The mutually complementary role of magnetic resonance enterography and conventional enteroclysis in patients with complicated and/or advanced stage of Crohn's disease.

AIM: To assess the diagnostic significance of magnetic resonance enterography (MRE) and conventional enteroclysis (CE) in patients with complicated and/or advanced stage of Crohn's disease. METHODS: Patients with abnormal CE findings suggestive of mural and/or extramural involvement with the diagnosis or pre-diagnosis of CD are evaluated. After real-time bowel distension by enteroscopic examination, the patients with advanced or complicated stage were taken to the MRE examination in the same session. Mucosal-mural-extramural and activation findings, presence of stenosis/stricture, skip lesions and the mean duration of exams were evaluated with both CE and MRE. The superiority of one method over the other relative to these findings was evaluated. RESULTS: A total of 110 patients evaluated by CE had the findings of CD. Of these, 24 patients with abnormal CE findings suggestive of advanced mural and extramural involvements were subsequently evaluated with MRE. CE was superior to MRE in the depiction of early superficial mucosal changes (aphthous-linear ulcer), cobblestone pattern (p = 0.002, p < 0.01), obstruction (p = 0.004, p < 0.01), and differentiation between the string sign and stricture. MRE was superior to conventional enteroclysis in mural and perienteric findings of bowel thickening, fibro-fatty proliferation, abscess (p = 0.016, p 0.05). CONCLUSION: CE and MRE are mutually complementary imaging modalities in CD staging, evaluation of activation findings, and detection of complications (Tab. 3, Fig. 8, Ref. 23).

Broadband, millimeter-wave antireflection coatings for large-format, cryogenic aluminum oxide optics.

We present two prescriptions for broadband ($ {\sim} 77 - 252\;{\rm GHz} $), millimeter-wave antireflection coatings for cryogenic, sintered polycrystalline aluminum oxide optics: one for large-format (700 mm diameter) planar and plano-convex elements, the other for densely packed arrays of quasi-optical elements-in our case, 5 mm diameter half-spheres (called "lenslets"). The coatings comprise three layers of commercially available, polytetrafluoroethylene-based, dielectric sheet material. The lenslet coating is molded to fit the 150 mm diameter arrays directly, while the large-diameter lenses are coated using a tiled approach. We review the fabrication processes for both prescriptions, then discuss laboratory measurements of their transmittance and reflectance. In addition, we present the inferred refractive indices and loss tangents for the coating materials and the aluminum oxide substrate. We find that at 150 GHz and 300 K the large-format coating sample achieves $ (97 \pm 2)\% $ transmittance, and the lenslet coating sample achieves $ (94 \pm 3)\% $ transmittance.

Cyanoacrylate in the treatment of gastric varices complicated by multiple pulmonary emboli.

Bleeding gastric varices are increasingly being obliterated with the aid of endoscopic injection of n-butyl-cyanoacrylate (histoacryl) diluted with lipiodol. This glue acts as a tissue adhesive that polymerizes on contact with blood in a gastric varix. Severe glue pulmonary embolism is a rare complication of injection therapy. This case involves a 52-year-old man with fundal gastric varices, who developed multiple pulmonary emboli following glue injection with profound hypoxia requiring hospital admission for 13 days, but with eventual recovery of normal lung function.

Living Labs: overview of ecological approaches for health promotion and rehabilitation.

PURPOSE: The term "Living Lab" was coined to reflect the use of sensors to monitor human behavior in real life environments. Until recently such measurements had been feasible only within experimental laboratory settings. The objective of this paper is to highlight research on health care sensing and monitoring devices that enable direct, objective and accurate capture of real-world functioning. METHOD: Selected articles exemplifying the key technologies that allow monitoring of the motor-cognitive activity of persons with disabilities during naturally occurring daily experiences in real-life settings are discussed in terms of (1) the ways in which the Living Lab approach has been used to date, (2) limitations related to clinical assessment in rehabilitation settings and (3) three categories of the instruments most commonly used for this purpose: personal technologies, ambient technologies and external assistive systems. RESULTS: Technology's most important influences on clinical practice and rehabilitation are in a shift from laboratory-based to field-centered research and a transition between in-clinic performance to daily life activities. Numerous applications show its potential for real-time clinical assessment. CONCLUSIONS: Current technological solutions that may provide clinicians with objective, unobtrusive measurements of health and function, as well as tools that support rehabilitation on an individual basis in natural environments provide an important asset to standard clinical measures. IMPLICATIONS FOR REHABILITATION: Until recently objective clinical assessment could not be readily performed in a client's daily functional environment. Novel technologies enable health care sensing and monitoring devices that enable direct, objective and accurate capture of real-world functioning. Such technologies are referred to as a "Living Lab" approach since they enable the capture of objective and non-obtrusive data that clinicians can use to assess performance. Research and development in this field help clinicians support maintain independence and quality of life for people who have disabilities or who are aging, and to promote more effective methods of long-term rehabilitation and maintenance of a healthy life style.

