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Biomedical subjects

G F Longstreth

Publications and source records attributed to G F Longstreth.

At least 19 recordsLinked to original sources
PubMed1990

Irritable bowel syndrome in women having diagnostic laparoscopy or hysterectomy. Relation to gynecologic features and outcome.

We identified irritable bowel syndrome (IBS) in 47.7% of 86 women having diagnostic laparoscopy for chronic pelvic pain, 39.5% of 172 women having elective hysterectomy, and 32.0% of 172 controls age-matched for the hysterectomy group (P = NS). Constipation and pain subtype IBS were more common in hysterectomy patients than controls (P less than 0.05). In laparoscopy patients, dyspareunia was more common in those with IBS than in those without it (P less than 0.05). In the hysterectomy group, more IBS patients had chronic pelvic pain (P less than 0.005), and abnormal menses (P less than 0.01). Chronic pelvic pain was more frequently the only prehysterectomy diagnosis in IBS patients (P less than 0.05), and IBS was present more often when pain was a reason for hysterectomy (P less than 0.01). One year after laparoscopy, IBS patients gave lower overall status ratings (P less than 0.01) and lower pain improvement ratings (P less than 0.05) than non-IBS patients. In women who had a hysterectomy for pain, there was less pain improvement one year later in those with the pain subtype of IBS than in non-IBS patients (P less than 0.05). IBS is associated with gynecologic symptoms and affects the symptomatic outcome of diagnostic laparoscopy and hysterectomy.

Adult↗
PubMed1989

Cyclophosphamide therapy of idiopathic hepatic granulomatosis.

A 50-year-old woman presented with idiopathic hepatic granulomatosis and autoimmune hemolytic anemia. Splenectomy corrected the anemia, and the liver disorder responded to prednisone. However, her liver disease relapsed on four occasions when prednisone was tapered, including three episodes when hepatic granulomatosis was proven by biopsy. Cyclophosphamide therapy allowed prednisone withdrawal, and she has remained in clinical and biochemical remission for two years on a low dose of the drug.

Anemia, Hemolytic, Autoimmune↗
PubMed1988

Checking for "the occult" with a finger. A procedure of little value.

The performance of an occult blood test on normal-appearing feces obtained by rectal examination probably yields such high rates of false positive and false negative reactions that it is of little value in the detection of colorectal neoplasia. In acute gastrointestinal bleeding, it helps to know what the stool looks like; nevertheless, many physicians merely describe it as "heme positive" and neglect to record its gross appearance. Both of these practices should be discouraged.

Colonic Neoplasms↗
PubMed1987

Detecting colorectal neoplasms. Assessment based on hypothetical cases.

Because of the controversy surrounding the detection of colorectal neoplasia, I used 10 hypothetical, typical patients to assess the testing attitudes of 33 experienced colonoscopists. There was great disagreement on the type and frequency of the advised diagnostic investigation in some cases. The magnitude of interphysician variation in testing attitudes has major implications concerning cost and risk. This is particularly applicable to the interval between follow-up colonoscopies after polypectomy and cancer surgery, and the evaluation of patients with a positive fecal occult blood test. I reviewed the recent literature most pertinent to the patients. Although I could not derive firm guidelines for most of the cases from my review, consideration of the case management decisions, in light of available information, suggests that some gastroenterologists are testing many patients more than necessary, especially with colonoscopy.

Adenocarcinoma↗
PubMed1986

Acute nonvariceal upper gastrointestinal bleeding. Care in three different San Diego practice settings.

We compared the care of all adults admitted directly for acute nonvariceal upper gastrointestinal bleeding in 1981 to three types of hospitals: private (n = 138), health maintenance organization (HMO) (n = 105), and university (n = 72). Some patient characteristics differed, but most indices of blood loss, all final diagnoses, and rates of surgery (less than 9%) and death (less than 5%) were similar. Use of intensive care and blood products differed from published guidelines. Health maintenance organization patients had the shortest stays and the fewest transfusions, limited almost completely to packed red cells. Intensive care unit use and duplicate diagnostic testing were greatest for university patients. Rebleeding rates, determined by including readmissions within 1 week of discharge, were less than 7% and similar at the three institutions. Endoscopic signs of recent hemorrhage from an ulcer were significant signposts to rebleeding. Patients endoscoped early and those without endoscopic signs of recent hemorrhage went home sooner than the others.

Aged↗
PubMed1985

Night blindness after jejunoileal bypass surgery.

