Colocolic Intussusception Associated with Octangium sp. (Digenea: Microscaphidiidae) in a Green Sea Turtle Chelonia mydas

Reports of intussusception in sea turtles are generally linked to marine debris ingestion; therefore, only a few cases of the disease are associated with parasitic infestations. The objective of this study was to describe the necropsy findings of the first reported case of colocolic intussusception in a green sea turtle Chelonia mydas, associated with the helminth Octangium sp. A juvenile female green sea turtle, which was registered and rescued by the team from the Cetaceans Project of Costa Branca, State University of Rio Grande do Norte, was examined. The animal died 1 d after being treated and was immediately submitted for necropsy. Our findings indicated that parasitic infestation by Octangium sp. in the green sea turtle caused intussusception and consequently led to the animal's death. Early diagnosis and surgical correction are fundamental for a good prognosis and, consequently, for successful rehabilitation of marine species.

What is Indigestion?1

Ninety patients and 30 senior hospital doctors were questioned about indigestion and dyspepsia. There were marked discrepancies between the views of patients and doctors. Most doctors considered indigestion to be synonymous with dyspepsia and associated it with peptic ulcer. Patients, however, were not generally conversant with the term dyspepsia and linked indigestion with psychological factors, feeding patterns and bowel function rather than physical illness. The patients’ concept of indigestion corresponded closely with medically-accepted features of irritable bowel syndrome. Uncritical use of these terms may lead to misinterpretation of the patient's complaint and inappropriate management.

[Irritable bowel syndrome]

In February 2002 the XXIX Scientific Session of the Central Research Institute on Gastroenterology was spent, where in the frames of the Round table some problems of the Syndrome of irritable intestine were discussed.

Clinical and functional results after elective colonic resection in 75 consecutive patients with diverticular disease

BACKGROUND

Functional results after elective colonic resection in patients with diverticular disease have seldom been studied.

METHODS

Seventy-five consecutive patients were reviewed and sent a questionnaire about abdominal symptoms and functional results. Possible associations between patients' characteristics and postoperative complications or functional outcome were analyzed.

RESULTS

Major complications including anastomotic leakage, bleeding, and bowel obstruction occurred in 10 patients (13%). Six patients (8%) had recurrent diverticulitis. No significant associations were found between clinical characteristics and postoperative complications or recurrent disease. Fifty patients classified their final result as excellent or good. Functional symptoms or symptoms suggestive of irritable bowel syndrome before the operation predicted a less successful result (P <0.05).

CONCLUSIONS

Elective surgery in patients with diverticular disease was hampered by postoperative complications but resulted in most cases in good functional outcome and a low rate of recurrent disease. Those with functional bowel symptoms before surgery had significantly worse results.

Problems of HRQL assessment: how much is too much?

Few investigations have explored the extent to which a number of less serious problems contribute to health-related quality of life (HRQL) impairment beyond a smaller number of more serious problems. Our study examined the relative impact of the number and severity of patient problems on HRQL. This study analyzed results from 100 patients with irritable bowel syndrome (IBS) and 100 women with polycystic ovary syndrome (PCOS). We compared an aggregation method that generated scores using all items that could affect HRQL as the denominator (all items) to a second method that considered only items that patients experienced as problems (problem items). For each IBS and PCOS questionnaire domain, we used regression analysis to examine the relative contribution of scores from the all-items and problem-items approaches to prediction of scores on the other instruments. Of 57 correlations between IBS domains and scores on the other questionnaires, the all-items method explained a statistically significant additional proportion of the variance beyond the problem items in 29 cases and the problem items a significant additional proportion of the variance between the all items in 7 (p < 0.001). Of the 28 correlations between the PCOS and the other questionnaires, the all-items approach explained a significant additional proportion of the variance in 21 cases and the problem items approach in 5 (p < 0.001). With IBS and PCOS, including all potential items in calculating a domain score provided a more accurate portrayal of HRQL than a selected approach focusing on problem items

Direct inhibitory effect of nicardipine on basolateral K+ channels in human colonic crypts

