scholarly journals Evaluation of gastric emptying by means of scintigra-phy using different test meals

2019 ◽  
Vol 7 (2A) ◽  
Author(s):  
Viviana Montoya ◽  
Viviane Parisitto ◽  
Mateus Fontes ◽  
Luiz Gonzaga ◽  
Luciene Das Graças ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Gold Standard ◽  
Delayed Gastric Emptying ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Mechanical Obstruction ◽  
Standard Meal ◽  
Solid Foods ◽  
Gastric Emptying Time

Gastroparesis is a disorder characterized by symptoms and evidence of delayed gastric emptying (GE) in the absence of mechanical obstruction. Scintigraphy has been considered a "gold standard" for measuring Gastric Emptying Time (GET) and retention percentage of radio-labeled food, after four hours of ingestion. To obtain the images, it is recommended, worldwide, the use of the Tougas diet (255kcal) as a standard meal. The objective of this study was to compare the GET and the percentage of retention in the time of 4 h, obtained by scintigraphy using the Tougas diet (255 kcal) and the proposed diet (319 kcal). Thirty patients, both genders, aged 23 to 76 years,  were selected, they presenting clinical symptoms suggestive of gastroparesis. These parameters were measured for the same patient, but in different days. The results showed that the diet fat content used to obtain EG of solid foods by scintigraphy did not influence the retention percentage results after 4 hours of ingestion of the radiolabeled food. However, the time of two hours is an important parameter to be observed in the result of this examination. In addition, the data suggest that the proposed diet may be more efficient for the classification of the severity of EG delay in patients with clinical signs suggestive of gastroparesis. 

Clinical Diagnostic Accuracy of Early/Advanced Parkinson Disease: Updated Clinicopathologic Study

2020 ◽  
pp. 10.1212/CPJ.0000000000001016
Author(s):  
Charles H. Adler ◽  
Thomas G. Beach ◽  
Nan Zhang ◽  
Holly A. Shill ◽  
Erika Driver-Dunckley ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Diagnosis ◽  
Gold Standard ◽  
Disease Duration ◽  
Clinical Signs ◽  
Confidence Levels ◽  
Clinicopathologic Study ◽  
Clinical Diagnostic ◽  
Neuropathological Diagnosis

AbstractObjectives:Update data for diagnostic accuracy of a clinical diagnosis of Parkinson’s disease (PD) using neuropathological diagnosis as the gold standard.Methods:Data from the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND) was used to determine the predictive value of a clinical PD diagnosis. Two clinical diagnostic confidence levels were used, Possible PD (PossPD, never treated or not responsive) and Probable PD (ProbPD, 2/3 cardinal clinical signs + responsive to dopaminergic medications). Neuropathological diagnosis was the gold standard.Results:Based on first visit to AZSAND, 15/54 (27.8%) PossPD cases and 138/163 (84.7%) ProbPD had confirmed PD. PD was confirmed in 24/34 (70.6%) ProbPD with <5 yrs and 114/128 (89.1%) with >5 yrs disease duration. Using the consensus final clinical diagnosis following death, 161/187 (86.1%) ProbPD had neuropathologically confirmed PD. Diagnostic accuracy for ProbPD improved if included motor fluctuations, dyskinesias, and hyposmia, and hyposmia for PossPD.Conclusions:This updated study confirmed lower clinical diagnostic accuracy for elderly, untreated or poorly responsive PossPD participants and for ProbPD with <5 yr disease duration, even when medication responsive. Caution continues to be needed when interpreting clinical studies of PD, especially studies of early disease, that do not have autopsy confirmation.Classification of Evidence:This study provides Class II evidence that a clinical diagnosis of probable PD at first visit identifies patients who will have pathologically confirmed PD with a sensitivity of 82.6% and specificity of 86.0%.

scholarly journals Gastroparesis

2020 ◽  
Vol 95 (4) ◽  
pp. 244-250
Author(s):  
Li-Chang Hsing ◽  
Kee Wook Jung
Keyword(s):  
Diabetes Mellitus ◽  
Abdominal Pain ◽  
Gastric Emptying ◽  
Nutritional Support ◽  
Delayed Gastric Emptying ◽  
Mechanical Obstruction ◽  
Upper Endoscopy ◽  
Pharmacological Treatments ◽  
Contrast Radiography ◽  
Gastric Scintigraphy

