Functional Abnormalities In Patients Research Articles

JOINT HYPERMOBILITY AND AUTONOMIC HYPERACTIVITY: RELEVANCE TO NEURODEVELOPMENTAL DISORDERS

ObjectiveTo test the hypothesis that Joint hypermobility and autonomic dysfunction are over-expressed within neurodevelopmental disorders. Joint hypermobility is a widespread poorly recognized connective tissue condition with affected individuals overrepresented among...

Impact of the PPARGC1A Gly482Ser polymorphism on left ventricular structural and functional abnormalities in patients with hypertension

The Gly482Ser polymorphism in the peroxisome proliferator-activated receptor gamma coactivator-1α (PPARGC1A) has been reported to contribute to the development of left ventricular (LV) hypertrophy. Little is known, however, about its possible impact on cardiac dysfunction. Enhanced myocardial fibrosis accompanying increased LV mass might represent a link with coexisting functional abnormalities. We investigated the association between the PPARGC1A Gly482Ser polymorphism and LV morphology and performance in essential hypertension, with special consideration of fibrosis intensity. A total of 205 hypertensive patients (60±8 years) underwent echocardiography with assessment of cardiac morphology, LV systolic (strain and strain rate) and diastolic function (peak early diastolic mitral flow velocity/peak late diastolic mitral flow velocity (E/A) ratio, peak early diastolic myocardial velocity (Em), and E/e' ratio (where e' is the peak early diastolic mitral annular velocity)), evaluation of serum procollagen type III amino-terminal propeptide (PIIINP) and procollagen type I carboxy-terminal propeptide (PICP)-markers of fibrosis and the PPARGC1A Gly482Ser genotyping. Subjects with the Ser-Ser genotype demonstrated more profound LV hypertrophy and diastolic function impairment, and higher PICP/PIIINP than the Ser-Gly and Gly-Gly groups. In multivariable analysis, the presence of the Ser-Ser allele was an independent correlate of E/e' (β=0.17, P<0.02), Em (β=-0.18, P<0.01) and LV mass index (β=0.28, P<0.001). In conclusion, in hypertensive patients, the PPARGC1A Gly482Ser polymorphism is associated with LV hypertrophy and diastolic dysfunction, with the presence of the Ser-Ser allele promoting these abnormalities. One of the possible mechanisms mediating the adverse effect on diastolic performance might be a relative increase in the anabolism of rigid collagen type I over that of the more elastic collagen type III, as indicated by an increased ratio of PICP to PIIINP.

Effectiveness of Laryngostroboscopy for Monitoring the Evolution of Functional Dysphonia after Rehabilitator Treatment

The aim of this study is to evaluate the effectiveness of the laryngostroboscopy for monitoring the evolution of patients with functional dysphonia before and after the logopedic vocal treatment. We performed a prospective observational study of 65 dysphonic patients diagnosed of functional dysphonia, where we analyzed four stroboscopic parameters (glottal closure, vocal fold vibration, mucosal wave and phase symmetry) by a protocol based on systematic subjective evaluation of the stroboscopic images before and after the rehabilitator treatment; and the results were stratified according to the clinical course. All patients, before the treatment, had some abnormality in at least one of the four analyzed aspects. After the vocal treatment, we found improvement of the four parameters in different degrees, and we just found a statistically significant relationship between the evolution of the glottal closure and the clinical course. We believe that the laryngostroboscopy, systematized through a protocol, is a useful technique for the diagnosis of functional abnormalities in patients with functional dysphonia but it is not a very useful technique for evaluating the results after the rehabilitator treatment, as there is not a statistically significant relationship between clinical course and the change in the most stroboscopic parameters, so it shouldn't be the only technique used for these proposes.

