No abstract

Anorexia nervosa is considered one type of eating disorder that may result in severe malnutrition. Patients with this disorder commonly complain of postprandial nausea, abdominal pain, and distension. We describe the radiologic and motility abnormalities associated with anorexia nervosa in a 21-year-old female. Barium gastrointestinal series demonstrated marked dilation of the duodenum, with prolongation of intestinal transit. A 4-hr fasting gastroduodenal motility study showed no propagating migrating motor complexes (MMC). Prolonged, but nonpropagating, bursts of high-amplitude phasic and tonic contractions were seen in the duodenum. In contrast, antral contractions were of low amplitude and esophageal motor function was normal. Metoclopramide and edrophonium caused an increase in gastroduodenal motor activity, but increased contractions were not associated with symptoms. Following a renutrition program that raised the patient's weight from 64 to 80% of her ideal body weight, the radiographic abnormalities and gastrointestinal dysmotility resolved completely. These observations suggest that anorexia-associated gastrointestinal motor dysfunctions are a consequence, not the cause of the generalized protein-calorie malnutrition associated with anorexia nervosa. The facts that motility in different parts of the gut is affected to different degrees and that gastric and duodenal muscle responds normally to exogenous stimulation argue against a generalized myogenic dysfunction and, rather, point to a reversible dysfunction of neural regulation.

Linxian, China has some of the highest rates of esophageal/ gastric cardia cancer in the world. In 1983, esophageal balloon cytology screening was performed in 3 communes in northern Linxian. Of the participants, 10,066 with no evidence of cancer were followed prospectively for 71/2 years to evaluate the ability of the initial cytologic diagnoses to identify individuals at increased risk for developing cancer of the esophagus or gastric cardia. A total of 747 incident cases of esophageal or cardia cancer and 322 deaths due to these tumors were identified during the follow-up period and used in this analysis. The risks for esophageal or cardia cancer incidence and mortality increased in parallel with the presumed severity of the 1983 Chinese cytologic diagnoses. After adjusting for potential confounding facton, relative risks for esophageal or cardia cancer incidence, by initial cytologic diagnosis, were normal = 1.00 (reference), hyperplasia = I .25, dysplasia I = 2.20, dysplasia 2 = 4.22 and near-cancer = 5.96. Our results suggest that

Rapid (advanced) destruction of the alveolar bone of the deciduous and permanent dentition is characteristic of the Papillon-Lefevre syndrome (PLS) (GORLIN et al, J Pediat 65:895, 1964). Recently, several microbiologic studies utilizing anaerobic methodology have demonstrated that gram-negative anaerobic rods predominate at the bottom of periodontal lesions in patients diagnosed as having periodontosis and rapid periodontitis, but there are no reports which describe the microbiota associated with periodontal lesions in patients with PLS.A three-year-old male child was diagnosed as having PLS. Marked generalized gingival inflammation, calculus, plaque, and suppuration from deep periodontal pockets were noted. In addition, generalized alveolar bone loss was noted radiographically.A total of seven different sites was sampled for microbiologic studies according to the methods of Newman et al and Socransky et al (J Periodontol Res 12:90-106, 1977). Three plaque samples were taken from apical sites in periodontal lesions (greater than 6 mm); two plaque samples were taken from control sites (less than 3 mm); and one sample each was taken from the tongue and saliva.The results are shown in Table 1. The distribution of the predominant cultivable microbiota from control and diseased sites was different. There were more gram-negative anaerobic rods in the lesions than in other anatomical sites. Approximately 42% of the gram-negative anaerobic rods from the lesions were not identified according to current classification schemes. The distribution of gram-positive organisms in control samples was similar to results reported for incipient periodontal lesions. The tongue and saliva samples clearly demonstrated the predominance of gram-positive facultative cocci and there were no unusual findings from these samples.The finding of large numbers of gram-negative anaerobic rods in lesion sites is similar to results of other previously mentioned investigators and suggests that the pathogenesis of these periodontal lesions is similar. Qualitative analysis of the unclassified bacteria might give insight into whether there is microbial specificity in the PLS and in other periodontal diseases.