Search

Background and Aim: Despite gastric feeding being a common method of artificial nutritional support, little is known about the effects of enteral nutrition on fundic motor function. The objective of this study was to assess variations of fundic tone and their relation to antroduodenal motility before, during and after nasogastric feeding supplemented or not with fibers. Method: Double-blinded studies were performed in random order with the three different diets (2100 kJ) in eight volunteers: fiber free (FF), insoluble fiber (IF) or mixed fiber (MF). Fundic tone was recorded by barostat concomitantly with antroduodenal manometry. Results: Before the infusion, seven spontaneous fundic relaxations occurred during the 24 studies. Concomitantly or less than 2 min before these relaxations, phase III of the migrating motor complex (MMC) with a duodenal onset was recorded. Only the 17 studies without spontaneous fundic relaxation (4 FF, 6 MF, 7 IF) were suitable for the assessment of fundic response to infusion. Disappearance of the volume waves at the beginning and during the whole infusion was observed in 11/17 studies (FF 50%, MF 66% and IF 71%, NS), but a proximal gastric relaxation following the beginning of the infusion occurred in only three individuals, one with the FF and two with IF. When it occurred, fundic relaxation was observed within 2 min and was not different from those observed spontaneously. Conclusion: Gastric infusion of a polymeric diet, supplemented or not with fiber, did not promote fundic relaxation in most of the cases but often induced a disappearance of gastric volume waves.

Background: Antroduodenal motility during enteral nutrition remains poorly understood. The aim of the study was to evaluate antroduodenal motor activity during intermittent intragastric feeding and between enteral solutions supplemented with new recommended soluble or standard insoluble fibers. Methods: Two 24-hour antroduodenal manometric studies were performed with a interval of 1 week in 8 healthy volunteers. Two similar enteral diets except for fiber (soluble vs insoluble) were separately assessed in random order at 2 intervals (lunch and dinner) for 2 hours each. Phase III was studied during three 6 hour-periods (after lunch, after dinner, and at night). The other quantitative manometric parameters were studied before (1 hour), during (2 hours), and after (2 hours) lunch and dinner. Results: During the 2-hour postinfusion period, phase III reoccurred in 14 cases during the day and in 16 cases during the night. Phase III was always interrupted during feeding, which reoccurred in 14 cases during the 2-hour postinfusion period and in 16 cases during the after-dinner period. Nocturnal phase III was more frequent, lasted longer, with a lower amplitude than the diurnal phase. Addition of either soluble or insoluble fiber did not appear to have an influence on phase III or on the antroduodenal motor activity. Conclusions: Intragastric feeding interrupted phase III at the antroduodenal stage during infusion but was correlated with interdigestive motility. Antroduodenal motility did not significantly change either during or after intragastric feeding. The addition of either soluble or insoluble fiber does not seem to have an influence on gastroduodenal motor response to intermittent intragastric feeding.

The aim of this prospective study was to determine the role of remote inflammation of the gut on duodenojejunal motor status by comparing patients with acute cholecystitis (AC) to those with biliary colic (BC). Thirty-six gallstone patients (11 AC and 25 BC) were explored. Manometric recordings were performed during fasting and after a 750-kcal meal and ended by an intravenous injection of 100 mg trimebutine. Patient data were compared to those of 20 healthy controls. Phases III were more frequently absent in AC patients than in BC patients (P

Objective To assess whether esophageal manometric motor disturbances are associated with abnormalities consistent with interstitial lung disease (ILD) on both pulmonary function tests (PFT) and high resolution computerized tomography (HRCT) scans in patients with systemic sclerosis (SSc), during initial evaluation and at 2 years followup. Methods Esophageal manometry, PFT, and HRCT scans were performed in 43 consecutive SSc patients. PFT and HRCT scan parameters were compared between patients with severe esophageal motor dysfunction (i.e., aperistalsis and decreased low esophageal sphincter pressure), patients with moderate esophageal motor dysfunction (hypoperistalsis), and patients without esophageal motor dysfunction on manometry. Results During initial evaluation of SSc, patients with severe esophageal motor impairment, compared with those with moderate and without esophageal dysmotility, exhibited significantly decreased median values of diffusing capacity for carbon monoxide (DLCO) (68% vs. 94% vs. 104%) and exhibited higher prevalence of evidence for ILD on HRCT scan (57% vs. 27% vs. 18%). At 2 years followup of SSc, patients with severe esophageal motor disturbances, compared with those without, had faster deterioration of DLCO median values (–16% vs. +1%) and higher frequency of ILD on HRCT scan (70% vs. 25%). Conclusion Our series underscores a correlation between the degree of esophageal manometric motor disturbances and evidence for ILD on PFT and HRCT scan in SSc patients, suggesting that gastroesophageal reflux (GER) may be one of the contributing factors of ILD in SSc. Our findings further indicate that patients with severe esophageal impairment may require closer followup of lung parameters. In turn, it suggests that aggressive therapy of GER should be initiated in these SSc patients, as it may result in decreased deterioration of pulmonary function.

