Schwere Verletzungen aufgrund eines Blitzschlags sind sehr selten. Nach Schätzungen geht nur jeder 10. Blitzschlag tödlich aus; in Deutschland starben 2005 4 Personen auf diese Weise. Obwohl Blitzverletzungen meist den gesamten Körper betreffen, sind das Herz-Kreislauf-System und das zentrale Nervensystem (ZNS) am häufigsten beteiligt. Neurologische Symptome können akut oder verzögert auftreten. Neben Störungen u. a. des visuellen Systems mit temporärer Blindheit und optischen Halluzinationen finden sich in der Literatur auch Fallberichte über kognitive Störungen, Kleinhirn- und Großhirninfarkte sowie Schädigungen des Rückenmarks bis hin zur Entwicklung eines spinalen Schocks.

To test in a prospective study whether the non-invasive 13C-acetate test is suitable for measuring gastric emptying time with a liquid/solid test meal. (99m)technetium scintigraphy served as the reference method.18 consecutive type 2 diabetics with symptoms of gastroparesis (nine men, nine women; mean age 64 [45-76] years) were, after a nocturnal fasting period, given a liquid/solid test meal (370 kcal; 100 ml coffee; doubly marked with 75 mg 13C-acetate and 0.5 mCi 99mTc-colloid). At ten-minute intervals breath samples were taken over two hours and examined by mass spectometry for the 13CO2/12CO2 ratio. In parallel scintigraphy was performed for one hour at one-minute intervals. Gastric emptying half-life (t1/2) was calculated and the correlation between the two methods determined. In addition, the 13C-acetate breath test was performed on 20 healthy subjects to assess reproducibility (ten men, ten women; mean age 44.4 [23-77] years).Median t1/2 with the scintigraphy was 93.5 min, with the breath test 55 min, i.e. a significant correlation (r = 0.8; P < 0.001). Four of five patients with delayed gastric emptying by scintigraphy also showed delay (compared with the control group) in the breath test (median t1/2: 41 min; 95th percentile: 86 min).The 13C-acetate test correlated significantly with the results by scintigraphy. It can therefore be recommended as a non-invasive test for assessing gastric emptying time after a liquid/solid test meal in type 2 diabetics.

BACKGROUND/AIMS:Chronic alcoholism is known to effect gastric motor activity. An association between gastric motility disorders and abnormal myoelectrical activity has been observed in various gastrointestinal and extra-intestinal diseases. The aim of this study was to investigate the effect of chronic alcoholism on gastric emptying and antral myoelectrical activity. METHODOLOGY:Electrogastrography (EGG) was performed on 20 chronic alcoholics with chronic dyspepsia using a pair of electrodes sonographically placed on the skin overlying the gastric antrum. After an overnight fast, patients were tested over a period of one hour in the a) fasting and b) fed state, after ingestion of a 370 kcal liquid-solid test meal. The following EGG parameters were determined: dominant frequency (DF (cpm); DF (%) in the normal range (2-4 cpm); bradygastria (<2 cpm); tachygastria (4-10 cpm); dominant frequency instability coefficient (DFIC), and postprandial to fasting power ratio (PR). The data were correlated with results obtained from 20 controls matched for age and sex. In 18 alcoholics, the EGG data were compared to the percentage of radionuclides (liquid phase labeled with 99m Tc colloid) remaining in the stomach after 60 minutes (%) (gamma camera system). Moreover, for the alcoholics, various parameters such as ethanol consumption, and gastrointestinal symptoms were determined and related to EGG values and scintigraphy. RESULTS:About 50% of the alcoholics showed delayed gastric emptying compared to normal values previously reported (t 60 values: >68%). In opposite to scintigraphy, the alcoholics did not exhibit abnormalities in antral myoelectrical activity. They had significantly decreased bradygastria measures compared to controls (p<0.05). The scintigraphic t 60 values did not correlate either with EGG values or with dyspepsia and clinical parameters. EGG values did not correlate with dyspepsia. However, increased preprandial DF was significantly correlated with ethanol consumption. CONCLUSIONS:Chronic alcoholism induces a disturbance of gastric emptying, probably resulting from toxic damage of the gastrointestinal smooth muscles. Disturbances in antral myoelectrical activity were not found.

