Dysphagia lusoria and segmental aperistalsis in the upper third of the esophagus.

An aperistaltic zone located in the upper third of the esophagus was present in a young woman with dysphagia, who had undergone surgical treatment for dysphagia lusoria 3 months before. The segmental absence of contraction in the upper third of the esophagus was the most probable cause for the persistence of dysphagia, and could have resulted from damage related to compression or to surgical intervention in the area.

Chronic Chagas' heart disease in children and adolescents: a clinicopathologic study.

A retrospective study of the medical records filed at the University Hospital from 1965 to 1983 and of 18456 autopsies carried out in the Department of Pathology of this Institution from 1953 to 1983, referring to patients aged less than 18 years was performed in an attempt to fully characterize chronic Chagas' heart disease in children and adolescents. Only 19 of these patients fulfilled the criteria for inclusion in the present study (12 cases with only clinical information and 7 cases with clinical and pathological information). We noted that the clinical manifestations of chronic Chagas' heart disease are congestive heart failure, thromboembolism and sudden death.

Esophageal dysfunction in patients with progressive systemic sclerosis and mixed connective tissue diseases.

Esophageal motility was studied in 37 patients with progressive systemic sclerosis (PSS), 12 patients with mixed connective tissue disease (MCTD) and 40 controls by the manometry method, using an open tube and continuous perfusion, and by radiological examination. Radiology was normal in 17 patients with PSS and five patients with MCTD, and abnormal in 15 patients with PSS and three with MCTD. The most frequent abnormality was slow transit time of barium.

Plasma gastrin and gastric acid responses to insulin hypoglycemia in Chagas' disease.

Plasma gastrin and gastric acid responses to intravenous injection of insulin (0.2 IU/kg) were measured in 8 patients with Chagas' disease, which is known to be associated with extensive reduction of the intramural neurons of the digestive tract, and in 6 control subjects. All subjects developed hunger, sweating and tachycardia, and exhibited less than 50 mg/dl venous blood glucose.

Angiography in Perthes' disease.

Angiography may play an important role in the understanding of the cause and treatment of Perthes' disease. Angiograms were performed in 30 patients, including 26 aortographies and six selective angiographies. The major angiographic alterations were: general decrease of blood flow in the affected hip, lack of a patent medial circumflex artery, an atrophic medial circumflex artery or obstruction of its branches, distended vessels in subluxations of the hip joint, and almost complete absence of the obturator artery.

Gastric accommodation to distension and early gastric emptying in diabetics with neuropathy.

Gastric accommodation to distension and gastric emptying were assessed in diabetics with neuropathy and in control subjects. Gastric accommodation was measured by recording intragastric pressures during the air insufflation of the stomach and gastric emptying was measured by the double sample test meal after intragastric instillation of 500 ml of saline into the empty stomach. Maximal intragastric pressures during air insufflation were significantly higher in diabetics (N = 6) than in control subjects (N = 15), 16.

[Pharyngo-esophageal time in Chagas esophageal disease].

The pharyngoesophageal time, the time interval between the peak pharyngeal pressure and the peak esophageal pressure ten centimeters apart, after wet deglutitions, was measured in 50 controls and 37 chagasic patients. The time was 2.90 +/- 0.

Fasting and food-stimulated plasma gastrin levels in chronic Chagas' disease.

Chagas' disease is known to be associated with extensive lesions of the intramural neurons of the digestive tract. In order to evaluate the contribution of the intramural plexuses to the control of plasma gastrin levels in man, we performed the following measurements: (a) fasting plasma gastrin in 18 chagasic patients and 16 control subjects; (b) integrated gastrin response to food in 9 chagasic patients and 10 controls, (c) basal acid secretion and gastric acid responses to graded doses of pentagastrin in 14 chagasic and 13 controls. Fasting plasma gastrin levels and integrated gastrin response were significantly higher in chagasics than in controls.

Segmental absence of contraction in the upper third of the esophagus.

In a manometric study of esophageal motility, segmental absence of contraction was encountered in the upper third of the esophagus in five patients, although only two of them had complained about dysphagia. If the manometric patterns were identical in the patients with and without dysphagia, it is difficult to explain this symptom in all the cases.

Abnormalities of interdigestive motility of the small intestine in patients with Chagas' disease.

