Patterns of free-radical production after tourniquet ischemia: implications for the hand surgeon.

Since use of the pneumatic tourniquet is standard procedure for the hand surgeon, ischemic and reperfusion injury is a risk. To determine optimal periods of ischemia, 100 rabbit hindlimbs were subjected to various ischemic insults and analyzed for malondialdehyde (an indicator of free-radical production). Group 1 (3 hours of continuous ischemia) had 12.5 percent more reperfusion damage than controls (p less than 0.05). Group 2 (three 1-hour ischemic insults) had 10 percent more damage than controls (p less than 0.05). Group 3 (two 90-minute ischemic episodes) had 21 percent more damage than controls (p = 0.0001). Group 4 (4 1/2 hours of continuous ischemia) had 14.5 percent more damage than controls (p less than 0.01). Group 5 (three 90-minute ischemic episodes) had 10.8 percent more damage than controls (p less than 0.01). Group 6 (6 hours of continuous ischemia) had 17.5 percent more damage than controls (p less than 0.002). Group 7 (four 90-minute ischemic episodes) had 14 percent more damage than controls (p less than 0.01). Group 8 (three 2-hour ischemic episodes) had 22.5 percent more damage than controls (p less than 0.003). And group 9 (two 3-hour ischemic episodes) had 42 percent more damage than controls (p less than 0.0001). These results suggest a direct correlation in reperfusion injury with duration of tourniquet ischemia. Additionally, allowing specific reperfusion periods in some groups ultimately increased the amount of reperfusion injury.     

Circadian Variation of Myocardial Ischemia in Patients with Stable Coronary Artery Disease

The circadian variation of myocardial ischemia detected during 24-h ambulatory electrocardiographic monitoring (AEM) was analyzed in 123 patients with stable angina pectoris, positive exercise test, and angiographically proven coronary artery disease. A total of 437 ischemic episodes (ST-segment depression ≥ 1 mm and duration ≥ 1 min) were observed; 333 (76%) episodes remained asymptomatic, and only 104 (24%) episodes were accompanied by anginal pain. Ischemic episodes predominantly occurred during the morning hours, between 6 a.m. and noon, and another smaller peak was observed in the afternoon, between 4 and 5 p.m.; this diurnal pattern was influenced neither by the extent of coronary artery disease nor the degree of left ventricular dysfunction. The circadian variation was restricted to the 345 (78%) ischemic episodes preceded by increases in heart rate; the 92 (22%) episodes without prior heart rate changes occurred randomly throughout the day. The morning peak in ischemic episodes was not associated with less myocardial oxygen supply; in contrast, heart rate profile showed parallel increases during the morning and afternoon hours, indicating elevated myocardial demand during these periods. Ischemia-related ventricular arrhythmias were concentrated during the morning hours, but their overall prevalence was low–28 (6%) of 437 ischemic episodes. These findings may provide further insight into the pathomechanisms of acute clinical events in patients with coronary artery disease, since the circadian variation of myocardial ischemia is very similar to that observed for the onset of myocardial infarction and sudden cardiac death.     

Circadian Variation of Myocardial Ischemia in Patients with Stable Coronary Artery Disease

The circadian variation of myocardial ischemia detected during 24-h ambulatory electrocardiographic monitoring (AEM) was analyzed in 123 patients with stable angina pectoris, positive exercise test, and angiographically proven coronary artery disease. A total of 437 ischemic episodes (ST-segment depression ≥ 1 mm and duration ≥ 1 min) were observed; 333 (76%) episodes remained asymptomatic, and only 104 (24%) episodes were accompanied by anginal pain. Ischemic episodes predominantly occurred during the morning hours, between 6 a.m. and noon, and another smaller peak was observed in the afternoon, between 4 and 5 p.m.; this diurnal pattern was influenced neither by the extent of coronary artery disease nor the degree of left ventricular dysfunction. The circadian variation was restricted to the 345 (78%) ischemic episodes preceded by increases in heart rate; the 92 (22%) episodes without prior heart rate changes occurred randomly throughout the day. The morning peak in ischemic episodes was not associated with less myocardial oxygen supply; in contrast, heart rate profile showed parallel increases during the morning and afternoon hours, indicating elevated myocardial demand during these periods. Ischemia-related ventricular arrhythmias were concentrated during the morning hours, but their overall prevalence was low-28 (6%) of 437 ischemic episodes. These findings may provide further insight into the pathomechanisms of acute clinical events in patients with coronary artery disease, since the circadian variation of myocardial ischemia is very similar to that observed for the onset of myocardial infarction and sudden cardiac death.     