Integrating Optimal Use of Echocardiography and Biomarkers in Heart Disease

Echocardiography remains the primary modality to identify cardiac structural and functional abnormalities in patients with signs and symptoms of heart failure. Echocardiography may also have a role in identifying patients at risk of heart failure, in other words, differentiating patients from ACC/AHA stage A (risk factors for heart failure) to stage B (structural abnormalities in the absence of symptoms). In recent years soluble (blood based) cardiac specific biomarkers have been broadly introduced into clinical practice for the diagnosis of acute myocardial infarction (cardiac troponins) and diagnosing and prognosticating patients with heart failure (the natriuretic peptide tests, B-type natriuretic peptide [BNP] and the amino-terminal of proBNP [NT-proBNP]). Specifically, a large number of studies have evaluated the use of natriuretic peptides to complement the results of echocardiography in a spectrum of cardiovascular diseases ranging from asymptomatic community based populations to prognosticating patients with cardiomyopathies, valve disease and pulmonary embolism. The focus of this review will be to assess the state of the evidence from a variety of scenarios where natriuretic peptide testing and echocardiography can provide complementary information for diagnosis, prognosis and potentially guiding therapy.

Cortical regional differences of delta waves during all-night sleep in schizophrenia

Background Delta sleep is mediated by thalamocortical circuits and is postulated to be abnormal in schizophrenia. Delta wave deficits during sleep have been observed in patients with schizophrenia. Negative symptoms have been reported to reflect frontal lobe dysfunction and to be associated with decreased delta wave sleep. This investigation was undertaken to identify cortical functional abnormalities in patients with schizophrenia shown on the electroencephalogram. Methods We compared seventeen male, medically treated or neuroleptic-naive outpatients with schizophrenia and 18 healthy male volunteers by all-night polysomnography and investigated cortical regional differences of delta waves. All-night sleep data was evaluated by period amplitude analyses. Delta waves during sleep were investigated in bilateral frontal, central, parietal, and occipital regions by computer analysis. The associations between delta waves in all regions and measures of clinical variables were also estimated. Results Patients with schizophrenia showed lower total delta wave counts during all-night sleep than did control subjects in all regions. Control subjects showed significantly higher delta wave counts in the right frontal and central region than in the left, which was not observed in patients with schizophrenia. Significant inverse correlations were observed between negative symptom scores and delta wave counts in all regions. Control subjects showed significant inverse correlations between delta wave counts and age, which were not identified in patients with schizophrenia. Conclusions Delta wave deficits in all regions may reflect thalamocortical dysfunction in schizophrenia. Reduced right frontal and central delta wave dominance is suggested to be involved in the pathophysiology of schizophrenia.

Prognostic Significance of Strain Doppler Imaging in Light-Chain Amyloidosis

To clarify the prognostic value of strain and strain rate imaging in light-chain (AL) amyloidosis. Myocardial strain and strain rate Doppler imaging are objective measurements that may detect regional subtle myocardial functional abnormalities in patients with amyloidosis. We prospectively examined 119 consecutive, untreated patients with biopsy-proven AL amyloidosis. The mean values of tissue velocity, strain, and strain rate were calculated from the basal, mid, and apical left ventricular (LV) multiple walls in apical 2- and 4-chamber views. The prognostic value of these parameters was compared with standard 2-dimensional echocardiographic and Doppler measurements of transmitral and pulmonary venous flow. Seventy patients had cardiac involvement defined as the mean value of LV wall thickness greater than 12 mm. Thirty-two patients (27%) (including 22 proven cardiac deaths) died during a mean follow-up period of 285 +/- 136 days. No echocardiographic or Doppler features differentiated patients with cardiac involvement without congestive heart failure (CHF) from noncardiac amyloid group other than the pre-defined wall thickness and LV end-diastolic and end-systolic diameters. On the other hand, strain rate and strain imaging clearly detected differences of longitudinal LV myocardial deformation among 3 groups (noncardiac involvement group, cardiac amyloidosis without CHF group, and cardiac amyloidosis with CHF group). Univariate analysis showed that strain rate, strain, and tissue velocity values were statistically significant predictors of outcome at most of the sites. Multivariate analysis showed that the mean LV basal strain was the only independent predictor of both cardiac and overall deaths. Among patients with AL amyloidosis, the mean basal strain, a measure of longitudinal LV function, was a powerful predictor of clinical outcome and was superior to standard 2-dimensional echocardiographic, Doppler flow measurements, and simple tissue velocity indexes.

