Patient satisfaction after biofeedback for constipation and pelvic floor dyssynergia.

BACKGROUND: Patients referred for chronic constipation frequently report symptoms of straining, feeling of incomplete evacuation, or the need to facilitate defecation digitally (dyschezia). When such patients show manometric evidence of inappropriate contraction or failure to relax the pelvic floor muscles during attempts to defecate, they are diagnosed as having pelvic floor dyssynergia (Rome I). AIMS: To evaluate long-term satisfaction of patients with pelvic floor dyssynergia after biofeedback. PATIENTS: Forty-one consecutive patients referred for chronic constipation at an outpatient gastrointestinal unit and diagnosed as having pelvic floor dyssynergia who completed a full course of biofeedback. METHODS: Data have been collected using a standardised questionnaire. A questionnaire survey of patients' satisfaction rate and requirement of aperients was undertaken. RESULTS: Mean age and symptom duration were respectively 41 and 20 years. Half of patients reported fewer than 3 bowel motions per week. Patients were treated with a mean of 5 biofeedback sessions. At the end of the therapy pelvic floor dyssynergia was alleviated in 85% of patients and 49% were able to stop all aperients. Satisfaction was maintained at follow-up telephone interviews undertaken after a mean period of 2 years, as biofeedback was helpful for 79% of patients and 47% still abstained from intake of aperients. CONCLUSIONS: Satisfaction after biofeedback is high for patients referred for chronic constipation and diagnosed with pelvic floor dyssynergia. Biofeedback improves symptoms related to dyschezia and reduces use of aperients.

Endoscopic features of Helicobacter pylori-related gastritis.

BACKGROUND AND STUDY AIMS: It is still controversial whether certain endoscopic features can be used to diagnose Helicobacter pylori (Hp)-related gastritis. To clarify this issue, we performed two consecutive prospective studies. PATIENTS AND METHODS: In the first study, we tried to identify endoscopic criteria associated with Hp-related gastritis from a total of 66 predefined gastric features on endoscopy. These features were selected by a stepwise logistic regression analysis in 101 patients. The validity of these features gained from this first study was then evaluated in a second study in 86 patients (40 with Hp gastritis, 8 with Hp-unrelated gastritis and 38 with normal gastric mucosa). RESULTS: Three features, namely an abnormal antral surface texture, a mammillated corpus surface, and white antral erosions, were identified in the first study as independent predictors of Hp-related gastritis. However, the sensitivity and specificity of these three criteria, as assessed in the second study, were only 75% and 63% respectively. CONCLUSIONS: We conclude that it is not possible to diagnose Hp-related gastritis on the basis of the endoscopic appearance alone. The diagnosis should be based on other criteria, such as a rapid urease test, or a histological examination of gastric biopsies, or both.

Effect of cisapride on gallbladder motility after extracorporeal shock-wave lithotripsy.

BACKGROUND/AIMS: Altered gallbladder motility is regarded as one of the important factors involved in the formation and recurrence of gallstones. Previous studies have suggested that cisapride increases postprandial gallbladder contraction and may therefore be theoretically useful in preventing stone recurrence. The aim of our study was therefore to investigate the effect of cisapride on gallbladder motility in stone-free patients after extracorporeal shock-wave lithotripsy, as compared to healthy volunteers pair-matched for age and sex. METHODS: Each subject received cisapride or placebo in a double-blind, cross-over, random order. Gallbladder volumes were measured by ultrasonography in the fasting state and after intake of a standard liquid meal. Plasma cholecystokinin levels were determined by radioimmunoassay. RESULTS: Fasting gallbladder volumes were smaller in patients as compared to volunteers (20.7 +/- 1.3 ml vs. 46.0 +/- 9.2 ml; p < 0.05) but were not modified by cisapride (21.1 +/- 1.7 ml vs. 58.6 +/- 11.3 ml). The maximal postprandial decrease in gallbladder volume was similar in patients and volunteers (64.5 +/- 12% vs. 62 +/- 10%; NS) and was not significantly altered by cisapride (59 +/- 9.4% vs. 54 +/- 9%; NS). In patients, cisapride increased integrated postprandial gallbladder volume by accelerating gallbladder refilling as compared to placebo by 37 +/- 15% (p < 0.05). Integrated cholecystokinin plasma levels were similar in patients and volunteers and were 13.4 +/- 4.7% higher after cisapride as compared to placebo (p < 0.05). CONCLUSIONS: The results of this study suggest that cisapride does not alter postprandial gallbladder contraction but accelerates gallbladder refilling in patients free from gallstones after extracorporeal shock-wave lithotripsy. This effect of cisapride is probably due to an acceleration of gastric emptying also causing a secondary enhanced cholecystokinin release.