Gastroparesis is a condition characterized by delayed gastric emptying without evidence of mechanical obstruction in the stomach. Its symptoms include nausea, vomiting, early satiety, abdominal bloating, and abdominal pain. Most cases of gastroparesis are either idiopathic, due to diabetes mellitus, or post-surgical complications. The diagnosis of gastroparesis requires upper endoscopy, contrast radiography, or validated gastric scintigraphy. Gastroparesis is managed with nutritional support and treatment of any underlying disorders, such as diabetes. Pharmacological treatments have been tried, including prokinetics and novel medications. Interventions focused on the pylorus have shown promising results.

Clinical, Aetiological, Anatomical and Pathological Classification (Ceap): Gold Standard and Limits

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 114-118 ◽  
Author(s):  
E Rabe ◽  
F Pannier
Keyword(s):  
Gold Standard ◽  
Varicose Veins ◽  
Clinical Signs ◽  
Consensus Conference ◽  
Scientific Publications ◽  
Consensus Document ◽  
Venous Diseases ◽  
Ceap Classification ◽  
Definition Of

The first CEAP (clinical, aetiological, anatomical and pathological elements) consensus document was published after a consensus conference of the American Venous Forum, held at the sixth annual meeting of the AVF in February 1994 in Maui, Hawaii. In the following years the CEAP classification was published in many international journals and books which has led to widespread international use of the CEAP classification since 1995. The aim of this paper is to review the benefits and limits of CEAP from the available literature. In an actual Medline analysis with the keywords ‘CEAP’ and ‘venous insufficiency’, 266 publications using the CEAP classification in venous diseases are available. The CEAP classification was accepted in the venous community and used in scientific publications, but in most of the cases only the clinical classification was used. Limitations of the first version including a lack of clear definition of clinical signs led to a revised version. The CEAP classification is the gold standard of classification of chronic venous disorders today. Nevertheless for proper use some facts have to be taken into account: the CEAP classification is not a severity classification, C2 summarizes all kinds of varicose veins, in C3 it may be difficult to separate venous and other reasons for oedema, and corona phlebectatica is not included in the classification. Further revisions of the CEAP classification may help to overcome the still-existing deficits.

Functional Dyspepsia and Gastroparesis

2016 ◽  
Vol 34 (5) ◽  
pp. 491-499 ◽  
Author(s):  
Michael Camilleri
Keyword(s):  
Gastric Emptying ◽  
Functional Dyspepsia ◽  
Delayed Gastric Emptying ◽  
Gastrointestinal Symptoms ◽  
Psychological Disorder ◽  
Mechanical Obstruction ◽  
Gastric Accommodation ◽  
Postprandial Fullness ◽  
Rumination Syndrome ◽  
Upper Gastrointestinal

Background: Upper gastrointestinal disorders typically present with common symptoms. The most relevant non-mucosal diseases are gastroparesis, functional dyspepsia and rumination syndrome. The literature pertaining to these 3 conditions was reviewed. Key Messages: Gastroparesis is characterized by delayed gastric emptying in the absence of mechanical obstruction of the stomach. The cardinal symptoms include postprandial fullness (early satiety), nausea, vomiting and bloating. The most frequently encountered causes of these symptoms are mechanical obstruction (pyloric stenosis), iatrogenic disease, gastroparesis, functional dyspepsia, cyclical vomiting and rumination syndrome. The most common causes of gastroparesis are neuropathic disorders such as diabetes, idiopathic, post-vagotomy and scleroderma among myopathic disorders. Principles of management of gastroparesis include exclusion of mechanical obstruction with imaging and iatrogenic causes with careful medication and past surgical history. Prokinetics and anti-emetics are the mainstays of treatment. Functional dyspepsia is characterized by the same symptoms as gastroparesis; in addition to delayed gastric emptying, pathophysiological abnormalities include accelerated gastric emptying, impaired gastric accommodation and gastric or duodenal hypersensitivity to distension and nutrients. Novel treatments include tricyclic antidepressants in patients with normal gastric emptying, acotiamide (acetyl cholinesterase inhibitor) and 5-HT1A receptor agonists such as buspirone. Rumination syndrome is characterized by repetitive regurgitation of gastric contents occurring within minutes after a meal. Episodes often persist for 1-2 h after the meal, and the regurgitant consists of partially digested food that is recognizable in its taste. Regurgitation is typically effortless or preceded by a sensation of belching. This has been summarized as a ‘meal in, meal out, day in, day out' behavior for weeks or months, differentiating rumination from gastroparesis. Patients often have a background of psychological disorder or a prior eating disorder. Treatment is based on behavioral modification. Conclusion: Precise identification of the cause and pathophysiology of upper gastrointestinal symptoms is essential for optimal management.

