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H Meshkinpour

Publications and source records attributed to H Meshkinpour.

14 recordsLinked to original sources
PubMed1992

Sphincter of Oddi dysfunction and unexplained abdominal pain: clinical and manometric study.

Unexplained, biliary-type abdominal pain is often attributed to an abnormal pressure profile of the sphincter of Oddi. In spite of this assumption, the true prevalence of this type of motor dysfunction among cholecystectomized patients with unexplained abdominal pain is not known. We studied 64 postcholecystectomy patients who were thought to have sphincter of Oddi dysfunction. Radiologically, other than a dilated common bile duct in some, they had no anatomic derangement of their pancreatobiliary tract to explain their symptoms. They were categorized into three groups on the basis of four objective findings suggesting abnormal biliary emptying mechanism. Basal sphincter of Oddi pressure, frequency of phasic contractions, and proportion of retrograde contractions were determined in all patients. Twenty-six (41%) of the patients demonstrated at least one motor abnormality, 16 (25%) had two, and 10 (16%) had all three abnormal parameters. The pressure profile of the sphincter was normal in 38 or 59% of the patients. Seventy-three percent (73%) of the patients in group I, who had three or four of the objective findings for sphincter of Oddi dysfunction, demonstrated at least one motor abnormality. Sixty percent of this group demonstrated an increased basal sphincter of Oddi pressure. On the other hand, only 19% of the patients in group III, who had none of the objective findings, revealed a motor abnormality. Increased basal sphincter of Oddi pressure was noted in 7% of this group. We conclude that, sphincter of Oddi dysfunction, as diagnosed manometrically, explains the recurrent biliary type abdominal pain in a minority of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Pain↗
PubMed1992

Achalasia evolving from segmental aperistalsis.

A 17-year-old woman was evaluated for dysphagia. Radiologic study revealed a rigid segment 10 cm long in the midesophagus, which was found to be aperistaltic on manometric evaluation. The rest of the esophagus and the lower esophageal sphincter were manometrically normal. Four years later the patient was seen for evaluation of severe dysphagia and symptoms of esophageal overflow. Characteristic radiologic and manometric findings of classic achalasia were noted. The case is discussed as an atypical form of achalasia evolving from a segmental esophageal aperistalsis.

Adolescent↗
PubMed1992

The role of the flow rate of the pneumohydraulic system on post-sphincter of Oddi manometry pancreatitis.

Manometry of sphincter of Oddi (SO) carries a risk of acute pancreatitis by a mechanism not yet clearly understood. This study attempted to evaluate the role of the flow rate of the perfusion system in the development of acute pancreatitis. During the past 60 months, we have performed 81 manometry studies of SO in 79 patients, 61 women and 18 men, who were referred for recurrent attacks of abdominal pain suggestive of SO dysfunction. All procedures were done by the same operator, utilizing the same instrumentation and similar premedication. In the first 54 studies, the pneumohydraulic system had a flow rate of 0.55 ml/min and a tank pressure of 15 lb/in2 while in the last 27 studies a flow rate of 0.27 ml/min and a pressure of 7.5 lb/in2 were employed. Acute pancreatitis was diagnosed after 16 (19.7%) procedures. Fourteen (26%) of them occurred after high-flow-rate perfusion. In contrast, only 2 (7%) of the 27 patients who had the procedure done at the flow rate developed this complication (p less than 0.05). There was no correlation between the occurrence of pancreatitis, clinical suspicion of SO dysfunction, and the underlying manometric profile of the sphincter. We conclude that the incidence of procedure-related pancreatitis after manometry of SO is higher than following diagnostic endoscopic retrograde cholangiopancreatography and that the flow rate in the perfusion system is a precipitating factor in the development of this complication.

Acute Disease↗
PubMed1992

Manometric and radiologic correlations in achalasia.

Achalasia is an esophageal motor disorder distinguished by clinical, radiologic, and manometric features. To evaluate the correlation among these features, we studied 109 achalasia patients. The four most common clinical complaints, the four most commonly encountered radiologic findings, and two manometric parameters were analyzed with a correlation matrix test and a multiple regression analysis. Significant correlation existed among symptoms of dysphagia, regurgitation, and weight loss. In contrast, chest pain inversely correlated with these symptoms. Dysphagia and weight loss significantly correlated with a bird-beak deformity but not with esophageal dilatation or a sigmoid esophagus. Moreover, no significant relationship between lower esophageal sphincter pressure and esophageal dilatation or sphincter pressure and sigmoid esophagus was found. However, in those patients with a resting lower esophageal sphincter pressure greater than 45 mm Hg, a reasonable correlation among clinical, radiologic, and manometric parameters did exist. In conclusion, although in a subset of patients with markedly increased lower esophageal sphincter pressure, a good correlation between clinical, radiologic, and manometric findings exists, such a correlation cannot be established in all of the achalasia patients; esophageal dilatation or a sigmoid esophagus may not be due to a hypertensive sphincter, and their presence must not necessarily be interpreted as an indication of severity of the disease; there is an inverse correlation between chest pain and symptoms of dysphagia, regurgitation, and weight loss; and finally, achalasia and hiatal hernia may coexist in 6% of the patients.

Adolescent↗
PubMed1989

Effect of aerobic exercise on mouth-to-cecum transit time.

