Biomedical subjects
C E Pope
Publications and source records attributed to C E Pope.
Medical and surgical treatment of nonallergic asthma associated with gastroesophageal reflux.
Patients presenting to a chest clinic because of adult-onset wheezing with no history of allergy had a 90 percent prevalence of gastroesophageal reflux, even though reflux symptoms were mild or absent. Ninety patients were randomly assigned to receive cimetidine or an identical placebo or to undergo antireflux surgery. During a six-month period, all groups improved clinically; the cimetidine and surgical groups improved more than the placebo group. The intake of pulmonary medication decreased significantly in both cimetidine and surgical groups. Pulmonary function test results improved in the cimetidine- and surgically treated patients; improvement was not statistically significant. At long-term follow-up, the surgical group maintained clinical improvement and decreased pulmonary medication intake, whereas the placebo group worsened. We conclude that gastroesophageal reflux can play a significant role in some patients with nonallergic pulmonary disease and that its treatment can improve pulmonary symptoms and objective measurements of pulmonary function.
A baboon model for pregnancy-associated antigens (PAPP-A, PP5, PP14).
By radioimmunoassays established on human derived antigens, PAPP-A, PP5 and PP14 immunoreactivity was detected in placental extracts and blood of pregnant baboons. None of the serial dilution curves suggested parallelism between respective human and baboon samples. Based on slopes of regressed logit-log transformed binding data, PAPP-A demonstrated the greatest degree of interspecies immunological crossreactivity. PP14 showed the least conservation of antigenic determinants. Physicochemical characterization on heparin, zinc chelate and bovine thrombin affinity matrices could not distinguish human from baboon-derived antigens. As in the human, baboon PAPP-A and PP5 were not detected in blood of male or non-pregnant animals. PP14 was detected in baboon follicular fluid, and only PP5 immunoreactivity was measured in culture media of baboon embryos. Of the three antigens, PAPP-A was detected in pregnant baboons at about 61 days gestation, that is, 4 weeks before PP5 and PP14. With the exception of PP14 which attained peak concentration at 118 days of pregnancy, PAPP-A and PP5 concentrations were greatest at term. In conjunction with physicochemical and immunological criteria, these physiological kinetics clearly support a role for developing a baboon model to serve for further studies into feto-maternal signals, particularly antigens such as PAPP-A and PP5.
Extended esophageal pH monitoring. An analysis of the literature and assessment of its role in the diagnosis and management of gastroesophageal reflux.
In this review article we examine several facets of extended pH monitoring of the esophagus. The different types of instrumentation and the technical difficulties of obtaining and interpreting tests are discussed. The wide variations among different laboratories in the duration and timing of pH monitoring sessions are summarized. We outline the problems in interpretation and reproducibility such as normal control values, criteria for separation of abnormal from normal subjects, correlation of pH events with symptoms and with esophageal injury. Comparison of extended with short-term monitoring of esophageal pH are drawn, as well as comparisons between results of extended monitoring and other tests of reflux. Cost considerations are listed. Finally, we present a proposed scheme for the use of extended pH monitoring as well as a cautious note about accepting extended pH monitoring as a routine clinical test at present.
Respiratory complications of gastro-oesophageal reflux.
The association between pulmonary symptoms and gastro-oesophageal reflux has been well documented. However, it is still unclear whether abnormal pulmonary function causes increased reflux or reflux causes pulmonary symptoms. Available data suggest that both theories may be accurate. Clinical features of patients with reflux-induced pulmonary complications have been identified, although there are no specific methods for confirming this diagnosis. An algorithm that defines a series of diagnostic tests is presented. From the results of the small number of published clinical trials, it appears that antireflux surgery is the most effective and longest-lasting treatment for the correction of pulmonary symptoms.
Effect of stress on oesophageal motor function in normal subjects and in patients with the irritable bowel syndrome.
Stress can modulate the motor function of the stomach, small bowel, and colon in healthy subjects, and of the small bowel and colon in patients with the irritable bowel syndrome (IBS). The effect of stress on oesophageal motility in eight healthy subjects and in eight IBS patients was studied, using two pressure transducers positioned just above the lower oesophageal sphincter and 5 cm proximally. Stressors were: a video arcade game, delayed audio feedback, and hand immersion in cold water. Each stress period was followed by five swallows of water. Frequency and amplitude of oesophageal contractions and the number of simultaneous and multipeaked contractions were manually counted for each stress period and compared to the preceding rest period. Frequency of contractions (per minute) tended to decrease during stress periods, but achieved significance only with the video arcade game in the control group (2.0 (0.6) v 1.2 (0.4); p less than 0.01). No other trend was evident in either control or IBS patients. No abnormalities of oesophageal body function were recorded in IBS patients either in basal conditions, or under stress. Unlike the more complex motor programmes elsewhere in the gut, the preprogrammed nature of oesophageal peristalsis is not modulated by stress.
Endocrine and reproductive response of beef cows to PMSG.
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Esophageal symptoms, manometry, and histology before and after antireflux surgery: a long-term follow-up study.
