Campylobacter pylori colonizing heterotopic gastric tissue in the rectum.

Campylobacter pylori specifically attaches to gastric epithelial cells and is the etiologic agent for type B gastritis. The authors report the case of a woman with the rare finding of heterotopic gastric mucosa in the rectum that was colonized with C. pylori.

Ultrastructure of another spiral organism associated with human gastritis.

Campylobacter pylori may not be the only organism that causes active chronic gastritis in man. We report two cases of gastric infection with a spiral organism distinct from C. pylori.

Myelolipoma: radiologic findings in seven patients.

Myelolipomas are rare, non-functioning, benign tumors which occur both in the adrenal gland and in various extra-adrenal locations, particularly presacrally. We report the computed tomographic (CT) and ultrasonographic (US) findings in seven patients with pathologically proven myelolipomas. Magnetic resonance (MR) imaging was also obtained in one.

The role of nifedipine therapy in achalasia: results of a randomized, double-blind, placebo-controlled study.

Utilizing the rationale that the calcium channel blocker nifedipine decreases lower esophageal sphincter pressure, we performed a double-blind, placebo-controlled, crossover trial of sublingual nifedipine in achalasia, a disorder whose treatment depends on reduction in lower esophageal sphincter pressure. Ten patients participated in this trial, completed diaries, underwent manometric determinations of lower esophageal sphincter pressure, and had testing of esophageal emptying rates by a solid-meal radionuclide method. Nifedipine, titrated to a dose of 10-30 mg before meals, was well tolerated.

The hypertensive lower esophageal sphincter. Manometric and clinical aspects.

Controversy exists as to whether the hypertensive lower esophageal sphincter (HLES) represents a clinical motility disorder of the esophagus or is merely the right-sided expression of a normal distribution curve. In the present study we describe 16 patients with HLES, defined as a lower esophageal sphincter (LES) pressure of greater than or equal to 40 mm Hg (mean + 3 SD of controls) with normal peristalsis. All of the patients suffered from chest pain and nine from dysphagia.

Segmental high amplitude peristaltic contractions in the distal esophagus.

High amplitude peristaltic contractions in the distal esophagus ("nutcracker esophagus") is the most common manometric disorder seen in patients with noncardiac chest pain. Although this abnormality is found in the distal esophagus, the definition regarding its precise level in the esophagus is unclear. A careful analysis of 99 consecutive manometric tracings performed during a 1-yr period revealed that in patients with noncardiac chest pain and/or dysphagia, the location of the abnormal esophageal contractions varied: 1) in 11 patients the esophageal contractions were abnormal at 2 cm, as well as 7 cm, above the lower esophageal sphincter (LES); 2) the abnormality was limited to the 2-cm location above the LES in six patients; and 3) was confined to the 7-cm location above the LES in five patients.

Detection of esophageal motor disorders by radionuclide transit studies. A reappraisal.

Radionuclide measurement of esophageal transit has been proposed as a screening test for esophageal motor dysfunction. In this study we evaluated the radionuclide esophageal transit test in 49 consecutive patients undergoing esophageal manometry for esophageal motor disorders. Esophageal transit was assessed using a 10-ml water bolus labeled with 250 microCi technetium-99m sulfur colloid.

Nonsurgical management of esophageal perforation from pneumatic dilatation in achalasia.

Perforation of the esophagus is a well-described complication of pneumatic dilatation in patients with achalasia. Although successful management of these patients without surgical intervention has been reported, little follow-up data exist. We report the successful nonsurgical management of esophageal perforation after pneumatic dilatation in three patients.

Sphincteric action of the diaphragm during a relaxed lower esophageal sphincter in humans.

We studied the effects of involuntary and voluntary contraction of the diaphragm on esophagogastric junction (EGJ) pressure during esophageal distension in healthy human volunteers. The EGJ pressure was monitored using a Dent sleeve device. Along with the pressure we concurrently monitored diaphragm electromyogram (EMG) using intra-esophageal bipolar electrodes that were placed on the nonpressure sensing surface of the sleeve device.

Sucralfate delays gastric emptying of liquids and solids in duodenal ulcer patients.

Gastric emptying studies were performed on nine healthy volunteers and ten duodenal ulcer (DU) patients utilizing a dual radionuclide technique to assess simultaneously emptying rates of liquid (111In labeled water) and solid (99mTc sulfur colloid labeled chicken liver) components of a meal. One gram of sucralfate was compared to placebo in separate days in a randomized double-blind crossover fashion. Subjects ingested the radiolabeled test meal 1 h after receiving medication, and gastric emptying was monitored for 3 h using a gamma camera interfaced with a computer.