The most abundant basolateral K+ channels in human colonic crypt cells have a low conductance (23 pS), respond to increases in intracellular Ca2+ and cAMP, and have been implicated in intestinal electrogenic Cl- secretion. The effect of nicardipine on the activity of these K+ channels was examined by patch-clamp recording in the cell-attached and excised inside-out configurations from the basolateral membrane of single crypts isolated from biopsied samples of human distal colon. During cell-attached recordings, addition of 2 micromol/l nicardipine to crypts pretreated with 200 micromol/l dibutyryl cAMP decreased single-channel open probability by 87%, but in parallel studies nicardipine had no effect on the intracellular Ca2+ concentration. Using inside-out patches from crypts pretreated with dibutyryl cAMP (bathed in 1.2 mmol/l Ca2+), the addition of increasing concentrations of nicardipine (200 nmol/l, 2 micromol/l and 20 micromol/l) decreased single-channel open probability in a concentration-dependent manner (IC50 0.47 micromol/l). In additional experiments using stripped rat distal colonic mucosa mounted in conventional Ussing chambers, serosal addition of nicardipine at increasing concentrations (ranging from 200 nmol/l to 20 micromol/l) produced a concentration-dependent inhibition of dibutyryl-cAMP-stimulated electrogenic Cl- secretion (IC50 2 micromol/l). Taken together, these results indicate that nicardipine has a direct inhibitory action on 23-pS basolateral K+ channels in human intestinal crypt cells, which is likely to decrease cAMP-stimulated electrogenic Cl- secretion. These basolateral K+ channels may provide a focal point for the development of new strategies in the treatment of secretory diarrhoeal diseases.

Quality of life in persons with irritable bowel syndrome: development and validation of a new measure

How irritable bowel syndrome (IBS) and its treatment affect quality of life (QOL) is important. To develop a quality-of-life measure specific to irritable bowel syndrome, items were generated using a conceptual model and qualitative interviews with persons diagnosed using the Rome criteria. Symptom frequency and bothersomeness indices were created. Psychometric evaluation methods involved an initial cross-sectional survey followed by a repeat survey. The resulting 34-item measure demonstrated high internal consistency (Cronbach's alpha = 0.95) and high reproducibility (ICC = 0.86) with average time of seven days (SD = 1). For discriminant validity: number of symptoms (P < 0.05), self-reported severity of symptoms (P < 0.001), and the functional bowel disorder severity index (P < 0.001) significantly predicted IBS-QOL scores. Convergent validity and analyses confirmed predictions that scores are more closely related to psychological well-being (0.45) than to function (0.36). We conclude this measure meets established psychometric criteria for reliability and validity; testing of its responsiveness is warranted.

Use of a novel electronic data collection system in multicenter studies of irritable bowel syndrome

BACKGROUND

The reliability of symptom data collected during efficacy studies in irritable bowel syndrome (IBS) is paramount to the proper assessment of potential therapeutic agents. Historically, data have been collected on paper diary cards, which patients were requested to fill out at a specified interval. However, with paper diary cards it is not possible to determine whether the cards are filled out as required, or at random times. To circumvent this problem, a novel electronic data collection system that ensures the reliability and security of data entry was used.

METHODS

Data were collected from 640 patients during the 2-week screening and 12-week treatment phases of two multicentre trials of IBS. The electronic data collection system used was based upon a touchtone telephone system.

RESULTS

The electronic data collection system had a potential 8135 up-time hours during the study. An up-time of 8040 h and down-time of 95 h was observed. This corresponds to an up-time of approximately 99%. Patient compliance for data entry in the two studies was 81% and 83%, respectively. On a single random day during their daily telephone call, patients were asked questions to assess satisfaction with the system. On aggregate, 79% of patients were satisfied or very satisfied with the system, only 10% were dissatisfied or very dissatisfied.

CONCLUSION

A unique electronic data collection system was tested for use in clinical studies in IBS. This system provided 100% reliability as to the date of data entry, and data were not subject to modification once entered. This methodology represents a marked advancement in clinical studies of IBS.

The fibromyalgia syndrome

The term fibromyalgia describes a complex syndrome characterized by pain amplification, musculoskeletal discomfort, and systemic symptoms. Although its existence has been controversial, nearly all rheumatologists now accept fibromyalgia as a distinct diagnostic entity. In fact, in the United States it is the third or fourth most common reason for rheumatology referral. Exciting new insights into the aetiology, pathogenesis, diagnosis and treatment of fibromyalgia will be reviewed.

Functional abdominal bloating

Ten to 25% of healthy persons have bloating at some time or other. It is very common in those with the irritable bowel syndrome, constipation, or anorexia nervosa. Although the cause of functional bloating remains unknown, old explanations such as a low diaphragm, exaggerated lumbar lordosis, and psychiatric problems have been disproved. New suggestions on its etiology include recent weight gain, weak abdominal muscles, and retained fluid in loops of small intestine. No treatment is of proven benefit, but treatment by weight loss, exercise, and prokinetics should be studied.

Chronic abdominal pain: a surgical or psychiatric symptom?

A prospective investigation of chronic, non-specific abdominal pain in 20 patients is reported. The cause was found to be psychiatric in 8 (40 per cent), while a surgical cause was found in only 3 (15 per cent). Four had irritable colon (20 per cent) and no diagnosis was made in 5 (25 per cent). It is suggested that such pain is more often a psychiatric than a surgical symptom and therefore a psychiatric consultation should be a routine part of the investigation.