The acute to subacute panautonomic polyneuropathy is an uncommon peripheral nerve disease, including (1) acute to subacute onset, (2) widespread and severe sympathetic and parasympathetic failure, and (3) relative or complete sparing of somatic nerve fibers. Widespread sympathetic failure is manifested as severe orthostatic hypotension, anhidrosis, and parasympathetic failure, as indicated dry eyes, dry mouth, and disturbances of bowel and bladder function. Abdominal pain, often colicky, is very common, and gastrointestinal symptoms, such as early satiety, bloating, nausea, vomiting, pain, diarrhea, or alterating constipation and diarrhea, may persist for years. Patients usually have a fixed heart rate (HR) and pupils. There may be an antecedent viral infection but the frequency of infection is unknown. Little information is available on the course and prognosis of panautonomic neuropathy. The mainstay of treatment is supportive for the management of orthostatic hypotension, and bowel and bladder symptoms. We have examined a 66-year-old woman complaining epigastric pain, orthostatic hypotension and voiding difficulty, and we report a case of acute to subacute panautonomic neuropathy presenting as gastrointestinal symptoms.
Abdominal Pain ; Aged ; Constipation ; Diarrhea ; Female ; Gastrointestinal Motility* ; Heart Rate ; Humans ; Hypohidrosis ; Hypotension, Orthostatic ; Mouth ; Nausea ; Nerve Fibers ; Peripheral Nervous System Diseases ; Polyneuropathies* ; Prognosis ; Pupil ; Syncope ; Urinary Bladder ; Vomiting

Gastroesophageal reflux disease (GERD) is thought to be caused by an incompetent lower esophageal sphincter, either because of a chronic hypotonia or an increased frequency of transient lower esophageal sphincter relaxation. Thus, it seems paradoxical under nutcracker esophagus to consider gastroesophageal reflux as a possible diagnosis, particularly in the patient presenting with chest pain. Current therapy in nutcracker esophagus is aimed at reducing the high amplitude peristaltic contractions characteristic of this disorder. Treatment directed at reducing contraction can decrease lower esophageal sphincter pressure and may exacerbate gastroesophageal reflux. It is not easy to treat a case of nutcracker esophagus associated with GERD. We report a 38-year-old male with nutcracker esophagus associated with GERD who lost the diagnostic features of nutcracker esophagus after 6 week of antireflux therapy.
Adult ; Chest Pain ; Diagnosis ; Esophageal Motility Disorders* ; Esophageal Sphincter, Lower ; Gastroesophageal Reflux* ; Humans ; Male ; Manometry* ; Muscle Hypotonia ; Omeprazole* ; Relaxation

Fecal impaction is defined as a large compacted mass of feces in the rectum or colon that cannot be passed by the patient. Fecal impaction may be caused by predisposing conditions such as mechenical impediments, neurologic diseases, psychiatric disorders, endocrine diseases, and some medications. And ninety percent of fecal impaction occur in rectum and sigmoid flexure. Recently, we experienced a case of fecal impaction in young female who had no predisposing conditions. A 30-year-old woman was adimtted with abdominal distension and constipation. She was diagnosed fecal impaction in splenic flexure and transverse colostomy was taken. After colostomy was repaired, recurrent fecal impaction was occurred and second transverse colostomy was done. After all, right hemicolectomy was done due to recurrent fecal impaction. She have one or two bowel movements a day after surgery.
Adult ; Colon ; Colon, Sigmoid ; Colon, Transverse ; Colostomy ; Constipation ; Endocrine System Diseases ; Fecal Impaction* ; Feces ; Female ; Humans ; Rectum