Effect of interleukin-6/interferon-beta 2 on glucocorticoid action in rat hepatoma cells.

Reuber hepatoma cells (RHC) were treated 4 h with dexamethasone (dex), with and without simultaneous fibroblast-conditioned medium (cIL-6). A cytosol fraction, prepared in the presence of molybdate and dithiothreitol, was analyzed for [3H]dex (20 nM) binding in the presence and absence of 1 microM dex at 4 degrees C. Receptor levels declined from 76.

"Segmental aperistalsis" of the esophagus: a cause of chest pain and dysphagia.

Although some patients with chest pain and dysphagia have manometric evidence of classic esophageal motor disorders, other patients with these symptoms may have only nonspecific findings of unknown importance. We describe five patients with chest pain and dysphagia in whom esophageal manometry showed a segment of esophagus with an increased frequency of simultaneous contractions associated with normal motility in the more proximal and distal esophagus. All patients had corresponding segmental abnormalities on video-esophagograms augmented with a solid bolus; in four patients, the solid bolus caused reproduction of symptoms during the esophagography.

Cisapride. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use as a prokinetic agent in gastrointestinal motility disorders.

Cisapride, a substituted piperidinyl benzamide chemically related to metoclopramide, is an orally administered prokinetic agent which facilitates or restores motility throughout the length of the gastrointestinal tract. Its novel mechanism of action is thought to involve enhancement of acetylcholine release in the myenteric plexus of the gut. Because of its specificity cisapride is devoid of central depressant or antidopaminergic effects; side effects such as diarrhoea or loose stools, which occur infrequently, are related to its primary pharmacological action.

Failure of glucagon to induce hepatic phosphoenolpyruvate carboxykinase in endotoxic shock.

We have determined that one reason for diminished PEPCK activity during endotoxemia is the inhibition of glucocorticoid action in hepatic cells. Since glucocorticoid and glucagon hormones act cooperatively to regulate the expression of PEPCK mRNA, we examined whether endotoxin also inhibits the action of glucagon to induce this enzyme. Treated mice were injected intraperitoneally with endotoxin and glucose after a 24 hr fast and given ad libitum access to food and water.

Characteristics and frequency of transient relaxations of the lower esophageal sphincter in patients with reflux esophagitis.

Electromyogram of the submental muscles, esophageal manometry, and pH studies were simultaneously performed in an unselected group of 12 patients with subjective and objective evidence of gastroesophageal reflux (GER) disease to determine the frequency of transient relaxation of the lower esophageal sphincter (LES) and mechanisms of GER. Findings from these patients were compared with data from 10 asymptomatic healthy volunteers. Recordings were obtained for 1 h in the fasting state and 3 h after a standard 850-kcal meal.

Human recombinant IL-1 alters glucocorticoid receptor function in Reuber hepatoma cells.

Exposure of Reuber hepatoma cells (RHC) to 30 and 300 fM human rIL-1 (hurIL-1) for 4 h significantly decreased cytosolic glucocorticoid binding. Scatchard analysis indicated that the 30 and 300 fM doses of hurIL-1 significantly decreased the Bmax (maximum number of available binding sites), but did not alter the Kd (affinity of the glucocorticoid receptor for ligand). The decrease in cytosolic glucocorticoid binding, expressed relative to cytosol protein, did not result from increased intracellular protein in hurIL-1-treated RHC.

MRI of periprostatic venous plexus in staging of early prostatic carcinoma.

The periprostatic venous plexus can be observed as a bright rim in coronal magnetic resonance (MR) images obtained by spin-echo (SE) 2060/60 technique. A carcinoma of the prostate which penetrates through the capsule into the periprostatic tissues interrupts or obliterates this rim, whereas an intact rim indicates that the tumor is confined within the prostatic capsule. One hundred patients with proven prostatic carcinoma were prospectively imaged by MR to detect periprostatic involvement.

Electrical and mechanical activity in the human lower esophageal sphincter during diaphragmatic contraction.

To determine the effect of contraction of the diaphragm on the lower esophageal sphincter (LES) pressure, we studied eight healthy volunteers during spontaneous breathing, maximal inspiration, and graded inspiratory efforts against a closed airway (Muller's maneuver). Electrical activity of the crural diaphragm (DEMG) was recorded from bipolar esophageal electrodes, transdiaphragmatic pressure (Pdi) was calculated as the difference between gastric and esophageal pressures, and LES pressure was recorded using a sleeve device. During spontaneous breathing, phasic inspiratory DEMG was accompanied by phasic increases in Pdi and LES pressure.