Abnormally rapid gastric emptying of an isosmotic liquid meal in patients with megaduodenum.

Duodenal resistance to gastric outflow is known to participate in the regulation of gastric emptying of liquids in animals, but the role of this mechanism in humans has not been extensively investigated. In this work we studied the gastric emptying of liquids in patients with megaduodenum, who putatively have increased duodenal receptivity to gastroduodenal transfer of liquids. Subjects included eight patients with megaduodenum and eight healthy volunteers. Since megaduodenum in all cases was associated with Chagas' disease, a further reference group consisting of 11 chagasic patients without megaduodenum was also studied. Fasted subjects ingested 200 ml of an isotonic dextrose solution labeled with 15 MBq of technetium-99m coupled to sulfur colloid, as an unabsorbable marker. Images of the anterior aspect of the stomach were taken immediately after test meal ingestion and thereafter up to 1 hr. Decay-corrected counts over the gastric region along time yield the calculation of early (5 min) and late (60 min) gastric retention as well as gastric emptying half-times (T1/2). Early gastric retention in patients with megaduodenum (median; range: 48%; 18-64%) was significantly lower (P < 0.05) than in both patients without megaduodenum (59%; 40-86%) and controls (82%; 68-99%). T1/2 values in patients with megaduodenum (5 min; 3-17 min) were also significantly lower (P < 0.01) than in patients without megaduodenum (23 min; 4 to >60 min) and controls (29 min; 13-60 min). There were no significant differences between the three groups concerning late gastric retention. We conclude that the early phase of gastric emptying of liquids is abnormally accelerated in patients with megaduodenum, which suggests that increased duodenal receptivity may have a significant effect on the gastroduodenal transfer of liquids in humans.

An improved mouth-piece to prevent environmental contamination during radioaerosol inhalation procedures.

The literature suggests that environmental contamination is common during labeled aerosol inhalation procedures in nuclear medicine. We have tested an adherent mask to prevent environmental contamination in 70 procedures. Two groups of patients were evaluated. Group 1 (60 inhalation cases in which the mask was used) presented no environmental contamination in 95% of the procedures (means of 553 dpm and 596 dpm before and after inhalation, p > 0.05, mean of the differences before/after inhalation 6.95, SD = 21.2 dpm) and the only 3 cases in which contamination did occur concerned bearded men; Group 2 (10 inhalation cases in which the mask was not used) showed large increases of environmental radioactive levels in 70% of the procedures (means of 601 dpm and 2,756 dpm before and after inhalation, p < 0.05, mean of the differences 3,066, SD = 2,98 dpm). We conclude that such a mask is very helpful in avoiding environmental contamination during radioaerosol inhalation procedures.

Abnormal intragastric distribution of a liquid nutrient meal in patients with diabetes mellitus.

Disordered gastric motility and emptying are well known complications of diabetes mellitus (DM), but the pattern of intragastric distribution of food has not been extensively studied in diabetics. We examined the partition of a liquid nutrient meal between the proximal and distal stomach and the relationships between intragastric distribution of food and gastric emptying (GE) and the symptoms in DM patients with and without autonomic neuropathy (AN). Fourteen healthy volunteers and 20 DM patients (13 with AN; 9 with dyspepsia symptoms) ingested a liquid nutrient meal (250 ml; 437 kcal) labeled with [99mTc]phytate. Anterior and posterior serial images of the stomach were taken for 90 min with a gamma camera. Regions of interest for the proximal and the distal halves of the stomach and for the total gastric area were defined. Counts from each region along time allowed estimation of GE and the proportion of activity retained in the proximal stomach after meal ingestion (initial) and throughout GE (mean). GE half-times in controls (median; range: 66 min; 29-90 min) were not significantly different from diabetics (76 min; 5->150 min, P > 0.10), but abnormal GE was found in 11 DM patients (seven delayed and four rapid). In DM patients, initial retention in the proximal stomach (42%; 16-79%) was significantly lower (P < 0.02) than in controls (55%; 44-71%). Mean retention in the proximal stomach throughout emptying also was significantly lower (P < 0.05) in DM patients (43%; 18-58%) than in controls (51%; 32-69%). There were no differences between subgroups of patients with normal, delayed, or rapid gastric emptying regarding mean meal retention in the proximal stomach. Patients with evidence of AN or with dyspepsia symptoms had significantly decreased retention of food in the proximal stomach throughout gastric emptying. We concluded that patients with diabetes mellitus have abnormally decreased retention of gastric contents in the proximal stomach after a liquid meal, which seems to be related to the occurrence of autonomic neuropathy and dyspepsia symptoms, but not to disordered gastric emptying.