Nap it or leave it in the elderly: A nap after practice relaxes age-related limitations in procedural memory consolidation.

Using a training protocol that effectively induces procedural memory consolidation (PMC) in young adults, we show that older adults are good learners, robustly improving their motor performance during training. However, performance declined over the day, and overnight 'offline' consolidation phase performance gains were under-expressed. A post-training nap countered these deficits. PMC processes are preserved but under-engaged in the elderly; sleep can relax some of the age-related constraints on long-term plasticity.

Fasting serum bile acid levels in the primary hyperlipoproteinemias.

A newly developed radioimmunoassay specific for conjugates of cholic acid (CCA) was used to measure the fasting serum levels of these bile acids in 233 patients with primary hyperlipoproteinemia classified as type IIa, IIb, III, IV, or V hyperlipoproteinemia as well as in 80 healthy control subjects. Subjects with type IIa hyperlipoproteinemia had significantly lower levels of CCA (0.9 plus or minus 0.06 muM, mean plus or minus SE) than did healthy controls (0.50 plus or minus 0.08 muM). Patients with type IIb, III, IV, and V hyperlipoproteinemia had values similar to those of the control group. The abnormally low fasting value of CCA in type IIa patients is considered to reflect decreased secretion of bile acid into the intestine in such patients, who are known to have defective bile acid synthesis rates and decreased bile acid pool sizes.

Biliary bile acid composition in Wilson's disease.

Biliary bile acid composition and pattern of bile acid conjugation with glycine or taurine were found to be within normal limits in six patients with documented Wilson's disease. Four patients had previous biopsy evidence of cirrhosis (three with active hepatitis), but most conventional liver function tests gave normal results at the time of the study. Serum levels of conjugates of cholic acid, measured by radioimmunoassay, were not increased. However, plasma disappearance if intravenously injected glycine conjugate of cholic acid was significantly delayed in all subjects, suggesting that this is a more sensitive test of hepatic excretory function and may be of value for assessing hepatic function in patients with this rare genetic disorder. No evidence of a primary disturbance in bile acid metabolism was found in these patients.

The long-term management of duodenal ulceration using an H2-antagonist: symptomatic self-care compared with maintenance treatment.

In a 48-week study of 319 duodenal ulcer patients, symptomatic self-care with an histamine H2-receptor antagonist (flexible self-chosen dosing with cimetidine 0, 400 or 800 mg/day) was compared with maintenance treatment (cimetidine 400 mg nocte). The rate of withdrawal from the study was similar in both groups. The mean consumption of cimetidine 400 mg tablets was significantly higher in the maintenance group (7.2 vs. 5.4 tablets/week; P less than 0.0001), but the mean cumulative number of days with ulcer symptoms was higher in the symptomatic self-care group (47.2 vs. 29.1 days in 48 weeks). The estimated number of days of work-loss due to ulcer symptoms was similar in both groups (approximately 4 days in the 48 weeks of observation). It is concluded that symptomatic self-care using an H2-antagonist can provide not only an economic but also an effective strategy for the long-term management of uncomplicated duodenal ulceration.

In-vivo anti-reflux and raft properties of alginates.

The comparative efficacy of two alginate-containing anti-reflux preparations (Gaviscon, Algicon) was assessed in a single blind crossover study of 20 patients with gastro-oesophageal reflux disease. The clinical efficacy study was preceded by two studies in healthy volunteers to assess the intragastric effects of Algicon and Gaviscon by pH measurement, endoscopic visualization and gamma scintigraphy. Algicon and Gaviscon were shown to form a raft in the fasting and fed human stomach, with Algicon alone having a potent antacid effect below and within the raft. Both Algicon and Gaviscon liquids significantly reduced the frequency and severity of reflux symptoms from baseline when given at their recommended doses (10 ml and 20 ml four times daily, respectively). There were no significant differences between Algicon and Gaviscon, although 12 patients preferred Algicon (vs 5 for Gaviscon) for control of reflux symptoms. It was concluded that both Algicon and Gaviscon were effective for the symptomatic control of gastro-oesophageal reflux disease.

The effect of atropine and vagal stimulation on the release of neurotensin-like immunoreactivity in man.

