RESUMEN
There is a paucity of data on the long-term behavior of dyspepsia, endoscopic findings, and gastroduodenal histology in patients with or without Helicobacter pylori colonization. We evaluated these parameters during a period of 7 to 19 years (average, 12.3 years) by baseline and follow-up studies. In 36 patients studied, the pattern of gastroduodenal dyspepsia and esophagogastroduodenoscopy findings remained essentially unchanged in 67% and 56% respectively. Dyspepsia patterns did not correlate significantly with either endoscopic or histologic findings, including the severity or location of gastritis in the fundus or antrum, or the presence or absence of H. pylori gastritis. Of 36 patients with adequate biopsies of the fundus and antrum, H. pylori colonization with gastritis was present in 73% but not in 27%. Progression to various degrees of atrophic gastritis was noted in 100% with, and in none without, H. pylori gastritis. In the fundus, atrophy progressed from 14% to 56%, but intestinal metaplasia did not change. In the antrum, atrophy increased from 22% to 64% and intestinal metaplasia increased from 17% to 36%. No patient demonstrated dysplasia, but severe atrophy was seen in the fundus (6%) and antrum (11%). Only two patients (5%) had severe loss of glandular elements and very low pepsinogen I, and thus can be considered to have developed advanced gastric atrophy.
Asunto(s)
Endoscopía del Sistema Digestivo , Mucosa Gástrica/patología , Infecciones por Helicobacter/diagnóstico , Gastropatías/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antibacterianos/análisis , Estudios de Cohortes , Recuento de Colonia Microbiana , Femenino , Gastrectomía , Mucosa Gástrica/microbiología , Gastritis Atrófica/sangre , Gastritis Atrófica/diagnóstico , Gastritis Atrófica/microbiología , Infecciones por Helicobacter/etiología , Infecciones por Helicobacter/cirugía , Helicobacter pylori/crecimiento & desarrollo , Helicobacter pylori/inmunología , Helicobacter pylori/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Pepsinógenos/sangre , Gastropatías/sangre , Gastropatías/microbiología , Úlcera Gástrica/diagnóstico , Úlcera Gástrica/microbiología , Úlcera Gástrica/cirugíaRESUMEN
This study was undertaken to determine the prevalence of vascular compression in manometric tracings and to determine whether these findings had any clinical significance. Vascular compression, defined as a localized area of elevated intraesophageal resting pressure > 4 mm Hg with superimposed cyclic pressure spikes with a frequency of 60-100/min, was noted in 55 of 241 consecutive tracings. The groups with and without vascular compression were similar with regard to mean age, sex, and prevalence of dysphagia. Radiographs were available for 29 of the 55 and showed compression in 18, but there was no relationship with the manometric findings, except for a trend towards finding a positive esophagogram with amplitudes > 16 mm Hg. Eleven tracings showed absent "relaxation" of this elevation of pressure in response to swallows, and five of six available esophagograms showed a corresponding area of compression. We conclude that manometric evidence of vascular compression is common and generally has no clear relationship with esophagographic findings or dysphagia. However, the combined findings of marked increases in pressure and absence of relaxation in response to swallows may indicate evidence for a vascular cause of dysphagia.
Asunto(s)
Trastornos de Deglución/etiología , Estenosis Esofágica/etiología , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/epidemiología , Estenosis Esofágica/diagnóstico , Estenosis Esofágica/epidemiología , Esófago/diagnóstico por imagen , Esófago/fisiopatología , Femenino , Humanos , Masculino , Manometría , Persona de Mediana Edad , Prevalencia , Radiografía , Arteria Subclavia/anomalíasRESUMEN
Although concern about perforation has led physicians to perform pneumatic dilation for achalasia with routine contrast radiography immediately afterwards and with hospitalization, the need for these precautions has not been demonstrated. In contrast, we have routinely performed pneumatic dilations without contrast studies or hospitalization, and we hereby present our experience. During a recent six-year period, 110 pneumatic dilations were performed, and 71 of the last 73 were performed as outpatients with about 5-8 hr of clinical monitoring. Detailed review of 100 records showed that only 15 patients underwent contrast studies because of pain or fever. Perforation occurred in seven of the 15 patients, all of whom underwent surgery successfully. Short-term follow-up in patients who did not sustain perforation showed good or excellent results in 82%. Thus, it has been our experience that pneumatic dilation could be safely performed in achalasia without routine use of contrast studies or hospitalization.