[Increased intestinal permeability to 51 Cr-EDTA among children with persistent diarrhea]. / Aumento da permeabilidade intestinal ao 51Cr-EDTA em crianças com diarréia persistente.

Persistent diarrhea, a condition highly prevalent in developing countries, causes different morphological and functional alterations of the mucosa of the small intestine, including increased permeability to different test molecules. In the present study we investigate for the first time the intestinal permeability to 51Cr-EDTA of Brazilian children with persistent diarrhea. The test of 51Cr-EDTA absorption was performed in 13 control children and in 14 children with persistent diarrhea by offering 50 microCi of the test substance by the oral route, with later detection of radioactivity excreted in 24-hour urine. There was a statistically significant difference between the control group (median = 1.26; range = 0.20-3.31%) and the group with persistent diarrhea (median = 4.68; range = 1.40-10.29%). Using the minimum and maximum values detected in the control group as the normal reference standard for the test of urinary 51Cr-EDTA absorption, we observed that 61.5% of the patients with persistent diarrhea showed altered results. Among the patients with persistent diarrhea, 51Cr-EDTA excretion was significantly higher in the group fed a protein hydrolysate diet and/or total parenteral nutrition than in the group that did not receive this diet. In four patients with persistent diarrhea, the test was performed after clinical recovery, with a fall in the excretion levels in all cases. On the basis of these data, we may conclude that: 1) in persistent diarrhea there must be alteration of intestinal permeability that might permit an increased entry of local alimentary antigens, with subsequent sensitization and allergic enteropathy, contributing to the perpetuation of the diarrhea, malabsorption and malnutrition cycle; 2) the 51Cr-EDTA test may be useful as an indicator of severity in persistent diarrhea; 3) alteration of intestinal permeability is a secondary phenomenon in persistent diarrhea, with normalization occurring after reconstruction of the intestinal barrier.

Age-related reduction in 99Tcm-DTPA alveolar-capillary clearance in normal humans.

Age is known to reduce the efficacy of body organs and systems, even in the absence of disease. The alveolar-capillary clearance (ACC) rate is representative of the alveolar-capillary barrier's functional state. We studied 29 healthy non-smokers, who were selected after clinical and radiographic evaluation. The patients were divided into three groups based on age: Group I, < or = 30 years (n = 10); Group II, 31-55 years (n = 9); Group III, > or = 56 years (n = 10). Each patient inhaled 750 MBq 99Tcm-diethylenetriamine pentaacetate (99Tcm-DTPA) aerosol generated by a Venticis nebulizer (particles with a mean diameter of 1.1 microns) for 5 min. Forty frames of 30 s duration each were acquired and the ACC rates for the right and left lungs determined using a computer program. The mean ACC rates for the three groups were as follows: Group I, 1.31% min-1; Group II, 1.08% min-1; Group III, 0.76% min-1. The differences between Groups I and III (P < 0.001) and Groups II and III (P = 0.03) were shown to be significant. There was no significant difference between Groups I and II. Possible explanations for an age-related reduction in ACC rates include a reduction in the internal alveolar surface, the closure of the small airways, a reduction in the lung blood capillaries and a reduction in cardiac output. We conclude that there appears to be an age-related reduction in ACC rates in healthy non-smokers, even in the absence of clinically and radiographically detectable lung disease. However, larger studies are required.

