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Biomedical subjects

G R Grahame

Publications and source records attributed to G R Grahame.

10 recordsLinked to original sources
PubMed1999

Risk of sedation for upper GI endoscopy exacerbating subclinical hepatic encephalopathy in patients with cirrhosis.

BACKGROUND: The risk of exacerbating subclinical hepatic encephalopathy associated with the administration of sedative drugs in patients with cirrhosis undergoing diagnostic upper gastrointestinal (GI) endoscopy for portal hypertension remains to be determined. METHODS: Ten adult patients with cirrhosis completed number connection tests before sedation for endoscopy and at discharge from the endoscopy unit 2 hours post-procedure. Control patients consisted of five patients with cirrhosis undergoing the same procedure for the same indication who did not receive sedation and 12 patients with no evidence of liver disease who received sedation before diagnostic endoscopy for a variety of GI complaints. The control populations were age, gender, education level, and, in the case of patients with cirrhosis, Child Pugh s score matched to the patients with cirrhosis who received sedation. RESULTS: The mean (+/- SEM) age of patients with cirrhosis who received sedation was 59.6 +/- 3.8 years. Seven of the ten (70%) were men. Their mean Child Pugh s score was 7.2 +/- 1.5. Nine of the ten (90%) had abnormal baseline number connection tests results (mean for the group 52.3 +/- 6.7 seconds) the extent of which correlated with Child Pugh s scores (p < 0.005). Individually, the baseline number connection tests results were normal in one (10%), mild in six (60%), moderate in one (10%), and severe in two (20%). After the procedure (before discharge) the mean number connection tests result was 61.5 +/- 7.9 seconds (p = 0.01 when compared with baseline). The results were now normal in none (0%), mild in four (40%), moderate in four (40%), and severe in two (20%). Pre- and post-procedure number connection tests results did not change in the non-sedated cirrhotic or sedated non-liver disease control patients. CONCLUSIONS: The results of this study indicate that (1) the majority of patients with cirrhosis and suspected portal hypertension have evidence of subclinical hepatic encephalopathy, (2) the extent of encephalopathy correlates with the Child Pugh's score, (3) sedation with midazolam for upper GI endoscopy exacerbates the encephalopathy, and (4) this adverse effect is still evident 2 hours after the procedure.

Adult↗
PubMed1997

The diagnostic yield of lower endoscopy plus biopsy in nonbloody diarrhea.

BACKGROUND: Patients presenting with diarrhea frequently undergo lower endoscopy plus biopsy as part of their diagnostic evaluation. The diagnostic yield of this approach has not been systematically evaluated. METHODS: To evaluate the diagnostic yield of endoscopy and biopsy in the investigation of nonbloody diarrhea, we performed a retrospective analysis using the endoscopy unit database of a tertiary care university hospital over a 3-year period. The database was searched for cases in which colonoscopy was performed for the single indication of diarrhea. The endoscopic findings and initial biopsy reports were extracted from a chart review, and each clinician was interviewed for the patient's current clinical diagnosis. The clinical diagnoses were compared with the endoscopy and biopsy results to determine whether the tests had contributed to making the clinical diagnoses. RESULTS: Three hundred six patients were identified. One hundred one were excluded for standardized predefined exclusion criteria, leaving 205 evaluable patients, of whom 77 had flexible sigmoidoscopy and 128 had colonoscopy. Eighteen percent had specific clinical diagnoses facilitated by endoscopy and/or biopsy. Endoscopy and biopsy results were normal in 74% of cases. In 8% of the cases either the endoscopy or biopsy findings were inconsistent with the final clinical diagnoses. CONCLUSIONS: Endoscopy and biopsy are important diagnostic tools in the evaluation of patients with nonbloody diarrhea, leading to a specific diagnosis in nearly one fifth of cases.

Adult↗
PubMed1997

A prospective randomized comparison between small bowel enteroclysis and small bowel follow-through in Crohn's disease.

BACKGROUND & AIMS: Small bowel enteroclysis (SBE) has been suggested to be superior to the small bowel follow-through (SBFT) for diagnosing the presence and extent of Crohn's disease. The aim was to perform a prospective randomized study at a single university medical center comparing SBE with SBFT in patients with Crohn's disease. METHODS: Consecutive patients with known Crohn's disease were randomized to receive either SBE or SBFT as the initial study and had the alternate study performed within 2 weeks. RESULTS: Twenty-six patients were enrolled. The mean time between studies was 8.7 +/- 0.8 days. Both studies were normal in 7 cases. The SBE was negative in 3 cases with positive findings of Crohn's disease by SBFT. One of these cases was a false-positive SBFT. The SBE and SBFT were both diagnostic of Crohn's disease in 15 cases; in 6 cases there was uniform agreement regarding disease pattern. The SBFT more accurately reported mucosal detail (n = 3) and a greater number of fistulas (n = 2). The SBE missed duodenal disease (n = 4). CONCLUSIONS: In known Crohn's disease, the SBFT is the procedure of choice. It is safer, preferred by patients, and will not miss gastroduodenal disease, and when the result is normal, there is no need to perform SBE.