[Effect of the menstrual cycle on the reproducibility of anorectal manometry]. / Influence du cycle menstruel sur la reproductibilité des mesures de la manométrie anorectale.

The influence of the menstrual cycle on the reproducibility of anorectal manometry was investigated in 6 healthy volunteers (median age 29 years) without hormonal treatment, who were studied during the follicular and the luteal phases and during the menstruation phase. The intra- and interindividual variations were compared by calculating KENDALL's concordance coefficient. The following results were obtained (mean +/- SD): sphincter length (41 +/- 4 mm), anal pressure at rest (79 +/- 6 cm H2O) and during voluntary contraction (167 +/- 23 cm H2O), threshold volume for the anorectal reflex (12 +/- 3 ml), duration after 20 ml (24 +/- 7 seconds), after 40 ml (47 +/- 3 seconds) and variation of the rectoanal inhibitory reflex after 40 ml (25 +/- 9 cm H2O), threshold volume of rectal sensation (16 +/- 5 ml), volume of constant perception after 30 seconds (101 +/- 27 ml), maximum tolerable volume (212 +/- 18 ml) and rectal pressure during maximum tolerable volume (23 +/- 6 cm H2O). For all of the above parameters, the intra-individual variations were not higher than the inter-individual variations. We therefore conclude that the menstrual cycle does not influence the reproducibility of anorectal manometry in the healthy woman.

[Extracorporeal shockwave lithotripsy of the gallbladder: importance of selection criteria]. / Lithotritie vésiculaire par ondes de choc extracorporelles: importance des critères de sélection.

In recent years, a number of alternatives to surgery for gallstones have been developed. Among them, extracorporeal shock-wave lithotripsy (ESWL) was promising, being non-invasive and risk-free. Nevertheless, its results vary according to the size, number and composition of the stones and according to the bile acids treatment used for fragment dissolution. To better evaluate the importance of these factors, we have widened the selection criteria currently used (1 to 3 non-calcified stones with a diameter below 30 mm) by including patients with large stones (up to 40 mm in diameter), multiple stones (up to 10 stones) and calcified stones. We also compared, for efficacy of fragment dissolution after ESWL, treatment by ursodeoxycholic acid alone as opposed to a mixture with chenodeoxycholic acid. Our results were (1) significant lessening of the fragmentation rate and of the number of gallbladders free of stones 1 year after ESWL when selection criteria are widened; (2) a mixture of ursodeoxycholic and chenodeoxycholic acids may favour fragment dissolution after ESWL compared to treatment by ursodeoxycholic acid alone.

Low sodium solution for colonic cleansing: a double-blind, controlled, randomized prospective study.

The standard polyethylene glycol electrolyte solution for colonic cleansing has a salty unpleasant taste resulting in limited patient acceptance. Introduced as a major advance allegedly providing a distinctly better taste, a new low sodium cleansing solution was recently described. In a double-blind controlled fashion, 66 colonoscopy outpatients were interviewed about general palatability and tolerance of the solution they had ingested for the preparation of endoscopy. Preparation quality was assessed endoscopically. Similar results were obtained for both solutions concerning palatability, tolerance, and cleansing quality. Furthermore, a small quantity of both solutions was tasted and directly compared for taste qualities before endoscopy. Fifty-one and one-half percent of patients preferred the new solution and 48.5% preferred the standard solution or had no preference (not significant). Of the patients, 39.2% were unable to differentiate between the more and the less salty solution. Moreover, 39.6% of patients preferred the solution they judged more salty. We conclude that the new low sodium lavage solution is not superior to the standard solution regarding patient acceptance, compliance, and cleansing quality. Thus, the reduction of salt concentration does not appear to be the appropriate approach to improve patients compliance with colonic cleansing solutions.

Palatability of a new solution compared with standard polyethylene glycol solution for gastrointestinal lavage.

The salty unpleasant taste of the standard polyethylene glycol electrolyte lavage solution constitutes a major drawback, which limits patient compliance. Recently, a new low-sodium cleansing solution was described and introduced as a major advance, allegedly providing a distinctly better taste and improving compliance. We compared the taste of both solutions, seeking a possible preference applying a double-blind randomized design. Twenty-eight healthy volunteers tasted one of the two solutions without a direct comparison. Both solutions were found to have a similar palatability and an equal salty taste. A different group of 50 volunteers compared the two solutions. Twenty-one preferred the standard solution, 25 preferred the new solution (not significant), and 4 subjects had no preference. Among the subjects basing their preference on the saltiness of the solutions, 18 estimated the standard solution to taste more salty than the new low sodium solution, while 18 volunteers found the new solution to taste more salty than the standard solution. This study does not confirm a taste preference for the new low-salt polyethylene glycol electrolyte lavage solution as compared with the standard solution for colonic cleansing. The difference in the salt concentrations of the two solutions could not regularly be distinguished by a group of healthy volunteers.

