Do parotid duct abnormalities occur in patients with chronic alcoholic pancreatitis?

OBJECTIVE: Several studies have suggested that ethanol affects the pancreas and parotid gland. We performed a prospective study to determine whether ductal lesions of ethanol-induced chronic pancreatitis occur in the parotid. METHODS: Parotid sialograms were performed in 11 alcoholic patients who had endoscopic retrograde pancreatograms. Sialograms and pancreatograms were examined in all subjects for ductal abnormalities. RESULTS: Seven of nine patients (77.8%) with ductal lesions of the pancreas had coexistent ductal abnormalities of the parotid gland (Kendall's tau = 0.578, p = 0.035). CONCLUSIONS: Chronic ethanol intake induces ductal alterations in the parotid gland similar to those seen in the pancreas. These results suggest a common histopathological effect of alcohol in the ductal system of the parotid gland and pancreas and raise the possibility that the parotid sialogram could be useful as an adjunct in the diagnosis of ethanol-induced chronic pancreatitis.

Exercise-induced asthma. Is gastroesophageal reflux a factor?

An acid-induced cholinergic esophagobronchial reflex has been described whereby acid refluxing into the esophagus causes bronchospasm. Reports of exertional gastroesophageal acid reflux prompted us to study the possibility that exercise-induced asthma (EIA) could be related to gastroesophageal reflux (GER). Following an overnight fast, 10 athletes with a history of EIA (nine men, one woman; mean age 31) were studied. Continuous monitoring of intraesophageal pH and motility, ECG, and arterial oxygen saturation was done. After baseline monitoring at rest for 15 min, subjects underwent treadmill exercise for 10 min followed by continuous monitoring for 30 min after exercise. Spirometry was done at baseline prior to exercise, then repeated every 5 min after exercise for 30 min. Two subjects were retested at a later date following a standard test meal. All 10 subjects demonstrated a decrease in FEV1 in response to exercise, but only half met criteria for EIA. Although 60% (6/10) showed some evidence GER, only three subjects demonstrated a pathologic degree of GER. In the two subjects retested postprandially, change in FEV1 was no different in one and improved in the other despite worsening of GER in both. There was no significant correlations between GER and EIA (P = 0.2). EIA correlated inversely with amplitude of esophageal contractions (P = 0.029) and was directly related to the percentage of multipeaked contractions and the duration of peristaltic contractions (P = 0.08). EIA is not associated with exertional GER.

Benign schwannoma of the small intestine: an unusual cause of gastrointestinal bleeding.

Neurogenic tumors of the small intestine are exceedingly rare accounting for less than 1% of all neoplasms involving the gastrointestinal (GI) tract. These lesions may remain clinically silent for years, but usually manifest by the 5th or 6th decade of life. Occult transient hemorrhage from the GI tract interspersed by relatively long asymptomatic periods is the most common presentation. This report describes a case of a patient with a solitary benign duodenal schwannoma and no prior symptoms presenting as an acute life-threatening upper GI hemorrhage. Small bowel tumors of neurogenic origin represent an unusual cause of GI hemorrhage. The diagnosis should be considered in such cases to insure appropriate and timely management.