猪源乳酸杆菌对鼠伤寒沙门氏菌DT104在猪肠道上皮细胞IPEC-J2上粘附的影响

采用猪肠道上皮细胞株IPEC-J2体外培养模型,考察9株猪源乳酸杆菌对IPEC-J2细胞的粘附特性,以及对鼠伤寒沙门氏菌DT104粘附的竞争、排斥、置换和抗侵袭作用.结果显示,9株乳酸杆菌均能粘附IPEC-J2细胞,粘附率在0.1%～10%之间,具有菌株特异性和浓度效应.乳酸杆菌和沙门氏菌同时加入细胞培养,能竞争性抑制沙门氏菌的粘附,并具有浓度效应,高浓度(109 CFU/mL)添加K30、K67和K16时,抑制率可达80%以上.乳酸杆菌预处理细胞后再加入沙门氏菌,高浓度乳酸杆菌可降低沙门氏菌粘附率40%～70%,而中浓度(108 CFU/mL)乳酸杆菌能抑制23%～33%沙门氏菌对细胞的侵入.但是,只有高浓度添加乳酸杆菌能置换已经粘附的沙门氏菌,置换率在12%～84%之间.该结果为临床上筛选乳酸杆菌,有效防治猪沙门氏菌病提供了一条新的途径.     

Augmentation rhinoplasty: observations on 1200 cases

Over the past 14 years, from January of 1975 to December of 1988, we have done 1263 aesthetic rhinoplasties using ear cartilage. In the field of augmentation rhinoplasty, many kinds of materials, such as bone, septal cartilage, ear cartilage, and prostheses, were used. In this paper, we limit discussion to our experience with the technique for the augmentation of the nasal dorsum using the ear cartilage and compare this with other materials. Patient ages ranged from 15 to 72 years, with an average of 24 years. Some 95 percent of patients (1199) were female, and only 5 percent (64) were male. Patients were followed for a minimum of 6 months and a maximum of 20 months, with average follow-up only 8 months. Of course, we know that this is a very short follow-up period, but we could not follow patients longer because if they had no complaint about the results at the 6-month visit, they never returned, despite our efforts. Five-hundred and ten of the 1263 patients (40 percent) had been augmented elsewhere, and the silicone prosthesis was already in place. However, 753 patients (60 percent) had no previous operation. For the 510 patients (secondary rhinoplasty patients), too-high or too-large a prosthesis was the largest complaint in number, totaling 378 cases (74 percent), and psychological dissatisfaction, such as pain or an uncomfortable sensation, was the second largest in number, totaling 104 cases (20 percent). For the 753 patients (primary rhinoplasty patients), the main complaint was too-short or too-flat a nose (100 percent).(ABSTRACT TRUNCATED AT 250 WORDS)     

Complications and vascular salvage of free-tissue transfers to the extremities

Complications were examined in 122 free flaps to lower and upper extremities in 104 patients, and vascular salvage was examined in 182 free flaps to lower and upper extremities in 158 patients. All patients were treated by the same surgeon. The overall survival rate of flaps was 96 percent. Complications occurred in 22 percent of the flaps. Complication rates were lower in patients with one free flap than in patients with two. Flaps had more vascular complications than nonvascular. Accompanying skin islands were found to be necessary to monitor vascularized bone transfers in order to avoid flap failure. Flow in the pedicle was reestablished in all flaps, but a higher percentage of flaps with longer ischemic times were lost. Although vascular compromise occurred frequently (15 percent), prompt surgical exploration and reexploration were thought to have greatly increased free-flap survival.     

Yale Studies of Patient Care : I. The Evaluation of the Febrile Patient 2

Observations are reported on the variation in evaluation and management of 216 episodes of fever in 690 patients on four services of a university hospital. Twenty-two percent of febrile episodes were not commented upon in the medical record. Thirty percent of all fevers and 14% of antibiotic-treated fevers were not evaluated with microbiologic cultures. The extent of evaluation varied with service and varied directly with the height of the fever and the clinical recording of abnormality in temperature.     

