Real-time ultrasonographic assessment of antroduodenal motility after ingestion of solid and liquid meals by patients with functional dyspepsia.

BACKGROUND AND AIMS: Although antroduodenal motility has usually been studied by using manometric or scintigraphic methods, ultrasonography is an established, non-invasive method to evaluate duodenogastric motility. We used ultrasonography to evaluate gastric motility in patients with functional dyspepsia. METHODS: Sixty-four patients with functional dyspepsia and 36 asymptomatic healthy subjects were given liquid and solid test meals. We investigated the gastric emptying rate, motility index, and duodenogastric reflux for the liquid meal and gastric emptying time, half-emptying time, and motility index for the solid meal. RESULTS: After the liquid meal, the gastric emptying rate and motility index were significantly lower and the duodenogastric reflux was significantly higher in functional dyspepsia patients than in healthy subjects. After the solid meal, gastric emptying time, half-emptying time and the motility index were significantly lower in the patients than in the healthy subjects. Delayed gastric emptying of both meals occurred in only 20.3% of patients. Delayed emptying of the liquid or solid meal occurred in 62.5% of patients. In both groups, gastric emptying time of the solid meal was positively correlated with the motility index at 15 min post-ingestion. CONCLUSION: In functional dyspepsia patients, delayed gastric emptying of a solid meal was related to antral hypomotility during the early postprandial phase. Ultrasonographic assessment of gastric motility in both liquid and solid meals may provide a better understanding of the pathogenesis of functional dyspepsia.

Assessment of the severity of coronary artery stenosis by the ratio of the regional washout rate determined by adenosine triphosphate stress Tl-201 SPECT.

BACKGROUND: Adenosine triphosphate stress thallium-201 single-photon emission computed tomography (ATP SPECT) is useful for diagnosis of coronary artery disease, but its usefulness for evaluating the severity of coronary artery stenosis has not been established. METHODS AND RESULTS: We performed region-of-interest analysis of short-axis images obtained by ATP SPECT in 31 patients with single-vessel disease (>50% stenosis of the luminal diameter). We selected the lowest and highest washout rates (WR) among the anterior, lateral, and inferior WRs and calculated the ratio of the lowest WR to the highest WR (WR ratio = 0.925+/-0.027 in 14 control subjects). ATP SPECT showed positive results in 29 (94%) of 31 patients. The severity of coronary artery stenosis was inversely correlated with the WR ratio (r = -0.703, P < .0001). The sensitivity and specificity of a WR ratio < or = 0.660 for the diagnosis of severe coronary stenosis (> or =80% stenosis) were 83% and 80%, respectively. CONCLUSIONS: Results suggest that ATP SPECT may be useful for assessment of the severity of coronary artery stenosis in patients with single-vessel disease.

Quantitative assessment of comparative potencies of cholesterol-crystal-promoting factors: relation to mechanistic characterization.

The crystallization of cholesterol is affected by various factors in bile. The present study evaluated the relative importance of cholesterol-nucleation-promoting factors and partially characterized the mechanisms of their action. Model biles with an identical relative composition of cholesterol, egg-yolk phosphatidylcholine and taurocholate, except for replacing phosphatidylcholine (5-20%) with dilinoleoyl-phosphatidylcholine or taurocholate (10-30%) with taurodeoxycholate. Cholesterol crystallization was quantitatively assessed spectrophotometrically and morphologically estimated by the laser-scattering diffraction analyser and video-enhanced microscopy in the absence and presence of concanavalin A-binding glycoprotein isolated from human bile. In a series of experiments, lipid distribution among particulate species was determined after isolation by FPLC. In all experiments, cholesterol crystallization was dose-dependently enhanced with a rank order of: concanavalin A-binding glycoprotein > dilinoleoyl - phosphatidyl choline> taurodeoxycholate. No morphological alteration was evident for vesicles and crystals, but the cholesterol/phospholipid ratio in vesicles was increased significantly by replacement with dilinoleoyl-phosphatidylcholine and excess cholesterol. A high proportion of relatively hydrophilic phosphatidylcholine species such as dilinoleoyl-phosphatidylcholine and excess cholesterol in bile cause a redistribution of cholesterol to increase a vesicular cholesterol/phospholipid ratio, eventually promoting cholesterol crystallization, whereas concanavalin A-binding glycoprotein acts via differing mechanisms.