Anorectal manometry is now widely performed to evaluate anorectal physiology in a variety of clinical conditions. No adverse consequence related with this procedure has been reported yet. There has been no known guideline or precaution regarding the upper limit of the volume inflating the rectal balloon in measuring maximum tolerable volume. We experienced 2 cases of colorectal rupture during measuring maximum tolerable volume. Both cases were in their early postoperative period, 1 month after low anterior resection due to rectal cancer and 3 months after Delorme's procedure due to rectal prolapse, respectively. The rectal sensory and anorectal motor responses to rectal distension are known to depend on the rate and pattern of distension. Therefore, results of different examiners and laboratories cannot be compared directly unless the pattern and rate of distension are the same. Wide intersubject and intrasubject variations in maximum tolerable volume have been also reported, and differentiation between patients and normal subjects is not necessarily possible. Measuring maximum tolerable volume is painful and unpleasant, and some authors believe that maximum tolerable volume in addition to the other steps of rectal sensations does not contribute any additional information. Based on our experience and literature, we suggest that measuring maximum tolerable volume might be better to be omitted, or if it be done, rectal balloon should be inflated with great care especially in early postoperative period or in those who cannot feel or express their symptoms clearly, such as elderly or infants.
Aged ; Humans ; Infant ; Manometry* ; Physiology ; Postoperative Period ; Rectal Neoplasms ; Rectal Prolapse ; Rupture* ; Sensation

BACKGROUND/AIMS: Dyspepsia is very common in the community. The aim of this study was to assess the frequency of various causes of dyspepsia. METHODS: Two hundreds nine patient with dyspepsia were investigated. Basic laboratory screening, ECG, Upper gastrointestinal endoscopy or upper gastrointestinal barium study, upper abdominal ultrasound were performed in every dyspeptic patients. RESULTS: Functional dyspepsia was the cause of symptoms in 92.3%, peptic ulcer in 2.9% (duodenal ulcer in five patients, gastric ulcer in one patient), reflux esophagitis in 0.5%, esophageal ulcer in 0.5%. Of dyspeptic patients, gallstone was found in 1.4%, gastric submucosal tumor in 1.0%, fatty liver in 1.9% (two of four patients with fatty liver had elevated transaminase), upper gastrointestinal cancer in 0%. Of functional dyspepsia patients, women was 60.3%, men was 39.7%. CONCLUSIONS: The most common cause of dyspepsia was functional dyspepsia. Various causes of organic dyspepsia was peptic ulcer, reflux esophagitis, and esophageal ulcer.
Barium ; Dyspepsia* ; Electrocardiography ; Endoscopy, Gastrointestinal ; Esophagitis, Peptic ; Fatty Liver ; Female ; Gallstones ; Gastrointestinal Neoplasms ; Humans ; Male ; Mass Screening ; Peptic Ulcer ; Stomach Ulcer ; Ulcer ; Ultrasonography

BACKGROUND/AIMS: The aim of our study was to evaluate the role of gastroesophageal reflux in patients with chronic laryngeal symptoms. METHODS: Fourty-four patients with chronic laryngeal symptoms had not responded to empirical therapies of otolaryngologist, mean age 44.3 years, were studied. They were evaluated with esophageal manometry and 24 hour ambulatory pH monitoring with 2 channel antimony probe. The pathologic reflux was defined as the percentage of total time that the pH was below 4.0 exceeded 4.0%. RESULTS: 1) Chronic laryngeal symptoms were sorethroat (57%), horeseness (50%), globus sensation (14%). 2) Six of the 44 patients had the pathologic reflux at the lower esophagus, four had the pathologic reflux at the upper esophagus. 3) Three (50%) of the 6 patients with pathologic reflux at the lower esophagus were upright refluxer, two (33%) were supine refluxer, and one (16%) was mixed refluxer. Three (75%) of the 4 patients with pathologic reflux at the upper esophagus were uprght refluxer, and one (25%) was supine refluxer. 4) Eleven of the 44 patients had symptoms of heartburn and chest pain. Seven of the 11 patients were more than 50% of the symptom index at the upper esophagus, Eight were at lower esophagus. Six (13.6%) of the 44 patients with positive symptom index did not have pathologic reflux. In summary, chronic laryngeal symptoms were related to acid reflux in twelve (27.2%) of the 44 patients. CONCLUSION: We suggest that some patients with chronic laryngeal symptoms in Korean may have abnormal gastroesophageal reflux.
Antimony ; Chest Pain ; Esophagus ; Gastroesophageal Reflux* ; Heartburn ; Humans ; Hydrogen-Ion Concentration ; Manometry ; Sensation

