Sphincter of Oddi dysfunction: psychosocial distress correlates with manometric dyskinesia but not stenosis.

AIM: To compare postcholecystectomy patients with Sphincter of Oddi (SO) dyskinesia and those with normal SO motility to determine the psychosocial distress, gender and objective clinical correlates of dyskinesia, and contrast these findings with comparisons between SO stenosis and normal SO motility. METHODS: Within a cohort of seventy-two consecutive postcholecystectomy patients with suspected SO dysfunction, manometric assessment identified subgroups with SO dyskinesia (n = 33), SO stenosis (n = 18) and normal SO motility (n = 21). Each patient was categorized in terms of Milwaukee Type, sociodemographic status and the severity of stress-coping experiences. RESULTS: Logistic regression revealed that in combination certain psychological, sociodemographic and clinical variables significantly differentiated SO dyskinesia, but not SO stenosis, from normal SO function. Levels of psychosocial stress and of coping with this stress (i.e. anger suppressed more frequently and the use of significantly more psychological coping strategies) were highest among patients with SO dyskinesia, especially women. Higher levels of neuroticism (the tendency to stress-proneness) further increased the likelihood of SO dyskinesia. CONCLUSION: A motility disturbance related to psychosocial distress may help to explain the finding of SO dyskinesia in some postcholecystectomy patients.

Facial emotion processing in criminal psychopathy. Preliminary functional magnetic resonance imaging study.

BACKGROUND: It has been suggested that people with psychopathic disorders lack empathy because they have deficits in processing distress cues (e.g. fearful facial expressions). AIMS: To investigate brain function when individuals with psychopathy and a control group process facial emotion. METHOD: Using event-related functional magnetic resonance imaging we compared six people scoring > or =25 on the Hare Psychopathy Checklist-Revised and nine non-psychopathic healthy volunteers during an implicit emotion processing task using fearful, happy and neutral faces. RESULTS: The psychopathy group showed significantly less activation than the control group in fusiform and extrastriate cortices when processing both facial emotions. However, emotion type affected response pattern. Both groups increased fusiform and extrastriate cortex activation when processing happy faces compared with neutral faces, but this increase was significantly smaller in the psychopathy group. In contrast, when processing fearful faces compared with neutral faces, the control group showed increased activation but the psychopathy group decreased activation in the fusiform gyrus. CONCLUSIONS: People with psychopathy have biological differences from controls when processing facial emotion, and the pattern of response differs according to emotion type.

Complications of sphincter of Oddi manometry: biliary-like pain versus acute pancreatitis.

OBJECTIVE: Although acute pancreatitis is the most significant complication of sphincter of Oddi manometry (SOM), acute biliary-like abdominal pain--similar or identical to the patient's usual recurrent acute episodes of pain and not fulfilling clinical criteria for acute pancreatitis--can also be provoked by SOM. The aim of the article is to determine and compare the relative frequency of occurrence of, and risk factors for, post-manometry biliary-like abdominal pain and post-manometry pancreatitis. MATERIAL AND METHODS: The clinical and laboratory features, the manometric recordings from the sphincter of Oddi, and the immediate post-manometry outcomes, were examined in 234 consecutive patients undergoing sphincter of Oddi manometry at our Unit. RESULTS: Post-manometry pancreatitis occurred in 9% of patients, and was associated with two risk factors on multivariate analysis: a history of post-ERCP pancreatitis (odds ratio [OR] 5.9) and a raised basal sphincter pressure (> or =40 mmHg) at SOM (OR 3.5). An increased sphincter phasic wave frequency (> or =7/min) at SOM was identified as a significant (p<0.05) risk factor on univariate testing only. Post-manometry biliary-like pain occurred in 12% of patients, and was associated with 3 different risk factors on multivariate analysis: age below 50 years (OR 4.6); less than a 2-year history of recurrent abdominal pain (OR 3.0); and ERCP and/or ES carried out during the SOM procedure (OR 9.3). CONCLUSIONS: Provocation of biliary-like pain following SOM, without clinical evidence of pancreatitis, occurs at least as frequently as post-manometry acute pancreatitis. In contrast to post-manometry pancreatitis, post-manometry biliary-like pain occurs more often in younger patients with a shorter duration of symptoms and does not appear related to the manometric features of the sphincter documented at SOM; we propose that this clinical entity may reflect the presence of bile duct or duodenal hypersensitivity/hyperalgesia.