Gastric motility dysfunction in patients with multiple sclerosis assessed by gastric emptying scintigraphy.

BACKGROUND: Gastrointestinal tract symptoms are common in patients with multiple sclerosis (MS), especially constipation and/or fecal incontinence. AIMS: To assess gastric emptying in patients with MS to detect the severity of autonomic disturbances in the gastrointestinal tract, and to find the relationship between lower bowel disturbances and the rate of gastric emptying. METHODS: Forty-nine patients with definite MS and 20 control subjects were included in the study. All patients underwent full neurological examination and magnetic resonance imaging of the brain and spinal cord. The labelled meal for gastric emptying scintigraphy consisted of cooked eggs mixed with 3 mCi of technetium-99m colloid, and was followed by serial images at 15 min intervals for 2 h. RESULTS: Five studies were excluded due to technical artifacts. Twenty-one patients (47.7%) demonstrated slow emptying, 15 (34.1%) demonstrated normal and eight (18.2%) demonstrated fast clearance curves. The mean half-time of gastric emptying in MS patients was 96.6+/-22.4 min and the controls showed a mean half-time of 41.3+/-18.7 min (P<0.05). The half-time was longer in patients with constipation; nevertheless, it showed no significant difference compared with patients without constipation (P=0.197). Moreover, although half-time was shorter in patients with fecal incontinence, there was not a significant difference compared with those without fecal incontinence (P=0.654). CONCLUSIONS: The gastric emptying rate is slow in MS patients. As for lower bowel disturbances, the gastric emptying rate was obviously affected in patients complaining of constipation and fecal incontinence, although statistical significance was not reached.

Delayed graft function is characterized by reduced functional mass measured by (99m)Technetium-mercaptoacetyltriglycine renography.

BACKGROUND: The mechanism that underlies delayed graft function (DGF) is still poorly defined. Previous studies using tubular function tests have shown that postischemic injury to the renal transplants results in profound impairment of paraimmunohippurate (PAH) extraction through the tubules. METHODS: Using (99m)Technetium-mercaptoacetyltriglycine ((99m)Tc-MAG3) renography and tubular function slope (TFS), a study of the tubular uptake of (99m)Tc-MAG3 was undertaken in a prospective study of renal transplant recipients with immediate graft function (IGF) and those with DGF. RESULTS: A total of 37 consecutive recipients of a cadaveric graft and 5 kidneys from living donors was evaluated within 48 hours after transplantation and in week 2, months 3 and 6, and 3 years after transplantation. In addition to the protocol scans, recipients with DGF were examined every other day until function was resumed. Repeated measurement two-way analysis of variance and a change point analysis were performed to determine the difference in the follow-up of TFS values between the two groups. Fourteen patients were classified as having DGF and 28 immediate graft function. In the DGF group, the initial TFS value was significantly lower than in the immediate graft function group (0.54 [+/-0.01] and 1.75 [+/-0.16], respectively; P=0.002), a difference that persisted for up to 3 years. Change point analysis revealed that the postischemic tubular excretion improved with time in both groups in the first 3 to 4 weeks, but both groups remained different up to 3 years after transplantation. Multivariate analysis revealed that only the cold ischemic time was an independent risk factor for a low TFS value. After the initial recovery from postischemic injury, the TFS may be used as a marker for functional renal mass. CONCLUSION: We propose that the tubular defect in DGF, as defined by (99m)Tc-MAG3 renography, is irreversible and may be a marker of initial graft function.