Biomedical subjects

E Chrysos

Publications and source records attributed to E Chrysos.

31 records · Page 2Linked to original sources

PubMed1996

Effect of nifedipine on rectoanal motility.

PURPOSE: Based on the rationale that the calcium channel blocker, nifedipine, decreases lower esophageal sphincter pressure in achalasia, a prospective controlled trial was performed to evaluate the effect of sublingual nifedipine on the anal sphincter of controls and patients with high anal resting pressures. METHODS: Ten age-matched and sex-matched controls without evidence of anal disorder and ten patients with hemorrhoids and/or fissure-in-ano were included in the study. Anorectal manometry, with an eight-channel, water-perfused catheter was performed on all patients before and 30 minutes after administration of 20 mg of sublingual nifedipine. RESULTS: Nifedipine significantly reduced anal resting pressure in both controls and patients by approximately 30 percent (P < 0.001 and P < 0.0001, respectively). A significant reduction was also noted in the length of high-pressure zone of the anal sphincter (P < 0.02 for both groups) and in the frequency (controls, P < 0.05; patients, P < 0.03) and amplitude (controls, P < 0.03; patients, P < 0.009) of slow waves in both groups, whereas the presence, frequency, and amplitude of ultraslow waves were significantly reduced only in the patient group (P < 0.05; P < 0.01; P < 0.0005, respectively). CONCLUSION: Nifedipine reduces the activity of the internal anal sphincter both in controls and patients with high anal resting pressure. The drug might be of some use in relieving symptoms in patients with hemorrhoids or anal fissure.

Administration, Sublingual↗

PubMed1996

The effect of intravenous erythromycin on esophageal motility in healthy subjects.

BACKGROUND: It has been confirmed that erythromycin has gastrokinetic properties of enhancing gastric emptying both in health and disease. The objective of the present study was to investigate any possible effect of erythromycin on esophageal motility. METHODS: In 14 healthy subjects, standard esophageal manometry was performed before and after the intravenous administration of 200 mg of erythromycin. The calculated manometric parameters of esophageal motility were the lower esophageal sphincter (LES) pressure; the amplitude and duration of peristalsis at 5, 10, and 15 cm proximal to the LES; and the velocity and strength of peristalsis at 5 cm proximal to the LES. RESULTS: Erythromycin significantly increased the LES pressure (P<0.001), and the amplitude (P=0.002), duration (P=0.003), strength (P=0.014) and velocity (P=0.008) of peristalsis at 5 cm proximal to LES. Erythromycin also increased the amplitude of peristalsis at 10 cm proximal to the LES (P=0.035). CONCLUSION: Erythromycin affects the motility of the distal esophagus.

Adult↗

PubMed1996

Laparoscopic Heller's cardiomyotomy and Dor's fundoplication for esophageal achalasia.

The study's aim was to assess the functional results of laparoscopically performed Heller's myotomy and Dor's fundoplication in our first few cases of esophageal achalasia. Four male patients (mean age: 61 years) with long-standing symptoms of achalasia (documented on esophagogram and esophageal manometry) and not responding to several sessions of pneumatic dilatation, had laparoscopic Heller's myotomy and Dor's fundoplication. Myotomy was facilitated by distending the esophagus. The mean duration of the operation was 99 min. The third patient developed a leak from the exposed esophageal mucosa on the 5th postoperative day while at home. The leak was attributed to late desloughing of a mucosal burn, and was sealed spontaneously 15 days later after drainage. The remaining three patients were discharged after resuming diet within the first 2 postoperative days. By 1 year postoperatively, dysphagia was abolished in all cases, and there were no gastroesophageal reflux symptoms. The esophagogram showed no reflux, which was also confirmed on ambulatory 24-h esophageal pH measurement. On manometry, lower esophageal sphincter (LES) pressure dropped significantly postoperatively (preop: 56 +/- 7 SD mm Hg, postop: 5 +/- 1 SD mm Hg, p < 0.001). In conclusion, laparoscopic Heller's myotomy with Dor's fundoplication for esophageal achalasia is a feasible procedure, offering clinical and laboratory results similar to the open approach, but with better patient tolerance.