scholarly journals The morphological changes in bitches endometrium affected by Cystic Endometrail Hyperplasia - Pyometra complex – the value of histopathological examination

2020 ◽  
Author(s):  
Magdalena Woźna-Wysocka ◽  
Marta Rybska ◽  
Beata Błaszak ◽  
Bartłomiej Maria Jaśkowski ◽  
Magdalena Kulus ◽  
...  
Keyword(s):  
Histological Analysis ◽  
Clinical Symptoms ◽  
Histopathological Examination ◽  
Morphological Changes ◽  
Clinical Signs ◽  
Control Group ◽  
Pathological Changes ◽  
Microscopic Evaluation ◽  
Uterine Diseases

Abstract Background: The cystic endometrial hyperplasia-pyometra complex (CEH-P) is one of the most common uteropathies in bitches. In diseases with mild or obscure clinical signs and normal uterine size, a diagnosis based on a clinical assessment might be incorrect. The main aim of the research was to determine the morphological variables accompanying uterine diseases in bitches in microscopic evaluation. Consequently, the obtained results can be used to create a new classification system for uterine pathological changes during the development of the CEH-P, diagnosed by microscopic examination in bitches. Material for the study consisted of the uteri of 120 female dogs, aged 1-16 years, obtained during routine ovariohysterectomies. Macroscopic observation after a longitudinal incision of the uterine horns, allowed a preliminary classification of the uteri into research groups: control group (physiological uteri), and groups GI-III uteri collected form bitches with varying degrees of endometrial pathology. These preliminary classifications were then verified by histological analysis (H&E stain).Results: The obtained results made it possible to determine and describe the prevalence (%) of pathological changes characteristic of the analyzed uterine diseases in the examined bitches. Histopathological analyses that were conducted have confirmed preliminary macroscopic evaluation for the control group, group GII (CEH), and group GIII (pyometra). In the uteri of the GI group, a severe congestion of endometrium has been observed – this is typical of inflammation – which was not confirmed during histopathological examinations. However, these examinations revealed acute endometrial haemorrhage of varying severity.Conclusions: Early reproduction disorders in bitches are, in general, not confirmed by clinical signs in the examined animals. The results show that during classification of typical morphological changes in endometrium over the development of the CEH-P complex in bitches microscopic examinations are required. The obtained results indicate a frequent lack of consistency in the macroscopic assessment and histological analysis of the endometrium, observed in the analyzed uterine diseases, which in most cases is not followed by clinical symptoms. The presented classification of uterine diseases may be useful as a diagnostic tool in reproductive disorders in bitches and in examination in the field of basic research.

scholarly journals Gastroparesis in carcinoma gallbladder: a scintigraphic study

2018 ◽  
Vol 5 (6) ◽  
pp. 2086
Author(s):  
Pitchai Rajapandi ◽  
Adimoolam Eakanathan ◽  
Jeyaraj Ravishankar
Keyword(s):  
Gastric Emptying ◽  
Gastric Outlet Obstruction ◽  
Delayed Gastric Emptying ◽  
Outlet Obstruction ◽  
Solid Meal ◽  
Gastric Stasis ◽  
Carcinoma Gallbladder ◽  
Gastric Emptying Time ◽  
Scintigraphic Study ◽  
Emptying Time