Background/Aims: The objective of the present study was to investigate the effect of hyperthyroidism on antral myoelectrical activity, gastric emptying and dyspepsia in man.Methodology: Twenty-three patients with manifest hyperthyroidism and dyspepsia confirmed by a standardized protocol were studied by electrogastrography (EGG). The following EGG parameters were determined: dominant frequency (DF cycles per minute (cpm), DF (%) in the normal range (2-4 cpm)), bradygastria (< 2 cpm), tachygastria (4-10 cpm), dominant frequency instability coefficient (DFIC), and postprandial to fasting power ratio. Data were correlated to results obtained in 18 age- and gender-matched controls. In 10 patients, a control measurement was performed after antithyroid therapy. In addition, in 15 consecutive patients, EGG data were compared to gastric emptying of radionuclides recorded simultaneously (gamma camera).Results: Hyperthyroid patients revealed a significant increase in preprandial DF, and in pre- and post-prandial tachygastrias compared to controls (3.3 cpm vs 3.1 cpm; 8.8% vs 3.5%; 12.3% vs 3.5%; p < 0.05). After antithyroid therapy postprandial tachygastrias were reduced significantly. About 50% of the patients exhibited delayed gastric emptying compared to previously evaluated normal values (t 60 nuclide retention: > 68%). However, these patients did not differ in tachygastria and the other EGG parameters from those with normal gastric emptying (p > 0.05). Both EGG and radioscintigraphy did not correlate significantly with dyspepsia.Conclusions: Dyspeptic patients with hyperthyroidism frequently display tachygastria and delayed gastric emptying. However, tachygastria has no important effect on gastric motor activity in hyperthyroidism.

Objective: To test in a prospective study whether the non-invasive C-13-acetate test is suitable for measuring gastric emptying time with a liquid/solid test meal. (99m)technetium scintigraphy served as the reference method.Patients and methods: 18 consecutive type 2 diabetics with symptoms of gastroparesis (nine men, nine women; mean age 64 [45-76] years) were, after a nocturnal fasting period, given a liquid/solid test meal (370 kcal; 100 ml coffee; doubly marked with 75 mg C-13-acetate and 0.5 mCi Tc-99m-colloid). At ten-minute intervals breath samples were taken over two hours and examined by mass spectrometry for the (CO2)-C-13/(CO2)-C-12 ratio. In parallel scintigraphy was performed for one hour at one-minute intervals. Gastric emptying half-life (t1/2) was calculated and the correlation between the two methods determined. In addition, the C-13-acetate breath test was performed on 20 healthy subjects to assess reproducibility (ten men, ten women; mean age 44.4 [23-77] years).Results: Median t1/2 with the scintigraphy was 93.5 min, with; the breath test 55 min, i.e. a significant correlation (r = 0.8; P < 0.001). Four of five patients with delayed gastric emptying by scintigraphy also showed delay (compared with the control group) in the breath test (median t1/2: 41 min; 95th percentile: 86 min).Conclusion: The C-13-acetate test correlated significantly with the results by scintigraphy. It can therefore be recommended as a non-invasive test for assessing gastric emptying time after a liquid/solid test meal in type 2 diabetics.

In patients with progressive systemic sclerosis (PSS) suffering from chronic dyspepsia the stomach may be affected by this disease. The objective of this study was to investigate both antral myoelectrical activity and gastric emptying in PSS patients.Electrogastrography (EGG) was performed in 17 PSS patients (16 female, one male, median age 58 years, range 32-74 years) with chronic dyspepsia. After an overnight fast during one hour in the fasting and one hour in the fed state after ingestion of a liquid-solid test meal (370 kcal; liquid phase labeled with 0,5 mCi Tc-99m-colloid) antral electrical activity was measured by one pair of electrodes sonographically placed on the skin overlying the gastric antrum. Several EGG parameters including dominant frequency (DF), percentages of DF in the normal range (2-4 cycles per minute [cpm]), bradygastria (< 2 cpm) and tachygastria (4-10 cpm), dominant frequency instability coefficient (DFIC), and postprandial to preprandial power ratio (PR) were calculated. The data were correlated to results obtained in 20 age- and gender-matched healthy subjects. In addition, the data were compared to gastric retention of the radionuclide at 60 min measured by simultaneous scintigraphy.The PSS patients did not reveal electrical disturbances. They even exhibited a significant postprandial decrease in DFIC, bradygastria, and tachygastria (ns) compared to healthy subjects. Over 50% of the PSS patients showed a delayed gastric emptying. However, EGG did not correlate to radioscintigraphy significantly.Our results reflect an absent relationship between antral myoelectrical activity in EGG and gastric emptying. Therefore, electrogastrography is unsuitable to assess gastric involvement in PSS.