Cardiac Structural and Functional Abnormalities in Patients With “Lone” Atrial Fibrillation

Cardiac Structural and Functional Abnormalities in Patients With “Lone” Atrial Fibrillation

Role of videofluorography in assessing functional abnormalities in patients of head and neck cancer treated with chemoradiotherapy

Aim: The major toxicity following treatment for head neck cancer is swallowing dysfunction which can be easily assessed by videofluorography (VFG), allowing documentation of the site and extent of abnormality thereby facilitating directed management. Methods: Between October 2003 and January 2007, 56 patients with locally advanced head and neck cancer were treated by an accelerated radiotherapy schedule with concurrent weekly cisplatin chemotherapy. Three months following treatment, these patients were locally disease free clinically, but complained of varying degrees of dysphagia and were subjected to a VFG evaluation. Results: This group comprised 52 men and four women with a median age of 56 years. The primary site distribution was: oral cavity (9), oropharynx (22), larynx (19), hypopharynx (5) and unknown primary (1). Swallowing function abnormalities in the form of structural displacement and temporal delays were documented and recorded as weakness of the tongue musculature (n = 6), palatal kink (n = 8), premature leak into the oropharynx (n = 20), impaired hyoid elevation (n = 23), impaired epiglottic tilt (n = 26), unilateral pharyngeal wall impairment (n = 16), residuum in vallecula or pyriform fossa (n = 30), aspiration in trachea (n = 29) and loss of nasopharyngeal seal (n = 7). Multiple abnormalities of different sub-sites were seen in each patient. Conclusion: VFG can document dysmotility disorders of upper aero-digestive tract like dysfunction of the base of tongue, larynx and pharyngeal musculature leading to stasis of the bolus and vallecular residuum, epiglottis dysmotility resulting in silent aspirations, and inadequate nasopharyngeal seal leading to nasal regurgitation. A clinical correlation alongwith quantification of VFG findings is required.

1381: Four-Dimensional Echocardiography in Diagnostics of Heart Diseases

To estimate opportunities of a 4D echocardiography (4DEcho) in diagnostics of anatomical, morphological and functional abnormalities in patients with different heart diseases. The 4DEcho was used on GE Vivid 7 Dimension with 3V transducer. 150 patients with congenital heart diseases, 20 patients with valvular diseases were included in this study. Spectrum of congenital heart diseases was wide: septum defects, atrioventricular channel (AVC), coarctation of aorta, pulmonary stenosis, intracardiac mass and other. The acquire heart diseases were presented defeat of mitral, tricuspid, aortic valves, prosthetic valves. We made 35 fetal 4DEcho examinations with congenital heart disease. The 4D diagnostics of septal defects has led to the most exact estimation of their localization, the form, edges. At AVC three components have been investigated: atrial, ventricular, valvular portions of the channel. 4DEcho at coarctation of aorta have allowed to define a level and character of narrowing, hypoplasia of descending aorta, LV hypertrophy. At pulmonary artery stenosis and right ventricular outflow tract obstruction the type and character of pathology has been appreciated with 4DEcho. Fetal 4D echocardiography allows to improving of visualization of cardiac structures at congenital heart diseases from 22 to 40 weeks of pregnancy. At valvular diseases the details of anatomy and morphology have been investigated. Research of prosthetic valves allows to estimating their conditions and dysfunction. 4DEcho allows us in routine practice to diagnose details of anatomy and morphology of heart structures and prosthetic valves, to improve revealing of congenital heart diseases in fetuses.

