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Researchers conducted a study to compare esophageal motility and gastroesophageal reflux characteristics in young, middle aged, and older healthy individuals. They recruited 40 healthy individuals from the community who underwent conventional esophageal manometry and scintigraphic study of gastroesophageal reflux. Although quantitative manometric parameters showed no correlation with gastroesophageal reflux patterns, abnormal peristalsis was found more in the older individuals. They also found that the number of gastroesophageal reflux episodes per individual was similar, but the duration of gastroesophageal reflux was longer in the older individuals.

One of the best examinations used routinely to detect gastro-oesophageal reflux (GOR) is scintigraphy and attempts are continuously being made to improve the performance of the test. We have tested a new manoeuvre to improve the results. Three hundred and twenty eight patients (190 males and 138 females, aged 1 month to 84 years, average 4.47 years) were studied after a 12 h fast period with 100 MBq of 99Tcm-phytate, 50 ml volume, directly delivered into the stomach in a mixture of orange juice. All patients were strongly suspected of having GOR. Conventional acquisition was done for 20 min, at a rate of one frame every 20 s. In the middle of the examination, small children were put in the upright position and held there for a few seconds or released in a way that allowed movement; adults were asked to stand up and walk a few metres. The test was then continued for the remaining 10 min. The global index of positivity was 64.6 (76 positive cases in the first half of the examination and 134 positive cases only after the manoeuvre). The mean of GOR episodes observed in the positive cases without the manoeuvre was 0.5 per patient, significantly different from the mean of 1.59 noted after the manoeuvre (P<0.01). In 28 cases the manoeuvre increased either the intensity or the frequency of reflux previously detected without it. We believe that this manoeuvre should be performed in all scintigraphic tests aiming to detect GOR. In the present series, the manoeuvre increased the frequency of GOR episodes.

This study demonstrated that polymorphonuclear neutrophils (PMN) participate in the acute inflammatory response in leprosy as effector cells. Lepromatous patients present intense infiltrate of neutrophils in reactional (ENL) lesions. Circulating PMN of nonreactional patients, healthy donors, and reactional patients were purified and analyzed in vitro.The study confirmed the short lifespan of these cells in culture with progressive changes characteristic of apoptosis. Apoptosis was greatly accelerated in ENL patients as shown by cellular morphology, later confirmed by qualitative and quantitative analysis of fragmented DNA. It was observed that neutrophils stimulated with lipopolysaccharide, Mycobacterium leprae, and lipoarabinomannan secrete interleukin‐8 and tumor necrosis factor α (TNF‐α). Thalidomide, a drug known to inhibit TNF‐α synthesis on monocytes, also exerted an inibitory effect on TNF‐α secretion in neutrophils. These data suggest that PMN can participate in the regulation of the immune response in leprosy and can contribute to the amplification of TNF‐α production at the site of ENL lesion. J. Leukoc. Biol.65: 364–371; 1999.

This study describes the abnormal pattern of gastrointestinal progression of a liquid meal in patients with the digestive form of chronic Chagas' disease. This condition is known as a natural model of intramural denervation of the gut. Sixteen patients with clinical and radiographic evidence of esophageal and/or colonic involvement and 18 healthy volunteers were studied. Orocecal transit time after the ingestion of a 10% lactulose solution (180 ml) tagged with99mtechnetium was measured by a conventional H2 breath technique. Gastric emptying and the arrival of the front of the meal to regions of interest corresponding to proximal and distal areas of the small intestine were assessed by abdominal scintigraphy. Orocecal transit time was significantly greater (P<0.05) in Chagas' disease patients (N=13) than in control subjects (N=18) (mean±sd: 100.7±48.7 min vs 62.9 ±18.2 min). Half-time for gastric emptying of liquids in chagasic patients (N=9) was significantly lower (P<0.01) than in controls (N=7) (9.7±2.7 min vs 26.4±3.4 min). The time of arrival of the liquid meal to the proximal small intestine was also significantly shorter (P<0.02) in patients than in controls (5.6±3.7 vs 11.4±5.5 min), but there was no difference between the two groups concerning the time the meal first arrived to the distal small intestine (15.0±11.0 min vs 23.5±11.4 min, P>0.05). These results indicate that patients with Chagas' disease have a combination of exceedingly rapid gastric emptying and abnormally delayed transit of liquids through the more distal segments of the small bowel. These abnormalities are likely to be a consequence of gut intramural denervation and emphasize the complex modulatory role of the enteric nervous system in gastrointestinal transit regulation.

