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Biomedical subjects

E D Ehrenpreis

Publications and source records attributed to E D Ehrenpreis.

At least 19 recordsLinked to original sources
PubMed2003

Electrolyte profiles within the ileoanal pouch: measurement by an in vivo equilibrium dialysis technique.

BACKGROUND: Patients with an ileoanal pouch have high rates of fluid and electrolyte loss. These improve with pouch adaptation. There is limited information concerning secretion and absorption in the stable ileoanal pouch. A new method to measure and characterize electrolytes in the ileoanal pouch is described. METHODS: Following an in vitro study, nine patients with a stable ileoanal pouch had consecutive placement of dialysis bags consisting of a semi-permeable membrane containing 5 ml of 10% dextran in normal saline into the ileoanal pouch. These were left in place for 15, 30, 60, and 120 min. After determining that 60 min was the optimal timing for measurement of electrolyte concentrations, 12 normal volunteers underwent a similar in vivo dialysis study with dialysis bags withdrawn at 60 min. Sodium, chloride, potassium, phosphorus, calcium and magnesium concentrations in the dialysis bags were compared between the two groups. RESULTS: In the in vitro and in vivo studies, the measured electrolytes reached equilibrium within 60 min. Statistically significant differences between sodium concentrations (160.9 +/- 30.2 vs. 116.8 +/- 13.8 mmol/l, respectively) and phosphorus concentrations (6.8 +/- 5.2 vs. 1.8 +/- 0.7 mg/dl, respectively) at 60 min in ileoanal pouch patients and volunteers were found (p<0.001). There were no statistical differences in the other measured electrolytes between the two groups. CONCLUSION: An in vivo dialysis technique is described for measuring electrolyte concentrations within the ileoanal pouch. Differences in sodium and phosphate concentrations may reflect incomplete adaptation of the ileoanal pouch, and are a potential explanation for increased stool frequency in these patients.

Adult↗
PubMed2002

A pilot study of thalidomide for patients with symptomatic mesenteric panniculitis.

BACKGROUND: Mesenteric panniculitis is a rare condition with no standard therapy. AIM: To assess the safety and efficacy of thalidomide for the treatment of patients with symptomatic mesenteric panniculitis using a newly established clinical disease activity index (Mesenteric Panniculitis Subjective Assessment Score). METHODS: In an open-label pilot study, five patients with symptomatic mesenteric panniculitis received oral thalidomide, 200 mg nightly, for 12 weeks. The primary end-point was a reduction in the Mesenteric Panniculitis Subjective Assessment Score by > or = 20% at 12 weeks or complete remission (absence of symptoms). RESULTS: Four (80%) of the five patients responded. The median Mesenteric Panniculitis Subjective Assessment Score at baseline was 39 and at week 12 was 25 (average decrease of 44%). One patient achieved complete remission by week 4, which was sustained. At 12 weeks, three (75%) patients experienced a global response, five (100%) patients had a > or = 20% (range, 29-98%) decrease in erythrocyte sedimentation rate and three (75%) patients had a > or = 20% (range, 61-93%) decrease in C-reactive protein. Abdomino-pelvic computed tomography scans were unchanged in all five patients. There were no serious adverse events. CONCLUSIONS: Thalidomide is safe, well tolerated and efficacious in the treatment of some patients with symptomatic mesenteric panniculitis. Further study is indicated.

Aged↗
PubMed2002

Gastro-oesophageal reflux disease in obesity: pathophysiological and therapeutic considerations.

Gastro-oesophageal reflux disease (GERD) is common in obese patients. Apart from the physical discomfort and the economic burden, GERD may increase morbidity and mortality through its association with oesophageal carcinoma. The pathophysiology of GERD differs between obese and lean subjects. First, obese subjects are more sensitive to the presence of acid in the oesophagus. Second, hiatal hernia, capable of promoting GERD by several mechanisms, is more prevalent among the obese. Third, obese subjects have increased intra-abdominal pressure that displaces the lower oesophageal sphincter and increases the gastro-oesophageal gradient. Finally, vagal abnormalities associated with obesity may cause a higher output of bile and pancreatic enzymes, which makes the refluxate more toxic to the oesophageal mucosa. The altered body composition associated with obesity affects the pharmacokinetics of drugs. There are no data regarding the efficacy of any of the drugs used for GERD treatment. The dosages of cimetidine and ranitidine should be calculated according to the patient's ideal body weight, not their actual weight. Of the operative procedures used for weight loss, Roux-en-Y gastric bypass was found to be most effective for GERD, while gastric banding was associated with a high prevalence of reflux. This review outlines the pathophysiology and the treatment of GERD in obesity with emphasis on the therapeutic considerations in this population of patients.

