Does local irradiation affect gastric emptying in humans?

The authors measured gastric emptying in 13 patients undergoing radiation therapy to the chest, abdomen, or pelvis for nongastrointestinal cancer to investigate whether gastric emptying (GE) was altered by this therapy. Symptoms and weight were monitored at regular intervals. Patients served as their own controls and were compared to a group of healthy subjects. When studied prior to radiation therapy (baseline), cancer patients had a gastric emptying rate that was similar to a healthy control group (t1/2 mean+/-SEM 92.0+/-15.3 vs. 80.4+/-8.2 min). Irradiation did not change the emptying rate, either after the first dose (early) of 180 cGy (t1/2 99.5+/-17.9) or after 2 weeks of therapy (late) with 3000 cGy (t1/2 75.5+/-7.3). There was no correlation of radiation field or tumor type with gastric emptying rate. Two of the 13 patients experienced nausea and vomiting during their course of radiation, but their gastric emptying was unchanged from baseline.

Deficient DNA repair in chronic ulcerative colitis.

Carcinoma of the colon is a serious complication of chronic ulcerative colitis (CUC), a disease of unknown etiology. Peripheral blood lymphocytes from nine patients with CUC showed deficient repair of radiation-induced DNA damage compared with a group of healthy controls. DNA repair was measured indirectly by quantifying chromatid breaks after irradiation of cells with X-rays or ultraviolet during G2 phase of the cell cycle. Such breaks represent unrepaired DNA strand breaks that may arise directly from the damaging agent or indirectly during repair processes. Two types of deficiency were revealed. One was an abnormally high frequency of chromatid breaks after G2-phase X-irradiation. These may reflect deficient strand-break repair. The second deficiency was manifest as a low frequency of breaks not increased by addition of the DNA repair inhibitor araC. This low frequency apparently results from negligible incision activity. Deficient DNA repair in CUC may thus be a requisite predisposing factor for genomic instability and the potential development of colon carcinoma.

Increased risk for vitamin A toxicity in severe hypertriglyceridemia.

A 48-year-old woman with malabsorption and type V hyperlipoproteinemia developed hypervitaminosis A with a total plasma vitamin A level of 871 micrograms/dL during therapy with an oral dosage of 18,000 retinol equivalents (60,000 IU) daily. Twelve percent of the total plasma retinol was found to be transported in the chylomicron-very low density lipoprotein (VLDL) fraction, which does not contain retinol-binding protein. For comparison, concentrations of retinyl esters and retinol were determined in nine patients with type V hyperlipoproteinemia and nine control subjects, none of whom were using vitamin A supplements. Both retinyl esters and retinol were significantly elevated in the group with hyperlipoproteinemia (p less than 0.0005 in both cases). Eight of these nine patients had retinol present in the chylomicron-VLDL fraction, whereas retinol was not detectable in this fraction in any of the nine normal controls. The data suggest that patients with severe hypertriglyceridemia associated with type V hyperlipoproteinemia are at increased risk for hypervitaminosis A.

Duodenal stenosis in chronic pancreatitis: clinicopathological correlations.

Persistent duodenal stenosis has been noted as a complication of chronic pancreatitis, but its clinical importance and histologic basis have not been defined. We report three patients with chronic alcoholic pancreatitis who developed duodenal stenosis and intractable abdominal pain. In two patients, the stenosis was caused by severe inflammation of pancreatic tissue within the wall of the duodenum. Pancreaticoduodenectomy resulted in prompt and sustained clinical improvement in both patients. In the third patient, who had mural inflammation in the distal stomach and presumably in the duodenum as well, vagotomy and gastrojejunostomy relieved severe duodenal obstruction but not pain. This study supports the view that duodenal stenosis is caused by severe intramural duodenal inflammation and suggests that a pancreaticoduodenectomy may be required for relief of pain.

Gastroscopic removal of a partial denture.

This report of an ingested dental prosthesis is submitted to emphasize the need for incorporation of radiopaque material in dental appliances and also to report the safety and efficacy of fiberoptic endoscopy in the nonsurgical treatment of accidental ingestions.