Adult↗

PubMed1995

Anorectal function after low anterior resection of the rectum.

Impaired neorectal function or sphincter incompetence have been respectively implicated as causative factors of increased frequency of defaecation or incontinence after low anterior resection of the rectum (LARR) for rectal carcinoma, although individual mechanisms of anorectal function have not been fully studied. Functional and laboratory results were evaluated in 19 subjects, who had a LARR for rectal carcinoma before and after the procedure, and were compared to those of normal subjects. LARR worsened anorectal function, mostly by significantly increasing the daily number of defaecations (p < 0.001), while major incontinence was reported in three cases. Patients with rectal carcinoma have a decreased resting anal pressure on manometry, as compared to controls (p < 0.001). LARR further reduces anal resting pressure (p < 0.001) as well as all parameters that express internal sphincter activity, such as presence and amplitude of either slow (p < 0.05 and p < 0.01) or ultraslow waves. LARR also impaired external anal sphincter activity, as expressed by the reduction in anal squeeze pressure (p < 0.001). Anorectal sampling was found reduced in incidence and frequency in LARR patients as compared to controls (p < 0.01 and p < 0.001), and was impaired even further postoperatively (p < 0.001). Rectoanal inhibitory reflex was present in all but three patients postoperative, but significantly impaired as compared to controls. Rectal volumes to elicit transient or permanent desire to defecate, maximal tolerable rectal volume and rectal compliance were also significantly reduced after LARR (p < 0.001, p < 0.001, p < 0.01 and p < 0.001 respectively). Large bowel transit was significantly enhanced after LARR (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Effect of hiatal hernia on esophageal manometry and pH-metry in gastroesophageal reflux disease.

An increased frequency of reflux events and a prolonged acid clearance have been shown in gastroesophageal reflux (GER) patients with a hiatal hernia as compared to those without. The objective of the present study was to further investigate esophageal motility and patterns of reflux in GER patients, in relation to the presence or absence of hiatal hernia. Esophageal manometry and ambulatory 24-hr esophageal pH-metry were used in 42 patients with GER and 18 controls. Eighteen of the patients were considered to have a nonreducing hiatal hernia on endoscopy. Hiatal hernia patients showed a higher extent of reflux (total composite score, P = 0.016; total reflux time, P = 0.008, reflux time in supine position, P = 0.024; reflux time in upright position, P = 0.008), a lower frequency of reflux events (P = 0.005), a more severe esophagitis on endoscopy (P < 0.01) and a lower amplitude of peristalsis at 5 cm proximal to LES (P = 0.0009) as compared to patients without hiatal hernia. The amplitude of peristalsis at the distal esophagus was inversely related to the extent of reflux (P = 0.024). Acid clearance was also significantly prolonged in the hernia subgroup (P = 0.011). Although LES resting pressure did not differ significantly between the two subgroups of patients, it was inversely related to the extent of reflux in the patients with hiatal hernia (P = 0.0005). It is concluded, that GER patients with hiatal hernia present with an increased amount of reflux and more severe esophagitis, which results in more severely impaired esophageal peristalsis as compared to patients without hernia. Prolonged acid clearance and impaired esophageal emptying observed in patients with hiatal hernia could be the result of both the presence of the hernia itself and the reduced peristaltic activity of the esophagus.

Adult↗

PubMed1994

Gallbladder emptying after antiulcer gastric surgery.