[Assessment of intestinal permeability using 51 CrEDTA: clinical usefulness in the detection of small bowel epithelial structural abnormalities]. / Estudo da permeabilidade intestinal pelo teste do 51CrEDTA: utilidade clínica na detecção de alterações estruturais do epitélio do intestino delgado.

Intestinal permeability tests have been increasingly used in the clinical management of small bowel diseases. Nevertheless, the application of such tests in Brazil is still limited. In this study we report the results of the application of 51Cr-EDTA for assessment of intestinal permeability in 13 healthy volunteers, 10 control patients with miscellaneous disorders, but without evidence of small bowel involvement, 11 patients with well characterized diseases affecting the small bowel, and five patients with inflammatory conditions affecting exclusively the colon. Urinary radioactivity levels in the 24 h following the ingestion of 51Cr-EDTA, expressed as the percentage of the ingested dosis, ranged from 1.99 to 5.93% (median: 3.14%) in healthy volunteers and was not significantly different from the results obtained in control patients (range: 1.48-3.98%; median 3.32%). Based on data from these two control groups, an upper limit of the normal range was set at 5.17% (95% confidence interval). Among patients with diseases of the small bowel, results ranged from 1.58 to 14.85% (median: 8.07%) and were significantly different from those observed in the control groups. Only two out of the 11 patients in this group had abnormal results. In the group of patients with diseases of the colon, results ranged from 3.48 to 5.13% (medium: 4.54%) and were not significantly different from the results obtained in control subjects. All patients in this group had results within the normal range. Data from control subjects and patients with diseases of the small bowel were used for the calculations of sensitivity (81%), specificity (96%), as well as false-positive (4.3%) and false-negative (18.1%) rates. Taken as a whole, the results of the present study indicate that the 51Cr EDTA test of intestinal permeability is accurate and may be useful in the clinical management of small bowel diseases in Brazilian patients.

Hypothyroidism affects pulsatile LH secretion in pubertal orchiectomized rats.

The present study evaluated the effect of hypothyroidism on the pituitary-testicular axis in rats rendered hypothyroid on the beginning of puberty. Rats were treated with propylthiouracil for 8 weeks and killed for determination of hormonal status and body parameters. For determination of pulsatile LH secretion other animals were orchiectomized two weeks before sampling. Analysis of the results led us to conclude that although the absolute weight of sex organs tended to decrease in hypothyroid animals, the relative weights were equal or higher than control, suggesting that the development of these organs were not affected by hypothyroidism; the androgenic activity of hypothyroid rat testes were preserved; basal plasma levels of pituitary hormones were similar in control and hypothyroid groups; the pulsatile LH secretion showed a decrease in the number of pulses, nadir mean and total LH secretion in hypothyroid animals. Our results demonstrate that although hypothalamic-pituitary axis of hypothyroid pubertal rats displays an abnormal pulsation LH release, no evidences of abnormalities in the reproductive system functions were found.

The spectrum of esophageal motor disorders in Chagas' disease.

OBJECTIVE: To determine the patterns of esophageal motility found in patients with Chagas' disease. METHODS: Clinical, manometric, and scintigraphic data were obtained from 43 subjects with positive serological tests for Chagas' disease and nondilated esophagus and 10 patients with Chagasic megaesophagus. RESULTS: Twenty (46.5%) of the seropositive subjects with nondilated esophagus were asymptomatic, and 23 (53.5%) had dysphagia, but only 12 (27.9%) had persistent dysphagia, a feature typical of Chagasic megaesophagus; only two (4.6%) had chest pain. Manometric findings within the seropositive group were: normal motility in 16 subjects, peristaltic multipeaked contractions in three, aperistalsis of the esophagus with relaxing lower esophageal sphincter in nine, and aperistalsis with nonrelaxing lower esophageal sphincter in 15 subjects. All of 10 megaesophagus patients had aperistalsis of the esophagus plus nonrelaxing lower esophageal sphincter. Scintigraphy was as sensitive as manometry in detecting esophageal dysmotility, but the erect scintigraphy was abnormal in subjects with complete aperistalsis only. CONCLUSION: In Chagas' disease, megaesophagus appears to be a disorder at the most severe end of a spectrum encompassing classical achalasia and its milder variants. Other esophageal motility disorders are rare, but normal esophageal function is common.