Effect of beta-endorphin on fetal breathing movements in sheep

It has been suggested that endogenous opioids, such as beta-endorphin (beta-EP), act to depress respiration in the fetus and newborn. We have investigated the effect of infusing beta-EP either intravenously or into a lateral cerebral ventricle on breathing movements and electrocortical activity in eight fetal lambs between 116 and 133 days gestation. Intravenous infusion of beta-EP (200 or 500 micrograms over 1 h) increased plasma beta-EP concentrations 2- to 230-fold and was associated with a small decrease in the percent time spent breathing, from 57.8 +/- 9.1 to 51.3 +/- 8.2%/h (n = 6 exp). There was no change in the amount of high- or low-voltage electrocortical activity. Intracerebroventricular beta-EP infusion (1 or 2 micrograms beta-EP/min for 120 min) was not associated with any change of breathing movements (n = 5 exp) during the period of the infusion. However, in four experiments, in the 6-h period after the end of the beta-EP infusion there were episodes of 2-4 h when the percent time per hour spent breathing exceeded 70%. Electrocortical activity increased in amplitude and distinct episodes of high- and low-voltage activity were sometimes lost in these experiments. We conclude that high concentrations of beta-EP in plasma or cerebrospinal fluid do not totally suppress fetal breathing directly in the fetal lamb.     

Saline-filled breast implant safety and efficacy: a multicenter retrospective review

Our center undertook an industry-funded, outcomes-based, multicenter, retrospective review to evaluate the safety and efficacy of saline-filled breast implants. Our review was part of a pre-market approval review process mandated by the U.S. Food and Drug Administration. The design of our review was modeled on a Plastic Surgery Educational Foundation outcomes study previously conducted by our center. For this study, several significant changes were made to our previous protocol, including improved patient tracking, stronger biostatistical support, and a mandatory 10-year minimum patient follow-up period. Physician-reported and patient-reported data on 450 patients with 882 saline-filled breast implants placed between January 1, 1980, and June 30, 1986, were obtained. Mean patient follow-up period was 13.0 years. Most implants (93.9 percent) were placed for breast augmentation. Seventy-four percent were placed in a submammary position; 25.6 percent, subpectorally; and 0.2 percent, subcutaneously. The overall complication rate was 20.2 percent. Reoperation for capsular contracture or implant deflation was necessary in 104 of 450 patients (23.1 percent). Deflation occurred in 73 implants (8.3 percent) and was underreported according to the physicians' record review alone. This deflation rate is higher than the 5.5 percent previously reported by our center. However, 26 of these 73 deflations (35.6 percent) occurred in a single cohort of patients at one center using Surgitek saline implants. If this cohort is excluded, the deflation rate drops to 5.8 percent, a figure more consistent with data published in the literature and found in our previous study. Of the 73 deflations, spontaneous deflation was reported for 50 (74.6 percent), and the remainder were iatrogenic. Actuarial survival of the non-Surgitek implants was 98.4 percent to 99.8 percent at 5 years and 96.9 percent to 98.9 percent at 10 years (95 percent confidence interval). Risk factors for implant deflation included the use of Surgitek saline-filled implants (odds ratio = 17.5, p < 0.01), use of Heyer-Schulte and Mentor model 1800 implants (odds ratio = 3.0, p < 0.01), and implant size greater than 450 cc (odds ratio = 1.01, p < 0.02). Risk factors for capsular contracture included submammary implant position (odds ratio = 2.05, p = 0.03) and implant size greater than 450 cc (odds ratio = 1.01, p < 0.01). Overall, satisfaction was high: 93 percent of patients were "satisfied" or "very satisfied" with their implants. As in our earlier study, risk factors for patient dissatisfaction were reconstruction after mastectomy (odds ratio = 7.6, p = 0.011), significant breast firmness (odds ratio = 6.2, p < 0.001), and patient desire for smaller implants (odds ratio = 3.0, p = 0.020). In conclusion, our review provides additional outcomes-based evidence that saline-filled breast implants remain a safe, effective alternative to silicone gel-filled models.     

Heparin-associated thrombocytopenia: low frequency in 104 patients treated with heparin of intestinal mucosal origin.

