Does diabetic autonomic neuropathy influence the clinical manifestations of reflux esophagitis?

Diabetic autonomic neuropathy is a common complication of diabetes mellitus and affects every segment of the gastrointestinal tract. Gastrointestinal problems tend to be more common and severe in diabetics compared with the nondiabetic population. In the literature, the prevalence of reflux esophagitis is not known. The aim of this study was to analyze esophagoscopic findings, compare them with esophageal symptoms, and evaluate reflux esophagitis in relationship with autonomic neuropathy. We examined 54 diabetics (15 type 1, 39 type II), 28 males and 26 females, average age 55.4 (95% confidence intervals 52.1-58.8), with duration of diabetes more than 5 (average 15.0; 12.4-17.6) years. All patients completed a structured questionnaire. After overnight fasting, gastroesophageal endoscopy was performed in the morning to establish the presence of reflux esophagitis, using the Los Angeles classification. Cardiovascular autonomic neuropathy was diagnosed with the help of cardiovascular autonomic reflexes (deep breathing, active orthostasis, Valsalva's maneuver) and spectral analysis of heart rate variation. Endoscopic esophagitis was present in 22 (40.7%) diabetics and 10 of them (45 %) also complained of reflux symptoms. Sensitivity of symptoms was 45.5% and specificity was 72%. We found the presence of symptoms of reflux esophagitis in 21 (38.9%) diabetics, but of this group only 10 (47.6%) had endoscopic changes. Autonomic neuropathy was present in 29 patients, 16 (55%) of them had reflux esophagitis and 18 (62%) were positive for reflux symptoms. In the diabetics without autonomic neuropathy, esophagitis was noted in 6 (24%), which reflects a significant difference (p < 0.05). Reflux symptoms were present in 10 (40%) diabetics without autonomic neuropathy, and in comparison with patients who had autonomic neuropathy, the difference was not statistically significant. Thus, reflux eosophagitis is common in diabetic patients, with a prevalence of 40.7%. Reflux symptoms do not have a great diagnostic value in establishing reflux esophagitis. We confirmed a relationship between autonomic neuropathy and the clinical manifestations of reflux esophagitis, but no association with accompanying reflux symptoms. (Tab. 2, Ref. 27.)

[Holter ECG monitoring during gastroscopy in patients with chronic atrial fibrillation]. / Holterovo ekg monitorovanie pocas gastrofibroskopie u pacientov s chronickou fibrilaciou predsieni.

The authors present their results obtained with Holter ECG monitoring during gastroscopy in a group of patients with chronic atrial fibrillation. In one third of the group, endoscopic procedure induced complex cardiac arrhythmias and also significant myocardial ischaemia. These findings can have serious hemodynamic consequences. Therefore previous evaluation of cardiac findings and extemporaneous for urgent therapeutical intervention are necessary. To these patients, especially to those with cardiac arrhythmias--including atrial fibrillation--it is necessary to devote intensified attention and precaution with interdisciplinary co-operation.

[Clinical importance of the Gavornik classification of mushroom poisoning]. / Klinický význam Gavorníkovej klasifikácie otráv hubami.

The lack of experience and fundamental knowledge about mycology by some mushroomers is one of the leading causes of increasing occurrence of fatal mushroom poisonings. Mushroom intoxications are caused not only by poisonous mushrooms (true primary intoxications), but under certain conditions also by edible mushrooms (secondary intoxications, false intoxications, pseudo-intoxications). Apart from fresh mushrooms intoxications may result also from preserved mushrooms (sterilized in pickles, soured, dried, used for preparation of mushroom extracts, powders, etc.), which are used as garnish. (Tab. 1, Ref. 44.)

[Nutritional status in patients after reconstructive surgery of the upper digestive tract--status after 3 years]. / Nutricný stav osôb po rekonstrukcných operáciách hornej casti tráviaceho traktu--stav po troch rokoch.