The recently developed C-13-octanoic acid breath test allows the measurement of gastric emptying of,solids. In this prospective study we wanted to investigate, whether the C-13-octanoic acid breath test using breath samples every half an hour is suitable in assessing gastric emptying in comparison to scintigraphy in diabetics. Furthermore, we examined the intraindividual reproducibility in healthy volunteers. 20 consecutive diabetics with clinical symptoms of gastroparesis received a solid double-labeled standard test meal. The meal consisted of 1 scrambled egg, labeled with 75 mg C-13-octanoic acid and 0.5 mCi Tc-99m colloid, 50 g rye bread, 20 g butter, 200 ml orange juice; 280 kcal. Breath samples were taken at half hour intervals for 4 hours and analyzed for (CO2)-C-13 by isotope ratio mass spectrometry Using a regression method gastric emptying half times (t 1/2) were determined and correlations to simultaneous (99mTc)-scintigraphy were calculated. There was a moderate significant correlation of C-13-octanoic acid breath test t 1/2 and scintigraphic t 1/2 (R = 0.6; p = 0.008). The C-13-octanoic acid breath test t 1/2 obtained in 20 healthy volunteers measured at two separate days showed a coefficient of variation (VC), that was greater between subjects (VK = 42%) than between two measurements in the same subject (VK = 24%), which reflects a moderate intraindividual reproducibility. Taking breath samples every half an hour the C-13-octanoic acid breath test only reveales a moderate intraindividual reproducibility and a moderate correlation to scintigraphy in diabetics. For detailed assessment of solid gastric emptying in diabetics a C-13-octanoic acid breath test using shorter breath sampling intervals is recommended.

Background: Electrogastrography (EGG) enables the cutaneous measurement of gastric electric activity. An association between electric abnormalities and gastrointestinal motility disorders has been shown. The primary objective of this study was to investigate whether diabetic gastroparesis could be predicted by EGG. Methods: EGG was performed in 18 insulin-treated type-II diabetics (9 female, 9 male; median age, 64 years; range, 45-76 years) with chronic dyspepsia. After an overnight fast, during 1 h in the fasting and 1 h in the fed state after ingestion of a liquid-solid test meal (370 kcal; liquid phase labeled with 0.5 mCi Tc-99m-colloid) antral electric activity was captured by one pair of electrodes sonographically placed on the skin overlying the gastric antrum. Several EGG variables including dominant frequency (DF), percentages of DF in the normal range (2-4 cycles per minute (cpm)), bradygastria (<2 cpm), and tachygastria (4-10 cpm), dominant frequency instability coefficient (DFIC), and postprandial to preprandial power ratio (PR) were calculated by fast Fourier transform. The data were correlated to results obtained in 20 age- and gender-matched healthy subjects (10 female, 10 male; median age, 68 years; range, 53-90 years). In addition, the data were compared with the percentages of retention of the radionuclide in the stomach at 60 min, and lag times measured by simultaneous scintigraphy. Results: The EGG values obtained in diabetics did not differ significantly from those in healthy subjects and did not correlate with radioscintigraphy (p > 0.05). Moreover, the EGG values in diabetics with delayed gastric emptying (about 40%) did not differ from data in diabetics without gastroparesis. Furthermore, whereas dyspepsia correlated significantly with radioscintigraphy, no correlation with EGG could be found. Conclusions: Electrogastrography seems to be unsuitable for assessment of motility disorders in type-II diabetics.