Comorbidities in heart failure: a key issue

Comorbidities in heart failure: a key issue

Early detection of right ventricular functional abnormalities in patients with complex right premature ventricular contractions

Right ventricular (RV) premature contractions, although generally benign, may represent the first manifestation of arrhythmogenic RV cardiomyopathy. The diagnostic and prognostic value of RV functional abnormalities evidenced by equilibrium radionuclide angiocardiography (ERNA) with multiharmonic Fourier analysis has been validated in patients with severe RV arrhythmias suspected of being affected by arrhythmogenic RV cardiomyopathy. The aim of this study was to assess the prevalence of the same RV functional abnormalities in patients with frequent left bundle branch block pattern premature ventricular contractions (PVCs), without known heart disease, using ERNA as a screening tool. The study included 377 consecutive patients (mean age: 40+/-15 years, males: 58%) presenting with complex PVCs. Cine mode and multiharmonic analysis were used to define global enlargement and areas of dyskinesia of both ventricles. Studies were classified as: normal, right and/or left ventricular abnormalities either localized or diffuse. ERNA was normal in 302 patients (80%) and evidenced RV functional abnormalities in 75 patients (20%). Patients with RV outflow tract PVCs (n=276) were affected to the same extent as patients with right or left axis PVCs. In a specific population with complex left bundle branch block pattern PVCs, RV functional abnormalities were detected by ERNA in 20% of patients. Consequently, ERNA may serve as a screening tool by selecting patients who may require a specific management.

Correlation of Visual Function Impairment and Optical Coherence Tomography Findings in Patients with Adult-Onset Foveomacular Vitelliform Macular Dystrophy

To investigate the relationship between morphologic and functional abnormalities in patients affected with adult-onset foveomacular vitelliform macular dystrophy (AFVD). Prospective, noncomparative observational study. A complete ophthalmologic examination, including best-corrected visual acuity (BCVA), fundus examination, fundus-related perimetry, and optical coherence tomography (OCT), was performed in 20 consecutive AFVD patients. The stage of the disease and the thickness of the neuroepithelium at the foveola (neurosensory retina) were compared with the BCVA as well as with the type of scotoma, the average retinal sensitivity, and the location and stability of fixation. Thirty-five eyes of 20 consecutive patients (10 men and 10 women; mean age, 58.2 years) were graded as follows: 10 had vitelliform stage (stage 1), nine had pseudohypopyon stage (stage 2), 10 had vitelliruptive (stage 3), and six had atrophic stage (stage 4) disease. Reduced thickness of the neuroepithelium at the foveola and BCVA were statistically correlated to an advanced stage of the disease (P = .001 and P = .0062, respectively). Moreover, worse BCVA was correlated statistically to reduced thickness of the neuroepithelium at the foveola (r = 0.14; P = .02). Reduced thickness of the neuroepithelium at the foveola was correlated statistically to the development of absolute scotoma (P = .03), eccentric fixation (P = .01), and unstable fixation (P = .03). OCT and fundus-related perimetry allow a correlation to be defined between foveal thickness and visual function and are useful tools to define better the degree of anatomic and functional impairment in AFVD patients.

Detection of Regional Myocardial Dysfunction in Patients with Acute Myocardial Infarction Using Velocity Vector Imaging

