[Study of esophageal transit with radioisotopes in the diagnosis of achalasia]. / Lo studio del transito esofageo con radioisotopi nella diagnostica della acalasia.

The investigations employed in the diagnosis of oesophageal achalasia have been assessed critically. Although electromanometry contributes most to diagnosis and pinpoints with absolute precision the physiopathological elements that characterise the disease, radioisotopic study of oesophageal transit is an important diagnostic aid. More readily than any other, this technique permits morphofunctional evaluation in selected patients; it also represents the most physiological investigation and the best tolerated and, second only to manometry, the most reliable. Oesophagography with baritate meal and oesophagoscopy also play a diagnostic role in oesophageal achalasia. The former makes it possible to document the cardial stop and the presence or otherwise of mega-oesophagus, the second excludes the presence of organic dysphagias and also has a therapeutic use because cycles of dilatation of the oesophago-cardial junction can be carried out.

[The motility of the biliary tract studied with 99mTc-Br-IDA in patients with type-2 diabetes mellitus]. / Studio sulla motilità delle vie biliari con 99mTc-Br-IDA in pazienti con diabete mellito di tipo II.

Autonomic neuropathy in diabetes mellitus can cause alterations of the motor function of various segments of the gastroenteric apparatus. With hepatocholangio-cholecystiscintigraphy-HIDA we have studied the motility of the biliary system in patients with diabetes mellitus type II. The research has been carried out in 29 patients with diabetic autonomic neuropathy; 12 healthy volunteers have been studied to compare the results obtained. The results showed a delay in the appearance of radionucleotide in the small intestine of diabetic subjects compared to controls with statistical significance. Moreover the diabetic subjects with a serious neuropathic injury showed increased intestinal transit time. These results match those obtained by other authors that have studied the cholecystic emptying in diabetic subjects with other methods. Consequently the biliary system is also affected by the diabetic autonomic neuropathy that can be in its turn the cause of other pathologies such as biliary lithiasis.

[Effects of fenoverine on biliary kinetics evaluated by hepatobiliary scintigraphy with 99mTc-Br-IDA]. / Effetti della fenoverina sulla cinetica biliare valutata con scintigrafia epatobiliare con 99mTc-Br-IDA.

Hepatobiliary scintigraphy was used to evaluate the action of fenoverine in 16 patients suffering from dyskinesia of the biliary tract; the drug was administered in doses of 300 mg per day per os for 20 days, the patients being subjected to hepatobiliary scintigraphy before and after treatment. The following parameters--accurate indicators of the motor coordination of the biliary tract--were evaluated: tracer appearance time in the gallbladder (Tc) and in the intestine (Ti). After treatment there was a normalization of these two parameters which initially were extended. Statistical analysis showed a highly significant reduction in these times. Stress is laid on the importance of hepatobiliary scintigraphy in the diagnosis of biliary dyskinesia and on the effectiveness of fenoverine in the treatment of this conditions.

[The evaluation of the time of gastric radio-isotopic emptying in subjects with non-insulin dependent diabetes mellitus]. / Valutazione dei tempi di svuotamento gastrico radio-isotopico in soggetti con NIDDM in terapia con cisapride.

Abnormal gastro-intestinal motility is a well-recognized complication of autonomic neuropathy in diabetics; delayed gastric emptying is frequently documented. Various pharmacologic agents have been used to treat this complication such as cisapride. We have evaluated the effects of cisapride on gastric emptying in nine diabetic patients with autonomic neuropathy through radio-scintigraphic method. Gastric emptying diabetic patients was significantly prolonged compared control subjects (p < 0.01). In our study cisapride increased gastric emptying, but this did not reach statistical significance. We concluded that cisapride may be considered as a good alternative in cases where limited efficacy or side effects preclude the use of metoclopramide.