Gastric Motility in Duodenal Ulcer

1. The pressing problem of peptic ulcer merits investigation from any hopeful viewpoint. The physiological upset which occurs in peptic ulceration is by no means fully understood and, in particular, our knowledge of the gastric motor activity is small. This thesis reports the results of a study of gastric motility in duodenal ulceration. 2. The technique of recording gastric motility is first described. with the patient fasting, a swallowed balloon is inflated to a standard pressure of 10cm. of water and connected to a tambour-kymograph unit for recording. The advantages of this method of gastro-graphy over other reported methods are discussed. The interpretation of the waves obtained is provided and certain difficulties and fallacies are defined. 3. The pattern of gastric motility in 30 normal subjects has been ascertained before investigating patients with duodenal ulcer. It was noted that the fasting stomach is never completely at rest and that, even in its most quiescent state, minor changes in tone are occurring constantly. 4. A detailed study has been made of the gastrograms obtained from 66 patients with active duodenal ulceration. Gastric contractions were found to be of greater amplitude and or shorter duration than in normal subjects and fusing of waves, not seen in controls, was common. Based on these criteria alone, the gastrographic diagnosis of duodenal ulcer would not be reliable. 5. The fact that inhibition of gastric motility follows the ingestion of cold water has been confirmed in 30 normal subjects. In audition, it is shown that the temperature of the water does not influence the type of gastric motor response but merely alters the duration of the response. In the presence of active duodenal ulceration, gastric activity was found to be either unaltered (Type II Reversal Response) or even stimulated (Type I Reversal Response) by the ingestion of water. This reversed response to water has been demonstrated consistently in 90 patients with active duodenal ulcer and it has been shown that a normal response returns with healing of the ulcer. Thus, the water test is of value in the diagnosis of active duodenal ulceration. This test has been used as an aid to the diagnosis of the "X-ray negative dyspepsias" and examples are provided which demonstrate its usefulness. 6. Evidence is presented which suggests that the receptor point for the gastric motor response to water is in the duodenum. This duodenal mechanism, which normally inhibits gastric motility, is damaged by active ulceration but functions normally when the lesion has healed. The water test can therefore be used to provide reliable evidence of healing. 7. The gastrographic diagnosis of pyloric stenosis depends on the demonstration of an increased latent period for the water test. This test also gives accurate information concerning the activity of the causal ulcer, provided it is duodenal. Save in extreme cases of stenosis accompanied by gastric atony, the gastrogram gives no accurate indication of the degree of pyloric obstruction. gastric arrhythmia may be present in patients with pyloric stenosis resulting from duodenal ulceration. It is especially common when the original ulcer is no longer in a state of activity. 8. It is a common practice to advise the patients suffering from peptic ulcer to smoke less tobacco. A study has been made of the effect of tobacco smoking on gastric motility in patients with duodenal ulcer. Smoking was not found to produce any constant change in gastric motor function. This result, taken in conjunction with similar reported observations on gastric acidity ana on symptomatology, indicates that moderate smoking is probably not harmful to the ulcer patient. 9. Opportunity has been taken to make observations on spontaneous ulcer pain. In two patients, pain was definitely related to the occurrence of true gastric contractions; in other cases, the level of gastric acidity appeared to play the predominant role. The literature on ulcer pain is reviewed and the merits of the various theories of its causation are discussed. It seems certain that a variety of stimuli can produce pain and the most usual one is probably hydrochloric acid. The view that these various stimuli all act by increasing the tissue tension around the ulcer has much to commend it. (Abstract shortened by ProQuest.)

