Anorectal motility in patients with achalasia of the esophagus: recognition of an esophago-rectal syndrome

BACKGROUND: During my study of constipation, I encountered patients who had achalasia of the esophagus (AE) as well. The possibility of an existing relationship between the 2 conditions was studied. METHOD: Investigations to study the anorectal motility in 9 AE patients included: the intestinal transit time, anorectal manometry, rectoanal inhibitory reflex, defecography and electromyography (EMG) of external anal sphincter and levator ani muscle. Anorectal biopsy was done. The study comprised 8 healthy volunteers as controls. RESULTS: 6/9 AE patients had constipation presenting as strainodynia (excessive prolonged straining at stool). Rectocele was present in 4 of them. The 6 constipated patients showed significantly high rectal neck pressure (p < 0.05), absent rectoanal inhibitory reflex and aganglionosis in the anorectal biopsy. The EMG revealed diminished activity in 4 of the 6 constipated patients. The remaining 3 patients with AE had normal anorectal function. Heller's myotomy with Nissen's fundoplication improved the dysphagia, but not the constipation which was, however, relieved after performance of anorectal myectomy. CONCLUSION: The high incidence of constipation with AE postulates a relationship between the 2 conditions. Both have the same pathologic lesion which is aganglionosis. This study is preliminary and requires further studies on a larger number of patients

Immediate chest X-ray for patients at risk of lung cancer presenting in primary care: randomised controlled feasibility trial

Background: Achieving earlier stage diagnosis is one option for improving lung cancer outcomes in the United Kingdom. Patients with lung cancer typically present with symptoms to general practitioners several times before referral or investigation. Methods: We undertook a mixed methods feasibility individually randomised controlled trial (the ELCID trial) to assess the feasibility and inform the design of a definitive, fully powered, UK-wide, Phase III trial of lowering the threshold for urgent investigation of suspected lung cancer. Patients over 60, with a smoking history, presenting with new chest symptoms to primary care, were eligible to be randomised to intervention (urgent chest X-ray) or usual care. Results: The trial design and materials were acceptable to GPs and patients. We randomised 255 patients from 22 practices, although the proportion of eligible patients who participated was lower than expected. Survey responses (89%), and the fidelity of the intervention (82% patients X-rayed within 3 weeks) were good. There was slightly higher anxiety and depression in the control arm in participants aged >75. Three patients (1.2%) were diagnosed with lung cancer. Conclusions: We have demonstrated the feasibility of individually randomising patients at higher risk of lung cancer, to a trial offering urgent investigation or usual care

An 11-week school-based “health education through football” programme improves musculoskeletal variables in 10–12-yr-old Danish school children

Purpose: To investigate the effects of the "11 for Health" programme on musculoskeletal fitness. Methods: A total of 108 Danish children aged 10-12&nbsp;years participated in the study, with 61 children in the intervention group (IG, 25 girls and 36 boys) and 47 children in the control group (CG, 21 girls and 26 boys). Measurements were conducted before and after an 11-week intervention consisting of twice-weekly 45-min football training sessions for IG or continuation of normal Physical Education program for CG. Whole-body dual X-ray absorptiometry was conducted for evaluation of leg and total bone mineral density as well as bone, muscle and fat mass. Standing Long Jump and Stork balance tests were employed to assess musculoskeletal fitness and postural balance. Results: During the 11-week study period, leg bone mineral density as well as leg lean body mass increased more (p&nbsp;&lt;&nbsp;0.05) in the intervention group (IG) compared to the control group (CG) (0.021&nbsp;±&nbsp;0.019 vs 0.014&nbsp;±&nbsp;0.018&nbsp;g/cm2 and 0.51&nbsp;±&nbsp;0.46 vs 0.32&nbsp;±&nbsp;0.35&nbsp;kg, respectively). Moreover, body fat percentage decreased more in IG than in CG (-0.6&nbsp;±&nbsp;0.1 vs 0.1&nbsp;±&nbsp;0.1&nbsp;%-points, p&nbsp;&lt;&nbsp;0.05). No significant between-group differences were found in bone mineral content. Stork balance test performance increased more in IG than in CG (0.5&nbsp;±&nbsp;2.6 vs -1.5&nbsp;±&nbsp;4.4&nbsp;s, p&nbsp;&lt;&nbsp;0.05), whereas no between-group differences were found in jump performance. Conclusions: The school-based football programme, 11 for Health, with twice-weekly 45-min training sessions over 11&nbsp;weeks improves various, but not all evaluated parameters related to musculoskeletal fitness in 10-12-yr-old Danish school children