Relation of symptoms to impaired stomach, small bowel, and colon motility in long-standing diabetes.

Stomach, intestinal, and colonic transit were measured in males with insulin-requiring diabetes of greater than 10 years' duration to compare with symptoms and to estimate the medical significance. For all diabetics only the symptom constipation correlated with the appropriate regional delayed transit. Diabetics with delayed transit in any region, however, had more overall gastrointestinal symptoms. Diabetics with delayed transit had disease of significantly longer duration than those without delay. Delayed transit was common in the diabetics selected for study with 21 of 54 stomachs, 10 of 20 small intestines, and 14 of 20 colons showing impairment. Of 35 diabetics with impaired transit at one or more locations, only seven were judged of medical importance and five of these responded to treatment. In this study, delayed transit was frequent; in the one fifth requiring management, the symptoms related closely to the region impaired.

Peritoneovenous shunt function 2-6 years after insertion for cirrhotic ascites.

To test the hypothesis that prolonged freedom from clinically detectable ascites after peritoneovenous shunt insertion is the result of continued drainage of ascitic fluid through the shunt, the authors studied shunt patency and function in 26 of the 27 survivors of 59 alcoholic cirrhotic patients operated upon 2-6 years previously for massive ascites resistant to medical therapy. Twenty-three patients were without clinically detectable ascites (minimal ascites--Group A), and three had large ascites (Group B). In 20 Group A patients the shunts were patent and functioning. The other three Group A patients had completely occluded shunts without demonstrable ascitic fluid flow. In one Group B patient with a daily fluid intake of 5-6 L, the shunt was partially obstructed but flow was rapid; in the other two, shunts were completely occluded. One subject in Group B with a completely obstructed shunt was resistant to medical treatment after 6 years of freedom from ascites, whereas the other two were controlled medically. In the three in Group A who had nonfunctioning shunts and required no diuretics, the severity of the ascites had decreased so that artificial drainage was no longer necessary. Thus, freedom from clinically significant ascites does not always indicate that the shunt continues to function.