"Cluster" headaches: A review of the literature

Thesis (M.D.)—Boston Universit

Cyclic vomiting syndrome in adults

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72300/1/j.1365-2982.2008.01113.x.pd

Dermatoses in the Elderly: Biochemical and Haematological Studies, With Special Reference to Serum Proteins

(1.) Literature regarding serum proteins, malnutrition, oedema, protein deficiency and disease of the skin has been reviewed. (2.) One hundred and thirty-seven investigations of serum protein concentrations and of haematological values have been carried out in fifty-two subjects, fifty of whom were over sixty years of age. Eighty-two estimations of serum total base have been carried out in thirty-five subjects. One hundred and thirty-four thymol turbidity values have been determined in fifty-two subjects and gruel fractional test-meals have been carried out in forty-two subjects. Ten normal control subjects who were over sixty years of age have also been investigated. Variations in the blood due to alteration of posture have been demonstrated in eleven subjects. Eighteen subjects with varicose conditions, seventeen with infectious eczematoid dermatitis, nine with scurvy and eight with pemphigus or bullous drug eruptions were investigated. (3.) The erythrocyte sedimentation rate was not related to the state of activity of the skin. (4.) Thymol turbidity estimations were within the normal range in all subjects. (5) In uncomplicated varicose conditions and in uncomplicated infectious eczema told dermatitis the serum total base was within the normal range. (6.) No close relationship between serum protein concentrations and oedema was found. Oedema occurring in uncomplicated infectious eczematoid dermatitis and in uncomplicated varicose conditions in elderly subjects may be explained by local tissue infection and by mechanical factors such as diminished tissue elasticity, impaired lymphatic drainage and local venous congestion. (7.) Significant low concentrations of serum total protein were not found in uncomplicated varicose conditions or in uncomplicated infectious eczematoid dermatitis. Serum total protein concentrations below normal were found in two subjects with scurvy, in one subject with pemphigus vulgaris, in one subject with varicose eczema and drug eruption and in one subject with infectious eczematoid dermatitis and thyrotoxicosis. (8.) The serum albumin concentration was below normal in one subject with pemphigus vulgaris. Low concentrations of serum albumin were commonly found in scurvy and in infectious eczematoid dermatitis. Normochromic, normocytic anaemia was present in the majority of scorbutic subjects and in one third of subjects with infectious eczematoid dermatitis. No relationship was evident between "achlorhydria" and serum protein concentrations or haematological values. (9.) Some evidence was presented that high protein diets were of value in restoring the blood picture to normal in scorbutic subjects and in those with infectious eczematoid dermatitis. Scurvy and infectious eczematoid dermatitis presented some features in common, with respect to the serum albumin concentrations and to the haematological values. Malnutrition may have been a factor in both groups, but it is not possible to state that malnutrition played a definite part in the production of infectious eczematoid dermatitis. (10.) Administration of a high protein diet to scorbutic subjects and to selected elderly subjects who are suffering from infectious eczematoid dermatitis is suggested as a necessary addition to other routine forms of treatment

Volume 09, issue 1

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research. Visit the journal website at http://canjsurg.ca/ for more.https://ir.lib.uwo.ca/cjs/1078/thumbnail.jp

A Comparitive study between Apache II and Ranson Scoring Systems in predicting the Severity of Acute Pancreatitis

BACKGROUND AND OBJECTIVES: A comparitve study between APACHE II and RANSON scoring system in predicting the severity of acute pancreatitis, is a prospective study of 33 cases of acute pancreatitis with the objective to compare the efficacy of APACHE II scoring system with RANSON scoring system in predicting the severity of acute pancreatitis. METHODS: 33 cases of acute pancreatitis admitted in Rajiv Gandhi Government General Hospital,were considered in the study .All patients diagnosed with acute pancreatitis based on clinical suspicion and raised serum amylase levels were assessed with multiple variables of APACHE II and RANSON scoring system, the scores of which would indicate the severity of the disease and the scores were compared with raised serum amylase levels to know the efficacy of both the scoring systems. The sensitivity, specificity, positive predictive value (ppv) and negative predictive value (npv) of both scoring system in the present study was compared with the standard literature. RESULTS; The APACHE II scoring system had a sensitivity of 100%, specificity 80%, positive predictive value (ppv) 62% and negative predictive value (npv) 100%. The RANSON scoring system had sensitivity of 66.7%, specificity 86.7%, positive predictive value (ppv) 33% and negative predictive value (npv) 96%. Area under curve (AUC) in APACHE II was 0.717 and in RANSON was 0.667. Of the 33 cases, 8 cases were considered severe pancreatitis of which all 8 were severe according to APACHE II but only 3 of the 8 were considered severe by RANSON score. There was no mortality in the study. Local and systemic complications were seen in patients considered severe by APACHE II score only. CONCLUSION: The APACHE II system takes into account all the major risk factors that influence outcome from disease, including the acute physiological derangements as well as patient ability to recover which may be diminished by advancing age or chronic disease. The range of APACHE II score is wide providing better spread between mild and severe attacks, because varying weights are assigned to increasingly abnormal values, rather than all or none judgements than RANSON scoring system. By the results obtained it can be concluded that APACHE II score is better than RANSON score in predicting the severity of acute pancreatitis