Administration, Oral↗
PubMed1989

Peritoneal surface-active material in continuous ambulatory peritoneal dialysis (CAPD) patients.

Phospholipids have been demonstrated to be present in the peritoneal dialysis effluent of 34 patients on continuous ambulatory peritoneal dialysis (CAPD). The phospholipids present have been characterized by chromatography and their relative concentrations are fairly consistent from patient to patient. The predominant phospholipid is phosphatidylcholine (81%). Surface activity of this phospholipid has been demonstrated. The concentration of total phospholipid correlates with the time the patient had been on CAPD. It is lower in those patients who have been on dialysis longer.

Chromatography, Gas↗
PubMed1985

Ranitidine does not alter pethidine disposition in man.

The effect of concurrent ranitidine administration on the disposition of pethidine was investigated in eight healthy male volunteers (19-33 years). The subjects received 70 mg i.v. pethidine HCl doses before and during ranitidine treatment (150 mg p.o. twice daily). Ranitidine therapy was not associated with significant alterations in pethidine elimination rate constant, volume of distribution at steady state, total body clearance, and 24 h urinary excretion. No alteration in pethidine oxidation to norpethidine was noted, as suggested by nonsignificant changes in lag time to appearance of quantifiable norpethidine in serum, time to peak concentration, peak concentration, area under the curve from time 0.24 h, and 24 h urinary excretion. It would appear that, unlike cimetidine, ranitidine does not interact pharmacokinetically with pethidine. Further studies are necessary to evaluate the potential clinical advantages of ranitidine vs cimetidine therapy in patients also receiving pethidine.

Adult↗
PubMed1984

Cimetidine alters pethidine disposition in man.

The effect of concurrent cimetidine administration on the disposition of pethidine was investigated in eight healthy male volunteers (18-31 years). The subjects received 70 mg i.v. pethidine HCl doses before and during cimetidine treatment (1200 mg/day p.o.). During cimetidine treatment, pethidine total body clearance (CL) decreased by 22% (0.611 +/- 0.101 [mean +/- s.d.] to 0.474 +/- 0.098 1 kg-1 h, P less than 0.05) and pethidine volume of distribution at steady state (Vss) decreased by 13% (4.79 +/- 0.82 to 4.16 +/- 0.75 l/kg, P less than 0.05). A cimetidine-induced reduction in pethidine oxidation to norpethidine was suggested by a 23% reduction in norpethidine area under the curve from 0 to 24 h (472 +/- 93 to 362 +/- 38 ng ml-1 h, P less than 0.05) and a 29% reduction in peak norpethidine concentration (26.7 +/- 5.3 to 18.9 +/- 1.9 ng/ml, P less than 0.05). There were no significant linear correlations of serum trough cimetidine concentration with percentage reductions in pethidine CL, pethidine Vss, norpethidine AUC (24), or norpethidine peak concentrations. It would appear that the cimetidine-pethidine kinetic interaction may be of sufficient magnitude to be clinically significant. Caution is advised when patients are treated concurrently with these two agents.

Adolescent↗
PubMed1983

Changes in electrical potential difference and sodium-potassium ATPase of canine mucosa after jejunal-ileal bypass surgery.

Changes in electrical potential difference and sodium-potassium ATPase activity of rectal mucosa in dogs were examined before and after jejunal-ileal bypass surgery. The potential difference in the postoperative period was significantly higher (P less than 0.05) than the preoperative value. The potential difference increased by 160% at the 3rd day after the surgery, and then gradually declined with prolonged recovery periods. Ouabain-sensitive sodium-potassium ATPase activity also increased at the 3rd day (160%) and at the 10th day (86%) after the surgery. Fourteen days after the surgery the sodium-potassium ATPase activity returned almost to the preoperative value. These results indicated a close correlation between changes in transmucosal potential difference and sodium-potassium ATPase activity of rectal mucosa, suggesting a significant participation of sodium-potassium ATPase in changes of potential difference induced by jejunal-ileal bypass surgery.

Animals↗