Increased platelet depleted plasma 5-hydroxytryptamine concentration following meal ingestion in symptomatic female subjects with diarrhoea predominant irritable bowel syndrome.

BACKGROUND: Meal ingestion is often associated with exacerbation of gastrointestinal symptoms in subjects with irritable bowel syndrome (IBS). Furthermore, recent preliminary data suggest that 5-hydroxytryptamine (5-HT) concentration in platelet poor plasma is elevated following meal ingestion in some subjects with diarrhoea predominant IBS (d-IBS) compared with healthy subjects, although it is not known whether this is related to postprandial symptomatology. AIM: To expand on previous data by evaluating a larger number of subjects but also to assess plasma 5-hydroxyindole acetic acid (5-HIAA) concentrations, 5-HT turnover, platelet 5-HT stores, and any relationship to symptomatology. METHODS: We assessed platelet depleted plasma 5-HT and 5-HIAA concentrations for two hours (60 minute intervals) under fasting conditions, and then for a further four hours (30 minute intervals) after a standard carbohydrate meal (457 kcal), together with fasting platelet 5-HT concentrations in 39 female subjects with d-IBS (aged 19-52 years; mean age 33) and 20 healthy female volunteers (aged 20-46 years, mean age 28). IBS symptomatology, in particular abdominal pain and bloating, and urgency to defecate were assessed throughout the study RESULTS: When related to fasting levels, there was no statistically significant difference in postprandial plasma 5-HT concentrations between d-IBS and healthy subjects. However, when fasting levels were not taken into consideration, d-IBS subjects exhibited higher postprandial plasma 5-HT concentrations compared with healthy subjects (p=0.040). Furthermore, d-IBS subjects who exhibited postprandial symptomatology had higher levels of postprandial plasma 5-HT, whether assessed with respect to fasting baseline levels (p=0.069) or not (p=0.047), compared with d-IBS subjects who did not report postprandial symptomatology. This appeared to be associated with a concomitant increase in plasma 5-HIAA (p=0.161) but reduction in turnover (p=0.058). Lastly, d-IBS subjects had higher platelet concentrations of 5-HT than healthy subjects (p=0.009). CONCLUSIONS: These data suggest that postprandial symptomatology may be associated with increased platelet depleted plasma 5-HT concentrations in female subjects with d-IBS. In addition, the presence of increased platelet stores of 5-HT may act as a useful marker for the diagnosis and management of d-IBS.

Radiology workload--a solution reviewed after 14 years' experience.

A method of controlling the radiological workload in a district general hospital, based on an estimation of the reasonable capacity of the department, was introduced in 1978. Measurement of the number of examinations performed compared with the estimated reasonable capacity shows that the method has been effective. An immediate 25% reduction in examinations was followed by a workload which varied between -4% and +16% of the capacity. An increase in the proportion of complex examinations in the period under review has been recognized. The method has encouraged referring doctors to exercise restraint and adopt guidelines, and helped persuade managers to increase capacity by appointing additional radiologists.

Bleomycin lung: computed tomographic observations.

Changes characteristic of bleomycin lung were seen in 15 out of 18 patients whose lungs were examined by computed tomography following standard chemotherapy for testicular cancers. These changes affected mainly the posterior aspects of the lungs and were predominantly subpleural in nature. The total dose of bleomycin given did not appear to correlate with the grade of bleomycin damage. Amongst six patients with adequate follow-up studies there has been improvement in the CT appearance of three.

Thin-walled ring shadows in early pulmonary sarcoidosis.

The appearance of ring shadows on the chest radiograph of patients with sarcoidosis is usually associated with generalised, irreversible pulmonary fibrosis. We report three patients in whom thin-walled ring shadows appeared early in the disease. These ring shadows occurred in areas of pre-existing lung shadowing and in two patients they disappeared with corticosteroid therapy over a period of 1-2 years. We postulate that these early sarcoid ring shadows may be caused by a combination of central necrosis of areas of coalescent granulomas and a check-valve mechanism beyond partial obstruction of airways by endobronchial sarcoidosis.