AIM: To investigate the proximal gastric motor response to duodenal nutrients in critically ill patients with long- standing type 2 diabetes mellitus. METHODS: Proximal gastric motility was assessed (using a barostat)...AIM: To investigate the proximal gastric motor response to duodenal nutrients in critically ill patients with long- standing type 2 diabetes mellitus. METHODS: Proximal gastric motility was assessed (using a barostat) in 10 critically ill patients with type 2 diabetes mellitus (59 ± 3 years) during two 60-min duodenal infusions of Ensure? (1 and 2 kcal/min), in random order, separated by 2 h fasting. Data were compared with 15 non-diabetic critically ill patients (48 ± 5 years) and 10 healthy volunteers (28 ± 3 years). RESULTS: Baseline proximal gastric volumes were similar between the three groups. In diabetic patients, proximal gastric relaxation during 1 kcal/min nutrient infusion was similar to non-diabetic patients and healthy controls. In contrast, relaxation during 2 kcal/ min infusion was initially reduced in diabetic patients (P < 0.05) but increased to a level similar to healthy humans, unlike non-diabetic patients where relaxation was impaired throughout the infusion. Duodenal nutrient stimulation reduced the fundic wave frequency in a dose-dependent fashion in both the critically ill diabetic patients and healthy subjects, but not in critically ill patients without diabetes. Fundic wave frequency in diabetic patients and healthy subjects was greater than in non-diabetic patients. CONCLUSION: In patients with diabetes mellitus, proximal gastric motility is less disturbed than non- diabetic patients during critical illness, suggesting that these patients may not be at greater risk of delayed gastric emptying.展开更多
Background and aims: Anal sphincter weakness and rectal sensory disturbances c ontribute to faecal incontinence (FI). Our aims were to investigate the relation ship between sym- ptoms,risk factors, and disordered anor...Background and aims: Anal sphincter weakness and rectal sensory disturbances c ontribute to faecal incontinence (FI). Our aims were to investigate the relation ship between sym- ptoms,risk factors, and disordered anorectal and pelvic floor functions in FI. Methods: In 52 women with “idiopa- thic" FI and 21 age matched asymptomatic women, we assessed symptoms by standa rdised questionnaire, anal pr- essures by manometry, anal sphincter appearance by endoanal ultrasound and mag netic resonance imaging (MRI), pelvic floor motion by dynamic MRI,and rectal com pliance and sensation by a barostat. Results: The prevalence of anal sphincter i njury (by imaging), reduced anal resting pressure (35%of FI), and reduced squee ze pressures(73%of FI) was higher in FI compared with controls. Puborectalis at rophy (by MRI) was associated (p<0.05) with FI and with impaired anorectal motio n during pelvic floor contraction.Volume and pressure thresholds for the desire to defecate were lower, indicating rectal hypersensitivity, in FI. The rectal vo lume at maximum tolerated pressure (that is, rectal capacity)was reduced in 25% of FI; this volume was associated with the symptom of urge FI (p< 0.01) and rectal hypersensitivity (p= 0.02). A combination of predictors ( age, body mass index,symptoms, obstetric history, and anal sphincter appearance) explained a substantial proportion of the interindividual variation in anal squ eeze pressure (45%) and rectal capacity (35%). Conclusions:Idiopathic FI in wo men is a multifactorial disorder resulting fromone ormore of the following: a di sordered pelvic barrier (anal sphincters and puborectalis), or rectal capacity o r sensation.展开更多
基金Supported by a project grant from the National Health and Medical Research Council of Australia.
文摘AIM: To investigate the proximal gastric motor response to duodenal nutrients in critically ill patients with long- standing type 2 diabetes mellitus. METHODS: Proximal gastric motility was assessed (using a barostat) in 10 critically ill patients with type 2 diabetes mellitus (59 ± 3 years) during two 60-min duodenal infusions of Ensure? (1 and 2 kcal/min), in random order, separated by 2 h fasting. Data were compared with 15 non-diabetic critically ill patients (48 ± 5 years) and 10 healthy volunteers (28 ± 3 years). RESULTS: Baseline proximal gastric volumes were similar between the three groups. In diabetic patients, proximal gastric relaxation during 1 kcal/min nutrient infusion was similar to non-diabetic patients and healthy controls. In contrast, relaxation during 2 kcal/ min infusion was initially reduced in diabetic patients (P < 0.05) but increased to a level similar to healthy humans, unlike non-diabetic patients where relaxation was impaired throughout the infusion. Duodenal nutrient stimulation reduced the fundic wave frequency in a dose-dependent fashion in both the critically ill diabetic patients and healthy subjects, but not in critically ill patients without diabetes. Fundic wave frequency in diabetic patients and healthy subjects was greater than in non-diabetic patients. CONCLUSION: In patients with diabetes mellitus, proximal gastric motility is less disturbed than non- diabetic patients during critical illness, suggesting that these patients may not be at greater risk of delayed gastric emptying.
文摘Background and aims: Anal sphincter weakness and rectal sensory disturbances c ontribute to faecal incontinence (FI). Our aims were to investigate the relation ship between sym- ptoms,risk factors, and disordered anorectal and pelvic floor functions in FI. Methods: In 52 women with “idiopa- thic" FI and 21 age matched asymptomatic women, we assessed symptoms by standa rdised questionnaire, anal pr- essures by manometry, anal sphincter appearance by endoanal ultrasound and mag netic resonance imaging (MRI), pelvic floor motion by dynamic MRI,and rectal com pliance and sensation by a barostat. Results: The prevalence of anal sphincter i njury (by imaging), reduced anal resting pressure (35%of FI), and reduced squee ze pressures(73%of FI) was higher in FI compared with controls. Puborectalis at rophy (by MRI) was associated (p<0.05) with FI and with impaired anorectal motio n during pelvic floor contraction.Volume and pressure thresholds for the desire to defecate were lower, indicating rectal hypersensitivity, in FI. The rectal vo lume at maximum tolerated pressure (that is, rectal capacity)was reduced in 25% of FI; this volume was associated with the symptom of urge FI (p< 0.01) and rectal hypersensitivity (p= 0.02). A combination of predictors ( age, body mass index,symptoms, obstetric history, and anal sphincter appearance) explained a substantial proportion of the interindividual variation in anal squ eeze pressure (45%) and rectal capacity (35%). Conclusions:Idiopathic FI in wo men is a multifactorial disorder resulting fromone ormore of the following: a di sordered pelvic barrier (anal sphincters and puborectalis), or rectal capacity o r sensation.
