The relationship among gastroparetic symptoms, quality of life, and gastric emptying in patients referred for gastric emptying testing.

BACKGROUND: Symptoms suggestive of gastroparesis are non-specific and conflicting reports exist regarding the ability of symptoms to predict the presence of gastroparesis. Our aim, therefore, was to evaluate the relationships between gastroparetic symptoms and their impact on quality of life and determine their relationship with clinical factors and gastric emptying. METHODS: Gastric emptying scintigraphy, sociodemographic features, health care resource utilization, gastroparetic symptoms, and quality of life using validated questionnaires were obtained from consecutive patients referred for gastric emptying testing (GET). Descriptive analyses were conducted and logistic regression was performed to evaluate associations with abnormal gastric emptying after controlling for other covariates. KEY RESULTS: Two hundred and sixty-six patients participated (195 females; mean age, 49.1 ± 17.6 years); 75% met Rome III criteria for functional dyspepsia. Gastric emptying was delayed in 28.2% at 4 h; the delay was mild in 48%, moderate in 20% and severe in 32%. Nausea/emesis and postprandial fullness, but not bloating, were significantly greater in those with delayed emptying. Postprandial fullness was most severe. Weak correlations were identified between symptom severity and the severity of gastric emptying delay. Quality of life was also lower in the delayed emptying group. Logistic regression analysis demonstrated associations between delayed gastric emptying and lower quality of life and increased symptom severity. CONCLUSIONS & INFERENCES: In patients referred for GET, gastroparetic symptoms were more severe in those with delayed emptying. A decrease in quality of life in those with delayed gastric emptying was also present; this was not related to the severity of the delay in gastric emptying.

Psychological distress in Rome III functional dyspepsia patients presenting for testing of gastric emptying.

BACKGROUND: There have been conflicting results from studies that have evaluated psychological disturbances in functional dyspepsia (FD). We conducted a comprehensive survey of psychological measures in patients undergoing gastric emptying testing (GET) in order to determine the relationship among psychological distress, gastric emptying, and dyspeptic symptoms. METHODS: Consecutive patients referred for GET were prospectively enrolled. Details regarding patient characteristics, health care utilization, dyspeptic symptoms, quality of life, and psychological dysfunction were obtained. Depression, anxiety, somatization, stress, positive and negative affect, and alexithymia were queried using validated questionnaires. We compared those dyspeptic patients who met Rome III criteria for FD to those who did not meet these criteria. KEY RESULTS: Two hundred and nine patients (160 female; mean age 46.6 years ± 17.3 years) participated. Around 151 patients (72%) met Rome III criteria for FD. In the entire group, a high level of depression, anxiety, somatization, and perceived stress was present compared to population norms. Health care seeking behavior and symptom severity were greater in those with FD and quality of life was lower compared to non-FD. Gastric emptying did not differentiate the two groups and similar degrees of psychological distress were present whether emptying was delayed or normal. CONCLUSIONS & INFERENCES: In patients referred for GET, substantial psychological distress is present. The degree of distress was similar regardless of whether the patient met Rome III FD criteria or not. Further evaluation of psychological dysfunction in FD patients may lead to improved diagnosis and determination of the most appropriate treatment.

Crossed cerebellar diaschisis during migraine with prolonged aura: a possible mechanism for cerebellar infarctions.

Migraineurs with frequent aura (>or=1 per month) are at a 12-fold increased risk of posterior circulation infarctions. Although the mechanism is unclear, these lesions are located in the arterial borderzone of the cerebellum. This case illustrates, for the first time, crossed cerebellar diaschisis in a patient with migraine with prolonged aura, and raises the possibility that hypoperfusion may be responsible in part for the development of these lesions.

Provocative imaging. Diuretic renography.

Diuretic renography remains the noninvasive functional study of choice in patients with hydronephrosis resulting from apparent UPJ obstruction. Meticulous attention to proper patient preparation, radiopharmaceutical selection, furosemide dosage and administration, and image interpretation and an awareness of potential pitfalls are essential for accurate diagnosis. For most patients, the F + 20 protocol is sufficient, however; the F-15 protocol allows clarification in cases of equivocal baseline F + 20 studies. Invasive antegrade techniques such as the Whitaker pressure/perfusion test are best reserved for patients in whom the diagnosis remains equivocal after diuretic renography, or in patients with massive hydronephrosis or renal insufficiency. New standardized protocol guidelines should help to ensure studies that are reproducible in different nuclear medicine laboratories.

Bowel wall thickening: differentiation of inflammation from ischemia with color Doppler and duplex US.

PURPOSE: To determine whether ultrasonography (US) can be used to differentiate inflammatory from ischemic bowel wall thickening. MATERIALS AND METHODS: Thirty-five patients (aged 23-96 years) with inflammatory or ischemic bowel wall thickening underwent US. Thickness was recorded, echotexture categorized, color Doppler flow graded, presence of intramural arterial signal recorded, and resistive index calculated. RESULTS: The difference between inflammatory and ischemic bowel wall thicknesses was not significant (P = .49). Differences in color Doppler flow (P < .0001), arterial signal (P = .0005), and bowel wall echotexture (P < or = .0200) between patients with inflammatory and ischemic bowel wall thickening were significant. Absence of or barely visible color Doppler flow and absence of arterial signal suggested ischemia; readily visible color Doppler flow and a stratified echotexture suggested inflammation. A resistive index less than 0.60 indicated inflammation. The difference in resistive index between the two groups was not significant (P = .12). CONCLUSION: Duplex and color Doppler flow US are helpful in differentiation between ischemic and inflammatory bowel wall thickening.

Temperature-sensitive steps in the secretory pathway for von Willebrand factor in endothelial cells.

The effect of reduced temperature on the post-translational processing and stimulated release of von Willebrand factor (vWf) from human umbilical vein endothelial cells was studied. Following pulse-labeling, cells were incubated for 4 h at 18 degrees C or 20 degrees C. Post-translational processing was reversibly arrested at the dimer stage, dimers were composed of Endo H-sensitive precursor subunits, and no vWf was detected in the culture medium. This block was reversible, since warming cells to 37 degrees C relieved it and resulted in the appearance of fully processed vWf in the cells and the culture medium. The same results were obtained when cells were incubated with carbonyl cyanide m-chlorophenol hydrazone or dinitrophenol which inhibit mitochondrial oxidative phosphorylation, known to block exit of secretory proteins from the endoplasmic reticulum (ER). This indicated that ER exit is not required for the complete dimerization of vWf. Reduced temperature (18 degrees C and 20 degrees C) also reversibly and nearly completely inhibited the secretagogue-induced release of vWf from Weibel-Palade bodies without affecting the microtubular cytoskeleton. We add reduced temperature to the list of useful tools for the study of the vWf secretory pathway in endothelial cells.