Acne Vulgaris: The Influence of Marriage, Pregnancy and Childbirth

SUMMARY. 1). It is difficult, time consuming, and in many cases impossible to get the co-operation of a large group of patients in a large industrial town, where movement of population is bound to be great, particularly in the 15-25 age group. Many of the questionnaires, though very simply worded were inadequately filled in. 827 addresses were collected, over 1100 letters were sent out and almost 100 homes visited personally, yet only 415 forms were finally collected. 2). The treatment given by a skin department, where only relatively stubborn and rather severely affected cases are treated would seem to shorten the duration of acne vulgaris, an important consideration in reassuring young women of marriageable age. See Table I. 3). Disfiguring scarring would appear to lessen a girl's chance of marriage. See Table II. 4). Marriage has an undeniable influence on the course of acne vulgaris. 43.4% in the series improved, 53%, however, noted no change in their skin condition, only 3.6% deteriorated following matrimony. The widely held belief of a universally beneficial influence of marriage on this complaint, while certainly true in a considerable percentage of women, has not been confirmed by this survey. See Table III. 5), Pregnancy, on the other hand, has a markedly beneficial influence on acne vulgaris according to this survey. See Table IV, This isthought to be due to an increase in secretion of oestrogens, progesterone and gonadotrophins during gestation, all of which have a beneficial effect on acne by suppressing the activity of the pilosebacecus apparatus. Androgen, the hormone which stimulates sebaceous gland activity is at a lower level than normal during gestation. The psychological, possibly hypothalamic influence of pregnancy leading to a happier, better balanced out-look would all appear to bring about an amelioration and often a permanent remission of acne vulgaris. 6). The largest percentage of patients improved after the birth of their baby. See table VI. Lactation appeared not to have further influenced the course of events. See Table VII. An analogy can be drawn between dysmenorrhoea and acne vulgaris, both conditions of varied aetiology, commonest in adolescents and both in many instances finally cured by child-birth. It is postulated that this final cure of acne vulgaris is due to a finally established ideal hormonal balance, only achieved by the hormonal stimuli of pregnancy and parturition. Other aetiological factors would appear to be only of secondary importance. A suggestion is made to qualify Plenck's dictum "Matrimonium varos curat" to "Non matrimonium sed infantes varos in feminas curant". 7). From experience in this and other skin departments the results of hormonal therapy are often disappointing and unpredictable and may give rise to unpleasant, though rarely dangerous side-effects. More, and if at all possible, controlled trials are necessary in this field, to find a more satisfactory and safer approach to the internal and external treatment of acne vulgaris with hormonal substances. 8). It is stressed that acne vulgaris must not be taken lightly, the presence of a disfiguring and usually all too obvious skin condition in a susceptible adolescent not only leads to psychological upset and trauma, but also may interfere with a young person's work and career, as well as jeopardizing a girl's chances in marriage

Volume 10, issue 1

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research. Visit the journal website at http://canjsurg.ca/ for more.https://ir.lib.uwo.ca/cjs/1083/thumbnail.jp