Body Composition↗
PubMed2001

Review article: current therapeutic options for radiation proctopathy.

Radiation proctopathy is a common unfortunate complication following radiation therapy of pelvic malignancies. Symptoms of chronic radiation proctopathy include haematochezia, urgency, constipation, tenesmus, diarrhoea and rectal pain. Currently, a wide variety of pharmacological options, endoscopic cautery techniques and surgical procedures have been proposed for the treatment of chronic radiation proctopathy. Although these have been proposed primarily as treatment for rectal bleeding, the control of other symptoms has been noted with some of these agents. Pharmacological options include 5-aminosalicylic acid preparations, coticosteroid enemas, sucralfate (oral, enemas), formalin, short chain fatty acid enemas, oestrogen/progesterone, hyperbaric oxygen, antioxidants, sodium pentosan polysulphate and misoprostol rectal suppositories. Of these, sucralfate and formalin therapy appear to be effective for bleeding control. Misoprostol rectal suppositories and oral sucralfate may be useful in the prevention of acute and chronic symptoms of radiation proctopathy. Endoscopic cautery techniques have included the use of Nd:YAG laser and argon laser for coagulation of bleeding neovascular telangiectasias. Argon plasma coagulation offers a safe non-contact method of delivering haemostasis which has proven to be particularly useful in targeting difficult to reach lesions tangentially. Surgery is generally reserved for severe refractory cases involving ongoing haemorrhage, obstruction, stricture formation, fistulas and perforation. Given that formal randomized placebo-controlled studies are lacking for most treatments, the management of these patients is often challenging and unclear. Hence, there is a need for more research and education on radiation proctopathy.

Adrenal Cortex Hormones↗
PubMed2001

Improving the serum D-xylose test for the identification of patients with small intestinal malabsorption.

BACKGROUND: D-Xylose absorption testing is a simple, low-cost method of screening for small intestinal malabsorption. The optimum method to measure D-xylose absorption (serum vs. urine testing) is uncertain. GOALS: We present a method of improving the accuracy of D-xylose testing. STUDY: Fifty-one consecutive patients (40 with chronic diarrhea and 5 asymptomatic patients with renal insufficiency) and 6 volunteers with normal renal function were recruited. All received D-xylose, 10 g intravenously and 25 mg orally, on two separate occasions. Serum concentration was determined at baseline and at frequent times thereafter. Area under the curve was calculated to infinity, and D-xylose bioavailability (F) was calculated. A nonlinear model used to derive the relationship between 3-hour D-xylose concentrations and F showed that a value of less than 22.5 mg/dL correlated with an F of less than 60% (malabsorption of D-xylose). A 1-hour D-xylose of less than 20 mg/dL was considered abnormal. RESULTS: Using these indexes for normal 1-and 3-hour D-xylose levels, 90% of patients with D-xylose malabsorption were identified (sensitivity, 90%; specificity, 95%), which represents a marked improvement within the conventional 1-hour D-xylose of less than 20 mg/dL alone (sensitivity, 71%; specificity, 100%). The model was applied prospectively to 15 additional patients with chronic diarrhea. Of these, 12 patients with an F of less than 60% were identified, including 2 patients with normal 1-hour D-xylose levels. CONCLUSIONS: Thus, the addition of a 3-hour D-xylose serum level of less than 22.5 mg/dL to conventional 1-hour D-xylose determination greatly improves the D-xylose test for malabsorption screening.

Adult↗
PubMed2001

Treatment of anal fissures with topical nitroglycerin.

