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Biomedical subjects

C Beglinger

Publications and source records attributed to C Beglinger.

At least 109 records · Page 6Linked to original sources
PubMed1997

Ileocecal segment transposition does not alter whole gut transit in humans.

OBJECTIVES: We have recently described a reservoir for rectal replacement after total mesorectal excision for rectal carcinoma. The ileocecal segment with its intact extrinsic nerve and blood supply is placed between the ascending colon and the anal canal. This reconstruction has been shown to provide good defecation quality and anorectal function. Whether gastric emptying and small as well as large bowel transit are affected by this transposition remains unclear. Our aim was to quantify whole gut transit in such patients and compare it with that of a matched group of controls. METHODS: Gastric emptying rates and small intestinal and colonic transit times were assessed scintigraphically in 12 patients aged 46 to 87 years with ileocecal reservoir reconstruction after total mesorectal excision and compared to a sex-matched group of asymptomatic healthy volunteers of similar age. Gastric emptying rates and small intestinal and colonic transit times were calculated as described previously. Data were compared using Wilcoxon's signed rank test for gastric emptying rates and small bowel transit or by analysis of variance for colonic transit; p < 0.05 was considered significant. RESULTS: Gastric time for half of the meal (T50) was 161 +/- 16 minutes for patients and 201 +/- 22 for the controls. Small bowel transit time was 150 +/- 15 minutes for patients and 177 +/- 22 for the controls. Geometric center at 6 hours was 1.53 +/- 0.13 for patients and 1.27 +/- 0.16 for the controls. Geometric center at 24 hours was 2.96 +/- 0.23 for patients and 2.57 +/- 0.25 for the controls. Data are mean +/- SEM. SUMMARY: Gastric emptying rates and small bowel transit and colonic transit times (expressed as geometric center at 6 and 24 hours) were similar in patients with ileocecal reservoir reconstruction and in a sex- and age-matched group of healthy controls. We conclude that the transposition of an ileocecal segment with intact extrinsic neurovascular supply between the sigmoid colon and the anal canal does not alter whole gut transit, not even in any of the presumably key regions.

Age Factors↗
PubMed1997

Effects of telenzepine and L-364,718 on canine pancreatic secretion before and after vagotomy.

In six conscious dogs we compared the action of the M1-receptor antagonist telenzepine (20.25-81.0 nmol.kg-1.h-1), the cholecystokinin (CCK) antagonist L-364,718 (0.025-0.1 mg.kg-1.h-1), and combinations of both on the pancreatic secretory response to intraduodenal tryptophan, given against a secretin background before and after truncal vagotomy. Before vagotomy, the higher doses of telenzepine and of L-364,718 significantly (P < 0.05) decreased the protein response to tryptophan by up to 97%. After vagotomy, all doses of L-364,718 abolished the protein response, whereas telenzepine had no further effect. Before and after vagotomy, all combinations abolished the protein response. The plasma CCK-like immunoreactivity basally, during secretin, and in response to tryptophan was not altered by vagotomy, telenzepine, and/or L-364,718. These findings indicate that in dogs 1) potentiation exists between M1 receptors and CCK for stimulation of the pancreatic enzyme response to intraduodenal tryptophan, 2) the cholinergic fibers of the enteropancreatic reflex activated by tryptophan run within the vagus nerves and end at least in part on M1 receptors, 3) CCK acts in part independently of the vagal nerves, and 4) the CCK release by intestinal tryptophan is not influenced by vagotomy, telenzepine, and/or L-364,718.

Animals↗
PubMed1997

Preoperative approach to rectal carcinoma.

The preoperative evaluation of patients with rectal carcinoma requires a careful medical history with close attention to symptoms. After a thorough physical examination including digital examination of the rectum, a proctoscopy reveals the size and localisation of the tumour. Even if a neoplasm has been documented by this procedure, total colonoscopy should be performed to detect synchronous neoplastic lesions at other sites in the colon which may affect the surgical resection. Endosonography is recommended as an additional diagnostic step because it allows a precise, preoperative staging of the tumour. Abdominal ultrasound or, alternatively, CT scan of the abdomen, is necessary to exclude hepatic metastases.

Algorithms↗
PubMed1997

[Therapy of chronic inflammatory bowel diseases].

The treatment of ulcerative colitis and Crohn's disease shares certain common principles. Initial treatment is primarily medical for both diseases. The most important drug classes in inflammatory bowel disease are antiinflammatory agents, corticosteroids, and 5-aminosalicylic acid formulations (5-ASA). Corticosteroids and 5-ASA preparations are effective medical treatments in up to 80% of the patients with inflammatory bowel disease. The use of immunosuppressive therapy with drugs such as azathioprine is less established and should be restricted to patients who fail on standard medical treatment.