It has been shown that truncal vagotomy with pyloroplasty (TVP), but not highly selective vagotomy (HSV), delays the onset, decreases the extent, and changes the pattern of gallbladder emptying. The aim of the present study was to investigate any alterations in gallbladder emptying after a variety of antiulcer gastric surgery, by milk-technetium 99m (99mTc)-dimethyl iminodiacetic acid (HIDA) scintigraphy. After excluding the cases with spontaneous gallbladder evacuation before milk ingestion, there were 26 controls, 41 duodenal ulcer (DU) patients, 22 after HSV (15 prospective cases), 50 after TVP (23 prospective cases), 8 after TV with gastrojejunostomy (TV-GJ), 10 after Billroth I gastrectomy, and 29 after Billroth II gastrectomy. None of the patients with gastrectomy had additional vagotomy. TVP significantly delayed the onset and decreased the rate of gallbladder emptying as compared with the control, DU, HSV, and Billroth I groups. TVP also changed the pattern of emptying in 20% of the cases (sequential emptying and refilling events). Antiulcer operations excluding the duodenum (TV-GJ and Billroth II) further reduced the rate of gallbladder emptying as compared with (1) control, DU, HSV, and Billroth I groups (P < 0.0001) and (2) TVP (P < 0.001). Onset of gallbladder emptying was not affected by Billroth II gastrectomy, but was significantly delayed by TV-GJ (P < 0.001). The latter two operations also significantly changed the pattern of gallbladder emptying, exhibiting sequential emptying and refilling events, in most cases (P < 0.01 versus TVP). In conclusion, all antiulcer procedures, except HSV, greatly disturb the pattern, the onset, and the rate of gallbladder emptying. Truncal vagotomy seems to disrupt vagally mediated preduodenal mechanism, resulting in delayed onset and reduced rate, whereas duodenal exclusion by gastrojejunostomy results in severely decreased rate of gallbladder emptying.

Duodenal Ulcer↗

PubMed1994

Reproducibility of gallbladder emptying scintigraphic studies.

UNLABELLED: This study was designed to investigate the reproducibility of the results obtained from 99mTc-dimethyliminodiacetic acid (99mTc-EHIDA) cholescintigraphy, when used as a method of estimating gallbladder emptying. METHODS: In a random controlled fashion, the reproducibility of scintigraphic gallbladder emptying studies was assessed in 30 subjects, of whom six were normal, four had duodenal ulcers and the remaining 20 had undergone antiulcer gastric surgery. In fasting subjects, who 30 min later drank 250 ml of fresh milk, 2 mCi of 99mTc-EHIDA was intravenously injected. Liver and gallbladder areas were scanned for 60 sec and then every 5 min for 1 hr. The study was repeated in all subjects within 2-5 wk. From the gallbladder emptying curves, the duration of the lag phase (time from milk ingestion to actual start of emptying), the ejection fraction of emptying (peak to least activity in the gallbladder), the time by which maximal emptying was achieved and the pattern of gallbladder emptying were calculated. RESULTS: Two subjects were excluded from the study because their gallbladders did not fill. Lag phase duration was well reproduced in duplicate studies (r = 0.87), as was ejection fraction (r = 0.84). The time by which maximal emptying was achieved was not sufficiently reproduced. The normal pattern of emptying (exponential function) was reproduced in all controls, subjects with duodenal ulcers and patients after antiulcer surgery that did not involve duodenal exclusion. The abnormal pattern of emptying, characterized by refilling, was reproduced in five of the seven patients with gastric surgery that mainly involved duodenal exclusion. CONCLUSION: Scintigraphy with 99mTc-EHIDA to assess gallbladder motility is a method with satisfactory reproducibility of both parametric variables and patterns of emptying.

Duodenal Ulcer↗

PubMed1993

Anal manometry in patients with fissure-in-ano before and after internal sphincterotomy.

The motility pattern of the internal anal sphincter was estimated manometrically in 42 patients with fissure-in-ano before and after left lateral internal sphincterotomy (LAS). Resting anal pressure and anal pressure during straining were significantly higher in patients than in controls (132 +/- 21 SD cmH2O vs 81 +/- 14 SD cmH2O P < 0.0002 and 46 +/- 16 SD cmH2O vs 13 +/- 4 SD cmH2O P < 0.0005), but were normal after LAS. Slow waves were more common in fissure patients (86 +/- 6 SD% of total recording time vs 68 +/- 11 SD% of total recording time, P < 0.0002), but also became normal after successful treatment. The presence of ultra slow waves was also more common in fissure patients (P < 0.0001), and although it was significantly reduced postoperatively (P < 0.0001), it did not return to normal. Sampling was less frequent in fissure patients (P < 0.0001) and improved significantly after successful treatment (P < 0.0002). Rectal distension produced significantly less reduction in anal pressure in fissure patients as compared to controls (P < 0.01), but successful treatment returned the response to normal. There were 2 patients with anal fissure who did not heal after left LAS. Those patients and a further 5 patients with non healed fissures after left LAS showed the same pathological manometric features as before surgery. Their fissures were successfully treated by additional right lateral internal sphincterotomy. In conclusion, increased internal sphincter activity is probably an aetiological factor in fissure-in-ano, while successful LAS improves anal sphincter function.(ABSTRACT TRUNCATED AT 250 WORDS)