Treatment of diabetic gastroparesis with oral clonidine.

BACKGROUND/AIMS: Clonidine, a specific alpha-2-adrenergic receptor agonist, has been suggested to improve symptoms of gastroparesis in diabetics with diarrhoea. The aim of this study was to investigate the effects of clonidine on gastric emptying and symptoms suggestive of gastroparesis in patients with longstanding diabetes mellitus and evidence of autonomic neuropathy. METHODS: Six diabetics with chronic, refractory symptoms of bloating, nausea and vomiting were studied. Gastric emptying of a liquid nutrient meal (250 mL; 430 kcal) was evaluated by scintigraphy and symptoms were scored. Patients were treated with clonidine (median dose: 0.3 mg/day) for 2-12 weeks (median: 4 weeks), after which symptoms and gastric emptying were re-evaluated. Treatment was then sustained for a median follow-up period of 7 weeks (range: 2-56 weeks). RESULTS: Gastric emptying half-time values in diabetic patients ranged from 16 to 180 min (median: 100 min) and four patients had abnormally delayed emptying before treatment. In all patients, half-time values decreased during treatment (median: 35 min; range: 14-106 min, P < 0.025 vs. pre-treatment values) and in three of the four patients with abnormal gastric retention, half-time values returned to the normal range. During clonidine treatment, a substantial decrease in the score for symptoms was observed (median and range: 7.5; 2-9 vs. 0; 0-9). In four patients, symptoms virtually disappeared, an effect that was maintained throughout follow-up (6-56 weeks). CONCLUSIONS: These findings suggest that impairment of adrenergic influences on gastrointestinal motility control may play a role in the pathophysiology of diabetic gastroparesis and that clonidine may be a useful alternative for treating patients with this condition.

Effect of isosorbide dinitrate on gastroesophageal reflux in healthy volunteers and patients with Chagas' disease.

The effect of isosorbide dinitrate (ISD) on gastroesophageal reflux and gastric emptying during the 24-min period following a liquid meal was studied in healthy volunteers, Chagas' disease patients with normal esophageal motility (CD-1 group), and Chagas' disease patients with esophageal dysmotility (CD-2 group) with dynamic scintigraphy. At random, on two separate days, the subjects received 5 mg isosorbide dinitrate or an identical-appearing placebo tablet, by the sublingual route, and ingested a liquid test meal containing [99mTc]phytate colloid before scintigraphic studies were performed. Gastroesophageal reflux episodes were more frequent (P = 0.016) and gastroesophageal reflux indexes were greater (P < 0.010) after isosorbide dinitrate than after placebo in CD-2 group (N = 15) but not in healthy volunteers (N = 14) or CD-1 group (N = 9); six of seven CD-2 patients presenting with gastroesophageal reflux after isosorbide dinitrate had abnormal clearance of refluxate. Gastric emptying was similar in healthy volunteers (N = 13), CD-1 patients (N = 6), and CD-2 patients (N = 13), and no effect of isosorbide dinitrate on it was detected in any of the groups. In separate studies, 5 mg isosorbide dinitrate reduced the lower esophageal pressure (P < 0.01) in seven CD-2 patients. These results indicate that ISD increases the tendency towards GER in CD-2 patients, but not in healthy volunteers or CD-1 patients. This effect is probably related to an exceedingly intense relaxation of the LES caused by ISD in CD-2 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormal progression of a liquid meal through the stomach and small intestine in patients with Chagas' disease.

