Successful diagnosis of lymphangioleiomyomatosis with transbronchial lung cryobiopsy.

A 47-year old female was evaluated in our clinic for an incidental discovery of diffuse cystic lung disease on high-resolution computed tomography (CT) scan of the chest. There was no personal or family history of tuberous sclerosis complex (TSC), sicca symptoms, pneumothorax, or skin or renal tumors. Review of her chest CT scan showed bilateral, round, uniform, thin-walled cysts present in a diffuse distribution characteristic of lymphangioleiomyomatosis (LAM). CT scan of the abdomen and pelvis did not reveal angiomyolipomas, lymphangioleiomyomas, abnormal lymphadenopathy, or chylous fluid collections. Serum vascular endothelial growth factor-D was non-diagnostic. In order to achieve diagnostic confirmation, the patient underwent transbronchial cryobiopsy of the lung, revealing changes consistent with LAM. Our case highlights the utility of transbronchial lung cryobiopsy in the evaluation of patients with suspected LAM and suggests that further investigation of this diagnostic technique is warranted in patients presenting with diffuse cystic lung disease.

Oesophageal function after oral ranitidine: an acute double blind study in normal subjects.

The effect of oral ranitidine on oesophageal peristalsis, LOS basal pressure and gastro-oesophageal acid reflux, was investigated in 6 healthy men in a double-blind randomized study. Simultaneous manometry and pH measurements were performed twice in each volunteer during a five hour study period which included the administration of a standard meal. Ranitidine did not affect the motor parameters studied (amplitude, duration and velocity of the peristaltic waves and LOS basal tone), whereas it almost abolished acid gastroesophageal reflux. Our results show that ranitidine, like cimetidine, does not alter the motor function of the oesophagus, while it virtually abolishes acid gastro-oesophageal reflux in normal man.

[Volumetric valuation of dural sac by standard measurement on radiographs and saccoradiculographs (author's transl)]. / Valutazione volumetrica del sacco durale mediante misurazioni standard su radiografie e saccoradicol grafie.

The Authors have planned to connect unexplained osphyalgias with dural pouch disease, through roentgenographic research. The Authors suggest a standard measurement primer to single out narrow pouches, in order to settle surgical operation.

Reproductive indices in natural nests of giant Amazon river turtles Podocnemis expansa (Schweigger, 1812) (Testudines, Podocnemididae) in the Environmental Protection Area Meanders of the Araguaia River.

A count was made of unhatched eggs and hatchling live and dead Podocnemis expansa turtles in 327 natural nests located on the beaches of the Environmental Protection Area (EPA) Meanders of the Araguaia River, to determine the percentage of hatching (94.63%), non-hatching (5.37%), survival (94.24%) and hatchling mortality (5.76%), and the average percentage of dead hatchlings during the 15 days in the nursery (0.97%). The mean number of hatchlings per nest was determined from the sum of the number of live and dead hatchlings divided by the total number of nests, while the mean number of eggs per nest was determined from the sum of live and dead hatchlings and unhatched eggs divided by the number of nests. These calculations yielded the following mean values: live hatchlings (88.98 ± 23.94), dead hatchlings (0.37 ± 0.93), unhatched eggs (5.07 ± 9.57), and total number of eggs (94.42 ± 21.30). The reproductive efficiency of the wild population of P. expansa can be affected by many environmental factors such as temperature, humidity and rainfall. In addition, man-made factors like the presence of chemicals in the water and the potential for infectious disease also have significant impact. The reproductive indices data obtained from this study are indispensable for future investigations of hatching anomalies.

Oesophageal motor events at the occurrence of acid reflux and during endogenous acid exposure in healthy subjects and in patients with oesophagitis.

In order to assess the oesophageal motor events associated with the occurrence of gastro-oesophageal acid reflux and those during endogenous acid exposure, we studied six healthy subjects and nine patients with symptoms and lesions of reflux oesophagitis. In the case of each subject simultaneous pressure and pH measurements of the distal oesophagus were taken both in fasting conditions and after a standardised balanced meal. Reflux episodes occurred in the absence of a lower oesophageal sphincter relaxation (34.3%, 17.7%) or in the presence of a relaxation associated (34.2%, 30.8%) or unassociated (31.5%, 51.5%) with a peristaltic sequence, in the controls and patients respectively. No significant differences were found between the two groups. During endogenous acid perfusion the distal oesophagus showed mainly a peristaltic motor activity, but the mean hourly number of peristaltic sequences was significantly lower in the patients than in the controls (33.5 +/- 27.2 vs 81.5 +/- 3.2, p less than 0.01). Our results show that the mechanisms of reflux are similar in controls and in patients, while the peristaltic frequency is reduced in the latter. This motor failure may be responsible for the increased reflux duration observed in patients with oesophagitis.

Function of the internal anal sphincter and rectal sensitivity in idiopathic constipation.

Anal manometry was performed in 8 control individuals (group A) and in 13 patients with idiopathic constipation (group B), 6 of whom were grouped apart (group C) because of an elective delay of the intestinal transit in the rectum. The basal pressure of the internal anal sphincter, the rectal inflation volume necessary to elicit the rectoanal inhibitory reflex, and the duration of the reflex were not significantly different in the three groups, while the maximal amplitude of the reflex was significantly lower in group C at 10 and 100 cm3 of rectal distension. However, the amplitude of the sphincteric relaxation and the rectal inflation volumes were significantly correlated (p less than 0.001) in the three groups. The rectal sensitivity was lower in the patient groups and particularly in group C (p less than 0.05 vs. controls up to 50 cm3 of rectal distension). The results obtained do not support the 'outlet obstruction' hypothesis as a mechanism of idiopathic constipation and point out that rectal hyposensitivity seems to be the only abnormality in these patients, particularly in those with an elective delay of the transit in the rectum.