Neurinoma of the facial nerve associated with a parietal meningioma.

A rare neurinoma of the labyrinthine portion of the facial nerve with a parietal meningioma is reported. The association of these two tumors is discussed. Steroid receptor assays were performed. No hormone receptors were found, and the levels of estradiol, progesterone, and testosterone in the plasma were normal.

Presence of sex steroid hormone receptors in meningioma tissue.

Meningiomas from 10 patients were studied for the presence of sex hormone receptors. No meningioma was found to have estrogen receptors, while 4 had no receptors. The presence of progesterone receptors was independent of the age or sex of the patient, whereas androgen receptors were found only in postmenopausal women. The possible relationship between the epidemiological characteristics of meningiomas and the presence of sex hormone receptors is discussed.

Human glioma-associated antigens detected by monoclonal antibodies.

Hybridoma cells were derived from a fusion between mouse P3x63/Ag8 myeloma cells and spleen cells from a mouse immunized with whole cells of a human malignant glioma line. Of 345 hybrids obtained, 36 secreted antibodies that reacted with the glioma cell line used for immunization as assayed by an indirect antibody-binding radioimmunoassay. After a first screening for the absence of reactivity on two nongliogenous cell lines, 3 hybrids were selected and cloned by limiting dilution. The specificity of these monoclonal antibodies was then investigated on a panel of 18 cell lines derived from human malignant gliomas, 18 cell lines from nongliogenous neoplasms, as well as normal peripheral blood lymphocytes, normal skin fibroblasts, and normal spermatozoa. The monoclonal antibodies from two positive hybrids, BF7 and GE2, reacted exclusively with glioma cells and appeared to be directed against common malignant glioma antigen(s). BF7 antibodies bound to 13 and GE2 to 17 of 18 glioma cell lines. The third monoclonal antibody, CG12, showed a broad reactivity since it bound to 10 of 18 glioma lines, five of five melanoma lines, and one of one neuroblastoma line. Absorption with normal adult and fetal brain homogenate did not modify the binding capacity of BF7 and GE2 for glioma cells, while the binding of CG12 antibodies was abolished. Reciprocal binding inhibition tests using [3H]leucine-labeled antibodies showed that BF7, GE2, and CG12 antibodies were directed against different antigenic determinants.

Infection of a lumbar dermoid cyst by an anaerobic peptococcus.

A case is reported of a dermoid cyst with a dermal sinus in a young adult, presenting as a subdural empyema due to an anaerobic peptococcus.

Characterization of an established human malignant glioma cell line: LN-18.

A human malignant glioma cell line, LN-18, has been established in monolayer culture and subcultured for more than 115 passages. LN-18 cells grow in vitro as bipolar or stellate cells with pleomorphic nuclei, have a doubling time of about 72 h and a plating efficiency of 3%. The glial nature of these cells has been assessed by ultrastructural examination. The synthesis of glial fibrillary acidic and S-100 proteins could not be demonstrated, although the initial biopsy tissue and the early cultures were positive for the former. The presence of Ia-like antigens on the surface of these cells was demonstrated using allo and xeno antisera. LN-18 cells were also shown to synthesize large quantities of fibronectin. The injection of LN-18 cells into nude mice induced the formation of solid tumor masses that could be retransplanted every 3 weeks and showed a morphology comparable to that of the initial biopsy. Karyotype analysis revealed the presence of three marker chromosomes, constantly present before and after hetero-transplantation.

[Double suprasellar and pineal germinoma with potomania]. / Double germinome suprasellaire et pinéal avec potomanie.

A case is reported of suprasellar and pineal germinoma in a 16-year-old male initially presenting with potomania without diabetes insipidus. The role of stimulation of the hypothalamus in producing pathological thirst is discussed.

[Central nervous system tumor tissue culture, part II: Mesodermic tumors, ectodermic tumors, neurinomas, metastasis]. / Cultures de tissus des tumeurs du système nerveux central Deuxième partie: Tumers mésodermiques, tumeurs ectodermiques, neurinomes, métastases.

The authors describe monolayer culture of meningiomas, neurinomas, craniopharyngiomas, pituitary adenomas, hemangioblastomas and metastases. The very peculiar in-vitro morphology of neurinomas and craniopharyngiomas is stressed.

[Cultures of tissue from central nervous system tumors. Part 1. Neuroglial tumors]. / Cultures de tissu des tumeurs du système nerveux central. 1re partie: Tumeurs neuro-gliales.

The authors report their experience with monolayer culture of 80 neuro-glial tumors. Of these 45 were glioblastomas and 17 astrocytomas. 7 glioblastomas gave long term lines, two of which have been transplanted into nude mice and studied by electron microscopy. The morphological and biochemical characteristics of neuro-glial tumors are discussed.