Asunto(s)
Atención Ambulatoria , Cateterismo/métodos , Acalasia del Esófago/terapia , Perforación del Esófago/etiología , Monitoreo Fisiológico/métodos , Cateterismo/efectos adversos , Perforación del Esófago/diagnóstico por imagen , Perforación del Esófago/epidemiología , Esófago/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Factores de TiempoRESUMEN
1. Nonlinear systems analytic techniques were used to characterize transformational properties of the network of neurons activated by perforant path input to the rabbit hippocampus. Trains of 4,064 impulses with randomly varying interimpulse intervals were used to stimulate perforant path fibers, and amplitudes of evoked dentate granule cell population spikes were measured. Interimpulse intervals of the random stimulus train were determined by a Poisson distribution with a mean interimpulse interval of 500 ms, and with intervals ranging from 1 to 5,000 ms. The response of dentate granule cells to this stimulation was assumed to reflect activity in the larger hippocampal network, because other subpopulations of neurons activated monosynaptically and polysynaptically within the hippocampal formation contribute to granule cell excitability through multiple feedforward and feedback pathways. System properties were characterized both for halothane anesthetized and chronically implanted, unanesthetized preparations. 2. Second-order kernel analysis showed that population spike amplitude was highly dependent on interimpulse interval. When population spikes of all latencies were included in the same analysis, stimulation impulses produced near-total suppression of spike amplitude when they were preceded 10-20 ms by another impulse in the train. Spike suppression extended to approximately 50 ms and was inversely related to length of the interimpulse interval. Suppression of granule cell response to intervals within the range of 10-50 ms was not influenced by halothane anesthesia. 3. Interstimulus intervals greater than approximately 50 ms resulted in a facilitation of population spike amplitude, with maximum facilitation occurring in response to intervals of 90-100 ms. The magnitude of maximum facilitation was significantly greater for anesthetized (129%) than for unanesthetized (74%) preparations. The range of intervals resulting in facilitation for unanesthetized animals could extend to 1,000-1,100 ms (average range, 61-714 ms). This was much greater than observed for population spikes recorded from anesthetized animals (50-364 ms), which exhibited suppression in response to intervals of approximately 300-700 ms. 4. Further analysis revealed that the nature of nonlinearities in population spike amplitude may depend on spike latency. For example, population spikes of "short" latency (3-4 or 4-5 ms, depending on the animal) exhibited only facilitation in response to interstimulus intervals of 1-4 ms.(ABSTRACT TRUNCATED AT 400 WORDS)
Asunto(s)
Hipocampo/fisiología , Potenciales de Acción , Animales , Masculino , Unión Neuromuscular/fisiología , Conejos , Análisis de SistemasRESUMEN
1. The transformational properties of the network of hippocampal neurons activated monosynaptically and polysynaptically by electrical stimulation of the perforant path were analyzed using random impulse train and paired impulse stimuli. In response to both types of input, the amplitudes of granule cell population spikes evoked in the dentate gyrus were used as the measure of network output. The random stimulus train consisted of a series of 4,064 electrical impulses, with interimpulse intervals determined by a Poisson distribution; the mean interimpulse interval of the train was 500 ms, and the range was 1-5,000 ms. Paired impulse stimuli consisted of pairs of impulses separated by 10-1,200 ms; impulses pairs were delivered once every 20 s. The procedures were applied to both anesthetized and chronically implanted, unanesthetized preparations. 2. Nonlinear systems analysis of population spike responses evoked during random train stimulation revealed that dentate granule cell output to any impulse was highly dependent on the interval since a prior impulse. Data from anesthetized animals showed that population spike amplitudes were markedly suppressed in response to intervals less than 50 ms, facilitated in response to intervals of approximately 100 ms, suppressed slightly in response to intervals of 300-700 ms, and unaffected by intervals greater than 700 ms. Data from unanesthetized animals showed similar results except that facilitation rather than suppression of spike amplitude was observed in response to intervals of 300-700 ms, and could extend to intervals as great as 1,000 ms. 3. The results of paired impulse stimulation applied to the same preparations also showed that granule cell response was highly dependent on interimpulse interval. However, nonlinearities observed with paired impulse stimulation differed from those revealed by a random impulse signal. Compared to results of random train stimulation, a paired impulse format produced greater magnitude spike suppression in response to short interimpulse intervals (e.g., 10-20 ms), maximum facilitation in response to shorter interstimulus intervals (50 ms rather than 100 ms), greater magnitude spike facilitation, and greater suppression in response to intervals greater than or equal to 300 ms. Furthermore, there were virtually no differences in the nonlinearities of granule cell response recorded from anesthetized and unanesthetized animals when a paired impulse format was used, whereas several differences were observed with random train stimuli. 4.(ABSTRACT TRUNCATED AT 400 WORDS)