Velocity vector imaging (VVI) is a new echocardiographic technique of measuring regional myocardial velocities and deformation. Our aim was to evaluate the feasibility and accuracy of VVI in defining regional functional abnormalities in patients with an acute myocardial infarction. Standard echocardiography and delayed enhancement (DE) magnetic resonance imaging were performed in 32 patients (29 men, mean age 61.2 +/- 8.1 years) within 36 hours of primary angioplasty. Twenty healthy volunteers (16 men, mean age 34.6 +/- 6.3 years) served as control subjects. Using VVI for offline analysis, segmental longitudinal deformation indices were measured. Infarcted, adjacent, and remote left ventricular segments were defined according to DE magnetic resonance imaging and coronary angiography. Infarct transmurality was also graded based on the DE extent within each segment on DE magnetic resonance imaging (0%-25%, 26%-50%, 51%-75%, and >76% of wall thickness). As compared with remote segments, myocardial infarction segments had significantly lower longitudinal systolic strain (S) (-9.6% vs -14.6%, P < .0001), lower S rate (-0.75 vs -1.08 s(-1), P < .0001), and a higher postsystolic S index (21% vs 8.3%, P < .001). By receiver operating characteristic curve analysis, a myocardial peak systolic longitudinal S lower than -6.5% in at least one ventricular segment showed best predictive value (94%) for detecting an infarcted left ventricle. Peak systolic S and S rate were useful predictors of the presence of regional dysfunction, and for the localization and transmural extent of the infarct. VVI is a promising new tool for studying myocardial motion and deformation with good feasibility in the clinical setting. The assessment of myocardial longitudinal systolic S and S rate with VVI can be used to identify the presence, location, and the transmural extent of myocardial infarction.

Correlation of Visual Function Impairment and Oct Findings in Patients with Stargardt Disease and Fundus Flavimaculatus

To investigate the relationship between morphologic lesions of the retina and functional abnormalities in patients with Stargardt disease (STGD) and fundus flavimaculatus (FFM). DESIGN. Case-controlled, prospective, comparative observational study. A complete ophthalmologic examination, including best-corrected visual acuity (BCVA) and optical coherence tomography (OCT), was performed in 61 eyes of 32 consecutive patients with STGD/FFM and in 60 eyes of 30 matched healthy control subjects. Furthermore, fundus-related perimetry was performed in 12 of the affected eyes. The age ranged from 21 to 71 years in STGD/FFM patients and from 21 to 72 years in controls. BCVA ranged from 20/20 to 20/400 and from 20/20 to 20/32, respectively, in STGD/FFM patients and in controls. A foveal thinning was found by OCT Stratus in almost all cases (average 160 microm) compared with controls (average 210 microm) (p<0.001). BCVA impairment significantly correlated to the degree of foveal thinning (r2=0.16; p=0.0014). Moreover, in STGD/FFM patients the authors observed two types of hyperreflective deposits which were not correlated with BCVA impairment or foveal thinning. In addition, fundus-related perimetry revealed a stable fixation in 8/12 eyes, that was predominantly central in only 4 of these eyes. A smaller degree of foveal thinning correlated to a more stable fixation (p=0.0108), even if not predominantly central (p=0.0218). In this series, lower visual acuity and unstable fixation correlated with a greater transverse foveal thinning. OCT and fundus-related perimetry may be useful tools in STGD/FFM patients.

Reguatory T-Cell Subsets Demonstrate Quantitative Differences but Not Functional Abnormalities in Patients with Multiple Myeloma (MM) Compared with Healthy Controls.