The recently developed 13C-octanoic acid breath test allows the measurement of gastric emptying of solids. In this prospective study we wanted to investigate, whether the 13C-octanoic acid breath test using breath samples every half an hour is suitable in assessing gastric emptying in comparison to scintigraphy in diabetics. Furthermore, we examined the intraindividual reproducibility in healthy volunteers. 20 consecutive diabetics with clinical symptoms of gastroparesis received a solid double-labeled standard test meal. The meal consisted of 1 scrambled egg, labeled with 75 mg 13C-octanoic acid and 0.5 mCi 99mTc colloid, 50 g rye bread, 20 g butter, 200 ml orange juice; 280 kcal. Breath samples were taken at half hour intervals for 4 hours and analyzed for 13CO2 by isotope ratio mass spectrometry. Using a regression method gastric emptying half times (t 1/2) were determined and correlations to simultaneous 99mTc-scintigraphy were calculated. There was a moderate significant correlation of 13C-octanoic acid breath test t 1/2 and scintigraphic t 1/2 (R = 0.6; p = 0.008). The 13C-octanoic acid breath test t 1/2 obtained in 20 healthy volunteers measured at two separate days showed a coefficient of variation (VC), that was greater between subjects (VK = 42%) than between two measurements in the same subject (VK = 24%), which reflects a moderate intraindividual reproducibility. Taking breath samples every half an hour the 13C-octanoic acid breath test only reveals a moderate intraindividual reproducibility and a moderate correlation to scintigraphy in diabetics. For detailed assessment of solid gastric emptying in diabetics a 13C-octanoic acid breath test using shorter breath sampling intervals is recommended.

Routine radiographs and PA dual x-ray absorptiometry (DXA) of the lumbar spine were performed in 253 patients. A T-score of -2SD (approximately 20% reduction from young normal bone mineral density (BMD)) as measured by DXA, was used as threshold for the diagnosis of osteopenia. A lumbar spine index (LSI) as proposed by Barnett and Nordin was assessed by one radiologist. The correlation between LSI and bone mineral density, measured by DXA, was poor, and our results indicate that osteopenic patients cannot be differentiated from non-osteopenic patients by LSI. 100 radiographs of the lumbar spine were evaluated by 9 observers in order to determine observer variation in the detection of osteopenia. A complete agreement between the readers for the diagnosis of osteopenia was achieved in 43 percent of all radiographs. DXA and observers agreed in 68 to 76 percent of all cases. For a decrease of BMD of more than 60 percent compared to young normal adults, as determined by DXA, all readers agreed in the diagnosis of osteopenia, whereas for higher BMD values the agreement between readers and DXA worsened. The inconsistency between DXA and observer agreement was greatest for patients with a BMD reduction between 10 and 20 percent. The mean values of the kappa-coefficients were 0,574 +/- 0,06 for interobserver variation and 0,437 +/- 0,06 for the agreement between readers and DXA-results. An only moderate kappa-coefficient of 0,573 for the intraobserver variation as determined in one reader was found.

Measurement of gastric emptying of liquids by sagittal antral planimetry is established. Ultrasonic measurement of gastric emptying of solids has not been assessed although gastroparesis often reveales a delayed gastric emptying of solids first. Therefore in this prospective study we used a solid meal (50 g rye bread, 1 egg, 40 g butter, 200 ml orange juice; 280 kcal) to examine intraindividual reproducibility of ultrasound in 20 healthy volunteers. Moreover, in 20 diabetics antral planimetry assessed by ultrasound was compared to scintigraphy. Antral planimetry showed a coefficient of variation, that was nearly three times greater between subjects than between two measurements performed on the same subject. This results reflect a good intraindividual reproducibility. Gastric emptying half-times assessed by ultrasound and scintigraphy did not correlate in diabetics (R = 0.2). However, correlation between sonographic measurement of antral area and scintigraphy at defined times (60, 120, 180, 240 min) was significant (R = 0.7; p < 0,001). These results imply that ultrasonic antral planimetry is a suitable orientating method for measuring gastric emptying of solids.