This study investigated the food stimulated release of neurotensin-like immunoreactivity (NTLI) in man with and without the administration of atropine, and the influence of vagal stimulation by modified sham feeding and insulin hypoglycaemia. NTLI was measured, after ethanol extraction, by specific C- and N-terminally directed antisera. With both a liquid fat meal and a mixed meal an early peak of NTLI occurred. The mixed meal also produced a second sustained rise in plasma NTLI. An intramuscular injection of 0.6 mg atropine sulphate abolished the early peak, but had no effect on the late peak. Modified sham feeding and insulin hypoglycaemia did not release NTLI. We conclude that it is possible that a cholinergic non-vagal mechanism is responsible for the early phase of food stimulated release of NTLI in man, and that the second sustained rise may be cholinergically independent.

EEG and autonomic responding to verbal, spatial and emotionally arousing tasks: differences among adults, adolescents and inhalant abusers.

The present study investigated the physiological responses of an adolescent inhalant abuse group, an adolescent non-abuse group, and an adult non-abuse group elicited by three types of tasks: verbal, spatial, and emotionally arousing. Each group consisted of 10 male Mexican-American subjects. Bilateral EEG and electrodermal activity, as well as heart rate, were monitored. While exploring for possible heart rate and hemispheric alpha wave differences in response to predominantly verbal and spatial tasks, an attempt was also made to discover if electrodermal responses could be bilaterally differentiated. Another purpose of the study was to explore possible psychophysiological differences between a younger and older group, and between an inhalant abusing group and a non-abuse group, in response to the three types of tasks. Results indicated that attempts to produce task-related EEG hemispheric asymmetry were largely nonsuccessful. Bilateral electrodermal responses were also not greatly differentiated. It was suggested that stronger task manipulations were needed. Significant group differences were found for initial physiological response levels (adults demonstrated higher levels than the two adolescent groups) and for heart rate response to the emotionally arousing task (non-abusing subjects demonstrated greater heart rate acceleration than inhalant abusing subjects). It was suggested that group differences in initial levels occurred due to the adult groups's greater involvement in the experimental situation. Heart rate differences to the emotionally arousing situation were discussed in terms of Zuckerman's sensation seeking hypothesis.

Management of upper gastrointestinal haemorrhage.

Upper gastrointestinal haemorrhage is a life threatening situation. Peptic ulcer disease, oesophageal varices and Mallory-Weiss tear are the major causes. Initial management usually includes hospital admission and, ideally, care by a specialized team involving Physician, Surgeon and Nursing Staff. Prompt and adequate blood replacement is the most important measure followed by diagnosis, usually based on flexible endoscopy. Specific treatment protocols for peptic ulcer and oesophageal varices aid definitive management. Prognosis is influenced by age, presence of complicating disease, aetiology and the severity of the bleed.

Duodenal ulcer.

Duodenal ulcer is a common disease which places heavy demands on health care costs. The aetiology is unknown, but its pathogenesis is related to acid secretion. The characteristic symptom is chronic epigastric pain which precedes meals, occurs one to three hours after food, and one to two hours after retiring. The pain is relieved by food or antacids. Barium meal remains the prime investigation, but flexible endoscopy allows accurate visualization of the ulcer particularly in a scarred deformed duodenum. Complications include haemorrhage, perforation and obstruction. Time-honoured therapy including diet, antacids and anticholinergics simply relieves pain, whilst newer drugs (Tagamet, De-Nol, and Duogastrone) are effective in healing the ulcer. Surgery is indicated for complications or inadequately relieved pain.

Neuropsychological effects of abuse of inhalants.

A neuropsychological battery of 67 measures was completed by 68 inhalant-abusing and 41 other-drug-abusing adolescent subjects. The measures tapped both global and specific functioning. Analysis of covariance was used to control effects of age and other drug use. These analyses indicated that inhalant abusers performed significantly more poorly than other drug abusers on 20 of the 67 measures. Deficits were observed on both global measures (WAIS and WRAT) and specific measures (perception of speech sounds, visual suppression, sensory perception, and Trails). These deficits suggest that the effect of inhalant abuse may be severe and widespread.

Influence of initial therapy on outcome of peptic ulcer.

Histamine 2 (H2) receptor antagonists, proton pump inhibitors, prostaglandin analogues, colloidal bismuth and sucralfate have all proved safe and effective in the initial treatment of peptic ulcer. Yet, most ulcers will recur when treatment is stopped. Continuous maintenance with H2 antagonists results in low symptomatic relapse, complications occur rarely, and such treatment is safe. An alternative is Symptomatic Self Care (on-demand therapy), which provides an economic option for patients with no concomitant disease or previous complications. Meta-analyses suggest a higher relapse rate after H2 antagonist therapy than that following sucralfate or bismuth. Whilst improved morphology and/or functional status of the gastro-duodenal mucosa ('quality of healing') has been claimed, the difference has not been explained. Successful prolonged eradication of Helicobacter pylori leads to a very low relapse rate, but more effective, predictable and safer eradication regimens are needed.