Anti-Inflammatory Agents↗
PubMed1996

The ileocecal reservoir for rectal replacement in complicated radiation proctitis.

BACKGROUND/AIMS: Total rectal resection is the radical treatment method for radiation proctitis complications. Park's straight colo-anal reconstruction to replace the rectum often impairs anal continence, increases stool frequency, and causes imperative urgency. We developed and assessed a colo-anal reconstruction (ileocecal reservoir) after resection of radiation-damaged rectum. METHODS: An ileocecal segment was isolated on its lymphovascular pedicel, rotated counterclockwise, and reanastomosed at the dentate line. This provided a neorectal segment with intact intrinsic and extrinsic nerve and lymphovascular supply. We evaluated the safety, defecation quality, and anorectal function of this neorectum in two radiation-injured patients when compared with 15 patients after total mesorectal excision without radiation damage. RESULTS: No perioperative morbidity related to this technique was observed. Neorectal patients showed good defecation quality with maximal tolerable volumes, compliances, and anal manometry comparable with patients without radiation injury. CONCLUSIONS: This rectal replacement technique permits good defecation quality and excellent anorectal function.

Adult↗
PubMed1996

Helicobacter pylori infection in the young in Bangladesh: prevalence, socioeconomic and nutritional aspects.

BACKGROUND: The gastric acid barrier, an important host defence against small bowel infection, may be compromised by infection with Helicobacter pylori. In developing countries, H. pylori infection occurs early in life and prevalence of hypochlorhydria is high particularly in the malnourished, which may predispose a child to repeated gastrointestinal infection and diarrhoea. Diarrhoea being a leading cause of childhood mortality and morbidity in developing countries, we investigated the prevalence of H. pylori infection in children in a poor Bangladeshi community and explored its association with socioeconomic and nutritional status. METHODS: The study was conducted in a poor periurban community among 469 children aged 1-99 months. Parents were interviewed using a questionnaire. To detect active infection with H. pylori a 13C-urea breath test was performed and weight was recorded on a beam balance with a sensitivity of 20 g. RESULTS: In all, 61% of 36 infants aged 1-3 months were positive for H. pylori; this rate dropped steadily with increasing age and was 33% in 10-15 month old children and then rose to 84% in 6-9 year olds. Overall H. pylori infection had no association with nutritional state of the child, or family income but the infection rate was 2.5 times higher in children of mothers with no schooling. CONCLUSIONS: The H. pylori infection rate is very high in early infancy in a poor periurban community of Bangladesh. The reason for a drop in the infection rate in late infancy is unclear but could be due to initial clearance of the infection by the body's defence mechanisms but with possible alteration of the gastric mucosa which sustains infection. Maternal education may be protective and may operate through some unidentified proximate behavioural determinants. The rate of H. pylori infection in infants and young children may predispose them to repeated gastrointestinal infection and diarrhoea.

Age Factors↗
PubMed1996

Ileocecal reservoir reconstruction with physiologic function after total mesorectal cancer excision.

BACKGROUND/AIMS: After proctectomy for low rectal cancer and straight coloanal reconstruction, the main causes for increased daily stool frequency, urgency, and incontinence are the limited capacity and distensibility of the anastomosed colic segment in the pelvis. The authors postulated that a pedunculated (preserving the nerve) ileocecal interpositional graft (cecum-reservoir) placed between the sigmoid colon and the anal canal would greatly reduce these inconveniences. METHODS: The authors evaluated the safety, defecation quality, and anorectal physiology of such a neorectum in 20 consecutive patients with rectal carcinoma between 5 and 10 cm above the anal verge who underwent total mesorectal excision. RESULTS: No perioperative morbidity related to the technique and no mortality was observed in these 20 patients. Six months after the operation, 16 patients showed excellent and 4 patients good defecation quality, with maximal tolerable volumes, compliance, and mean colonic transit times comparable to age- and gender-matched healthy volunteers. In addition, anal resting pressure was decreased, squeeze pressure was maintained, and the rectoanal inhibitory reflex remained positive in 80%. CONCLUSIONS: The cecum-reservoir as a neorectum, using an intact neurovascular colonic segment, is a safe technique, providing excellent defecation quality. It enables a nearly normal physiologic anorectal function, which is already seen 6 months postoperatively.