Routine radiographs and PA dual x-ray absorptiometry (DXA) of the lumbar spine were performed in 253 patients. A T-score of -2SD (approximately 20% reduction from young normal bone mineral density (BMD)) as measured by DXA, was used as threshold for the diagnosis of osteopenia. A lumbar spine index (LSI) as proposed by Barnett and Nordin was assessed by one radiologist. The correlation between LSI and bone mineral density, measured by DXA, was poor, and our results indicate that osteopenic patients cannot be differentiated from non-osteopenic patients by LSI. 100 radiographs of the lumbar spine were evaluated by 9 observers in order to determine observer variation in the detection of osteopenia. A complete agreement between the readers for the diagnosis of osteopenia was achieved in 43 percent of all radiographs. DXA and observers agreed in 68 to 76 percent of all cases. For a decrease of BMD of more than 60 percent compared to young normal adults, as determined by DXA, all readers agreed in the diagnosis of osteopenia, whereas for higher BMD values the agreement between readers and DXA worsened. The inconsistency between DXA and observer agreement was greatest for patients with a BMD reduction between 10 and 20 percent. The mean values of the kappa-coefficients were 0.574 +/- 0.06 for interobserver variation and 0.437 +/- 0.06 for the agreement between readers and DXA-results. An only moderate kappa-coefficient of 0.573 for the intraobserver variation as determined in one reader was found.

Binc wicht ig~ Manil'estation des rtieumatischen Pinbers ist die Cliorea niiiior (Sydentiarn). Sie erhält ihrcn Narncn durch die ungeordneten und unfrciwilligcn charakteristisclieri Bcwcgungcn dcs Körpcrstarnnies und de r Extremitäten des ~a t i e i t enT ~ a t h o p h ~ s i ~ l o g i s c h liegen Läsionen im Bcrcich von Kaudatum, Putarnen. äußerem I'allidumglied und Nucleus subthalamicus vor. Von der postrhcumatischei~ Cliorea sind Kirider und .Jugendlichr ain haiiligsten betroffen (Feinstein und Mitarb.. 1964). Mit Einführung eincr antibiotischen Thcrapic ist die Inzidcnz dicscr Erkrankung in dcn Ielzteii .Jahrzeliiiteii drastisch gesunken.

Gastric emptying, mouth-to-cecum transit, and whole gut transit of a solid-liquid meal was measured in 20 hyperthyroid patients and in 30 control subjects by using scintigraphic techniques, the hydrogen breath test, and stool markers. In the hyperthyroid patients predefined gastrointestinal symptoms were determined and related to gastrointestinal transit. There was no significant overall difference of gastric emptying between the hyperthyroid patients and the control subjects, whereas both mouth-to-cecum transit time (mainly reflecting small intestinal transit) and whole gut transit time (mainly reflecting large intestinal transit) were significantly accelerated in hyperthyroid patients as compared to the control subjects (P less than 0.005). Mouth-to-cecum transit in hyperthyroid patients with diarrhea tended to be more rapid than in those without diarrhea (P = 0.094) and the T3 concentrations were inversely correlated with mouth-to-cecum transit time. It is concluded that in thyrotoxicosis 1) small and large intestinal transit is accelerated, while gastric emptying remains unchanged and 2) rapid intestinal transit is likely to be one factor among others implicated in the generation of diarrhea.

Gastric emptying, mouth-to-cecum transit, and whole-gut transit of a solid-liquid meal were measured in 46 chronic alcoholics and in 30 control subjects by using scintigraphic techniques, hydrogen breath test, and stool markers. In the alcoholics various parameters such as ethanol consumption, gastrointestinal symptoms, and alcoholic neuropathy were determined and related to gastrointestinal transit times. Although there was no significant overall difference of gastric emptying, abnormally delayed gastric emptying was detected in 23.9% of the alcoholics but no control subject (P < 0.005). Mouth-to-cecum transit was significantly prolonged in the alcoholics (P < 0.001) with 14 alcoholics (37.8%) disclosing delayed mouth-to-cecum transit. No significant differences between both groups were detected concerning whole gut transit. In the alcoholics there was a significant correlation of dyspeptic symptoms with delayed gastric emptying (P < 0.006), and alcoholics with diarrhea had an accelerated mouth-to-cecum transit as compared to those without diarrhea (P < 0.05). Neither the presence of autonomic or peripheral neuropathy nor the presence of liver cirrhosis or ascites was significantly related to gastrointestinal transit times. However, the daily ethanol ingestion significantly correlated with gastric emptying (P < 0.005). It is concluded, therefore, that in chronic alcoholics the small intestine and the stomach are most likely to be affected by gastrointestinal transit disorders and that these transit abnormalities are potentially related to toxic damage of gastrointestinal smooth muscle.