Quality of Life in duodenal ulcer.

A Quality of Life questionnaire was administered to 200 duodenal ulcer patients taking daily H2 antagonists and compared with the responses given by 50 newly diagnosed duodenal ulcer patients. Assessment involved 17 questions which attempted to measure ulcer symptoms, emotional and social function. Age, sex and percentage of smokers were identical in the two groups. Patients on long-term daily H2 antagonists showed high Quality of Life scores and this is hardly surprising, given the safety, efficacy and economy of H2 antagonists. By contrast, the low scores demonstrated in newly diagnosed ulcer patients reflect the troublesome nature of ulcer pain and the disruption it causes to social and emotional performance.

Long-term strategies for peptic ulcer.

Commonly when treatment is stopped most peptic ulcers recur. The prevention of ulcer recurrence by continuous long-term therapy, usually with H2-receptor antagonists, provides effective and convenient management in patients at risk in order to reduce the chance of relapse, complications, and associated mortality. High relapse rates of peptic ulcer suggest the need for continuous H2-antagonists in elderly patients, those receiving NSAID, aspirin or anticoagulants, those with coexistent medical conditions and those with previous haemorrhage or perforation. Patients suitable for intermittent therapy include those who are < 60 years, with no previous ulcer complications, no coexistent medical conditions and few recurrences. Long-term H2-antagonists have an enviable safety profile and are cost effective. Despite this, the possibility of permanent cure of peptic ulcer by Helicobacter pylori eradication suggests that long-term therapy may not be needed. We face the exciting prospect of placing peptic ulcer into the annals of history.

Helicobacter pylori eradication: therapy other than with bismuth or proton-pump inhibitors.

Antibiotics alone do not achieve Helicobacter (H. pylori) eradication perhaps because of reduced activity in an acid environment. Some reports suggest that ranitidine combined with amoxicillin and metronidazole is highly successful in eradicating H. pylori, but other have found less success with H2-antagonists. Studies have shown that sucralfate is equally as effective as omeprazole when combined with clarithromycin and metronidazole in achieving H. pylori eradication. Similarly, sucralfate triple therapy (substituted for bismuth) may provide cost efficient treatment. Whilst immunization to protect against Helicobacter infection seems attractive, a large amount of animal work needs to be done before the necessary tedious human trials. Future trends in H. pylori eradication may involve 1-week therapy combining proton-pump inhibitors, bismuth or sucralfate and two antibiotics. It is hoped that such regimens will be simple, effective, relatively inexpensive and free of side effects.

Helicobacter pylori: fact or fiction?

The recent isolation and classification of the spiral gastric bacteria Helicobacter pylori has led to an explosion of worldwide research. The data strongly suggest that H. pylori is the causative agent for type-B active chronic gastritis. The role of H. pylori in duodenal ulcer awaits clarification, and, more importantly, potential treatment regimens need clear documentation and further detailed research. The past decade has revealed many intriguing facts about H. pylori infection. If, during the 1990s, eradication of H. pylori by means of appropriate and safe medication can lead to the control and prevention of gastroduodenal disease, then major clinical and economic benefits can be anticipated.

Helicobacter pylori and peptic ulcer.

Helicobacter pylori is an important pathogen causing both gastric and duodenal ulcer. The causal relationship is based on the strong association of peptic ulcer with H. pylori-induced gastritis, the improved rate of healing with H. pylori suppression, and markedly low recurrence rates for ulcer after H. pylori eradication. The ideal regimen for H. pylori eradication should be simple, inexpensive, free of side effects, and effective in at least 90% of patients. Triple therapy involving bismuth, metronidazole and tetracycline or amoxicillin results in the best and most consistent eradication data, but there is a significant incidence of side effects and problems with compliance. Acid suppression with ranitidine or omeprazole combined with antibiotics is effective but expensive with variable results in clinical trials. Sucralfate may also reduce H. pylori density and enhance the action of antibiotics used in eradication regimens. Studies reported in this Journal suggest that sucralfate can be successfully substituted for bismuth in triple therapy regimens with documented efficacy and few side effects. Considerable progress in developing newer regimens to eradicate H. pylori has been made. However, the development of an ideal drug or regimen remains a challenge.