The fasting motor activity of the upper small intestine was studied in 36 patients with chronic Chagas' disease, which is known to be associated with extensive lesions of the myenteric plexuses, and the results compared with those obtained in 15 control subjects. The migrating motor complex (MMC) was detected as frequently in the Chagas' disease group as in the control group, and the frequency of contractions during the activity front was virtually the same in the two groups. In the Chagas' group the propagation of the activity fronts was slower, their duration was longer in the jejunum, but not in the duodenum, and the calculated length was shorter than normal.

Effect of pentagastrin on the motor activity of the dilated and nondilated sigmoid and rectum in Chagas' disease.

In order to evaluate the effect of pentagastrin on the motor activity of the sigmoid and rectum in patients with Chagas' disease, manometric studies were performed on 22 chagasic patients, 11 without and 11 with megacolon, and 11 control subjects. Pentagastrin had a stimulating effect on the sigmoid and rectum in control subjects as well as in chagasic patients without megacolon. In chagasic patients with megacolon, pentagastrin had no effect on sigmoid or rectum motility, probably as a result of the intrinsic denervation known to occur in this disease.

[The lower esophageal sphincter in patients with Chagas' disease with peristalsis and aperistalsis].

The opening of the lower esophageal sphincter (LES) were studied by intraluminal manometry in 23 control subjects, 10 chagasic patients with peristalsis in esophagus and 15 chagasic patients with aperistalsis in esophagus. The opening of the LES were 2,1 +/- 0,7 seconds after wet deglutitions in controls, 3,2 +/- 1,2 seconds in chagasic with peristalsis and 3,5 +/- 1,7 seconds in chagasic with aperistalsis. The duration of relaxation were 7,9 +/- 1,5 seconds in controls, 5,2 +/- 1,0 seconds in chagasic wih peristalsis and 5,9 +/- 1,3 seconds in chagasic with aperistalsis.

Basal motility of dilated and non-dilated sigmoid colon and rectum in Chagas' disease.

The basal motility of the sigmoid colon and rectum was evaluated manometrically over 3 consecutive 10-minute periods in 29 control subjects, 14 chagasic patients without megacolon, and 32 chagasic patients with megacolon. The results indicated that the sigmoid colon of both chagasic groups had a lower motility index and lower wave frequency than that of the controls. Reduced wave frequency was observed in the rectum of patients with megacolon, out the rectum of the chagasic patients without megacolon showed manometric characteristics similar to those for the controls.

Acid and pepsin secretion in chronic Chagas' disease patients in response to graded doses of pentagastrin and pentagastrin plus bethanecol.

Gastric acid and pepsin secretory responses to graded doses of pentagastrin were measured in 12 Chagas' disease patients and 18 control subjects, and in 7 Chagas' disease patients and 6 controls the study was repeated with an infusion of bethanecol. Calculated maximal outputs of acid and pepsin (Vmax) and responsiveness (D50) of the acid- and pepsin-secreting cells to pentagastrin were lower in the chagasics. Bethanecol had no significant effect on pentagastrin-stimulated gastric secretions in controls.

Peripheral blood flow in the neonate; 1. Changes in total, skin, and muscle blood flow with gestational and postnatal age.

Total peripheral blood flow and blood flow through the skin and muscle were measured in the calf with an electrocapacitance plethysmograph with counter pressure in a group of 62 "well" newborn infants (birth weight, less than 3500 g). Blood pressure in the contralateral leg was measured with an Arteriosonde 1010, and peripheral vascular resistance was calculated as mean blood pressure (mm Hg) divided by blood flow (ml per 100 ml tissue per min). The results show that total peripheral blood flow and blood flow through he skin and muscle correlated inversely with increasing birth weight and gestational age.

Impaired gastric accommodation to distension and rapid gastric emptying in patients with Chagas' disease.

In order to evaluate the contribution of the myenteric plexuses to the control of gastric accommodation to distension and to the rate of gastric emptying of a saline solution in man, we have evaluated these functions in patients with Chagas' disease, which is known to be associated with extensive lesions of the myenteric plexuses. Intragastric pressure was significantly higher (P < 0.05) in Chagas patients (N = 15) than in normal controls (N = 15) for air distension volumes of 100-700 ml.