Anal fissure is a painful condition that is caused by anodermal tearing after the passage of hard stool. Severe cases result in involuntary internal anal sphincter spasm and have traditionally been treated surgically with a lateral sphincterotomy. Investigators have demonstrated that nitric oxide causes relaxation of the smooth muscle of the anal canal, so topical nitroglycerin ointment preparations have recently been studied as an efficacious alternative to surgery. Despite the fact that there are a number of trials examining topical nitroglycerin for the treatment of anal fissures, there remains no consensus about concentrations, compositions and applications necessary to obtain good results. This review summarises current literature regarding topical nitroglycerin pharmacotherapy for anal fissure.

Administration, Topical↗
PubMed2001

Thalidomide treatment for refractory Crohn's disease: a review of the history, pharmacological mechanisms and clinical literature.

Several recent case reports and clinical trials have demonstrated that thalidomide is emerging as an efficacious alternative in the treatment of selected patients with refractory Crohn's disease. The effects of thalidomide are at least partly mediated by down-regulation of tumour necrosis factor (TNF)-alpha, a potent proinflammatory cytokine. However, thalidomide is also known to inhibit angiogenesis, and it has several other well-described immunomodulatory properties. Clinical studies have confirmed that previously refractory Crohn's disease patients respond to thalidomide, and many enter clinical remission. Efficacy usually occurs within 4 weeks. Thalidomide also has steroid-sparing properties, and it is particularly useful in treating oral and fistulous complications of Crohn's disease. Although it is usually tolerable, careful monitoring is recommended to prevent toxicities, such as birth defects and peripheral neuropathy. This review provides a detailed summary of the literature to date on the use of thalidomide treatment for Crohn's disease. Special attention is directed towards its history, mechanisms, and proposed role. The recent development of thalidomide analogues is also discussed briefly.

Anti-Inflammatory Agents↗
PubMed2000

Malabsorption testing: a review.

Malabsorption syndromes often present diagnostic dilemmas to even the most experienced clinicians. Several malabsorption screening tests are available, but d-xylose testing is our initial screening method of choice. Recent innovations such as serum assays for antibodies associated with celiac sprue are improving the work-up of patients with suspected malabsorption. In addition, physicians are applying technological advances in imaging to determine the underlying pathologies responsible for the occurrence of malabsorption and maldigestion. Breath testing remains a controversial modality in the work-up of patients with malabsorption. Tubeless tests of pancreatic function are also the subject of debate due to a lack of sensitivity for diagnosing mild to moderate chronic pancreatic insufficiency. This review identifies and provides critical analysis of new developments in the field of malabsorption testing. The authors also provide a clinical algorithm for diagnosing malabsorption.

Algorithms↗
PubMed2000

D-xylose kinetics and hydrogen breath tests in functionally anephric patients using the 15-gram dose.

Malabsorptive evaluation in renal failure is difficult because most absorptive testing requires urinary collections. Kinetic analysis of d-xylose absorption and d-xylose breath testing were performed in an effort to establish an effective absorption test in functionally anephric patients. We studied 13 fasting renal failure patients with no diarrhea or symptoms suggesting malabsorption on two separate nondialysis days after they received 15 g oral d-xylose on day 1 and 10 g IV on day 2. Serum collections were used to calculate the kinetic rate constants and extent of d-xylose absorption. After the oral d-xylose, end expiratory breaths were collected every 15 minutes for 3 hours and were analyzed for H2 with gas chromatography. Five subjects also allowed upper endoscopy and duodenal biopsy. The mean absorption rate constant (Ka) and bioavailability (F) were similar to published values for normal subjects using the 15-g dose (0.936 min(-1); range, 0.227-1.96; and 74%, range 46-99, respectively). Of the patients, 12 had normal 1-hour serum d-xylose concentrations (>20 mg/dL). There was no clear inverse correlation between the rate constant for absorption or bioavailability and peak breath hydrogen or the area under the curve for breath H2 versus time. Using 15 g oral d-xylose, mean bioavailability and absorption rate constants are normal in functionally anephric patients with no clinical evidence of malabsorption. Three patients had elevated breath peak H2 concentrations, but there was no clear inverse correlation between bioavailability and the breath H2 values. A 1-hour serum dxylose concentration >20 mg/dL may be considered normal in this patient group, similar to patients with normal renal function.

