction confirmed the patency of the reconstructed renal artery. Eleven such cases have been reported in Japan, including the present case. In 5 cases, renal artery reconstruction was performed, and the isthmus was preserved in 8 cases. However, the sites of renal artery bifurcation were correctly detected preoperatively in only 3 of these patients. It appears that accurate preoperative imaging is very important, along with renal artery reconstruction.
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The long-term efficacy of various treatments for intermittent claudication was studied to determine which regimen should be selected. Two hundred and nineteen patients with arteriosclerosis obliterans (ASO) and intermittent claudication of the extremities were divided into two groups based upon the type of treatment: 1) 170 patients who underwent arterial reconstruction and 2) 49 receiving conservative treatment. Fifty-five patients with Buerger's disease (TAO) with intermittent claudication were divided into three groups: 1) 17 patients who underwent arterial reconstruction, 2) 15 with lumbar sympathectomy, and 3) 23 receiving conservative treatment. The background factors of both disease groups were analyzed, and the changes in claudication, the quality of life, and the survival rate were followed up. Among ASO patients, the improvement of intermittent claudication was significantly better in the arterial reconstruction group (<i>p</i><0.001) than in the conservative treatment group. The quality of life and 5-year surival rate were also superior in the arterial reconstruction group (<i>p</i><0.01), and they were closely related to the improvement of intermittent claudication. On the other hand, there was no significant difference in any of these parameters between the three groups of TAO patients. This discrepancy in outcome was concluded to be due to differences in the background factors of the two diseases. Accordingly, the treatment for intermittent claudication should be discussed making a clear distinction between ASO and TAO. In conclusion, the treatment of choice for intermittent claudication is arterial reconstruction in ASO patients, whereas surgical treatment should only be considered for TAO patients when conservative therapy is ineffective.
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Ulcer developed on the left leg of a 47-year-old man, in 1989, and phlebography showed deep vein thrombosis extending from the politeal to the common femoral vein. Subfascial ligation of the perforators achieved healing of the ulcers. In November 1991, at the age of 52 years the patient noticed a pulsatile mass on the right side of his neck. CT scanning showed a carotid artery aneurysm 4cm in diameter. Angiography indicated that the aneurysm was located at the bifurcation of the carotid artery. In February 1992, reconstructive surgery was performed with a Dacron graft, but an anterile abscess developed around the graft. In September 1992, the graft was removed and the carotid artery was ligated. Only seven cases of carotid aneurysm associated with Behçet's disease have previously been reported in Japan. Five of them underwent reconstructive surgery and two of them underwent carotid ligation due to complications. Because of the clinical course of Behçet's disease, carotid aneurysmectomy without reconstructive surgery may be the procedure of choice.
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An educational video describing the acupunctural stimulation of the pudendal nerve for treatment of urinary disturbances was produced. Treatment points on the meridian were selected within the limits of the top 1/2 to 3/5 of the line that connects the superior posterior iliac spine and the inner lower edge of the ischiatic tuberosity. Since the pudendal nerve is situated between the sacrospinous ligament in this region, it could be readily stimulated from the body surface. A 90mm (#24) acupuncture needle was used for the treatments. When the needle was inserted to a depth of 50-80mm from the body surface, the pudendal nerve was reached. Echo sensation in the penis indicated that the acupuncture needle had contacted the pudendal nerve.<br>Either the sparrow-pecking, needle-twisting, or the low frequency acupunctural techniques were used to delver stimulation to the pudendal nerve. In conclusion, acupunctural stimulation of the pudendal nerve was clinically useful for treatment of urinary disturbances, such as uncoordination of the detrusor muscles in neurogenic bladder and urinary incontinence.
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Effects of acupuncture on SHENSHU were examined in Gromerular Filtration Rate (GFR) by creatinine clearnce tests, urinary volume, urinary substancce (Na, K, Cl, Cre, BUN, UA) and plasma substance (the same substance as urines) on 7 normal examinees. The subjects were divided in two experimental groups (control and stimulation on SHENSHU).<br>Except for K level in plasma, there had not been found a significant change. However, urinary volume had a tendency to increase. Plasma K level at 90 minute in stimulation group showed a statitical increase. The results were as follows. Compared with control group, There was no significant change in GFR, urinary volume, urinary substance levels, plasma levels except for plasma K level.
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We investigated effects of renal function by acupuncture stimulation on SHENSHU as an index on phenol-sulfonphthalein (PSP) test.<br>Acupuncture stimulation on SHENSHU group was increased excretion rate in PSP values in 15minutes with consistency of statistical value when comparted to without acupuncture stimulation group (P<0.02). From the results of this experiment, acupuncture stimulation on SHENSHU seems to activate the excretory function in proximal renal tubule. And this suggests that acupuncture stimulation on SHENSHU may accelerate the renal plasma flow (RPF) rate.