Aged↗
PubMed1996

Comparison of the effects of the M1-receptor antagonist telenzepine and the CCK-receptor antagonist loxiglumide on the pancreatic secretory response to intraduodenal tryptophan in dogs.

In six conscious dogs with chronic gastric and pancreatic fistulas we compared the action of different doses (20.25 to 81.0 nmol/kg/h) of the muscarinic M1-receptor antagonist telenzepine, the cholecystokinin (CCK) antagonist loxiglumide (2.5 to 10.0 mg/kg/h) and several combinations of both drugs on the pancreatic secretory response to intraduodenal perfusion of graded loads of tryptophan (0.37-10.0 mmol/h) given against a background of secretin (20.5 pmol/kg/h i.v.). Except for 20.25 nmol/kg/h telenzepine, all tested doses of telenzepine and/or loxiglumide decreased the 180-min integrated bicarbonate response to tryptophan by 55 to 119%. Except of 20.25 nmol/kg/h telenzepine and/or 2.5 mg/kg/h loxiglumide, all tested doses of telezepine and/or loxiglumide inhibited the tryptophan stimulated integrated pancreatic protein responses by 54 to 88%. While telenzepine mainly inhibited the bicarbonate and protein response to the lower loads of tryptophan (0.37-1.1 mmol/h), loxiglumide decreased the response to all loads of tryptophan. The inhibition evoked by the combinations of telenzepine and loxiglumide was not significantly greater than that by single infusion of either drug. The CCK plasma levels basally and in response to tryptophan were not significantly altered by telenzepine and/or loxiglumide. These findings indicate that (1) both enteropancreatic cholinergic reflexes and the hormone CCK are mediators of the protein response to intraduodenal trytophan (2) enteropancreatic cholinergic reflexes are probably the dominant mediators of the response to low amounts of tryptophan, whereas CCK is the major mediator of the response to high loads of tryptophan, (3) the two mediators seem to act independently of each other, and (4) the release of CCK by intestinal trytophan is not influenced by telenzepine or loxiglumide.

Animals↗
PubMed1996

Permeation enhancement of octreotide by specific bile salts in rats and human subjects: in vitro, in vivo correlations.

1. The potential of bile salts to improve the enteral absorption of octreotide, an orally active somatostatin analogue, was investigated by a combination of in vitro, in situ and in vivo experiments. 2. Incorporation of octreotide into lipid monolayers (as measured by area increase of the monolayer at constant surface pressure using a Langmuir-Blodgett trough set-up) depended on the type of bile salt used for monolayer pre-treatment. Addition of 20 microM octreotide to the subphase containing 20 microM of the dihydroxylated bile salt ursodeoxycholate (UDCA) causes a 9% increase in area, whereas addition of octreotide to the subphase containing the 7 alpha-enantiomer of UDCA, chenodeoxycholate (CDCA), resulted in an area increase of the lipid monolayer of 20%. Area increase by octreotide alone was not significantly different from the increase of octreotide and UDCA in combination. 3. CDCA and UDCA in combination with octreotide increased the permeability of liposomal membranes for rubidium ions, whereas octreotide alone did not significantly change the permeability. This indicates membrane distortion as a possible cause for the enhanced absorption of octreotide by bile salts. 4. In polarized Caco-2 cell monolayers octreotide exhibited a permeation coefficient of 0.008 +/- 0.004 cm h-1. Addition of 0.2-1% of UDCA to the apical incubation medium had no significant effect upon the permeation coefficient. In contrast, 0.2-1% CDCA in the incubation medium resulted in a significant increase (P < 0.05) of the monolayer permeability of octreotide (0.015-0.037 cm h-1). 5. Octreotide was absorbed as the intact peptide from the gastrointestinal tract in rats with an absorption efficiency of 0.26%. Coadministration of bile salt resulted in a dose-dependent increase in absorption efficiency of the peptide up to 20.2%. The observed effect was more pronounced for CDCA than for UDCA. 6. The effect of CDCA and UDCA on octreotide absorption in vivo was assessed in a pharmacokinetic study with healthy volunteers. After oral administration of 4 mg octreotide in the presence of 100 mg bile salt, an average bioavailability of the peptide of 1.26% was achieved in the presence of CDCA, whereas in the presence of UDCA a bioavailability of only 0.13% was reached. This difference was statistically significant (P < 0.01). 7. In conclusion, the co-administration of CDCA is able to enhance the enteral absorption of octreotide. The in vitro and in situ experiments were predictive for the observed effect in human subjects.

Adult↗
PubMed1996

Relevance of p-glycoprotein for the enteral absorption of cyclosporin A: in vitro-in vivo correlation.

