Gut
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A safe non-invasive technique for the measurement of gastric volume by real-time ultrasound is described. The application of this technique to the measurement of the emptying of liquid from the stomach is outlined. Gastric emptying of liquid was found to be log-linear, the mean half-life of emptying in 10 volunteers being 22 . 0 +/- 2 . 5 min. Ultrasound measurement of gastric emptying provides an opportunity to study the effects of drugs and disease on gastric motor function in man.
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Case Reports
Acute gastric dilatation with infarction and perforation. Report of fatal outcome in patient with anorexia nervosa.
This is a report of a 22-year-old woman with treated anorexia nervosa who died of complications of acute gastric dilatation-that is, infarction and perforation with severe and irreversible shock. Binge eating and drinking, precipitated by emotional crises, contributed to her acute gastric dilatation. This complication of anorexia nervosa has been previously reported, but, unlike the others, this case ended fatally. The literature is reviewed.
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Cerebral oedema is the commonest immediate cause of death in fulminant hepatic failure and an investigation was carried out to determine the value of monitoring intracranial pressure (ICP) and to examine the effects of ICP of dexamethasone therapy and mannitol administration. ICP values in 10 patients at the time of insertion of a subdural pressure transducer (grade IV encephalopathy) averaged 15.5 +/- SD 14.8 mmHg. ⋯ Mannitol consistently reversed or arrested ICP rises when pressure was < 60 mmHg. ICP monitoring provides additional information in the managment of patients and is essential if mannitol therapy is to be used.
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Case Reports
Benign recurrent intrahepatic cholestasis: studies of bilirubin kinetics, bile acids, and cholangiography.
Three patients with benign recurrent intrahepatic cholestasis are described. They had had between five and 16 attacks of cholestasis. Between attacks the liver function tests, including serum bile acids, were normal. ⋯ During the cholestasis, the 45 minute retention (25%) and the fractional extraction coefficient (Ke=0.069 min-1) were markedly abnormal. The hepatic clearance of unconjugated radiobilirubin was normal at all times in this patient, although during cholestasis, conjugated bilirubin reflexed from the liver to the plasma and was then cleared slowly with a half life of approximately 12 hours. Treatment with corticosteroids, cholestyramine, and phenobarbitone was unsatisfactory.