A quantitative assessment of serum chylomicron by light scattering intensity: application to the intestinal fat absorption test.

A novel fat absorption test to clarify the malabsorption syndrome was developed using a micronephelometric technique and compared with the classic conventional technique using 131I-triolein. An integrity of time-sequential light scattered from chylomicron-related turbidity in serum was determined between 0 and 300 min after butter fat load, being expressed in terms of the light scattering intensity (LSI). A good correlation was obtained between LSI and the serum level of chylomicron-triglyceride determined by an ultracentrifugation technique (r = 0.819, P < 0.001). The maximal LSI was consistently observed at 180 min after administration of a test meal in the normal group (n = 39), whereas the malabsorption syndrome group (n = 35) was distinctly different and could be further classified according to four patterns of LSI changes. In addition, an inverse correlation was found between this fat absorption test and the 131I-triolein absorption test. It was concluded that the micronephelometric technique which does not use a radionuclide is advantageous in its simple and safe evaluation of fat malabsorption syndrome.

Method for quantitative assessment of transformation of non-micellar cholesterol carriers in model bile systems.

Aggregation and fusion of non-micellar particulate species, such as unilamellar vesicle and phospholipid lamellae, are believed to precede the nucleation of cholesterol crystals in bile. However, little is known about the time sequence relationship between transformation of non-micellar particles and the initial appearance of cholesterol crystals, as no adequate technique is available for assessing such transformations quantitatively. We have developed a novel method for quantitatively estimating vesicle transformation in supersaturated model bile systems, using a spectrophotometric technique to determine the time sequence relationship between such transformations and cholesterol crystal nucleation. We also investigated the potency of a given effector substance on this transformation. This method permits simultaneous quantitative determination of vesicle aggregation and of cholesterol crystal growth. Maximal vesicular aggregation as determined from turbidity, coincided with initiation of cholesterol crystal nucleation. The addition of divalent cations, Ca2+ and Mg2+, to the model bile solutions promoted vesicle aggregation and cholesterol crystal nucleation and growth. In contrast, apolipoproteins A-1 and A-2 retarded such processes. These data were highly reproducible and reliable. The method described is easy to perform, provides reproducible results and permits the determination of the potency of effector substances on vesicle transformation and on the nucleation of cholesterol crystals.

Assessment of platelet cytosolic concentration of free magnesium in healthy subjects.

We measured basal cytosolic concentration of free Mg2+ ([Mg2+]i) in platelets from 30 healthy volunteers by using mag-fura-2, a new fluorescent Mg2+ indicator. The mean [Mg2+]i was 381 +/- 22 mumol/L, with values ranging from 226 to 771 mumol/L. The day-to-day intrasubject coefficient of variation was relatively small (3.6%). [Mg2+]i was significantly higher in men than in women (430 +/- 38 vs 332 +/- 17 mumol/L, p < 0.03), and was not correlated with age. There was no significant relation between platelet [Mg2+]i and serum total Mg concentration. The results indicate that the gender but not age may decide intracellular Mg2+ status. In addition, the mechanisms that regulate [Mg2+]i may be independent of those that influence the extracellular concentration of Mg.

[The risk factors of lymph node metastasis in submucosal invasive gastric carcinoma--assessment of the indication for endoscopic treatment].

Recent advances in endoscopic diagnosis and treatments have increased the number of early gastric carcinomas being treated by endoscopic resection. However, the appropriate criteria for endoscopic resection of gastric carcinomas with submucosal invasion are not completely established. During the past 12 years from 1980 to 1992, 116 lesions in 116 patients were treated by surgical operation for differentiated type submucosal invasive gastric carcinoma. In this study, the risk factors of lymph node metastasis were investigated clinicopathologically. As the result, 1) Heterogeneity of submucosal invasive tumor margin was demonstrated in 19 (16%) of the 116 lesions of which predominant histology was differentiated adenocarcinoma. 2) Lymph node metastasis was demonstrated in 16 (16%) of the 97 lesions of which histology was differentiated type. 3) Significant risk factors of lymph node metastasis was demonstrated in submucosal massive invasion (sm3), papillary adenocarcinoma, INF gamma, lymph vessel involvement (ly(+)), and existence of ulcer (ul(+)). 4) Sm3 and papillary adenocarcinoma (pap) had a higher malignant potential than ly(+), INF gamma, and ul(+) by multivariate analysis using the logistic regression. 5) All lesions with both well differentiated adenocarcinoma (tub1) and sm minimal invasion (sm1) had no lymph node metastasis. These results suggested that the lesions with both well differentiated adenocarcinoma tub1 and sm1, which have no other risk factors such as ly(+), INF gamma, and ul(+), may be considered as the appropriate indication for endoscopic treatment of gastric submucosal carcinoma.