A 53-year-old woman developed night blindness 9 years after jejunoileal bypass surgery. Abnormal rod function was confirmed by dark-adapted electroretinography, and vitamin A deficiency was confirmed by low serum levels of vitamin A and carotene. Administration of oral vitamin A supplementation resulted in complete resolution of the patient's symptom and return of the electroretinogram to normal. Based on this case and the four previously reported cases, we suggest that jejunoileal bypass patients be routinely questioned about decreased night vision. Patients with this complaint should undergo thorough ophthalmic evaluation. Dark-adapted electroretinography or dark adaptation testing should be done to establish the presence of abnormal rod function, and serum levels of vitamin A or carotene should be obtained to identify the cause. It is important to identify vitamin A-deficient patients because of their potential to develop permanent impairment of night vision.

Administration, Oral↗
PubMed1977

Abdominal pain caused by diabetic radiculopathy.

In diabetes mellitus, pain and weakness in a lower extremity can result from lumbosacral radiculopathy. However, abdominal pain caused by a similar type of thoracic nerve root disease is not generally recognized. Four diabetic patients with abdominal pain were studied. In none of the patients was the actual cause--radiculopathy--suspected until after extensive negative diagnostic investigation, which frequently included invasive procedures. Their clinical features were suggestive of malignant disease. Electromyographic examination revealed the correct diagnosis, and all four of the patients had a spontaneous and complete recovery.

Abdomen↗
PubMed1977

Postprandial gastric, pancreatic, and biliary response to histamine H2-receptor antagonists active duodenal ulcer.

Histamine H2-receptor antagonists are potentially useful agents in duodenal ulcer and knowledge of their effect on postprandial digestive events will contribute to their clinical application. We studied the effect of 200- and 300-mg doses of cimetidine, an H2-receptor antagonist, taken with an ordinary meal, on gastric, pancreatic, and biliary function. Both doses significantly reduced acid output and its delivery into the duodenum. Gastric secretory volume and pepsin output were less affected. Acid inhibition was related to blood drug levels and was less than that previously found at night in nocturnal fasting studies. As the stomach emptied the food, the gastric pH rose. The fractional gastric emptying rate, pancreatic enzyme, and bile acid outputs were unaltered. Cimetidine taken orally with meals at these doses is a potent gastric antisecretory agent without affecting other postprandial gastric, pancreatic, or biliary functions.

Adult↗
PubMed1977

Gastric secretion and emptying after ordinary meals in duodenal ulcer.

We have studied the gastric response to an ordinary solid-liquid meal in 12 patients with active duodenal ulcer and 8 healthy volunteers. Our method employs gastric and duodenal markers to quantify acid, pepsin, and volume outputs in response to the meal, without manipulating intragastric pH. Intragastric volume, rate of gastric emptying, delivery of acid into the duodenum, and serum gastrin response were also measured simultaneously. On a separate day, peak acid output in response to betazole (1.5 mg per kg subcutaneously) was determined. Our results indicate an inappropriately prolonged gastric secretory response to meals in duodenal ulcer disease, without a concomitant increase in peak postprandial secretory rates or an increase in serum immunoreactive gastrin levels. Further, the stomach in duodenal ulcer disease did not "retain" the additional acid secreted in the later postprandial period, and abnormally high rates of acid delivery into the duodenum occurred. Our data are consistent with a dual defect in the duodenal mechanisms regulating both acid secretion and acid delivery into the duodenum.

Adult↗
PubMed1976

Cimetidine suppression of nocturnal gastric secretion in active duodenal ulcer.

Nocturnal pain and gastric hypersecretion are common in duodenal ulcer. Therefore, we investigated the antisecretory effects of a new H2-receptor antagonist, cimetidine, in 200-, 300- or 400-mg doses, taken orally at bedtime. The 200-mg dose did not cause a statistically significant change in nocturnal (midnight to 7 a.m.) acid output and had only a borderline effect on pH. However, the 300-mg and 400-mg doses significantly (P less than 0.001) lowered acid output and increased (P less than 0.01) intragastric pH. All doses caused substantial decreases in secretory volume output. After a 400-mg dose, half the patients remained anacidic for eight hours. Dose-related increases of drug blood levels were observed and correlated with the degree and duration of inhibition of acid output. Serum gastrin levels were unaffected. Cimetidine appears to be a potent inhibitor of nocturnal gastric secretion.

Administration, Oral↗