This study describes the abnormal pattern of gastrointestinal progression of a liquid meal in patients with the digestive form of chronic Chagas' disease. This condition is known as a natural model of intramural denervation of the gut. Sixteen patients with clinical and radiographic evidence of esophageal and/or colonic involvement and 18 healthy volunteers were studied. Orocecal transit time after the ingestion of a 10% lactulose solution (180 ml) tagged with 99mtechnetium was measured by a conventional H2 breath technique. Gastric emptying and the arrival of the front of the meal to regions of interest corresponding to proximal and distal areas of the small intestine were assessed by abdominal scintigraphy. Orocecal transit time was significantly greater (P < 0.05) in Chagas' disease patients (N = 13) than in control subjects (N = 18) (mean +/- SD: 100.7 +/- 48.7 min vs 62.9 +/- 18.2 min). Half-time for gastric emptying of liquids in chagasic patients (N = 9) was significantly lower (P < 0.01) than in controls (N = 7) (9.7 +/- 2.7 min vs 26.4 +/- 3.4 min). The time of arrival of the liquid meal to the proximal small intestine was also significantly shorter (P < 0.02) in patients than in controls (5.6 +/- 3.7 vs 11.4 +/- 5.5 min), but there was no difference between the two groups concerning the time the meal first arrived to the distal small intestine (15.0 +/- 11.0 min vs 23.5 +/- 11.4 min, P > 0.05). These results indicate that patients with Chagas' disease have a combination of exceedingly rapid gastric emptying and abnormally delayed transit of liquids through the more distal segments of the small bowel.(ABSTRACT TRUNCATED AT 250 WORDS)

Distribution and properties of endo-oligopeptidases A and B in the human neuroendocrine system.

The thiol activated endo-oligopeptidases A and B were studied in the soluble fraction of human hypothalamus and various endocrine glands. For the identification, characterization and purification of the enzymes, Z-Gly-Pro-NH-Np and bradykinin were used as substrates. Endo-oligopeptidase B showed a molecular mass ranging from 55.5 to 65.5 kDa and isoelectric point from 4.7 to 4.95. Its activity in tissues was highest in the testis, with intermediate levels in the thyroid, neurohypophysis, adenohypophysis and hypothalamus and the lowest activity in the pineal gland. Endo-oligopeptidase A, 467-fold purified by immunoaffinity chromatography, exhibited a molecular mass of 65.5 kDa in the adenohypophysis but 58.5 kDa in other tissues. The isoelectric point ranged from 5.22 to 5.50. High endo-oligopeptidase A activity was observed in the adenohypophysis, testis and hypothalamus with lesser activity in the neurohypophysis and thyroid and the lowest in the pineal gland. Endo-oligopeptidase A cleaved the bonds Phe-Ser of bradykinin, Met-Arg of BAM-12P and Arg-Arg of neurotensin as described for rabbit brain and heart and bovine brain enzymes. This work shows that endo-oligopeptidase A also hydrolysed the bonds Tyr-Gly of LH-releasing hormone, Pro-Phe of angiotensin I and Tyr-Ile of angiotensin II.

Short report: comparison of the effects of sublingual nifedipine and isosorbide dinitrate on oesophageal emptying in patients with Chagasic achalasia.

The effects of sublingual nifedipine and isosorbide dinitrate on oesophageal emptying were compared in 11 patients with Chagasic achalasia. The oesophageal emptying of a radiolabelled test meal was assessed three times in each patient by a scintigraphic technique. No treatment preceded one of the studies (basal study). Nifedipine (20 mg) by the sublingual route 30 min before the meal, preceded one study. Isosorbide dinitrate, 5 mg by the sublingual route 5 min before the meal, preceded the third study. The order of the studies was allocated randomly for each patient. Oesophageal retention at the completion of the meal was significantly less (P less than 0.01) after isosorbide dinitrate (median: 54%, range: 5-87%) than after sublingual nifedipine (median: 78%, range: 7-99%) or after the control study (median: 83%, range: 5-100%). This difference persisted up to 20 min after the meal. Values measured in the control study and after sublingual nifedipine were not different (P greater than 0.10). These results show that isosorbide dinitrate, but not sublingual nifedipine, enhances oesophageal emptying in Chagasic achalasia.

[Paracoccidioidomycosis assessed with 4 isotopic studies]. / La paracoccidioidomycose évaluée par quatre études isotopiques.