PURPOSE To identify the prognostic factors of poor visual outcome (visual acuity < or =6/240) in eyes with intraocular foreign bodies. METHODS The records of 95 consecutive patients were retrospectively reviewed for 6 years (1990-1995). All eyes underwent a primary surgical repair and foreign-body removal (electromagnet or vitrectomy). The mean follow-up period was 25 months (6-72 months). Single analysis and multiple logistic stepwise regression analysis were performed to determine predictors of poor vision. RESULTS Thirty patients (31.6%) showed 6/240 or worse vision at the end of their follow-up period. Three significant predictive factors had independent and combined effects on post-operative visual outcome: a corneo-scleral entry wound (odds ratio (OR)=14.5, p=0.001), largest diameter of IOFB (OR=1.21, p=0.01) and the presence of secondary retinal detachment (OR=9.48, p=0.0002). Post-operative complications included traumatic cataracts (51%), retinal detachments (28%) and phthisis bulbi (8%). CONCLUSION Using multivariate analysis, corneo-scleral entry wound, largest diameter of foreign body and secondary retinal detachment were found to be predictors of poor visual outcome after intraocular foreign body removal. Our results suggest that patients with high-risk intraocular foreign body trauma should be candidates for pars plana vitrectomy rather than electromagnet procedure.

A clinical questionnaire concerning anorectal symptoms and urodynamic tests was used to investigate 409 women consulting for stress urinary incontinence. To compare urodynamic data, patients were divided into three goups of women who had either stress urinary incontinence associated with incontinence for formed and/or liquid stools or with gas incontinence, or isolated stress urinary incontinence. To take in account the patients'age for data interpretation, a Mantel-Haenszel test or covariate analysis was performed. Anal incontinence was reported in 114 (28%) of the 409 women investigated. The prevalence of incontinence for gas only, for liquid, or for solid stools was 18.3, 9.3, and 1%, respectively. The duration of gas incontinence was longer than that of fecal incontinence or stress urinary incontinence. Difficult defecation was more frequently observed in patients with double incontinence than in patients with only stress urinary incontinence, and the difference was significant between patients with gas incontinence and patients with stress urinary incontinence (53% versus 37%, P = 0.03). There was no difference in the number of bowel movements per week among the three groups of patients. The number of vaginal deliveries was surprisingly lower in patients with fecal incontinence associated with urinary incontinence than in others. There was no urodynamic feature that could distinguish patients with urinary incontinence and patients with double incontinence. This study confirmed the close relationship between anal and stress urinary incontinence. Neurourol. Urodynam. 18:579–590, 1999. © 1999 Wiley-Liss, Inc.

Purpose Gaudric classification, stage 1 corresponds to intraretinal pseudocyst in the inner part of the foveola. The prolongation of the cyst laterally results in a split between the inner retina and the photoreceptor layer and a disruption of the outer retinal layers. Methods Four patients presented with a history of blurred vision and metamorphopsia. OCT examination showed a foveolar serous detachment between pigment epithelium and photoreceptor layer. Six months later, two patients presented lamellar holes and two patients evolved into stage 3 macular holes. In all cases we reported a complete resolution of the foveolar serous detachment . A surgical treatment was performed for three patients. Results OCT scans performed one month after surgery showed a total closure of the macular holes, an increase of visual acuity and a disappearance of the metamorphopsia. The main physiopathological theory formulated about macular holes formation concerns vitreo retinal tractions. As the posterior hyaloid remained attached to the center of the foveola and to the optic disc, displaying a convexity that may indicate the exertion of anteroposterior traction on its vitreous side, Gaudric admits that stage 1a macular hole is the result of antero posterior vitreo retinal tractions. Stage 1 as described by Gass is characterized by a serous foveolar detachment and is a consequence of tangential tractions of the pre foveolar vitreous cortex. Conclusion Our cases seem to be the tomographic illustration of the anatomic description of the stage 1 macular hole proposed by Gass and not mentioned in the tomographic classification proposed by Gaudric suggesting the implicationof tangential traction in macular holes formation.

Normal intraocular pressure (IOP) is the result of an equilibrium between aqueous humor (AH) production, AH outflow and episcleral venous pressure. Most available antiglaucoma agents produce their effects by interacting with autonomic mechanisms (beta-blockers, epinephrine or parasympathomimetics). In contrast, the role of the central nervous system (brain and nerves) in the regulation of IOP remains unclear in view of the complex haemodynamic, metabolic or hormonal changes which occur under experimental conditions. In this paper, we discuss a basic understanding of the anatomic and physiological relationships between central nervous system and IOP and describe how the brain can affect functions in ciliary body and trabeculum meshwork.