The authors present an analysis of the nutritional status of eleven patients after reconstruction operations of the upper digestive tract (9 men and 2 women, aged 27-67 years, 7 times gastric resection, 4 times resection of the oesophagus), almost in all instances on account of malignant tumours. During the investigation the patients were given dietary advice incl. on the need of a higher vitamin and mineral intake. Three years after surgery the nutritional status of the investigated subjects did not change significantly as compared with the status before surgery but some trends were detected (decline of the serum calcium and albumin concentrations). Based on the results assembled in this small group the authors support views reported in the literature that reconstruction surgery of the upper digestive tract is safe as regards the patient's nutritional status.

[Transverse laparotomy closed with continuous absorbable loop sutures]. / Priecna laparotómia uzatvorená pokracujúcim rezorbovatel'ným sluckovým stehom.

The authors emphasize the advantages of a transverse incision which are beyond doubt, because they provide the surgeon not only with an excellent bilateral view of the operated area, but what is most important, they have the significantly least negative effect on respiratory functions and the composition of blood gases, which is of major importance in patients with chronic respiratory failure. Due to the much smaller retraction forces the incidence of postoperative dehiscences and hernias is smaller. It is an incision which interferes least with the innervation of the abdominal wall and thus is not only less painful but has also better healing parameters. Its closure by a continuous, absorbable, loop-on mucosa double suture is not only simple, but what is most important, it is reliable and associated with a minimum of postoperative complications.

Urgent proctocolectomy in ulcerative colitis.

UC being a typical medical disease is encountered by the surgeon only in the stage of toxic megacolon or in case of severe complication during conservative treatment such as perforation, haemorrhage, obstruction or malignity. The authors operated urgently 6 young women with all these complications performing total proctocolectomy, constructing ileal pouch with complete stapling technique. In spite of high rate of complications the results are promising. The best prevention of malignant change and complication is the earlier indication for operative treatment which offers the ideal treatment for patients with UC.

[Vulvar varices]. / K problematike vulválnych varixov.

The authors treated in 1983-1993 72 patients with vulvar varicosities who suffered particularly during pregnancy. Typical symptoms are pruritus, pain caused by pressure in the vulvar area and the sensation of prolapse. According to the authors surgical treatment is unnecessary and involves risk. They recommend compressive sclerotherapy as described by Fegan, using sodium tetradecyl sulphate S.T.D. Hegefort England not only in case of a marked clinical symptomatology but also as prevention of dangerous haemorrhage during delivery.

[Advantages of continuous resorbable mattress sutures in closing extensive laparotomies]. / Výhody pokracujúceho rezorbovatel'ného sl'uckového stehu pri uzatváraní vel'kých laparotómií.

In a group of 170 patients the mean time taken to close the abdominal cavity was 10 minutes, suppuration and fistulation resp. was observed in 2% of patients after 6 weeks. In 1.1% dehiscence occurred and in 3.5% hernia in the scar. All this applies to patients with severe malignity and hypoproteinaemia. Smead Jones technique of a continuous absorbable suture without knots is not only quick, safe, effective, cheap but also reliable in risk patients and obese patients with impaired healing, but only when its basic principles are respected: reliable anchoring and termination in fasciae, regularly alternating distances of stitches.

[Mechanical anastomoses in gastrointestinal surgery]. / Mechanická anastomóza v gastrointestinálnej chirurgii.

The authors present an account of possibilities to use a mechanical anastomosis by means of staplers in gastrointestinal surgery and the advantages of this procedure. It is a rapid, simple, and above all, reliable technique with a minimal percentage of postoperative complications. Despite the relatively high cost its importance is invaluable in particular in surgery of the oesophagus, cardia and in low resections of the rectum where it is possible to fix a reliable anastomosis up to 2 cm from the linea dentata. The authors evaluate 95 mechanical anastomoses, incl. three where during the postoperative period dehiscence occurred.

[Surgical treatment of ulcerous colitis]. / Chirurgická liecba ulceróznej kolitídy.

Ulcerative colitis, being a typical medical disease, is encountered by the surgeon only in the stage of toxic megacolon or in case of sever complications during conservative treatment such as perforation, haemorrhage or obstruction. The authors operated six young women where they performed as the only choice total proctocolectomy with formation of an ileal reservoir which was sutured to the rectum stripped of the mucosa. Despite the serious condition at the time of operation, the patients survive the operation, although the percentage of postoperative complications is high, with the exception of one patient who died on the 126th day after operation. The remainder survive in a fair condition with complete and continence.