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Biomedical subjects

B Kaul

Publications and source records attributed to B Kaul.

At least 37 records · Page 2Linked to original sources
PubMed1986

The acid perfusion test in gastroesophageal reflux disease.

An acid perfusion test, isotope scanning, endoscopy, and esophageal biopsy were performed in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. A positive acid perfusion test within 30 min (APT) and within 5 min (TAPT) was found in 70.2% and 37.6% of the patients, respectively. A positive APT was found significantly more often in patients with than without endoscopic esophagitis, whereas a positive TAPT was found significantly more often in patients with severe symptoms than in patients with moderate symptoms and in a significantly higher proportion of patients with than without GER by scintigraphy. Neither the APT nor the TAPT showed any dependency on the presence of histologic esophagitis. Most (97%) patients with a negative acid perfusion test, in addition to typical symptoms, also presented with scintigraphic, endoscopic, or histologic evidence of GER disease. Although it shows that the acid perfusion test, particularly when early positive, may serve as a weak predictor of the severity of GER disease, the present study gives little support to the test's clinical usefulness.

Adult↗
PubMed1986

Gastroesophageal reflux disease. Scintigraphic, endoscopic, and histologic considerations.

Radionucleotide scintigraphy and esophagoscopy with biopsy were carried out in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. GER was visualized by scintigraphy in 86.1% of the patients. Endoscopic and histologic esophagitis were found in 68.1% and 58.4% patients, respectively, whereas both examinations taken together showed evidence of esophagitis in 82%. Histologic evidence of esophagitis was found in nearly all patients with severe endoscopic changes and in 43.7% patients with no endoscopic abnormality. Scintigraphic reflux was demonstrated more frequently (p less than 0.05) in the patients with severe endoscopic esophagitis (97.5%) than in those with no or only mild endoscopic changes (78.6%). Scintigraphic reflux was found in 91.5% and 78.5% of the patients with and without histologic evidence of esophagitis (p = 0.07). Fifteen of the 18 patients (83.3%) without endoscopic and histologic abnormalities in the esophagus had scintigraphic evidence of reflux. The present study strongly supports the clinical significance of scintigraphy in GER disease and confirms that esophageal biopsy specimens increase the sensitivity of endoscopic evaluation.

Adult↗
PubMed1986

Gastroesophageal reflux disease. Acute and maintenance treatments with cimetidine.

The comparative efficacy of a 12-week acute treatment with 800 and 1600 mg cimetidine daily and the effectiveness of a 400-mg single-dose maintenance treatment versus placebo lasting 6 months were studied in a double-blind fashion in 30 and 24 patients, respectively, with gastroesophageal reflux (GER) disease. Cimetidine in a dose of 800 or 1600 mg daily resulted in a significant symptomatic improvement and a decrease in the extent of endoscopic esophagitis. An improvement in the gastroesophageal sphincter function during treatment was suggested by a significant decrease in the frequency of reflux, as evaluated by isotope scintigraphy. No significant differences were found between the two doses of cimetidine. The overall initial improvement tended to be maintained during maintenance treatment, but no significant differences were found between cimetidine and placebo. The present study thus supports the use of 800 mg of cimetidine daily for short-term treatment of GER disease but provides no support for maintenance treatment with a low dose. The study further suggests that cimetidine treatment, by reducing the tendency to GER, may induce long-lasting remission of the disease.

Adult↗
PubMed1985

Scintigraphy, pH measurement, and radiography in the evaluation of gastroesophageal reflux.

Scintigraphy as a diagnostic tool has been explored in 69 patients with gastroesophageal reflux (GER) symptoms and endoscopic esophagitis. In all subjects the presence of reflux was also evaluated by radiography and intraesophageal pH measurements (standard acid reflux test). The overall sensitivity of scintigraphy (85.5%) was significantly higher than those of radiography (27.5%) and pH measurements (69.5%). Scintigraphy was performed with normal saline and with acidified orange juice as the transport medium for the isotope 99mTc. The yield of positive scintigrams was higher (22.3 to 61.1%, depending on the grade of endoscopic esophagitis) with the latter variant. Moreover, demonstration of spontaneous reflux was greatly facilitated by the acid scintigraphy. This was particularly obvious in the grade I esophagitis, in which the frequency of spontaneous reflux with the saline method was 3.4% and with the acid medium, 34.3%. Reflux (induced or spontaneous) was seen in 2 of 22 normal control subjects with the saline method and in 1 subject only with the acid method. On the basis of these findings, it is concluded that scintigraphy, especially the acid variant of the technique, is a valuable diagnostic procedure in GER disease.

Adult↗
PubMed1983

[Duodenoplasty].

Explore the source record for details and available documents.

Aged↗
PubMed1983

Free erythrocyte protoporphyrin and zinc protoporphyrin measurements compared as primary screening methods for detection of lead poisoning.

We compared two commonly used primary screening methods (FEP and ZnP) for detecting Pb poisoning in children, used according to three major protocols. The results showed that FEP and ZnP values were comparable for only 36% of the children examined; 54% had FEP greater than ZnP and 10% had ZnP greater than FEP. One would identify approximately twice as many children with Pb greater than 300 micrograms/L by an FEP (500 micrograms/L cutoff) as with a ZnP (400 micrograms/L cutoff) screen. With a cutoff of 350, as compared with 500 micrograms/L for ZnP, one would perform 33% additional confirmatory blood Pb determinations with a 3% increased detection of Pb intoxication. If the number of false-negative Pb specimens is to be minimized, the cutoff "action level" for hematofluorometers should be lowered from the currently recommended 500 micrograms/L of whole blood to 350 micrograms/L. Our long experience and that of other laboratories leads us to recommend a revision of Centers for Disease Control risk categories and cutoff values, depending on whether FEP or ZnP is measured in combination with a patient's blood Pb concentration. Our finding of above-normal values for ZnP and FEP with Pb concentrations less than 300 micrograms/L indicates that iron deficiency constitutes an equally important public-health problem for children in New York City.