A prospective study of 104 patients receiving heparin obtained from porcine intestinal mucosa for 4 or more days was conducted to determine the frequency of associated significant thrombocytopenia (platelet count less than 100 x 10(9)/I on 2 consecutive days). No episodes of significant thrombocytopenia were identified in the 13 patients receiving heparin by continuous intravenous infusion for a mean of 8.0 days or in the 38 patients receiving heparin subcutaneously for a mean of 9.9 days. In 1 of the 26 patients receiving heparin as intermittent intravenous boluses for a mean of 8.2 days significant thrombocytopenia developed; this patient had laboratory evidence of disseminated intravascular coagulation. In none of the 17 patients receiving uninterrupted heparin therapy for 4 or more days by more than one route of administration but for less than 4 days by any single route did significant heparin-associated thrombocytopenia develop. Of the 104 patients 13 had one or more platelet counts of less than 150 x 10(9)/I, but in most it was not possible to definitely relate the thrombocytopenia to the heparin therapy. Platelets in normal platelet-rich plasma did not aggregate when heparin and serum from patients with thrombocytopenia were added. The frequency of heparin-associated thrombocytopenia noted in this study was considerably lower than that reported previously.     

Auditory deprivation modifies biological rhythms in the golden hamster

To assess to what extent auditory sensory deprivation affects biological rhythmicity, sleep/wakefulness cycle and 24 h rhythm in locomotor activity were examined in golden hamsters after bilateral cochlear lesion. An increase in total sleep time as well as a decrease in wakefulness (W) were associated to an augmented number of W episodes, as well as of slow wave sleep (SWS) and paradoxical sleep (PS) episodes in deaf hamsters. The number of episodes of the three behavioural states and the percent duration of W and SWS increased significantly during the light phase of daily photoperiod only. Lower amplitudes of locomotor activity rhythm and a different phase angle as far as light off were found in deaf hamsters kept either under light-dark photoperiod or in constant darkness. Period of locomotor activity remained unchanged after cochlear lesions. The results indicate that auditory deprivation disturbs photic synchronization of rhythms with little effect on the clock timing mechanism itself.     

Superoxide Dismutase (SOD)Zymogram Patterns and Their Geographical Distribution of Wild (Glycine soja) and Cultivated Soybean (G. max) in China

The purpose of this study was to examine the superoxide dismutase (SOD) zymogram patterns, their frequency and geographical distribution of wild (Glycine soja) and cultivated soybean (G. max) in China. Seeds of 226 wild soybean germplasms and 104 cultivated soybean cultivars (land races) were collected from all provinces and autonomous regions in China except Taiwan, Xinjiang and Qinghai provinces About 50 embryos per wild soybean germplasm and I0 embryos per cultivated soybean cultivars were used for test. Vertical polyacrylamide gel electrophoresis and a stainning system modified after Luo (1984)were used. The Japanese GS- 930 Scanner was used in gel-plate scanning. In program scanning the maximum and minimum absorption wavelength were 700 and 550 nm respectively. The results showed that: 1. Six zymogram patterns were found in soybean (Fig. 1, 2). Wild soybean displayed five patterns (Ⅰ, Ⅱ, Ⅳ Ⅴ, Ⅵ), while the cultivated soybean displayed only two patterns (Ⅱ, Ⅲ). 2. Fourty six percent of wild germplasms gave an 7-band zymogram (Table Ⅰ) (pattern Ⅰ), fourty nine percent had a 6th and 7th band with faster mobility (pattern Ⅱ), about two percent produced a 6-band zymogram which lacked the SODc4 band (pattern Ⅳ), about two percent had a 5-band pattern which lacked the SODc,c4 bands (pattern Ⅴ), and only one germptasm displayed a 5-band zymogram which lacked SODb2b3 bands (pattern Ⅵ). 3. More than ninty eight percent of cultivated cultivars belonged to pattern Ⅱ, only about two percent belonged to pattern Ⅲ. 4. The geographical distribution of frequency of pattern Ⅱ between wild and cultivated soybean was most close in 36–51º N area. The difference of zymograms between G. soja and G. max, and the problems of the origional area and evolution of soybean were discussed.     

Effect of inhaled corticosteroids on episodes of wheezing associated with viral infection in school age children: randomised double blind placebo controlled trial.