Anal Canal↗

PubMed1993

Differences in manometry and 24-H ambulatory pH-metry between patients with and without endoscopic or histological esophagitis in gastroesophageal reflux disease.

UNLABELLED: In this study, our objective was to examine prospectively, by endoscopy and histology of the esophageal mucosa, the severity of reflux esophagitis and any possible correlation between endoscopic and histological findings on the one hand, and manometric and 24-h ambulatory pH-metry measurements on the other. Forty-two patients with gastroesophageal reflux were prospectively examined. The results were compared with those of 18 healthy controls. Methods used were: 1) upper alimentary endoscopy and grading of severity of esophagitis, 2) esophageal mucosa biopsies, to estimate severity of esophagitis on histology, 3) standard esophageal manometry, by using a water perfused catheter with four side holes, and 4) standard 24-h ambulatory esophageal pH-metry. RESULTS: The severity of esophagitis as determined by both endoscopy and histology was significantly inversely related to the amplitude (p < 0.001) and duration (p < 0.01) of esophageal peristalsis at 5 cm proximal to LES; it was significantly related to the pH-metry total composite score (p < 0.001 for endoscopy, p < 0.05-0.01 for histology), the total reflux time (p < 0.001 for endoscopy, p < 0.01 for histology), the duration of longest reflux episode (p < 0.001 for endoscopy, p < 0.01 for histology), the number of reflux episodes lasting more than 5 min (p < 0.05 for endoscopy), and the frequency-duration index of reflux episodes (p < 0.001 for endoscopy, p < 0.01 for histology). Furthermore, strength reduction of peristalsis (< 60 mm Hg x s) was associated with acid exposure greater than 40%, in esophagitis patients. We conclude that the severity of reflux esophagitis, not only through endoscopy but also histologically, is related to the amount of reflux, as expressed by the duration and frequency of the reflux episodes. A very high amount of reflux is in turn associated with impairment of the esophageal body motility, as expressed by the amplitude and strength of esophageal body peristalsis.

Adult↗

PubMed1993

The effect of floppy Nissen fundoplication on esophageal and gastric motility in gastroesophageal reflux.

Thirty-five patients with gastroesophageal reflux (GER) proved on ambulatory esophageal hydrogen monitoring were surgically treated by a floppy Nissen fundoplication. Postoperatively, reflux and symptoms related to it were almost completely abolished. Transient bloating syndrome was observed in five instances. The operation significantly improved esophagitis (p < 0.01), increased lower esophageal sphincter pressure (p < 0.01) and increased amplitude of esophageal peristalsis (p < 0.01). However, postoperative motility of the esophagus as detected by manometry was still impaired as compared with that for the control group. Delayed esophageal transit did not improve postoperatively, although no dysphagia was accounted. Impaired esophageal motility in GER was associated with delayed gastric emptying, which, however, improved postoperatively. It is concluded that esophageal and gastric motor abnormalities are rather primary disorders in GER. After successful fundoplication, esophageal dysmotility, aggravated by reflux esophagitis, improves to some extent, while gastric emptying is enhanced.

Adult↗

PubMed1993

The effect of erythromycin in gastric emptying of solids and hypertonic liquids in healthy subjects.