BACKGROUND/AIMS: Not only scintigraphic measurement of gastric emptying(GE) is not standarized, but also several discrepancies exist in the influence of technical factors including instrument and methods of analysis on gastric emptying studies. The aim of this study was to determine whether investigating instruments, methods of analysis, affect gastric emptying rates of a radiolabeled meal in scintigraphic measurement. METHODS: Using two different scanners (single-headed gammma camera and double headed gammma camera), gastric emptying studies of radiolabeled meal (consisting of 1 g of resin) labeled with 2mCi of 99mTc-DTPA (50g of egg, 150ml of milk, 100g of rice; 611Kcal) were done in 16 healthy volunteers (16 men, age 27.5+/-3yrs). Anterior and posterior image were obtained from the supine position with two scanners at every timing interval. Anterior image only was analyzed to determine whether the differences in instruments affect gastric emptying rates. Sum of anterior and posterior counts obtained by double-headed gamma camera were compared to geometric mean. RESULTS: There were significant difference in gastric emptying rates obtained with anterior image between a single-headed scanner and a dual-headed scanner (P < 0.05, T1/2= 105.8+/-16.3 min vs 80.9+/-14.7 min). Sum of anterior and posterior counts was correlated well with geometric mean (r=0.93). Also observed difference between intraobserver and interobserver variation. CONCLUSIONS: These results indicate that instrumental variations in gastric emptying studies should be considered in interpreting individual study results. The simple sum of anterior and posterior counts could be an useful parameter in the analysis and interpretation of gastric emptying data.
Gamma Cameras ; Gastric Emptying* ; Head ; Healthy Volunteers ; Humans ; Male ; Meals ; Milk ; Observer Variation ; Ovum ; Supine Position

No abstract available.
Chest Pain* ; Thorax*

Diffuse esophageal spasm (DES) is a motility disorder of the esophagus characterized by symptoms of retrosternal chest pain and intermittent dysphagia. The diagnosis of DES has relied on criteria obtained from a standard esophageal manometry (more than one simultaneous contraction in a series of 10 wet swallows with the rest being peristaltic). Because symptoms and/or typical manometric findings are not always documented during the standard manometry, 24 hour manometry may be more useful in such cases. We recently assessed a 29-year-old male patient who complained of chest pain and dysphagia. He showed nonspecific findings on the laboratory based manometry, but DES was diagnosed by his typical manometric findings on the 24 hour manometry. Therefore, a 24 hour manometry should always be performed when the patient's history suggests the presence of DES and the laboratory based manometry failed to detect the symptomatic contractions of DES. Following we report this case with a review of the literature.
Adult ; Chest Pain ; Deglutition Disorders ; Diagnosis* ; Esophageal Spasm, Diffuse* ; Esophagus ; Humans ; Male ; Manometry* ; Swallows

BACKGROUNDS/AIM: Scintigraphic measurement of colon transit has been proven useful clinically and in the research area, however this method requires well equipped laboratories. The aim of this study was to develop a new colon transit test using radiopaque markers instead of radiolabeled pellets in a methacrylate-coated capsule. METHODS: Ten healthy volunteers were studied. After simultaneous administration of two methacrylate-coated gelatin capsules containing activated charcoal mixed with 8 mCi of 99mTc or a commercially used radiopaque marker, scintigraphies and plain abdominal X-rays were performed. We compared colon transit profiles as the geometric center at 4, 8, 24, and 48 hours after ingestion of gelatin capsules. This new radiopaque marker test was validated with a scintigraphic method as the gold standard. RESULTS: Geometric centers (mean+/-SEM) of 99mTc-scintigraphy were 0.50+/-0.18 at 4 hours, 1.16+/-0.05 at 8 hours, 3.31+/-0.36 at 24 hours, and 4.16+/-0.29 at 48 hours. Geometric centers of the radiopaque marker method were 0.40+/-0.16, 1.13+/-0.05, 3.33+/-0.37, and 4.18+/-0.30 respectively. Transit profiles were the same with both methods and highly correlated (r=0.994, p < 0.001). The difference between the two methods against the mean for the geometric center was within 2SD. CONCLUSIONS: A colon transit test using radiopaque markers in a methacrylate-coated, delayed release capsule was inexpensive, simple, and reliable. This new test could be applicable when a gamma camera is not available.
Capsules ; Charcoal ; Colon* ; Eating ; Gamma Cameras ; Gelatin ; Healthy Volunteers ; Radionuclide Imaging