The assessment of proliferating cell nuclear antigen immunohistochemical staining in small hepatocellular carcinoma and its relationship to histologic characteristics and prognosis.

BACKGROUND: A precise prognostic factor for small hepatocellular carcinoma (HCC), the diagnosis of which recently has increased in incidence because of the development of diagnostic imaging techniques, is desirable. It has been reported that proliferating cell nuclear antigen (PCNA) would be related to proliferating cells, and thus the PCNA labeling index may provide useful information about the biologic behavior of small HCC. METHODS: An assessment was made of proliferative activity by immunohistochemical staining using a monoclonal antibody against PCNA in 46 nodules of HCC less than 3 cm in diameter resected from 44 patients. A correlation between PCNA labeling index and clinicopathologic findings or prognosis was sought. RESULTS: The mean labeling index was 18.7% in HCC and 1.9% in nontumor liver tissue. The labeling index corresponded to the degree of histologic differentiation, and the labeling index of well differentiated HCC was significantly lower (P < 0.05) than that of moderately or poorly differentiated HCC. The incidence of capsule formation in the high labeling index group (labeling index > or = 20%) was significantly higher (P < 0.05) than that in the low labeling index group (labeling index < 20%). A high incidence of capsular and vascular invasion was found in the high labeling index group. The survival rate after resection was significantly higher (P < 0.05) and the recurrence rate significantly lower (P < 0.05) in the low labeling index group than in the high labeling index group. CONCLUSIONS: The PCNA labeling index was shown to be closely related to histologic characteristics, and proved to be a useful indicator of recurrence and survival in small HCC.

Ultrasonographic assessment of inflammatory bowel disease.

Ultrasound examinations were performed in 36 patients with Crohn's disease, 28 with ulcerative colitis, and 50 with no bowel disease. The pathological findings were classified into three types and compared with the radiographic and/or colonoscopic findings. Crohn's disease and ulcerative colitis could be detected by ultrasonography with a sensitivity of 86% and 89%, respectively. The ultrasonographic features correlated with the radiographic/colonoscopic findings and with disease activity, but did not help much in making a differential diagnosis, although the location of the pathologic changes was helpful to some extent. In conclusion, ultrasonography can serve as a useful alternative diagnostic procedure that permits us to obtain information about transmural changes in inflammatory bowel disease.

Assessment of supra-valvular abnormal signal with color Doppler flow mapping in patients with aortic regurgitation.

A supra-aortic abnormal flow signal (proximal acceleration) was studied in 62 patients with aortic regurgitation with the use of color Doppler flow mapping. The proximal acceleration signal was detected in 28 of the 62 patients and was shaped like a V or a teardrop. In the 29 patients who underwent aortography, a proximal acceleration signal was observed in all 18 patients with severe and moderate regurgitation and in only one of the 11 patients with mild regurgitation. The sensitivity for the diagnosis of severe regurgitation from the existence of a proximal acceleration signal was 100%, specificity 50%, and predictive accuracy 47%. A close correlation between the area of the proximal acceleration signal and the width of the aortic regurgitant jet signal was observed (r = 0.81). An acceleration area of 45 mm2 or more was observed in eight of the nine patients with severe regurgitation, in four of the nine patients with moderate regurgitation, and in none of the patients with mild regurgitation. Sensitivity for the diagnosis of severe regurgitation from an area of proximal acceleration of more than 45 mm2 was 89%, specificity 80%, and accuracy 67%. These results suggest that evaluation of the area of the supra-aortic abnormal signal may be a useful auxiliary aid in estimating the severity of aortic regurgitation.