Background: Gastroparesis is characterized by delayed gastric emptying in the absence of mechanical gastric outlet obstruction. There is strong association of gastroparesis with carcinoma gallbladder. The aim of the study was to find out the incidence of delayed gastric emptying in carcinoma gallbladder and its correlation with symptoms of stasis and stage of the disease.Methods: Patients diagnosed with carcinoma gallbladder and their matched controls were included in this study. Patients with mechanical gastric outlet obstruction were excluded. All patients underwent contrast enhanced computer tomography scan and radio labeled (Technitium 99) solid meal Scintigraphy study. Normal gastric emptying time was calculated from control group as Mean +2SD.Results: 30 patients were matched with 20 controls after obtaining informed consent. Upper limit of gastric emptying time is 55.09 minutes. Adenocarcinoma was the commonest histological subtype (50%), abdominal pain was the commonest symptom (86.7%) and hepatomegaly was the commonest sign (46.7%), GETt1/2 for patients was 66.72±26.52 minutes while it was 40.53±7.28 minutes in controls (p <0.05). Gastroparesis increased with advancing stage of carcinoma gallbladder (p <0.05). Symptoms of gastric stasis were seen only in 15.6% of patients.Conclusions: Patients with carcinoma gallbladder can have gastroparesis without obvious symptoms of delayed gastric emptying. This delay in gastric emptying can be documented reliably using solid meal scintigraphic study even in patients without symptoms of gastroparesis. The pathophysiology of gastroparesis needs further study. It may be prudent to remember that while performing palliative bypass surgery for gastric outflow obstruction, that in patients with carcinoma gallbladder, the gastrojejunostomy may not function as expected due to delayed gastric emptying.

scholarly journals Gastroparesis in pregnancy: case report and literature review

2011 ◽  
Vol 4 (1) ◽  
pp. 30-34 ◽  
Author(s):  
N Achong ◽  
N Fagermo ◽  
K Scott ◽  
M D'emden
Keyword(s):  
Diabetes Mellitus ◽  
Case Report ◽  
Gastric Emptying ◽  
Small Bowel ◽  
Delayed Gastric Emptying ◽  
Mechanical Obstruction ◽  
Neuromuscular Dysfunction ◽  
Proximal Small Bowel ◽  
Per Se ◽  
In Pregnancy

Gastroparesis is a syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction. The most common underlying aetiology is diabetes mellitus; however, many cases are idiopathic. Pregnancy per se is associated with gastrointestinal neuromuscular dysfunction; however, reports of gastroparesis arising during pregnancy are rare. We report a case of severe gastroparesis and proximal small bowel paresis presenting during pregnancy.

scholarly journals Theory about traumatic brain injury effects. Part I. Definitions, classification, clinical signs and quantitative tomography

2021 ◽  
Vol 2 (5) ◽  
pp. 25-29
Author(s):  
Leonid B. Likhterman ◽  
◽  
Aleksandr D. Kravchuk ◽  
Vladimir A. Okhlopkov ◽  
◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Vascular Effects ◽  
Assessment And Treatment ◽  
X Ray Computed ◽  
Intrathecal Space ◽  
First Time

The paper presents the experience of assessment and treatment of 5000 cases of various traumatic brain injury (TBI) effects using brain imaging methods, minimally invasive and reconstructive neurosurgery. Definitions of TBI “effects” and “complications” have been proposed for the first time. Clinical and morphological classification of those has been developed, which identifies tissue effects, effects on cerebrospinal fluid system dynamics, and vascular effects of TBI. The major clinical symptoms of TBI effects have been described: neurologic deficit, mental dysfunctions, disturbances of vegetative function, epilepsy. Focal and diffuse alterations in brain tissue, intrathecal space and ventricular system resulting from TBI, identified by x-ray computed tomography, have been systematized. This has become the basis for investigation of pathogenesis and sanogenesis of brain disorders resulting from TBI, as well as for developing theory about the TBI effects.

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