Temporal variation in manometric findings in achalasia: a case report.

Esophageal manometry is a valuable tool in the diagnosis of achalasia. The manometric features proposed for diagnosing classic achalasia are incomplete relaxation of the lower esophageal sphincter and aperistalsis in the body of the esophagus. Atypical achalasia cases have been reported that do not have the characteristic manometric features of classic achalasia. We report the clinical, radiological and manometric follow-up of a 45-year- old woman who presented with atypical manometric features of achalasia that have not been reported in the literature and who after a short period demonstrated the manometric features of classical achalasia.

The relationship between intestinal hypoperfusion and serum d-lactate levels during experimental intra-abdominal hypertension.

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) may result from several clinic situations and carries high morbidity and mortality risk, particularly in intensive care unit patients. The clinical spectrum changes from splanchnic hypoperfusion and intestinal ischemia to multiple organ failure. Previous studies demonstrated that serum D-lactate levels may be an early indicator in intestinal ischemia. This study aimed to investigate the relationship between intestinal ischemia and serum D-lactate levels during experimental IAH. Thirty-two male Wistar Albino rats weighing 250+/-50 g were divided into four groups. Three different intra-abdominal pressure (IAP) levels supplied by placement of an intraperitoneal Peritofix catheter and iso-osmotic polyethylene glycol infusion. Each of the IAP levels (15, 20, and 25 mm Hg groups) was checked with the monitor system and fixed for an hour. Control-group animals were not subjected to increased IAP. One hour later, 5-ml blood samples were taken for measurement of serum D-lactate levels and 2-cm intestinal tissue samples were taken 5 cm proximal to the ileocecal valve for histopathologic examination. Elevated serum D-lactate levels were recorded in animals with higher IAP levels. There was a positive correlation between serum D-lactate levels and IAP levels. Histological examinations of the intestinal tissue samples showed no significant pathologic changes in concordance with intestinal ischemia. Serum D-lactate levels may be an early indicator for increased IAP pressure before intestinal ischemic changes occur.