Adult↗
PubMed1999

Colonoscopy in octogenarians: a review of 428 cases.

Studies on the use of colonoscopy in the octogenarian are few. Therefore this study evaluated the results and cost-effectiveness of colonoscopy in octogenarians. A total of 403 patients 80 years of age or older who underwent colonoscopy from May 1994 to May 1996 were reviewed (median 84, range 80-95). Parameters evaluated were indications for colonoscopy, significant endoscopic findings (biopsy-confirmed adenocarcinoma and adenomatous polyps >/=1 cm), complications, colonoscopy completion rate, and mean charge per procedure. Postpolypectomy bleeding occurred in one patient. The cecal intubation rate was 94%. The calculated cost per procedure was U.S. $2,342. Indications for colonoscopy/number of cancers detected include: change in bowel habits, 78/2; blood/hemoccult positive, 69/8; abdominal pain, 12/0; constipation, 9/0; diarrhea, 8/0; surveillance for history of polyps, 159/3; surveillance for history of cancer, 51/1; cancer or polyp on sigmoidoscopy, 42/4. The cancer detection rate in patients with bleeding was 11.5%, compared with 1. 9% for all other symptoms. Colonoscopy can be safely performed in the octogenarian population. Our data suggest that more stringent selection criteria for colonoscopy in the octogenarian could result in significant cost savings.

Adenocarcinoma↗
PubMed1999

Acute pancreatitis in human immunodeficiency virus-infected patients: a review.

Acute pancreatitis is a clinical condition that develops when active pancreatic inflammation is induced by stimuli noxious to the pancreas. Patients infected with human immunodeficiency virus (HIV) often have histologic abnormalities of the pancreas, and acute pancreatitis is much more common in HIV-infected patients than in the general population. This article reviews the epidemiology and etiology of acute pancreatitis in HIV-infected patients. The clinical presentation and treatment of acute pancreatitis in HIV-infected patients are also reviewed.

AIDS-Related Opportunistic Infections↗
PubMed1999

Thalidomide therapy for patients with refractory Crohn's disease: an open-label trial.

BACKGROUND & AIMS: Inhibition of tumor necrosis factor is a proposed mechanism for the anti-inflammatory properties of thalidomide. We performed an open-label trial of thalidomide in refractory Crohn's disease. METHODS: Twenty-two patients with refractory Crohn's disease (Crohn's Disease Activity Index [CDAI] > 200 and/or draining perianal disease) initiated therapy with thalidomide, 200 mg at bedtime (18 patients), or 300 mg at bedtime (4 patients). CDAI and goal interval scores (GIS) were assessed at weeks 0, 4, and 12. Clinical response for patients with luminal disease was defined as reduction in CDAI score of >150 points and for fistula patients was 2 scores of >/=1+ in 3 parameters of the GIS. Clinical remission was defined as a total CDAI < 150 (luminal patients) or >/=2+ for all parameters of the GIS (fistula patients). RESULTS: Nine patients with luminal disease and 13 with fistulas (16 male, 6 female) were enrolled. The median CDAI score at entry was 371 (95-468). Sixteen patients completed 4 weeks of treatment (12 clinical responses, 4 clinical remissions). All 14 patients completing 12 weeks met criteria for clinical response. Nine achieved clinical remission (3 luminal, 6 fistula patients). The median CDAI score was 175 (30-468; P < 0.001 vs. baseline). CONCLUSIONS: Thalidomide is efficacious in some patients with refractory Crohn's disease.

Adult↗
PubMed1999

D-xylose testing.

The literature on D-xylose testing has been reviewed, stressing advances in our understanding of absorption in general (including D-xylose absorption), the relationship of D-xylose testing to the development of excellent serologic tests for the diagnosis of celiac disease, the use of D-xylose testing in the evaluation of diarrhea in acquired immunodeficiency syndrome, new information on breath testing for the evaluation of malabsorption, and recent information on the understanding of D-xylose absorption compared with transcellular vs. paracellular transport. The authors suggest ways in which D-xylose testing might be employed in malabsorption or diarrhea evaluations, including some algorithms.

