Central corneal thickness in primary open angle glaucoma, pseudoexfoliative glaucoma, ocular hypertension, and normal population.

PURPOSE: This study was designed to determine the relationship between central corneal thickness (CCT) and intraocular pressure (IOP) measured by applanation tonometer in glaucomatous, ocular hypertensive, and normal eyes. METHODS: A total of 125 subjects were included in the study. Twenty-six had primary open angle glaucoma (POAG), 25 had pseudoexfoliative glaucoma (PXG), 24 had ocular hypertension (OHT), and 50 of them were normal. IOP values were measured by Goldmann applanation tonometer whereas CCT values were measured by ultrasonic pachymeter. RESULTS: CCT values in the OHT group (595.75+/-22.52 microm) were greater than the CCT values of the POAG group (539.92+/-21.50 microm), the PXG group (526.28+/-31.73 microm), and the normal group (533.96+/-29.25 microm) (p<0.05). Eight patients who were diagnosed with OHT showed IOP values of 21 mm Hg or lower with corrected IOP values according to CCT. CONCLUSIONS: Increased CCT may lead to falsely high values of IOP measured with Goldmann applanation tonometer. In this study, when IOP values of the OHT group were redefined according to the formulae regarding the CCT, the authors noted that one third of them were normal. Determination of the CCT in OHT cases is crucial since it has great impact on IOP values, measured with applanation tonometer, which is the main parameter in the diagnosis and follow-up of glaucoma.

Diagnostic yield of alarm features in irritable bowel syndrome and functional dyspepsia.

OBJECTIVE: The diagnostic value of the addition of alarm symptoms in distinguishing functional from organic gastrointestinal disease remains uncertain. We aimed to establish the value of alarm features in differentiating between organic disease and irritable bowel syndrome (IBS) and functional dyspepsia (FD). METHODS: A total of 568 consecutive patients (63% female; mean age 44.7 years) completed a detailed symptom questionnaire and then received a complete diagnostic workup, as required. Questionnaire data were collected prospectively and audited retrospectively; the treating physician was blinded to the results of the questionnaires. Patients were coded and allocated to the following diagnostic groups: IBS, FD, organic diseases of the upper gastrointestinal tract, or organic diseases of the lower gastrointestinal tract. Logistic regression was used to identify the best subset of symptoms that discriminated organic disease from functional illness. Separate models compared IBS (n = 214) with diseases of the lower gastrointestinal tract (n = 66), and FD (n = 70) with diseases of the upper gastrointestinal tract (n = 250). RESULTS: Age (50 years at symptom onset: odds ratio (OR) 2.65 (95% confidence interval 1.4-5.0); p = 0.002) and blood on the toilet paper (OR 2.7 (1.4-5.1);p = 0.002) emerged as alarm features that discriminated IBS from lower gastrointestinal illness. A diagnosis of IBS was typically associated with female sex (OR2.5 (1.3-4.6); p = 0.004), pain on six or more occasions in the previous year (OR 5.0 (2.2-11.1); p<0.001), pain that radiated outside of the abdomen (OR 2.9 (1.4-6.3); p = 0.006), and pain associated with looser bowel motions (OR 2.1 (1.1-4.2); p = 0.03). A model incorporating three Manning criteria and alarm features yielded a correct diagnosis of IBS in 96% and a correct diagnosis of organic disease in 52% of cases. Alarm features did not discriminate FD from upper gastrointestinal disease. Patients with FD were significantly more likely to report upper abdominal pain (OR 3.7 (1.7-8.3); p = 0.002) and significantly less likely to report aspirin use (OR 0.26 (0.1-0.6); p = 0.001). The predictive value of symptoms in diagnosing FD was only 17%. CONCLUSIONS: Symptoms plus alarm features have a high predictive value for diagnosing IBS but the predictive value for a diagnosis of FD remains poor. Current criteria for the diagnosis of IBS should incorporate relevant alarm features to improve the diagnostic yield.

Endoscopic management of a duodenal duplication cyst associated with biliary obstruction in an adult.

Duodenal duplication cysts are distinctly uncommon and most often present in infancy or early childhood. The clinical presentation is generally duodenal obstruction, hemorrhage, or pancreatitis. Duodenal duplication cysts rarely cause biliary obstruction in adults. So far, duodenal duplication cysts have been almost exclusively treated by surgical intervention. This report describes both endoscopic diagnosis and treatment of a large periampullary duodenal duplication cyst associated with biliary obstruction in an adult patient.

Reduction of peptic ulcer disease and Helicobacter pylori infection but increase of reflux esophagitis in Western Sydney between 1990 and 1998.

We aimed to determine if changes in the patterns of upper gastrointestinal diseases at endoscopy have occurred over the past decade. Retrospectively, 917 consecutive patients were selected based on upper endoscopy between June 1 and August 31, in 1990 (n = 217), 1994 (n = 270), and 1998 (n = 430). Demographic, clinical, endoscopic, and histological information were extracted from the medical records on a standardized case record form. Over the eight-year period, follow-up of peptic ulcer (15%, 5%, and 5%, respectively, in 1990, 1994, and 1998, df = 2, P < 0.001), bleeding (22%, 14%, and 13%, P = 0.008), and nausea/vomiting (15%, 16%, and 10%, df = 2, P = 0.003) had become less frequent, but reflux (21%, 19%, and 34%, df = 2, P < 0.001) and dyspepsia (24%, 43%, and 32%, df = 2, P < 0.001) more frequent indications for upper endoscopy. The prevalence of peptic ulcer disease decreased (22%, 15%, and 13%, df = 2, P = 0.025), but the prevalence of reflux esophagitis increased significantly (29%, 30%, and 39%, df = 2, P = 0.010). The prevalence of both the use of nonsteroidal antiinflammatory drugs (NSAIDs) (18%, 20%, and 11%, respectively, in 1990, 1994, and 1998, df = 2, P = 0.004) and H. pylori infection (39% in 1994 and 30% in 1998, df = 1, P = 0.032) decreased. Overall, NSAID use was independently associated with gastric ulcers (OR = 2.39, 95% CI 1.21-4.73, chi2 = 6.31, df = 1, P = 0.012), but not esophagitis. H. pylori infection was independently associated with duodenal ulcers (OR = 4.74, 95% CI 2.30-9.77, chi2 = 17.8, df = 1, P < 0.001), histologically chronic (OR = 166.8, 95% CI 76.1-365.4, chi2 = 313.0, df = 1, P < 0.001) and active (OR = 30.1, 95% CI 17.0-53.5, chi2 = 189.7, df = 1, P < 0.001) gastritis and lymphoid aggregates (OR = 5.49, 95% CI 3.02-9.97, chi2 = 36.3, df = 1, P < 0.001). In conclusion, the prevalence of peptic ulcer disease appears to have been decreasing, whereas reflux esophagitis has been increasing over the past decade in Western Sydney. The decreased use of NSAIDs and decline of H. pylori infection have likely both contributed to the reduction of peptic ulcer disease, but the increase in reflux esophagitis remains to be fully explained.