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A case of acute gastric dilatation due to massive aerophagy in a patient who had previously had a laryngectomy is reported. Excitement during regional analgesia was responsible. The pathophysiology of this mechanism is discussed and suggestions are made about its prevention.
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Two minor tranquilizers, diazepam and lorazepam were significantly better than a placebo preparation in relieving symptoms of functional gastrointestinal distress in 28 patients who took part in a double-blind cross-over trial. The beneficial therapeutic effect may be group- rather than preparation-specific. Both agents were also of significant benefit to the sub-group of patients with aerophagy as a major symptom.
Patients with functional bowel disease commonly complain of abdominal pain, bloating, and excessive flatulence and eructation. Pain and bloating may be primarily caused by abnormal intestinal motility rather than by excessive intestinal gas. As yet there are no data available that prove excessive flatulence is actually caused by the presence of excessive intestinal gas. A study of the composition of intestinal gas provides insight into whether it is derived from swallowed air or from intraluminal metabolism. Therapy aims primarily at excluding the presence of organic disease as a cause and reassuring the patient that the disorder is functional in nature. Dietary manipulation, changing the habit of aerophagia, exercise, and pressure and heat applied to be abdominal area are all possibilities to be tried.
Metrizamide and meglumine iocarmate (Dimer-X), which at present are the contrast media for myelography best tolerated by central nervous system, were compared in a double-blind test comprising a total of 86 patients, all with symptoms of lumbar or sacral root involvement. Symptoms appearing were recorded using a standard interview formula 24 hoaurs after myelography. EEG, routine laboratory analyses of CSF and neurologic examinations were also made. In some cases CSF paper electrophoresis, CSF pressure recordings and determination of CSF iodine content were obtained.
The excessive accumulation of gas in the gastrointestinal tracts was invariably induced on experimental animals (mice, rats, guinea pigs, hamsters and rabbits) by simply obstructing nasal passages. The analysis of the gas showed the almost identical composition to the ambient air or flutus which was largely due to swallowed air. Also the numerous small foams were found on and underneath the epithelial lining of small intestine. The pathological evaluation was done both macroscopically and microscopically. Dying animals after nasal obstruction showed hemorrhagic and necrotic changes in the jejunum and ileum. This observation may cast some light to the pathogenesis of necrotizing enterocolitis in human neonatal.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
An old test to investigate fecal fermentation was modified with the purpose of changing it from qualitative to quantitative. The modified test consists in placing in stove, at 37 degrees C for 24 hours, 5 grams of feces, suspended in water. The fermentable alimentary residues, present in the feces, suffer the action of bacteria, also there present, yielding gas that is collected and measured. Using the test, fecal fermentation was determined in 3 groups of individuals: a) 40 patients with meteorism that had persisted or improved only slightly or fairly with treatment; b) 28 apparently healthy subjects; and c) 6 patients with meteorism that had disappeared or become minimal with treatment. In the group of 28 apparently healthy subject, the obtained results varied from 0.1 to 1.1 ml gas/24 h., with a mean +/- s.d. of 0.55 +/- 0.29 ml. gas/24 h. When a distribution curve was made with the results obtained in the group of 40 patients with meteorism, these results separated into 2 subgroups: one subgroup with 28 patients, in whom results varied from 1.0 to 13.3 ml. gas/24 h., with a mean of 4.8 gas/24 h. (only) in 1 of these 28 patients a normal result of 1.0 ml. gas/24 h. was obtained, while in the remaining 27 patients results of 1.5 or more ml. gas/24 h. were obtained); and the other subgroup with 12 patients, in whom results varied from 0.0 to 0.9 ml. gas/24 h., with a mean of 0.29 ml. gas/24 h. Finally, in the group of 6 patients with successfully treated meteorism, results were from 0.1 to 0.9 ml. gas/24 h., with a mean of 0.4 ml. gas/24 h. The above mentioned results strongly suggest the existence of a relationship between meteorism and exagerated fecal fermentation. The nature of this relationship has not yet been completely clarified. However, the test used to determine fecal fermentation already promises to be very helpful for a better understanding and management of meteorism.
Interposition of the colon between the liver and diaphragm, ie. Chilaiditi's syndrome, visible during roentgenographic examination, has been described as an asymptomatic finding in adults of no clinical importance: it is occasionally symptom-producing in children. In mentally retarded adults, however, a unique syndrome commonly occurs, characterized by nausea, pain, vomiting, anorexia, distension, audible bowel sounds, and constipation: all are associated with three roentgenographic features of interposition. The symptoms respond to simple treatment and can be prevented by routine prophylactic measures.
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