William J. Griffiths

Alcohol and sleep in young adults

In two separate experiments, sleep patterns of 17 young male adults were examined following single and repeated doses (0.9 g/kg body weight) of alcohol. A third study of 10 additional Ss measured the rate of elimination of alcohol from blood during sleep and waking. With a single dose of alcohol, onset of sleep was brisk, the latency of SW sleep (stages 3+4) was reduced and the first episode of stage REM was shortened. These transient alterations were accompanied by loss of high-frequency beta rhythms in the EEG and a gain in abundance and synchrony of activity in the alpha-rhythm range.Experiment 3 found no significant difference between sleep and waking for rate of elimination of alcohol from blood. Starting with peak blood alcohol concentrations (BACs) of about 75 mg percent, average BACs after 4 h of bedtime had decreased to about 30 mg percent. The effects noted above, associated with higher BACs, were confined to the first half of the night. Thus, these results are consistent with conclusions of previous investigators that the depressant effects on EEG sleep patterns of a moderate dose of alcohol are due to its direct action on the brain.There are, however, longer range compensation and adaptation effects associated with single and repeated doses of alcohol which cannot be directly related to its presence in the brain. For example, in the single-dose study reported here, and in most previous studies, rebound of stage REM occurred during the second half of the alcohol night. Further, in the repeated-dose study, most of the effects of alcohol on sleep stages and EEG frequencies observed during the first dose session, disappeared on the second and third alcohol sessions. Finally, heart and respiration rates increased whereas eye movements during stage REM, sigma spindles in stage 2 and non-specific GSR responses in SW sleep tended to be suppressed throughout the night in each alcohol session. Several mechanisms are discussed which might account for these more persistent alterations.

Bacteremia associated with esophageal dilatation.

The present study was undertaken because the previously reported incidence of bacteremia associated with esophageal dilatation seemed high, and did not correlate well with clinical experience. Seventeen adult patients were dilated for benign esophageal strictures with one to three dilators on 41 occasions. Five blood cultures were taken over the 30-minute period after each dilatation. Either routinely sterilized dilators or dilators resterilized just before the procedure were used in a random fashion. On 22 of the occasions that routinely sterilized dilators were used in 17 patients, temperatures, white blood counts, and blood cultures were normal in each instance. Resterilized dilators were used on 19 occasions in 15 subjects, and postdilation temperatures and white blood counts were also normal. Two blood cultures from different patients grew Staphylococcus epidermidis, which were felt to be contaminants. On the basis of this and previous studies, extra precautions do not appear to be necessary for dilatation of routine benign strictures. In patients at risk for endocarditis, or those with cancer or tight strictures, it seems advisable to sterilize dilators just before use, and take extra precautions.

Hepatobiliary Involvement in von Recklinghausen's Disease

Excerpt Von Recklinghausens disease is a syndrome characterized by multiple cutaneous neurofibromas, cafe-aulait spots, and a broad spectrum of clinical, pathologic, and radiologic findings. Von R...

Adequacy of endoscopic biopsy specimens for disaccharidase assays

Intestinal mucosa from 40 patients obtained by fiber-endoscopic biopsy was assayed for disaccharidases to determine suitability of this tissue for assay. The combined specimens from each patient provided 4.7–38.7 mg of tissue, adequate in all instances for duplicate determinations of protein, lactase, sucrase, and maltase. Tissue remained for assays of palatinase in 39 instances, trehalase and cellobiase in 37, and alkaline phosphatase in 22 cases. Twenty-four subjects had normal lactose tolerance tests and normal sucrase/lactase ratios. Thirteen patients with abnormal oral lactose tolerance tests were identified as having a primary low lactase activity on the basis of elevated sucrase/lactase ratios. This ratio was most helpful in making the diagnosis of a primary low lactase, since the mucosal specimens were not obtained from comparable areas. Tissue from three subjects with an abnormally low maltase was unsuitable for diagnosis. Endoscopic biopsy of mucosa appears to be satisfactory for disaccharidase assays in most instances.

Endoscopic cultures of the proximal gastrointestinal tract

The purpose of this study was to evaluate two methods of obtaining culture material under direct visualization through a fiberoptic upper gastrointestinal endoscope. Collections were made both with a wash pipe and a sterile brush through a sterilized Olympus D panendoscope. Paired aspirate collections were made on 20 occasions from 10 postgastrectomy and six nonoperated patients. Significant bacterial overgrowth was identified equally well by both methods, the the wash tube, which can be reused, is cheaper. The endoscopic method for collecting proximal fluid for culture is simple and can be performed during a routine endoscopy.

Effect of psyllium hydrophilic mucilloid on oral glucose tolerance and breath hydrogen in postgastrectomy patients.

Twenty postgastrectomy patients ingested glucose solutions with or without psyllium hydrophilic mucilloid to determine its effects on their blood glucose and breath hydrogen excretion. On the basis of the breath hydrogen tests following glucose alone, 15 had various degrees of glucose malabsorption which the addition of psyllium markedly reduced. In all 20 patients, psyllium significantly lowered peak blood glucose and prolonged its rate of fall. However, areas under the glucose concentration time curves were similar with and without psyllium, suggesting that total glucose absorption was unaltered by psyllium.In vitro, centrifuged psyllium-water-glucose slurries released glucose over 3 hr into water. Although the mechanisms of the psyllium alteration of the blood glucose and breath hydrogen responses are probably multifactorial, our studies suggest that release from the psyllium-glucose slurry results in a slower and more complete glucose absorption.