Paracoccidioidomycosis (south-american blastomycosis) is a consumptive granulomatous disease that is found in all Latin-America. The ethiological agent is a fungus (Paracoccidiosis brasiliensis) and mechanisms of disease transmission are not clear. Affection is frequent in the lungs, liver, spleen, ganglia, oropharynx and brain. Disease's response to therapy (Amphotericin, Ketoconazole) is good but recurrence is frequent. We have studied 12 patients with gallium-67, bone scintigraphy, bone marrow scintigraphy and lymph-scintigraphy. Six of these patients were re-studied after variable time of therapy. Gallium-67 accumulated in all patients's lungs. Other abnormal areas included ganglia, liver, spleen and bone. Bone scintigraphy was abnormal in all bone sites that were abnormal at the gallium study. Bone marrow scintigraphy showed expansion to the periphery in 6/12 cases and lymph nodes accumulated the radiopharmaceutical in 5 patients. Patients re-studied after the beginning of therapy presented decreased degrees or normalization of the radio-pharmaceutical's uptake (gallium and MDP), a regression of the bone marrow periphery expansion (bone marrow scintigraphy) and normalization of the lymph node aspects. These four radioisotopical studies may be useful for staging and for therapy follow-up. The sensitivity of the method is greater than the one noted for the conventional radiological studies.

Scintigraphic study of the gastrointestinal transit of a liquid meal in patients with chronic Chagas' disease.

Gastric emptying and small bowel transit of a liquid meal (isotonic dextrose) were assessed by a scintigraphic technique in 16 patients with Chagas' disease involving the esophagus and/or the colon, including one case with mega-jejunum, and in 10 control subjects. Initial gastric emptying was faster in the Chagas' disease group than in controls (gastric retention at 15 min, median and (range): 52% (15-86) vs 71% (43-97), P < 0.01) although there was no significant difference in total gastric emptying (T1/2: 20 min (4-132) vs 31 min (13-280), P > 0.05). Both the front (time to reach the proximal small bowel: 2.5 min (2.5-8) vs 15 min (5-40), P < 0.01) and the bulk of the meal (geometric center values at 15 min: 1.8 (1.2-2.4) vs 1.6 (1.2-1.8), P < 0.05) travelled faster through the proximal small bowel in Chagas' disease patients than in control subjects. There was no difference between the two groups concerning the time taken by the front of the meal to arrive to the caecum (110 min (15-180) vs 90 min (60-140), P > 0.20), but a precise delineation of this region was possible in only less than half of the patients and controls. In the patient with mega-jejunum, a remarkable delay in the intestinal progression of the liquid meal was found. These results suggest that the diffuse lesion of the enteric nervous system in chronic Chagas' disease mainly affects the control of gastric emptying and leads to accelerated proximal small bowel transit of a liquid meal.(ABSTRACT TRUNCATED AT 250 WORDS)

Scintigraphic study of the gastrointestinal transit of a liquid meal in patients with chronic chagas'disease

Gastric emptying and small bowel transit of a liquid meal (sotonic dextrose) were assessed by a scintigraphic technique in 16 patients with Chagas'disease involving the esophagus and/or the colon, including one case with megajejunum, and in 10 control subjects. Initial gastric emptying was faster in the Chagas'disease group than in controls (gastric retention at 15 min, median and (range): 52% (15-86) vs 71% (43-97), P<0.01) although there was no significant difference in total gastric emptying (T1/2:20 min (4-132) vs 31 min (13-280), P>0.05). Both the front (time to reach the proximal small bowel: 2.5 min (2.5-8) vs 15 min (5-40), P<0.01) and the bulk of the meal (geometric center values at 15 min:1.8(1.2-2.4) vs 1.6(1.2-1.8), P<0.05) travelled faster through the proximal small bowel in Chagas'disease patients than in control subjects. There was no difference between the two groups concerning the time taken by the front of the meal to arrive to the caecum (110 min (15-180) vs 90 min (60-140), P>0.20), but a precise delineation of this region was possible in only less than half of the patients and controls. in the patient with megajujunum, a remarkable delay in the intestinal progression of the liquid meal was found. These results suggest that the diffuse lesion of the enteric nervous system in chronic Chagas'disease mainly affects the controlnof gastric emptying and leads to accelerated proximal small bowel transit of a liquid meal. Impairment of the intestinal progression of the liquid meal seems to occur only inn assocaition of the small bowel

[Nonfunctioning parathyroid cyst simulating thyroid nodule]. / Cisto não funcionate de paratiróide simulando nódulo tiróideo.