Adult↗
PubMed1998

Which form of erythromycin should be used to treat gastroparesis? A pharmacokinetic analysis.

BACKGROUND: Erythromycin is a macrolide antibiotic that exhibits prokinetic effects. It has been shown to enhance antral contractility and accelerates gastric emptying rates, primarily by stimulating motilin receptors. AIM: To determine the optimal dosage form of erythromycin for use as a prokinetic agent. METHODS: Eight normal volunteers and three patients with documented gastroparesis ingested 250 mg erythromycin in tablet. suspension and intravenous forms. Serum erythromycin levels were determined at frequent intervals. These data were plotted vs. time and analysed for lag time, time to maximum concentration (tmax), maximum concentration (Cmax) and bioavailability (F). RESULTS: The absorption kinetics of the erythromycin suspension was notable for short lag times and early tmax, while lag times and tmax were delayed with the tablet form. Median lag time was 15 min for the suspension vs. 90 min for the tablet (P < 0.005). Median tmax for the suspension was 45 min vs. 180 min for the tablet (P < 0.005). A non-significant decrease in F was seen with the suspension compared to the tablet (P = 0.12). CONCLUSION: Based on the kinetic data from this study, erythromycin suspension is the ideal dosage form for administration of this drug as a prokinetic agent.

Administration, Oral↗
PubMed1998

Alterations in colonic anatomy induced by chronic stimulant laxatives: the cathartic colon revisited.

Cathartic colon is a historic term for the anatomic alteration of the colon secondary to chronic stimulant laxative use. Because some have questioned whether this is a real entity, we investigated changes occurring on barium enema in patients ingesting stimulant laxatives. Our study consisted of two parts. In part 1, a retrospective review of consecutive barium enemas performed on two groups of patients with chronic constipation (group 1, stimulant laxative use [n=29]; group 2, no stimulant laxative use [n=26]) was presented to a radiologist who was blinded to the patient group. A data sheet containing classic descriptions of cathartic colon was completed for each study. Chronic stimulant laxative use was defined as stimulant laxative ingestion more than three times per week for 1 year or longer. To confirm the findings of the retrospective study, 18 consecutive patients who were chronic stimulant laxative users underwent barium enema examination, and data sheets for cathartic colon were completed by another radiologist (part 2). Colonic redundancy (group 1, 34.5%; group 2, 19.2%) and dilatation (group 1, 44.8%; group 2, 23.1%) were frequent radiographic findings in both patient groups and were not significantly different in the two groups. Loss of haustral folds, however, was a common finding in group 1 (27.6%) but was not seen in group 2 (p < 0.005). Loss of haustral markings occurred in 15 (40.5%) of the total stimulant laxative users in the two parts of the study and was seen in the left colon of 6 (40%) patients, in the right colon of 2 (13.3%) patients, in the transverse colon of 5 (33.3%) patients, and in the entire colon of 2 (13.3%) patients. Loss of haustra was seen in patients chronically ingesting bisacodyl, phenolpthalein, senna, and casanthranol. We conclude that long-term stimulant laxative use results in anatomic changes in the colon characterized by loss of haustral folds, a finding that suggests neuronal injury or damage to colonic longitudinal musculature caused by these agents.

Aged↗
PubMed1997

Idiopathic midesophageal stricture: a new cause of dysphagia in a patient with AIDS.

A number of disorders may result in the complaint of dysphagia in HIV-infected patients. These include fungal, viral, bacterial, parasitic, medication-induced, and idiopathic lesions in the esophagus. In the current case, a 32-year-old man with advanced HIV infection had recurrent bouts of esophageal stricture. No ulcer was associated with this stricture. No infectious causes of the stricture could be determined. The patient required multiple upper endoscopies and dilatations for treatment of this stricture and subsequently had a food impaction. This is the first case in the medical literature of an idiopathic stricture in the middle portion of the esophagus in an HIV-infected patient. We postulate that this lesion may have been caused by the patient's medications. Esophageal strictures should be considered in HIV-infected patients with severe dysphagia or food-bolus impactions of the esophagus.

Acquired Immunodeficiency Syndrome↗