The immunologically hostile microenvironment of MM contributes to the limited success of immunotherapy strategies. In addition to direct tumour-induced immunosuppression, tumour cells may generate suppressor cells such as Treg cells which can profoundly suppress immune responses and induce tolerance. This study aimed to determine if Treg subsets are increased in the peripheral blood (PB) and bone marrow (BM) of patients with MGUS/MM and how this correlates with increasing disease burden. PB samples from 166 patients with MGUS/MM (Newly diagnosed (ND), n=34; Plateau/low disease burden (LD), n=63; Relapsed/refractory (R/R), n=27 and MGUS, n=42) with a median age of 69 years (range 39–89 yrs) were analysed by FACS and compared to PB from 32 age/sex matched controls. Using a sequential gating strategy, naturally occurring Treg cells (nTregs) were identified as CD4+/CD25+/FoxP3+ T-cells and expressed as a percentage of the CD4+ T-cells. Double negative T cells (DN Tregs) were identified as CD3+/CD4−/CD8−/alphabeta-TCR+/gammadelta−TCR− and expressed as a percentage of the CD3+ cells. Sera were analysed by ELISA for IL10 and TGF-beta. nTReg cells were significantly increased in patients with MGUS/MM compared with controls (Controls 1.6% ± 0.2, MGUS 2.3% ± 0.3, ND 2.4% ± 0.2, LD 4.2% ± 0.7 & R/R 3.8% ± 0.5; p=0.003). There was a positive correlation of nTRegs number with paraprotein level (R=0.3, p=0.005). Patients on Thalidomide at the time of sample collection had significantly higher numbers of nTRegs of 6% in comparison to patients who never received Thalidomide (3%) and patients who previously received the drug (3.5%, p=0.005). Analysis of BM (n=12) demonstrated a significantly reduced number of nTRegs in comparison to PB (1.6% vs 3.0%, p=0.025), which is higher than the number of nTRegs in the BM of controls (0.7%). Functionally, nTRegs from patients demonstrated suppressive activity of both autologous and allogeneic T-cells similar to nTRegs cells from control PB (p=NS). In contrast, DN TRegs were significantly reduced in patients with myeloma (ND 1.0% ± 0.2, LD 1.1% ± 0.1, R/R 1.3% ± 0.2) compared with MGUS and controls (2.1% ± 0.9 & 3.3% ± 0.7, respectively; p=0.02). Serum IL10 levels were significantly lower in ND (17 ± 38 pg/ml) and LD (29 ± 36 pg/ml) than in Controls (55 ± 89 pg/ml), MGUS (72 ± 151 pg/ml) and R/R (90 ±182 pg/ml, p=0.02). TGF-b levels differed significantly between groups (Controls 3765 ± 1593 pg/ml, MGUS 3506 ± 1504 pg/ml, ND 4774 ± 9879 pg/ml, LD 1915 ± 1324 pg/ml, R/R 2802 ± 2011 pg/ml, p=0.025). These results provide further evidence of immune dysregulation in MM. The association with advanced disease stage suggests a causal association.

Patogeneza i klinika nieastmatycznego eozynofilowego zapalenia oskrzeli

The introduction of induced sputum, as the diagnostic and research tool allowed to define nonasthmatic eosinophilic bronchitis characterized as a chronic cough in patients with no symptoms or objective evidence of variable airflow obstruction, with normal airway hyperresponsiveness and sputum eosinophilia. Eosinophilic bronchitis is an important cause of chronic cough. Studies in which the assessment of airway inflammation has been undertaken in chronic cough patients have shown that nonasthmatic eosinophilic bronchitis accounts for 10 to 30% of cases referred for specialist investigation. Eosinophilic bronchitis, like asthma, is characterized by eosinophilic airway inflammation, but unlike asthma, there is no airway hyperresponsiveness or bronchoconstriction. The airway immunopathology of asthma and eosinophilic bronchitis are almost identical. An obvious question is why an apparently similar pattern of airway inflammation is associated with different functional abnormalities in patients with nonasthmatic eosinophilic bronchitis and asthma. The differences in functional association may be related to differences in the localization of mast cells within the airway wall, with airway smooth muscle infiltration occurring in patients with asthma, and epithelial infiltration in patients with nonasthmatic eosinophilic bronchitis.

Persistent seizures following left temporal lobe surgery are associated with posterior and bilateral structural and functional brain abnormalities

To perform a quantitative MRI and retrospective electrophysiological study to investigate whether persistent post-surgical seizures may be due to brain structural and functional abnormalities in temporal lobe cortex beyond the margins of resection and/or bilateral abnormalities in patients with temporal lobe epilepsy (TLE). In 22 patients with left TLE and histopathological evidence of hippocampal sclerosis, we compared pre-surgical brain morphology between patients surgically remedied (Engel's I) and patients with persistent post-surgical seizures (PPS, Engel's II-IV) using voxel-based morphometry (VBM). Routine pre-surgical EEG and invasive and non-invasive telemetry investigations were additionally compared between patient groups. Results indicated widespread structural and functional abnormalities in patients with PPS relative to surgically remedied patients. In particular, patients with PPS had significantly reduced volume of the ipsilateral posterior medial temporal lobe and contralateral medial temporal lobe relative to surgically remedied patients. Furthermore, successful surgery was associated with clear anterior (89%) and unilateral (100%) temporal lobe EEG abnormalities, whilst PPS were associated with widespread ipsilateral (91%) and bilateral (82%) temporal lobe abnormalities. We suggest that these preliminary data support the hypothesis that PPS after temporal lobe surgery are due to functionally connected epileptogenic cortex remaining in the ipsilateral posterior temporal lobe and/or in temporal lobe contralateral to resection.

