Læknablaðið : fylgirit - 01.06.1996, Blaðsíða 77

LÆKNABLAÐIÐ 1996; 82/FYLGIRIT 31
69
Tafla I.
Tilfelli Aldur LES Vélindabolur Orsök
#1 29 t LESP eðlileg slökun Aperistalsis Kirtilmyndandi magakrabbamein
#2 49 t LESP ófullkomin slökun Aperistalsis Kirtilmyndandi magakrabbamein
#3 66 t LESP ófullkomin slökun Aperistalsis Meinvörp frá brjóstakrabbameini
f töflu I sést niðurstaða úr vélindaþrýstingsmæl-
ingu og orsök fyrir pseudoachalasia hjá þessum
þremur sjúklingum.
Ályktanir: Aldursdreifing pseudoachalsia er mikil
og meðalaldur er 53 ár. Greining þessa sjúkdóms er
erfið og fyrsta magaspeglun og röntgenrannsóknir
eru oft villandi. Niðurstaða vélindaþrýstingsmæling-
ar var óeðlileg en gat ekki með vissu greint á milli
achalasia og pseudoachalasia.
V-40. Is achalasia caused by viruses?
Sigurbjörn Birgisson, MS Galinski, JR Gold-
blum, TW Rice, JE Ricliter
Frá the Cleveland Clinic Foundation, Cleveland,
Ohio, USA
Background: Achalasia is an esophageal motility
disorder of unknown etiology. Several studies sug-
gest possible herpes or measles virus etiology, but
results are inconclusive.
Purposc: To test whether herpes virus (HV), mea-
sles (MV) or human papilloma virus (HPV) se-
quences can be detected in myotomy specimens
from achalasia patients, using polymerase chain
reaction (PCR) technique.
Material and methods: Thirteen achalasia pat-
ients, fourM/nineF, mean age 45 (range 15-69).
Nine esophageal cancer patients, eightM/oneF,
rnean age 60 (range 49-72) and six fetuses, fourM/
twoF. Fixed, paraffin embedded muscle strips ob-
tained at myotomy for achalasia, sections from non-
tumor margins of esophagectomy patients, fetal au-
topsy samples, and viral controls. DNA extracts
prepared from lOp sections. RNA phenol extracted
and precipitated. Paired primers for DNA amplif-
ication of HV sequences (HSV-1 & 2, CMV, EBV,
VZV and HHV-6), MV and HPV selected from
published sequences. Exon 3 of the HPRT gene
primer amplified from all specimens. PCR ampli-
fications performed and products resolved on agar-
ose gels and stained with ethidium bromide.
Results: All specimens yielded the appropriate
sized product for exon 3 of the HPRT gene and viral
controls yielded PCR products of correct size for the
amplified gene products. No amplified products
were seen in the achalasia specimens corresponding
to any of the virus sequences tested.
Conclusions: Using PCR technique on achalasia
specimens, HV, MV and HPV sequences were not
detected. This suggests that these viruses are un-
likely to be the cause of achalasia but does not
exclude the possibility of previously unidentified
viruses as a causal agent. A new technique, repres-
entational difference analysis, has been used to de-
tect new herpes virus-like DNA sequences (Science
1994; 266:1865). Applying this technique on achala-
sia myotomy specimens is warranted.
V-41. A meta-analysis of
somatostatin VS H2 blockers or
placebo in the management of acute
nonvariceal upper gastrointestinal
hemorrhage
Sigurbjörn Birgisson*, Thomas F Imperiale**
Frá *the Cleveland Clinic Foundation, **Case West-
ern University at MetroHealtli Medical Center,
Cleveland, OH, USA
Background: While endoscopic procedures are
currently a standard part of management for acute
nonvariceal upper gastrointestinal hemorrhage
(UGIH), no effective, noninvasive therapies are
available.
Purpose: Using meta-analysis to determine the
efficacy of somatostatin (SS) for acute nonvariceal
UGIH.
Methods: MEDLINE used to identify ali random-
ized trials comparing SS with either H2 antagonists
or placebo among patients with a clinical and/or
endoscopic diagnosis of acute, nonvariceal UGIH.
Study methods and quality evaluated, and quan-
titative outcomes data abstracted. For dichotomous
outcomes, both the relative risk (RR) and the num-
ber needed to be treated (NNT) calculated.
Results: There was clinical and statistical hetero-
geneity among the 13 trials accepted for analysis.
Among the 1,745 patients from all trials, the RR of
persistent bleeding or rebleeding on SS treatment