The retina is a highly complex nervous tissue that converts light into patterns of electrical action potentials in order to process visual information. To carry out its function as a transducer and processor of visual information, the retina must be structurally and biochemically organized to send a coherent signal to the visual areas of the brain. In recent years, a number of biologically active substances have been demonstrated to be located within neurons in the retina. Most of them are thought to be involved in the modulation of the signal and its transmission to the brain through the optic nerve. The present paper attempts to summarize the immunocytochemical distribution and physiology of some neuronally localized substances in the mammalian retina, namely dopamine and neuropeptides.

Purpose To evaluate the effects on intraocular pressure (IOP) reduction and bleb morphology of a new biodegradable collagen implant iGen TM, a porous matrix reducing scar formation after glaucoma surgery. Methods We conducted a prospective interventional case series in 18 eyes of 18 patients with uncontrolled primary open-angle glaucoma. We performed limbal-based deep-sclerectomy with implantion of the device in the scleral bed. We performed a complete ophtalmic examination, ultrasound biomicroscopy (UBM) and Visante anterior segment Optical Coherence Tomography (OCT) at each follow up visit, scheduled 1 day, 1 week, 4 and 12 weeks post-operatively. Results Postoperative IOP decreased significantly (p < 0.001) from a preoperative mean value of 25.1 ± 5.9 mm Hg (n = 2.73 glaucoma medications) to a postoperative mean value of 8.0 ± 1.1 (n = 0), 8.3 ± 1.2 (n = 0), 11.5 ± 3.0 (n = 0) and 14.1 ± 3.7 mm Hg (n = 0.28) at 1 day, 1week, 4 and 12 weeks respectively. Characteristic imaging parameters of successful bleb were frequently observed (14/18 patients): high and hypoechoic bleb with UBM; thin and hyporeflective bleb wall, multiple subconjunctival fluid spaces and hyporeflective deep bleb tissue with OCT. Bleb height and trabeculocorneal membrane thickness are correlated with low IOP (r = 0.91 p < 0.01, r = 0.90 p < 0.001) with UBM examination. Thin bleb wall, large subconjunctival fluid spaces and low reflectivity of bleb tissue are associated with lower IOP (r = 0.81 p < 0.01, p < 0.001 and p < 0.001) with OCT examination. No post-operative complications were reported. Conclusion In our series, deep-sclerectomy with iGen TM implantation seems to be an effective and well-tolerated method to lower IOP and avoid conjunctival scarring.

Editor, A lthough open-globe injuries are one of the major reasons for visual loss in children, there are little published data analysing the prognostic factors in such injuries according to internationally standardized terminology (Kuhn et al. 2002). This review was undertaken to identify the potential prognostic factors that relate to final visual outcome after penetrating ocular injury in children. The study included 74 patients younger than 14 years admitted to the Edouard Herriot Hospital, Lyon, France, between January 1998 and December 2002. Patients were followed for a median of 22 months (range 18–30 months). Annual incidence was 1.5 per 100 000 inhabitants. Males were affected in 76% of cases. The average age at admission was 7 years. The highest proportion of injuries (61%) occurred at home and sharp objects were the most frequent causative agents (66%). The overall outcome showed 45% of patients attained visual acuity (VA) of 20/40 or better. For statistical analysis, the final clinical outcome was defined as poor if final VA was less than 20/100. The most common preoperative factors were studied using univariate analysis (Table 1). Two variables were predictive of poor visual outcome: (1) initial lens damage (p < 0.001), and (2) intravitreal haemorrhage (p < 0.001).

Although cyclic nocturnal total parenteral nutrition is a widely used technique, its metabolic consequences have not been fully investigated. During two successive 7-day periods, 12 patients received randomly either standard continuous (infusion 24 hr/day) or cyclic (infusion between 5 pm and 9 am) total parenteral nutrition (TPN). Calorie and nitrogen intakes were identical during both periods. Energy expenditure was investigated by indirect calorimetry and showed practically no difference between continuous standard (1383 +/- 41 kcal/day-1) and cyclic total parenteral nutrition (1428 +/- 46 kcal/day-1). However, in the cyclic regimen, when compared with continuous infusion, energy expenditure was higher between 5 pm and 9 am and lower between 9 am and 5 pm. At the end of the noninfusion period, the 24-hr profile of the nonprotein respiratory quotient showed a slight decrease in patients receiving the cyclic infusion, in contrast with the stability of the quotient in the standard regimen. However, the nitrogen balance and variations in nutritional status did not differ significantly. In conclusion cyclic TPN is efficient for achieving a positive energy and nitrogen balance and in addition it induces a metabolic profile closer to physiological conditions.