To examine the premise that exercise reduces the gastrointestinal transit time, we evaluated the effect of walking 4.5 km in an hour on mouth-to-cecum transit time. Twenty-three healthy volunteers, 9 men and 14 women, with an age range of 19-28 yr, were studied. After an overnight fast, the subjects ingested 10 g of lactulose in 150 ml of water while breath hydrogen concentrations were analyzed at 15-min intervals. On separate days, in random sequence, subjects either sat in a chair or walked on a treadmill for 60 min. Mean transit time was 55 +/- 8 min when resting and 89 +/- 4 min when exercising (p less than 0.001). In conclusion, light aerobic exercise prolonged the mouth-to-cecum transit time. On the basis of this observation, exercise as a causative factor in runner's diarrhea and its value in the management of chronic constipation may be questioned.

Adult↗
PubMed1979

Esophageal motor function in Graves' disease.

Esophageal motor function was studied in 10 patients with untreated Graves' disease and 15 healthy volunteers who served as controls. A noncompliant recording system with a triple-lumen assembly was used. Resting upper- and lower-esophageal-sphincter pressures, amplitude, duration, and velocity of peristaltic contractions in the body of the esophagus, and the number of repetitive and simultaneous contractions were measured. There was no significant difference in peristaltic amplitude and duration between the controls and the patients with Graves' disease. However, there was a significant increase in velocity of contractions in Graves' disease as compared with controls. On restudy of 5 patients who became euthyroid after treatment with 131I, all the measured parameters were unchanged except for velocity of the peristaltic contractions. The value for this measurement decreased essentially to the same as that found in the control subjects. It is concluded that: (1) thyrotoxicosis increases the propagation velocity of esophageal contraction, and (2) thyroid hormones may play a physiologic role in the control of esophageal motor function.

Adult↗
PubMed1979

Cimetidine in the treatment of acute alcoholic pancreatitis. A randomized, double-blind study.

A double-blind study was made of the comparative effectiveness of cimetidine in the treatment of acute alcoholic pancreatitis. The study group was composed of 27 patients with acute episodes of alcoholic pancreatitis of mild to moderate severity. The patients were randomized into 2 groups, either receiving cimetidine, 300 mg four times daily or a placebo. Both groups were given intravenous fluids and meperidine hydrochloride (Demerol) as needed. There were no significant differences between the 2 groups as measured by a variety of clinical and laboratory parameters. The mean value of the daily serum amylase in the placebo group declined steadily to normal; hyperamylasemia in this group persisted for 52 +/- 11 hr (mean +/- SE). By contrast, serum amylase in the cimetidine group peaked at 24 hr after the start of treatment and remained abnormal slightly longer; the duration of hyperamylasemia in the group was 69 +/- 10 hr. It is concluded that: (1) cimetidine is not superior to a placebo in the management of mild to moderately severe acute alcoholic pancreatitis and (2) serum amylase activity in patients with acute alcoholic pancreatitis given cimetidine tends to be greater and hyperamylasemia is of somewhat longer duration than in those treated with a placebo.

Acute Disease↗
PubMed1979

Significance of endoscopically visible blood vessels as an index of atrophic gastritis.

The endoscopic criteria for atrophic gastritis are. 1. pale mucosa; 2. shiny surface and 3. prominent submucosal vessels. To evaluate the diagnostic accuracy of circumscribed atrophic gastritis based on these findings, we studied 184 consecutive upper gastrointestinal endoscopies. The endoscopic diagnosis of atrophic gastritis was made only if two endoscopists both agreed on the findings and interpretation. The location of the atrophic pattern and whether it was circumscribed or diffuse were recorded. Two biopsy specimens were than obtained. Histologic material was interpreted by a pathologist who had no prior knowledge of the endoscopic findings. Twenty-five patients (13%) had atrophic gastritis endoscopically; in four it was diffuse and in 21 it was circumscribed. Utilizing the criteria of Whitehead, et al, atrophic gastritis was diagnosed histologically in three of four patients with diffuse gastritis but in one of those considered to have circumscribed atrophic gastritis. It is concluded from these preliminary data that a circumscribed atrophic mucosal pattern is a frequent endoscopic finding that does not necessarily represent atrophic gastritis histologically.

Adult↗
PubMed1977

A unique multisystemic syndrome of unknown origin.

A unique multisystemic syndrome of polyneuropathy, anasarca, polycythemia, pigmentation, and endocrinopathy that occurred outside of Japan is reported, along with the results of postmortem examination. A review of the literature on this syndrome is presented, and the possible etiological considerations are discussed.

Adult↗
PubMed1977

Effect of cholestyramine on the symptoms of reflux gastritis. A randomized, double blind, crossover study.

Bile acids have been proposed to be important in the pathophysiology of the syndrome of "bile reflux gastritis" after surgery. To examine the role of cholestyramine, an ion exchange resin that binds bile acids, on symptoms of this syndrome, we did a randomized, double-blind crossover study on 16 patients. No differences in frequency of abdominal pain, nausea, vomiting, or bitter taste were observed among cholestyramine (4 g, three times daily for 3 weeks), placebo, and routine (dietary restriction and ad libitum antacid) treatment periods. We conclude that this regimen of cholestyramine was ineffective in symptomatic treatment of bile reflux gastritis.

Adult↗
PubMed1976

Upper gastrointestinal hemorrhage clinical, radiological and endoscopic correlation of 100 consecutive cases.

One hundred consecutive cases of upper gastrointestinal hemorrhage were studied clinically, radiologically and endoscopically. Erosive gastritis, duodenal and gastric ulcer, and bleeding esophageal varices accounted for 85% of the cases. The presenting sign of hematamesis or melena was of no value in localizing the bleeding site relative to the pyloric sphincter. Erosive lesions of the esophagus and stomach were suspected clinically in less than 50% of the cases and were the lesions least amenable to radiologic diagnosis and where early endoscopy was most useful. Our observations demonstrate again the frequent association between ethanol or aspirin ingestion and erosive gastritis.

Adult↗