The fasting motor activity of the upper small intestine was studied in 36 patients with chronic Chagas' disease, which is known to be associated with extensive lesions of the myenteric plexuses, and the results compared with those obtained in 15 control subjects. The migrating motor complex (MMC) was detected as frequently in the Chagas' disease group as in the control group, and the frequency of contractions during the activity front was virtually the same in the two groups. In the Chagas' group the propagation of the activity fronts was slower, their duration was longer in the jejunum, but not in the duodenum, and the calculated length was shorter than normal. Chagas' disease patients without clinical manifestation or x-ray pathology of the digestive tract had no abnormalities of the MMC. These findings suggest that the intramural nervous system of the gut plays a role in the normal migration of the MMCs along the small intestine.

In order to evaluate the contribution of the myenteric plexuses to the control of gastric accommodation to distension and to the rate of gastric emptying of a saline solution in man, we have evaluated these functions in patients with Chagas' disease, which is known to be associated with extensive lesions of the myenteric plexuses. Intragastric pressure was significantly higher (P<0.05) in Chagas patients (N=15) than in normal controls (N=15) for air distension volumes of 100–700 ml. In the range 300–700 ml, the difference between the groups was approximately twofold (P<0.001). The gastric emptying rate of 500 ml 154 mM NaCl in a second group of Chagas' disease patients (N=13) was significantly faster than that of the control group (N=17) at 5 min (P<0.0005) and at 15 min (P<0.005) after the test meal, but at 25 min the volumes remaining in the stomach were not statistically significant for the two groups (P>0.10). The impairment of gastric accommodation to distension and consequent rapid gastric emptying demonstrated for chagasic patients emphasizes the role of the myenteric plexuses in gastric reservoir function in man and complements previous evidence obtained in animal studies.

The effect of isosorbide dinitrate (ISD) on gastroesophageal reflux and gastric emptying during the 24-min period following a liquid meal was studied in healthy volunteers, Chagas' disease patients with normal esophageal motility (CD-1 group), and Chagas' disease patients with esophageal dysmotility (CD-2 group) with dynamic scintigraphy. At random, on two separate days, the subjects received 5 mg isosorbide dinitrate or an identical-appearing placebo tablet, by the sublingual route, and ingested a liquid test meal containing [99mTc]phytate colloid before scintigraphic studies were performed. Gastroesophageal reflux episodes were more frequent (P=0.016) and gastroesophageal reflux indexes were greater (P<0.010) after isosorbide dinitrate than after placebo in CD-2 group (N=15) but not in healthy volunteers (N=14) or CD-1 group (N=9); six of seven CD-2 patients presenting with gastroesophageal reflux after isosorbide dinitrate had abnormal clearance of refluxate. Gastric emptying was similar in healthy volunteers (N=13), CD-1 patients (N=6), and CD-2 patients (N=13), and no effect of isosorbide dinitrate on it was detected in any of the groups. In separate studies, 5 mg isosorbide dinitrate reduced the lower esophageal pressure (P<0.01) in seven CD-2 patients. These results indicate that ISD increases the tendency towards GER in CD-2 patients, but not in healthy volunteers or CD-1 patients. This effect is probably related to an exceedingly intense relaxation of the LES caused by ISD in CD-2 patients. Considering the role of the destruction of the intramural neurons in the pathogenesis of the esophageal motor disorder in Chagas' disease, these findings are likely to be a consequence of the loss of the normal neural influences on the lower esophageal sphincter in Chagas' disease.

Yeasts were found concentrated at the sediment surface and with the highest counts at the most polluted site. Candida krusei, Pichia membranaefaciens and similar species typically forming rugose colonies with radiating ridges were the prevalent yeasts in these sediments, and species like Rhodotorula rubra related to basidiomycetous fungi were found in relatively low numbers.

The aim of this work was to determine the oesophageal transit time (OTT) of a bolus using the biomagnetic technique and compare the results to those obtained by means of scintigraphy. For the biomagnetic evaluation, a test meal (yoghurt) uniformly labelled with 5 g of powder ferrite was swallowed in a single gulp by 19 normal volunteers in the upright position. One sensor (first order gradiometer) was placed at the furcula and a second one at the xiphoid process to detect the passage of the test meal and the magnetic signal output was recorded in a computer. The OTT was determined by plotting the voltage signal against time. The scintigraphic technique was used in the same volunteers: the test meal was labelled with less than 350 MBq of and swallowed in the same way. The bolus transit was recorded at 4 frames (100-120 frames acquisition) and the OTT was determined by drawing two regions of interest in the same areas as the sensors. The results were determined by plotting counts against time. The averages for OTTs were s for the scintigraphic technique and s for the biomagnetic technique. Although scintigraphic OTT was significantly shorter than magnetic OTT, there was a significant correlation between them. We conclude that the biomagnetic study may be used to evaluate OTT.