OBJECTIVES: To determine the effect of regular prophylactic inhaled corticosteroids on wheezing episodes associated with viral infection in school age children. DESIGN: Randomised, double blind, placebo controlled trial. SETTING: Community based study in Southampton. SUBJECTS: 104 children aged 7 to 9 years who had had wheezing in association with symptoms of upper and lower respiratory tract infection in the preceding 12 months. INTERVENTIONS: After a run in period of 2-6 weeks children were randomly allocated twice daily inhaled beclomethasone dipropionate 200 micrograms or placebo through a Diskhaler for 6 months with a wash out period of 2 months. Children were assessed monthly. MAIN OUTCOME MEASURES: Forced expiratory volume in 1 second (FEV1); bronchial responsiveness to methacholine (PD20); percentage of days with symptoms of upper and lower respiratory tract infection with frequency, severity, and duration of episodes of upper and lower respiratory symptoms and of reduced peak expiratory flow rate. RESULTS: During the treatment period there was a significant increase in mean FEV1 (1.63 v 1.53 1; adjusted difference 0.09 1 (95% confidence interval 0.04 to 0.14); P = 0.001) and methacholine PD20 12.8 v 7.2 mumol/l; adjusted ratio of means 1.7 (1.2 to 2.4); P = 0.007) in children receiving beclomethasone dipropionate compared with placebo. There were, however, no significant differences in the percentage of days with symptoms or in the frequency, severity, or duration of episodes of upper or lower respiratory symptoms or of reduced peak expiratory flow rate during the treatment period between the two groups. CONCLUSIONS: Although lung function is improved with regular beclomethasone dipropionate 400 micrograms/day, this treatment offers no clinically significant benefit in school age children with wheezing episodes associated with viral infection.     

Computer-assisted immunocytochemical determination of breast cancer steroid receptors on cytological smears of excised surgical specimens compared with frozen sections

BACKGROUND: Due to the widespread use of fine needle aspirate biopsy the practice of determining estrogen (ER) and progesterone (PR) receptors in breast carcinoma from cytological smears (CS) is becoming very common. The aim of this study was to determine concordance between ER and PR assessed by immunocytochemical assay (ICA) on CS and FS both evaluated by image analysis since we have found no data in literature on this. METHODS: 104 breast carcinoma cases were selected. For all cases ER and PR determination was performed on CS, obtained by light scraping of the freshly cut surface of the excised surgical tumors at the time of frozen section diagnosis, and FS using the same monoclonal antibodies. Computer-assisted image analysis was performed in all cases using CAS 200. Results were expressed as percent positive area of neoplastic nuclei compared with total nuclear area of the examined neoplastic cells. RESULTS: Good correlation was demonstrated between percent positive nuclear neoplastic area by ER-ICA on CS and FS (r = 0.759; P < 0.0001). Concordance of results was 90.19% (P < 0.001). Good correlation was also demonstrated between percent positive nuclear neoplastic area by PR-ICA in CS and FS (r = 0.889; P < 0. 0001). Concordance of results was 97.02% (P < 0.0001). CONCLUSIONS: Our data suggest that ICA on CS with automated image analysis is efficient in evaluating ER and PR content in human breast cancer, especially when CS is the only method pathologists have to evaluate receptor status e.g. in advanced breast cancer cases when neoadjuvant therapy is necessary before surgery or when surgery is impossible.     

The reproductive biology of Bennett's wallaby (Macropus rufogriseus rufogriseus) ranging free at Whipsnade Park

Between August 1981 and October 1982, 76 female and 50 male of the estimated 400 Bennett's wallabies at Whipsnade were caught and examined. Sixty-four of the adult females inspected (84%) were carrying pouch young. A small captive breeding colony was established in the laboratory. Weight and growth curves were established for captive born pouch young and these curves were used to determine the approximate age of pouch young examined at Whipsnade. Eighty-four percent of births occurred in August and September, exactly a six month difference from births reported for this species in Tasmania. The mean length of pouch life of wild living wallabies was 247 days with a range of185–284 days. Young wallabies were observed accompanying their mothers for up to 204 days after emerging permanently from the pouch. Sixty-three percent of young vacated the pouch in May. Sixty-three percent of the total (104) pouch young examined in the course of this study, from animals caught or from post mortem records, were male, but teat selection showed a random distribution. The gestation period from removal of pouch young to day of birth was 27·3 days. The Bennett's wallaby showed precise seasonal breeding with embryonic diapause that may extend for up to 11 months.     

"Natural cause of death or not?" How do nursing home physicians act when in doubt of natural cause of death?

The objective of the study was to explore if nursing home physicians act by law, when they doubt the natural cause of death. In May 1999, a questionnaire was sent to 153 nursing home physicians in the region of Utrecht and Nijmegen. They were asked if they consult the coroner when they have doubts about the natural cause of death. Eighty-six percent (104) returned the questionnaire. Thirty-two percent of the nursing home physicians always consult the coroner and 52% does so most of the time. Only 12% does not consult the coroner most of the time and 2% never does. The main reasons for not consulting the coroner were that nursing home physicians judge a death after a fall as an incident that fits in the descending lifeline of patients and that some nursing home physicians had bad experiences consulting the coroner. We conclude that this policy may lead to underregistration of unnatural deaths. Changing the definition or changing the law may reduce this problem. Education and information can also contribute to change in physician's attitudes.     