A parathyroid cyst is a rare disease. A 48 year old man with a nonfunctioning parathyroid cyst is described. The cyst was initially misdiagnosed and taken for a thyroid cyst based on physical examination, thyroid scan, sonography and needle biopsy. Cervical exploration was performed due to the recurrence of the lesion. The cyst was resected and histology showed it to be a parathyroid cyst. Pre and post operative clinical aspects are discussed.

[The effect of isosorbide dinitrate on esophageal emptying in chagasic megaesophagus]. / Efeito do dinitrato de isossorbitol sobre o esvaziamento esofagiano no megaesôfago chagásico.

The effect of 5 mg of sublingual dinitrate isosorbide (DNI) on the esophageal emptying of a semi-solid test meal labeled with 99mTc-sulfur colloid was studied by a scintigraphic technique in 18 chagasic patients with megaesophagus. DNI significantly reduced the esophageal retention measured at 0, 5, 10, 15, and 20 minutes after the end of the test meal ingestion. Five minutes after the meal not preceded by DNI the esophageal retention was always higher than 10% whilst 5 minutes after the meal preceded by DNI the retention was lower than 10% in 10 patients. These results indicate that DNI may be useful to reduce esophageal retention in chagasic megaesophagus.

Peripheral glucose metabolism in human hyperthyroidism.

The present study was designed to determine the effect of spontaneous hyperthyroidism on the forearm muscle glucose uptake and oxidation during the postabsorptive state and after an oral glucose challenge. Ten normal subjects and 11 hyperthyroid patients were studied after an overnight fast (12-14 h) and for 3 h after ingestion of 75 g glucose. Peripheral glucose metabolism was analyzed by the forearm technique to estimate muscle exchange of substrate combined with indirect calorimetry. Increased forearm glucose uptake was observed in the hyperthyroid patients compared to that in the normal subjects (1286 +/- 212 vs. 677 +/- 88 mumol/100 mL forearm.3 h) with enhanced glucose oxidation (443 +/- 40 vs. 147 +/- 29 mumol/100 mL forearm.3 h). Nonoxidative glucose metabolism was also greater in hyperthyroid patients than in normal subjects (842 +/- 234 vs. 529 +/- 90 mumol/100 mL forearm.3 h). Basal serum FFA levels were significantly higher in hyperthyroid than in normal subjects (0.252 +/- 0.025 vs. 0.182 +/- 0.022 g/L), as were the basal lipid oxidation rates in the forearm muscles of the thyrotoxic individuals (0.290 +/- 0.066 vs. 0.088 +/- 0.016 mg/100 mL forearm.min). After glucose ingestion, serum FFA levels and lipid oxidation rates declined significantly to equivalent values in both groups of subjects, and the similar basal insulin concentrations increased to significantly higher levels in the hyperthyroid patients. In conclusion, spontaneous human hyperthyroidism increases glucose uptake by the forearm muscles in the postabsorptive state and during an oral glucose challenge, with augmented fluxes of glucose through the oxidative and nonoxidative pathways.

Spermatogenic and steroidogenic testicular function in hypothyroid pubertal rats.

The reproductive system of immature rats is held to be more influenced by thyroid dysfunction than that of adult animals. The effect of hypothyroidism on the spermatogenic process of the rat has not been reported previously. The objective of the present study was to investigate the spermatogenic and steroidogenic functions of pubertal hypothyroid rats. Hypothyroidism was induced by ad libitum ingestion of a 0.05% solution of propylthiouracil for 60 days, and confirmed by reduced plasma thyroxine levels in treated rats. Plasma testosterone level, the histological features of the testis and cauda epididymis and the concentration of spermatozoa stored in the cauda epididymis were unchanged by hypothyroidism.