We report our study of the effect of erythromycin on gastric emptying of solid and liquid meals in 10 healthy subjects. On different occasions, subjects consumed either a radiolabeled 50% glucose solution, or a radiolabeled standard solid meal after placebo, and after receiving 200 mg of erythromycin intravenously. Erythromycin accelerated the gastric emptying of the hypertonic liquid meal by significantly decreasing the duration of lag phase (p < 0.0001), by significantly increasing the emptying rate at the postlag period (p < 0.001), and by significantly decreasing the duration of the postlag period (p < 0.0001) and the meal remaining in the stomach at 15 (p < 0.05), 30 (p < 0.001), and 60 (p < 0.01) min postprandially. In addition, erythromycin administration induced a significant plasma fall at 15 (p < 0.05) and 30 (p < 0.01) min and a significant increase in pulse rate at 15 and 30 min (p < 0.01) after consumption of the hypertonic glucose solution, whereas three subjects experienced symptoms suggesting dumping syndrome. Furthermore, erythromycin administration enhanced the gastric emptying of solids by almost abolishing the duration of lag phase (p < 0.0001) and by reducing the overall t1/2 of emptying (p < 0.0001), whereas less food was retained in the stomach at 60 (p < 0.001) and 120 (p < 0.0001) min postprandially. Conversely, the postlag t1/2 of the solid meal emptying was not affected by erythromycin, as compared to placebo. We conclude that erythromycin has gastrokinetic properties, affecting the gastric emptying of both liquids and solids.

Adult↗

PubMedDate not supplied

Treatment of unresectable malignant abdominal, pelvic and thoracic tumors using abdominal pelvic and thoracic stop-flow chemotherapy.

BACKGROUND: Stop-flow perfusion (SFP) has been recently used to enhance the effects of chemotherapy in patients with locally advanced tumors. PATIENTS AND METHODS: Over a 2-year period we performed abdominal, pelvic and thoracic SFP in 12 patients with unresectable or metastatic tumors, using balloon catheters inserted into the abdominal aorta and inferior vena cava. Blood flow was occluded and hypoxic extracorporeal perfusion or SFP was performed for advanced diseases. The chemotherapeutic agents were directly administered into the aorta and/or inferior vena cava for thoracic SFP. The procedure was repeated in each patient, with one-month interval between sessions. Haemofiltration was also applied in two patients with generalized abdominal disease in order to reduce systemic toxicity. RESULTS: At post-operative CT or MRI follow-up, tumor shrinkage of more than 50% was observed in six patients, while post-SFP chemotherapy surgical resection of the tumors became feasible in four cases. The relief of pain, wherever present, was dramatic in the immediate post-operative period. Overall clinical improvement was achieved in all 12 patients. Post-operative recovery was uneventful in all but two patients, who developed minor systemic toxicity. CONCLUSION: SFP appears to be a safe technique with low morbidity which improves the quality of life of cancer patients and allows satisfactory control of locally advanced tumors and metastatic carcinomatosis.

Abdominal Neoplasms↗

PubMedDate not supplied

A composite score of enterogastric reflux quantitation on 99mTc-HIDA scintigraphy.

BACKGROUND/AIM: Enterogastric reflux of bile, and duodenal and pancreatic secretions may occur either spontaneously or, more commonly, after gastric surgery. The most reliable method in discriminating symptomatic from asymptomatic postgastric surgery refluxers, and in predicting a good clinical result after surgical diversion in the former group, is the quantitation of reflux by 99mTc-HIDA scintigraphy. MATERIALS AND METHODS: In 28 normal subjects and 143 postgastric surgery patients, the enterogastric reflux (EGR) was demonstrated by 99mTc-HIDA scintigraphy on 230 occasions. The EGR index was quantitated according to two different formulae: the former one based on the amount of refluxate (percentage of maximal radioactivity of the gastric area over the total abdominal activity--EGR-Im) and the latter one based on the amount and the duration of the time of reflux (CompEGR-Im) and representing the area of the surface below the curve, which was yield by plotting EGR-Im values (obtained every 5 min for one hour) against time. RESULTS: Although there was a highly significant correlation of values between the two methods (p<0.0000001), the latter one was more reliable in classifying postgastric surgery patients according to the presence of reflux symptoms and the reflux index. CONCLUSIONS: In patients with a CompEGRpIm>770 and postgastric surgery symptoms, at least some of the symptoms can be safely be attributed to enterogastric reflux.

Bile Reflux↗