Tobacco smoking and complications in elective microsurgery.

This study assesses the risk for complications in patients who chronically smoke but who have quit in the perioperative period of an elective free-tissue transfer as compared with patients who do not smoke. A retrospective review identified 104 free-tissue transfers in 93 smokers and 58 transfers in 51 nonsmokers. The demographics, wound etiology, and recipient sites were similar in the two populations. With the exception of a higher incidence of chronic obstructive pulmonary disease (COPD) among smokers, preexisting comorbid factors also were similar. Postoperative medical complications were comparable between populations. When comparing smokers with nonsmokers, we found that anastomotic patency and flap survival were not different (95 versus 94 percent, respectively), that delayed wound healing at the recipient site was different (35 versus 24 percent), and that smokers require an additional procedure to achieve final wound closure more frequently (27 versus 12 percent, p = 0.03). These findings suggest that cigarette smokers are at increased risk for complications, not at the site of the anastomosis in free-tissue transfer, but rather at the flap's interface with the wound or overlying skin graft.     

The assessment of the rice cultivars/lines resistance to blast disease in Mazandaran province, Iran

Blast, caused by Magnaporthe grisea, is one of the most important diseases in rice production regions of the world including Iran. To determine progress of rice blast disease on the selective cultivars and lines also to assay some components of partial resistance, a set of Iranian rice cultivars (Local and breeding) along with near-isogenic lines (NILs) and breeding lines from International Rice Research Institute (IRRI) were tested with some field races of the fungus in blast nursery and five of selective races in greenhouse. These experiments were conducted in a Randomized complete Block Design (RCBD) with three replications (except greenhouse experiment on the leaves). Traits in this study consisted of Infection Neck Number (INN), Neck Lesion Size (NLS), Infection Type (IT), percent Diseased Leaf Area (DLA) and Area Under Disease Progress Curve (AUDPC); also IT, Sporulation Lesion Number (SLN), Sporulating Region Diameter (SRD) and percent DLA were measured in leaf blast in greenhouse (one replication). The Iranian local cultivars and NILs i.e. Co-39 and C104-PKT located as susceptible group for AUDPC, IT, INN and NLS. Iranian breeding cultivars, breeding lines from IRRI and NILs (except Co-39 and C104-PKT) were resistant or indicated hypersensivity reaction (HR). Some cultivars (Fujiminori, Onda, and Hassan Saraii) were semi susceptible to leaf blast in nursery. The main point is correlation in 1% (a = 0.0001) between the traits in greenhouse and blast nursery. Neck node infection of Haraz cultivar in greenhouse experiment to IA-89 race is very important, because Haraz is a resistant cultivar to blast disease in Iran.     

Pressure-geometry relationship in the antroduodenal region in humans

Understanding of the control mechanisms underlying gastric motor function is still limited. The aim of the present study was to evaluate antral pressure-geometry relationships during gastric emptying slowed by intraduodenal nutrient infusion and enhanced by erythromycin. In seven healthy subjects, antral contractile activity was assessed by combined dynamic magnetic resonance imaging and antroduodenal high-resolution manometry. After intragastric administration of a 20% glucose solution (750 ml), gastric motility and emptying were recorded during intraduodenal nutrient infusion alone and, subsequently, combined with intravenous erythromycin. Before erythromycin, contraction waves were antegrade (propagation speed: 2.7 +/- 1.7 mm/s; lumen occlusion: 47 +/- 14%). Eighty-two percent (51/62) of contraction waves were detected manometrically. Fifty-four percent of contractile events (254/473) were associated with a detectable pressure event. Pressure and the degree of lumen occlusion were only weakly correlated (r(2) = 0.02; P = 0.026). After erythromycin, episodes of strong antroduodenal contractions were observed. In conclusion, antral contractions alone do not reliably predict gastric emptying. Erythromycin induces strong antroduodenal contractions not necessarily associated with fast emptying. Finally, manometry reliably detects ~80% of contraction waves, but conclusions from manometry regarding actual contractile activity must be made with care.