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Cimetidine in the treatment of symptomatic gastroesophageal reflux: a double blind controlled trial.
The effectiveness of cimetidine for symptomatic relief in patients with chronic gastroesophageal reflux was studied in a multicenter, double blind clinical trial. Patients were entered into the study for a total of 8 weeks, receiving either cimetidine, 300 mg four times daily, or identical placebo tablets. Throughout the trial, frequent assessments were made of symptom severity and frequency, combined with careful measurement of antacid use. Esophagoscopy, esophageal acid sensitivity, and lower esophageal pressures were performed before and at the completion of the treatment period. Significant (P less than 0.05) decreases in symptom frequency and severity were noted throughout the study in the cimetidine-treated patients, as compared with the placebo group. This subjective improvement was corroborated by a concomitant decrease in antacid use, which was significantly (P less than 0.05) reduced in the cimetidine-treated group. In addition, significant improvement in esophageal acid sensitivity resulted from cimetidine therapy. No objective improvement in esophageal endoscopic appearance or sphincter pressures was noted. The results of this double blind trial indicate that cimetidine is more effective than the placebo for the relief of symptoms of gastroesophageal reflux.
Esophageal motility--who needs it?
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Esophageal manometrics in patients with angina-like chest pain.
Fifty-eight patients with angina-like chest pain had esophageal manometric testing. Forty-three had no evidence of coronary artery disease at the time of referral or at subsequent contact; 15 patients were proven to have coronary artery disease. High-amplitude contraction waves were the most frequently found manometric abnormality (15 patients). Less frequent were increased duration of contractions, achalasia, and diffuse esophageal spasm; the latter was present in only 3 patients. An approach to the interpretation of information obtained during manometry is presented. Using this approach, the esophagus was strongly implicated as the cause of the pain in 20 patients and was suspect in 18 others. Seven patients had results that exonerated the esophagus, and in the 13 remaining individuals, the esophagus was probably not the offending organ.
Motor disorders of the esophagus.
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Transfer of preimplantation pig embryos following in vitro culture for 24 or 48 hours.
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Studies of idiopathic intestinal pseudoobstruction. II. Hereditary hollow visceral myopathy: family studies.
Twelve relatives of a 15-year-old girl with idiopathic intestinal pseudoobstruction were studied with esophageal manometry or cine-esophagography to determine whether the disease was genetically transmitted. Four maternal relatives, including the patient's mother, 13-year-old brother, one aunt, and one of that aunt's children had mild dysphagia and esophageal motor dysfunction. In addition, the patient's mother and 13-year-old brother had a flaccid bladder and bilateral ureteral reflux, respectively. The brother had abnormal bladder smooth muscle by light microscopy. We conclude that idiopathic intestinal pseudoobstruction in this family is secondary to a generalized disease of smooth muscle which is transmitted as a dominant trait of variable expressivity, manifested in some family members as a mild disorder of esophageal smooth muscle dysfunction, at times accompanied by bladder dysfunction. We suggest that this form of idiopathic intestinal pseudoobstruction be called "hereditary hollow visceral myopathy." Esophageal manometry may prove useful as a tool for studying the inheritance of this disorder.
Esophageal reflux--an unrecognized cause of recurrent obstructive bronchitis in children.
Forty-three children with recurrent obstructive bronchitis but without prominent gastrointestinal symptoms were studied for esophageal reflux roentgenographically and by manometry. Roentgenographic evidence for reflux was shown in 26; these patients had a mean lower esophageal sphincter pressure of 6.3 mm Hg as compared to a mean LES pressure of 21.9 mm Hg in normal control infants. The remaining 17 patients had a mean LES pressure of 10.0 mm Hg, also significantly lower than that of control subjects. Fifteen of 20 patients with recurrent obstructive bronchitis noted alleviation of their pulmonary symptoms after medical treatment of their reflux. Sequential studies of another group with radiologically demonstrated reflux showed increases in sphincter pressures and disappearance of radiologically observed reflux in one third of the patients. It is suggested that esophageal reflux should be sought in patients with recurrent bronchitis: if found, antireflux therapy might be expected to improve the pulmonary symptomatology.
Influence of elevated ambient temperature on reproductive performance of boars.
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Esophageal motor dysfunction in idiopathic intestinal pseudoobstruction.
Five patients with idiopathic intestinal pseudoobstruction were studied with esophageal manometry and all had abnormalities of esophageal motility. In 2, primary peristalsis was replaced by simultaneous contractions and repetitive spontaneous activity was marked. The lower esophageal sphincter failed to relax and the Mecholyl test was positive in both. In the other 3, primary peristalsis was absent, low amplitude simultaneous waves followed swallows, no spontaneous activity was present, and defects in lower esophageal sphincter relaxation were found in two. The Mecholyl test was negative in the one patient tested. The esophagus appears to be abnormal in idiopathic intestinal pseudoobstruction and could prove useful as an organ for diagnostic study in patients who may have this syndrome.