Prevalence of Structural and Functional Abnormalities in Patients with Pancreas Divisum Undergoing ERCP

Background: Pancreas Divisum is the most common congenital abnormality (variant) of the pancreas, whereby the pancreatic outflow is via the minor papilla rather than the sphincter of Oddi. It is widely believed that this entity can result in acute pancreatitis. Whether this entity causes abdominal pain (“pancreatic-type pain”) and/or eventually results in chronic pancreatitis is unknown. Aims: To determine the structural and functional abnormalities of the pancreas in patients with Pancreas Divisum undergoing ERCP.

Effect of chronic renal failure on foregut smooth muscle reactivity: an experimental study

Purpose An association between chronic renal failure (CRF) and gastroesophageal reflux (GER) is well known. The aim of this study was to pharmacologically characterize and investigate the possible contribution of smooth muscle reactivity pathways involving GER on the CRF rat model. Material and Methods Chronic renal failure was created in Sprague-Dawley rats by 5 of 6 nephrectomy. The rats were divided into 2 groups: the CRF-induced group (CRF group) and the sham-operated group (control group). Esophageal smooth muscle strips were studied in vitro for their contractile (KCl, carbachol) and relaxant (isoproterenole, serotonin, and papaverine) response to receptor activation in the organ chambers set up. Subsequently, the in vitro lower esophageal sphincter (LES) smooth muscle study was generated by KCl, carbachol, isoproterenole, nicotine, sodium nitroprusside (SNP), and papaverine. Results Compared with controls, esophageal strips taken from CRF-induced rats associated with decreased smooth muscle responses to carbachol, serotonin, and increased response to KCl. Isoproterenole- and papaverine-induced relaxant responses were not affected. Contractility of the isolated LES strips were significantly increased to KCl and carbachol in the CRF group compared with the control group. Similar relaxant responses were obtained in LES strips stimulated by isoproterenole, SNP, and papaverine in the CRF and control group. Nicotine-induced relaxant responses were decreased in the CRF group compared with the control group. Conclusions Our study revealed alterations of receptor-dependent esophageal and LES smooth muscle reactivity in the CRF-induced rats. Impaired foregut smooth muscle reactivity may contribute to the development of GER-related functional abnormalities in patients with CRF.

Abnormalities in auditory evoked potentials of 75 patients with Arnold-Chiari malformations types I and II

To evaluate the frequency and degree of severity of abnormalities in the auditory pathways in patients with Chiari malformations type I and II. This is a series-of-case descriptive study in which the possible presence of auditory pathways abnormalities in 75 patients (48 children and 27 adults) with Chiari malformation types I and II were analyzed by means of auditory evoked potentials evaluation. The analysis was based on the determination of intervals among potentials peak values, absolute latency and amplitude ratio among potentials V and I. Among the 75 patients studied, 27 (36%) disclosed Arnold-Chiari malformations type I and 48 (64%) showed Arnold-Chiari malformations type II. Fifty-three (71%) of these patients showed some degree of auditory evoked potential abnormalities. Tests were normal in the remaining 22 (29%) patients. Auditory evoked potentials testing can be considered a valuable instrument for diagnosis and evaluation of brain stem functional abnormalities in patients with Arnold-Chiari malformations type I and II. The determination of the presence and degree of severity of these abnormalities can be contributory to the prevention of further handicaps in these patients either through physical therapy or by means of precocious corrective surgical intervention.