Child, Preschool↗
PubMed1982

Anticholinergic poisoning.

Since the fall of 1979 numerous patients have been brought to emergency departments in New York City after being poisoned with an alcoholic beverage. On admission to the emergency services, they were noted to manifest significant anticholinergic toxicity. An analysis of the case histories, clinical presentations and laboratory data suggests that scopolamine eyedrops were deliberately used to poison these patients.

Adult↗
PubMed1981

Drug abuse patterns of patients on methadone treatment in New York City.

Urine specimens from methadone treatment clinics were screened for various abused drugs between 1974-1979 by thin-layer chromatography (TLC) and immunoassay techniques (IAT). A comparison of the relative incidence of drugs abused reveals that IAT are more sensitive and detect far greater number of subjects abusing drugs than TLC. The results also show a significant abuse of heroin and cocaine during the period studied and a variation of the incidence of other drugs used during the same period. While these patients did not receive benzodiazepenes and tricyclic antidepressants by prescription, their abuse alone and in combination with each other was also found to be widespread. Low levels of PCP and/or its analogs were found in 1978 and 1979. The frequent finding of low levels of PCP in combination with other drugs indicates the availability of this hallucinogen and point to its use in combination with other illicit drugs such as cocaine, amphetamine, and heroin. The suggestion is made that more sensitive analytical methods for drugs screening be utilized in methadone monitoring programs, and that other classes of drugs be added than are currently required.

Amphetamines↗
PubMed1980

Health status of cable splicers with low-level exposure to lead: results of a clinical survey.

The results of a cross-sectional clinical field survey of 90 telephone cable splicers are presented. Despite the rare occurrence of clinically overt lead poisoning among cable splicers, the observed prevalence of symptoms was 29% for lead-associated central nervous system symptoms and 21% for gastrointestinal symptoms. These two groups of symptoms were directly related to zinc protoporphyrin (ZPP) levels but no relationship was found between them and blood lead concentrations. Only 5% of the workers had significantly elevated blood lead levels (greater than 40 microgram/100ml). Because of the intermittent lead exposure encountered in this trade, individuals were identified with "normal" blood lead levels associated with "elevated" zinc protoporphyrin concentrations, indicating the difference in biological significance between exposure-(blood lead) and biological-response tests (ZPP). Suggestion is made that both types of diagnostic tests be utilized in the medical surveillance of lead-exposured workers.

Adult↗
PubMed1980

Radioimmunoassay screening test for detection of phencyclidine (PCP, "angel dust") abuse among teenagers.

An immunogen was prepared from a succinamide derivative preparation of phencyclidine (PCP) and coupled to bovine gamma globulin by means of water-soluble carbodiimide. Phencyclidine, 10 of its analogs, and a 3,4-3H-PCP all bound competitively to antibodies induced in rabbits. An assay was developed using the ammonium sulfate precipitation separation method. The minimum detection limit to PCP was 2 ng/mL and that for various analogs ranged from 50 pg/mL to approximately 100 ng/mL. No cross reactivity was observed with at least 25 commonly used drugs. A double blind qualitative clinical evaluation of the assay was conducted with gas-liquid chromatography (GLC) and GLC-mass spectrometry methods. No false positive or false negative results were observed. For qualitative screening a "cut-off" level equivalent to 5 ng/mL was used for both serum and urine to distinguish between positive and negative specimens. Urine and serum samples from emergency room patients with neuropsychiatric symptoms and methadone clinic patients and autopsy material showed a significant incidence of PCP abuse, particularly among adolescents and young adults.

Adolescent↗
PubMed1978

Treatment of lead poisoning by 2,3-dimercaptosuccinic acid.

2,3-Dimercaptosuccinic acid (D.M.S.), a new orally effective agent for the treatment of heavy-metal intoxication, was administered to five lead-poisoned smelter workers for six days at dosages ranging from 8.4--12.7 mg/kg/day on the first day to 28.1--42.2 mg/kg/day on the last day. Mean blood-lead concentration decreased significantly from an initial value of 97 +/- 6 microgram/dl to 43 +/- 4 microgram/dl on the last day. Urinary lead excretion was significantly raised. D.M.S. was very well tolerated with no signs of toxicity and no effect on urinary zinc, calcium, magnesium, or iron excretion. Urinary copper excretion was significantly increased, but the magnitude of that effect was not clinically important. D.M.S. seems to be safe and effective for the treatment of lead poisoning.

Administration, Oral↗
PubMed1977

Determination of morphine by electron capture gas-liquid chromatography.

We describe a micromethod for determining as little as 0.1 microgram of morphine per liter of human urine. The procedure is about 20-fold more sensitive than are currently used gas-liquid chromatographic methods. It is particularly suitable for use as a confirmatory method for large-scale radioimmunoassay screening tests. The procedure involves extraction of morphine from urine and analysis of its heptafluorobutyryl derivative by gas-liquid chromatography with electron capture detection. Morphine can be determined by this procedure over a range of 0.1-200 microgram/liter of urine, 2 pg of the pure derivative being the lowest amount detectable. Urine samples from patients receiving methadone were analyzed by thin-layer chromatography, radioimmunoassay, and our procedure. The results by our procedure agreed well with those obtained by radioimmunoassay.

Chromatography, Gas↗