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Rapid solid phase gastric emptying (SPGE) resulting in decreased satiety is postulated to be a contributing factor to obesity. Twenty-six morbidly obese patients with a weight range of 189-523 lb were entered into the Garren-Edwards gastric bubble program. SPGE studies were performed pre-bubble implantation and repeated within 2 wk after bubble implant. There was no significant difference between study patients pre-bubble insertion emptying time and the normal population curve. Emptying time was found to be significantly increased, post-bubble implant, compared with pre-bubble implant over five time periods of testing. The Garren-Edwards gastric bubble bas been used as a method for inducing early satiety for the morbidly obese patient. It bas been postulated that delay of SPGE would be associated with satiety. Our patients experienced satiety despite their more rapid SPGE. Thus, the satiety which was experienced by our subjects was not on the basis of delayed SPGE, as previously thought. [ABSTRACT FROM AUTHOR]

Objective: There is growing evidence supporting the use of coronary CT angiography (CTA) to triage patients in the emergency department (ED) with acute chest pain and low risk of acute coronary syndrome (ACS). We hypothesized that coronary CTA can guide early management and safely discharge patients by introducing a dedicated patient management protocol., Subjects and Methods: We conducted a prospective cohort study in three EDs of a large health care system (> 1300 beds). Five hundred twenty-nine patients (mean age, 52.1 years; 56% women) with chest pain, negative cardiac enzyme results, normal or nondiagnostic ECG findings, and a thrombolysis in myocardial infarction (TIMI) risk score of 2 or less were admitted and underwent CTA. A new dedicated chest pain triage protocol (levels 1-5) was implemented. On the basis of CTA findings, patients were stratified into one of the following four groups: 0, low (negative CTA findings); 1, mild (1-49% stenosis); 2, moderate (50-69% stenosis); or 3, severe (≥ 70% stenosis) risk of ACS. Outcome measures included major adverse cardiac events (MACEs) during the first 30 days after CTA, downstream testing results, and length of stay (LOS). LOS was compared before and after implementation of our chest pain triage protocol., Results: Three hundred seventeen patients (59.9%) with negative CTA findings and 151 (28.5%) with mild stenosis were discharged from the ED with a very low downstream testing rate and a very low MACE rate (negative predictive value = 99.8%). Twenty-five patients (4.7%) had moderate stenosis (n = 17 undergoing further testing). Thirty-six patients (6.8%) had stenosis of 70% or greater by CTA (n = 34 positive by invasive angiography or SPECT-myocardial perfusion imaging). The sensitivity of CTA was 94%. The rate of MACEs in patients with stenosis of 70% or greater (8.3%) was significantly higher (p < 0.001) than in patients with negative CTA findings (0%) or those with mild stenosis (0.2%). A 51% decrease in LOS-from 28.8 to 14.0 hours--was noted after implementation of the dedicated chest pain protocol (p < 0.001)., Conclusion: Chest pain patients with negative or mild nonobstructive CTA findings can be safely discharged from the ED without further testing. Implementation of a dedicated chest pain triage protocol is critical for the success of a coronary CTA program.

Quantification of coronary artery calcium by electron beam and spiral computed tomography (CT) is being increasingly utilized as a technique to assess the presence and extent of coronary artery disease (CAD) as well as the prognosis for clinical events in both symptomatic and asymptomatic individuals. Much of the demand for this procedure is generated by patients exposed to marketing efforts, and patients often ask physicians about the value of this test. Since elderly patients have a high prevalence of coronary artery calcium as well as a higher incidence of clinical CAD, the interpretation and clinical utility of this test differs from that for younger individuals. This paper attempts to review currently available information concerning coronary artery calcium quantification and its potential uses in elderly patients. (c)1999 by Quantification of coronary artery calcium by electron beam and spiral computed tomography (CT) is being increasingly utilized as a technique to assess the presence and extent of coronary artery disease (CAD) as well as the prognosis for clinical events in both symptomatic and asymptomatic individuals. Much of the demand for this procedure is generated by patients exposed to marketing efforts, and patients often ask physicians about the value of this test. Since elderly patients have a high prevalence of coronary artery calcium as well as a higher incidence of clinical CAD, the interpretation and clinical utility of this test differs from that for younger individuals. This paper attempts to review currently available information concerning coronary artery calcium quantification and its potential uses in elderly patients. (c)1999 by CVRR, Inc.