1. The interaction of cyclosporin A (CyA) with p-glycoprotein during intestinal uptake was investigated by a combination of in vitro experiments with human Caco-2 cells and an intubation study in healthy volunteers. 2. CyA uptake into the cells was not saturable and exhibited only a low temperature sensitivity, suggesting passive diffusion. When the permeation of CyA across Caco-2 monolayers from the apical to the basolateral side was determined, overall transport had an apparently saturable component up to a concentration of 1 microM. At higher concentrations permeation increased over-proportionally. Calculation of the kinetic parameters of apical to basolateral permeation suggested a diffusional process with a KD of 0.5 microliter min-1 per filter, which was overlayed by an active system in basolateral to apical direction with a KM of 3.8 microM and a Jmax of 6.5 picomol min-1 per filter. 3. CyA permeation was significantly higher when the drug was given from the basolateral side as compared to the permeation from the apical side. Apical to basolateral transport of CyA was increased in the presence of vinblastine, daunomycin and a non-immunosuppressive CyA-derivative. All compounds inhibit p-glycoprotein-mediated transport processes. Basolateral to apical permeation of CyA showed a dose-dependent decrease in the presence of vinblastine. Permeation of daunomycin across Caco-2 cell monolayers was also higher from the basolateral to the apical side than vice versa. Basolateral to apical permeation was decreased in the presence of SDZ PSC 833 and cyclosporin A. 4. Western blot analysis of Caco-2 cells with the monoclonal antibody C219 confirmed the presence of p-glycoprotein in the used cell system. 5. When the absorption of CyA in the gastrointestinal (GI)-tract of healthy volunteers was determined, a remarkable decrease of the plasma AUC could be observed dependent on the location of absorption in the rank order stomach > jejunum/ileum > colon. The decrease in absorption exhibited a marked correlation (r = 0.994) to the expression of mRNA for p-glycoprotein over the GI-tract (stomach < jejunum < colon). 6. All data provide evidence that CyA is a substrate of p-glycoprotein in the GI-tract, which might explain the local differences and the high variability in cyclosporin absorption found in vivo.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1996

Comparison of the effects of two cholecystokinin-receptor antagonists, loxiglumide and L-364,718, on the pancreatic secretory response to intraduodenal tryptophan in dogs.

BACKGROUND: The aim of the study was to compare the effects of the cholecystokinin (CCK)-receptor antagonists loxiglumide and L-364, 718 on the endogenously stimulated pancreatic exocrine secretion. METHODS: In six conscious dogs with chronic gastric and pancreatic fistulas we compared the action of different doses of loxiglumide (2.5 to 10.0 mg/kg/h) and L-364, 718 (0.025 to 0.1 mg/kg/h) on the pancreatic secretory response to intraduodenal perfusion of graded loads of tryptophan (0.37-10.0 mmol/ h), given against a background of secretin (20.5 pmol/kg/h intravenously). RESULTS: Both loxiglumide and L-364, 718 inhibited the secretin-stimulated pancreatic bicarbonate output by up to 47% and 48%, respectively. The pancreatic protein output during secretin was significantly inhibited by all doses of L-364,718 (by 65% to 82%) but not by loxiglumide. All doses of loxiglumide and L-364, 718 abolished the 180-min integrated bicarbonate response to tryptophan. The two higher doses of loxiglumide (5.0-10.0 mg/kg/h) and L-364,718 (0.05-0.1 mg/kg/h) significantly decreased the 180-min integrated response to tryptophan by 59% and 79% (loxiglumide) and by 72% and 97% (L-364, 718). The plasma CCK-like immunoreactivity basally and in response to tryptophan was not significantly altered by loxiglumide or L-364, 718. CONCLUSIONS: These findings indicate that in dogs 1) the pancreatic bicarbonate response to secretin is augmented by the hormone CCK; 2) L-364, 718 but not loxiglumide decreases pancreatic protein output during secretin; 3) endogenous released CCK is involved in the pancreatic bicarbonate response and is a major mediator of pancreatic protein response to intraduodenal tryptophan; and 4) the release of CCK by intraduodenal tryptophan is not influenced by loxiglumide and L-364, 718.

Animals↗
PubMed1996

[Chronic pancreatitis: diagnosis].

