Examination of gastroesophageal reflux by transabdominal ultrasound: can a slow, trickling form of reflux be responsible for reflux esophagitis?

BACKGROUND: Ultrasound can visualize significant portions of the upper and lower esophagus; it is without any instrumental interference in real conditions and displays events in motion. PURPOSE: To study the events that occur during swallowing and gastroesophageal reflux. PATIENTS AND METHODS: Group 1 comprised 25 patients with retrosternal complaints, selected for esophageal surface ultrasonography for endoscopic signs of esophagitis. Group 2 comprised 25 patients who underwent initial transabdominal ultrasonography. For 3 to 6 h before ultrasonography, nothing was given by mouth to the 50 patients labelled as having gastroesophageal reflux disease (GERD). Ultrasonography was then performed for 15 to 20 mins after drinking one mouthful of water or tea, or swallowing some saliva to provoke reflux. The events were recorded on videotape rolls. Endoscopy was carried out in all 50 cases; in 46 cases (21 and 25 from groups 1 and 2, respectively), gastric acidity and bacteriology were subsequently examined (test meal). Manometry and pH were not measured to avoid provocation of reflux by the instruments. Thirty patients without any esophageal complaints or signs of esophagitis (though suffering from gastric and duodenal diseases) were designated as the control group (group 3). The available results were compared. RESULTS: In 32 of 46 patients diagnosed with GERD (69.5% in groups 1 and 2), a special kind of reflux was observed by ultrasonography: a slow, trickling reflux of the gastric content was seen, mostly after swallowing. A fast clearance followed four to six episodes of the trickling reflux, only after an interval of 0.5 to 2 mins. Only fast refluxes and immediate clearance were observed in the control group. CONCLUSIONS: The observations above may indicate a special form of gastroesophageal reflux, namely, a slow, trickling form of it. It can be responsible for the development of GERD. Fast reflux and immediate clearance are common; however, this special trickling form was observed only in GERD patients. This may explain a number of often contradictory measurements and can make the effect of cisapride more understandable. A test meal is always necessary to distinguish a bilious reflux from an acidic one, because only the latter may require aggressive antacidic treatment.

[A recovered case of actinomycosis in the small intestines diagnosed with ultrasonography]. / Ultraszonográfiával diagnosztizált vékonybél-actinomycosis gyógyult esete.

The authors report the history of a patient suffering from abdominal actinomycosis. The correct diagnosis could be established by an ultrasound-guided aspiration sampling from the small-intestinal abscess, following the sonographic localisation of the lesion. The patient recovered by a long-term antibiotic treatment. Related to the case the authors review the relevant literary data of the past few years and point to the value of ultrasonography in the successful management of the disease.

[The use of a somatostatin analog (Sandostatin) in percutaneous drainage of pancreatic pseudocysts]. / Somatostatin analog (Sandostatin) alkalmazása pancreas pseudocysták percutan katéteres kezelésében.

The inflammatory pancreatic diseases are usually hardly governable; special problems are arosen with the treatment of pancreatic fluid collections. The focal pericystic pancreatitis, the reactive inflammation developing in the course of the injury of the gland as well as draining pancreatic duct filling the cyst up may result in pitfalls. Thus subcutaneous administration of Sandostatin was added to the usual therapeutic regimen in 12 patients. It was applied with external and internal drainage of pseudocysts in 10 patients and in one of them the complication was reduced in an unsuccessful attempt, respectively. The pseudocyst of one patient disappeared by sole somatostatin administration. One cystic formation did not respond to this kind of treatment thus a drainage procedure had to be performed. Based on our initial experiences we seem to find a rather promising tool that may influence the basic process beneficially and makes our instrumental interventions safer and more successful.

[Gluing of sterile abdominal benign cyst walls with tissue adhesives (Tissucol) (preliminary report)]. / Steril, benignus hasi folyadékgyülemek falainak összeragasztása szöveti ragasztóval (tissucol) (elözetes közlemény).

The authors, endeavouring to stick the walls of percutaneously emptied cysts together had applied the two-component Tissucol fibrin glue in the treatment of abdominal and thoracic cysts. Their ten cases, however, may be considered only as preliminary experiences. It seems that the method can be recommended for an attempt to cease these formations in a fast and simple way. Nevertheless, this method must not be the subject of treatment in infected and malignant fluid collections, but seems successful in pancreatic pseudocysts, in spite of their higher proteolytic activity.

Immunological side effects of some long term taking medicaments.

In view of epidemiologic aspects of AIDS we studied the immunological side-effects of oral hormonal contraceptives and the barbiturates--which are used by many people in Hungary. We studied healthy persons using more than six months one of the above described drugs. We found significant decrease in the number of "O" cells and in the serum concentration of IgG in the O.C. test group. In B test group decreased significantly the number of T, B, T-active, T-helper lymphocytes and the serum concentration of IgM. The amount of IgA and IgD increased in both the test groups. We detected HBV-markers only in 0.83% of control-group but in 4.23% of O.C. group and in 2.28% of the B test group. The data suggests that all of studied medicaments cause increase in susceptibility against infections.

[Visible venous bloodflow in real-time abdominal sonography, possibly a sign of hepatitis B virus-induced, compensated immune hemolysis]. / Real-time hasi ultrahang vizsgálat során látható vénás vérkeringés, amely B-hepatitis vírus által indukált, kompenzált immun-haemolysis sonographiás jele lehet.

In 15 patients examined for the suspicion of hepatobiliary disease the venous blood flow was visible by the permanent circulation of soft particles in both the systemic and the portal veins with abdominal real-time ultrasonography. In order to clarify the background of the phenomenon there were extended laboratory examinations carried out. In the course of them the infectedness of the patients with Hepatitis-B virus, immune haemolysis and the disorder of the cellular immunity could be demonstrated. Similar visual phenomenon was found only in one patient suffering only from immune haemolysis, but no hepatic disease. The hepatic patients generally do not show the phenomenon. On the basis of these it is presumed that visible venous flow in real-time abdominal ultrasonography may be a sign of compensated immune haemolysis induced by Hepatitis-B virus infection.

[Ultrasound-guided percutaneous antegrade wirsungography in chronic calcifying pancreatitis]. / Ultrahanggal vezérelt percutan antegrad wirsungographia idült kalcifikáló pancreatitisben.

Dilated pancreatic duct was found by ultrasonography in a patient in association with the characteristic sonographic features of chronic calcifying pancreatitis. Endoscopic retrograde pancreatography showed an obstruction of the Wirsung's duct 3 cm far from the papilla of Vater. Further parts of the duct could not be opacified by this manner. However, visualisation of the rest of the pancreatic duct was successfully performed by ultrasonically guided antegrade wirsungography making the preoperative planning of the suitable type of surgery possible. Beside the case history the importance of the is method is also discussed in diagnosis of pancreatic diseases.