Chronic pancreatitis is a chronic, inflammatory process leading to destruction of the exocrine tissue, filorosis, and in some patients a loss of endocrine function. Because chronic pancreatitis results in a permanent destruction of pancreatic tissue, exocrine and/or endocrine pancreatic insufficiency may follow. However, owing to the tremendous reserve of pancreatic function, insufficiency may be subclinical at least in the beginning of the disease. The diagnosis of chronic pancreatitis is not difficult; it is based on a typical medical history, specific imaging procedures, and pancreatic function testing. The main differential diagnosis is to separate chronic pancreatitis form pancreatic carcinoma. In the present summary, the different imaging procedures and pancreatic function tests are discussed.

Chronic Disease↗
PubMed1996

[Significance of ursodeoxycholic acid in the eradication of Helicobacter pylori].

In this pilot study we investigated the value of a fourteen-day regimen with amoxicillin (1 g bid), ranitidine (300 mg/d) and ursodeoxycholic acid (300 mg tid) in eradicating Helicobacter pylori. 15 patients with non-ulcer dyspepsia (reactive CLO test, positive histology or 13C urea breath test) were enrolled. Helicobacter pylori was eradicated in 6 of 13 patients (13C urea breath test 4 weeks after the end of treatment). 2 patients were not followed up because of too short treatment (< 1 week). Only 5/15 patients had no side effects (33%). These results strongly suggest that ursodeoxycholic acid in this application regimen is not of use in eradicating Helicobacter pylori.

Adult↗
PubMed1995

[How reliable is the measurement of colonic transit time using a marker technique?].

Radioopaque markers are well established tools to determine segmental and total colonic transit time. However, since no data are available on intraindividual reproducibility, in this study reproducibility was assessed in 14 health male and 12 healthy female volunteers. The mean segmental colonic transit and total colonic transit time were not significantly different for the two measurements. Colonic transit time was consistently shorter in males than in females. The menstrual phase did not show a significant influence in the latter. The intraindividual variations of the colonic transit times were acceptable with a reproducibility coefficient of 20 h.

Adult↗
PubMed1995

[Thrombocytes express functional cytokine receptors in patients with Crohn disease and ulcerative colitis].

Inflammatory bowel disease (IBD) is characterized by T-cell activation and mucosal influx of inflammatory cells partly mediated by increased local release of cytokines and chemokines. Increased levels of activated platelets are reported in IBD. Activated platelets induce endothelial cells in vitro to secrete several cytokines and growth factors and to express adhesion molecules. This study investigates the expression of interleukin-1 (IL-1), IL-8 and granulocyte-macrophage colony-stimulating factor (GM-CSF) receptors on circulating platelets from patients with IBD and healthy controls and assesses the in vitro effect of various concentrations of IL-1 beta, IL-8 and GM-CSF on platelet activation in healthy controls. Flow cytometry was performed to quantify the percentage of platelets binding phycoerythrin (PE) labeled recombinant human IL-1 beta, IL-8 and GM-CSF. Platelet activation was assessed using fluorochrome labeled anti-GMP-140, an activation-dependent antigen. Results are expressed as percentage cytokine receptor expressing platelets (median and interquartile range IQR). Platelets from patients with IBD expressed significantly more cytokine receptors compared to healthy controls: IL-1R [8.7% (5.5-18.2) vs 3.1% (2.4-4.8), p < 0.05], IL-8R [22.5% (18.1-27.9) vs 8% (4.5-9.2), p < 0.001)], GM-CSFR [25.9% (16.1-39.2) vs 3.9% (2.7-3.9), p < 0.001]. The percentage of activated platelets was significantly increased after in vitro stimulation with IL-1 beta, IL-8 and GM-CSF. We conclude that cytokines and chemokines modulate platelet activation through specific, functional receptors which are upregulated in IBD.

Blood Platelets↗
PubMed1995

[Sphincter-conserving surgery in tumors of the middle and distal rectum: methods, indications and limitations].

The purpose of this review is to summarize new developments in the surgical treatment of benign and malignant tumors of the rectum, focusing on oncological requirements and postoperative functional aspects which affect the quality of life. One of the developments is the transanal endoscopic microsurgical (TEM) approach to resection of adenomas and low risk early cancers in the rectum. Another focus is total rectum resection with colo-anal reconstruction with a colon pouch. This procedure reconstructs anorectal anatomy and provides nearly normal function. The reconstruction exists in two forms, (a) the colon-J-pouch and (b) the ileocecal interposition pouch (cecum pouch), which was developed at our institution. The review includes 33 consecutive patients with a rectum tumor. Standardized tumor-specific and functional staging determines which technique is used. 12 patients were operated on using the transanal endoscopic approach, 3 patients had a posterior proctotomy, another patient a transanal local excision and 17 patients total rectum resection with colon pouch reconstruction as described above.

Aged↗