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Biomedical subjects

J A DiPalma

Publications and source records attributed to J A DiPalma.

At least 19 recordsLinked to original sources
PubMed1992

Comparison of L-hyoscyamine, glucagon, and placebo for air-contrast upper gastrointestinal series.

Previous studies have compared the use of anticholinergic drugs and glucagon for upper gastrointestinal (UGI) radiography. Many radiologists prefer glucagon because these comparisons showed it to have a shorter duration of action with fewer side effects. L-Hyoscyamine is the levo-rotatory form of atropine with minor adverse side effects. This study compared the effects of glucagon (N = 48), L-hyoscyamine (N = 43), and placebo (N = 45) on gastric and duodenal distension, mucosal coating, and patient tolerance. L-Hyoscyamine provided gastric and duodenal images equal in quality to glucagon. Except for the more frequent reporting of dry mouth with L-hyoscyamine, side effects were not different among the groups. L-Hyoscyamine is an economical alternative to glucagon for hypotonic gastrointestinal radiography.

Atropine↗
PubMed1991

A new oral lavage solution vs cathartics and enema method for preoperative colonic cleansing.

Sulfate free-electrolyte lavage solution is a new osmotically balanced electrolyte gut lavage solution for colon surgery that has been formulated for improved taste and reduced water and electrolyte changes. Sixty patients were prospectively randomized to receive a 1-day preparation with sulfate free-electrolyte lavage solution or a 3-day preparation using a clear liquid diet, cathartics, and enemas. The patient groups were similar in age, race, male-female ratio, and the types of colonic resections performed. Colonic cleansing was better with sulfate free-electrolyte lavage solution (100% vs 63% "good" to "excellent" cleansing). Patient tolerance evaluated by a questionnaire showed more overall discomfort with sulfate free-electrolyte lavage solution but no difference between the preparations in individual symptoms of fullness, cramping, nausea, or vomiting. One patient developed a low level of serum potassium after a cathartic and enema preparation, while there were no complications with sulfate free-electrolyte lavage solution. Patient taste questionnaires showed a slight preference for sulfate free-electrolyte lavage solution (53%) over a polyethylene glycol electrolyte lavage solution (47%). This study confirms that sulfate free-electrolyte lavage solution is a safe and effective method of preoperative colonic cleansing.

Administration, Oral↗
PubMed1991

Occupational and industrial toxin exposures and the gastrointestinal tract. Gastrointestinal Toxicology Subcommittee of the American College of Gastroenterology Patient Care Committee.

The subcommittee on Gastrointestinal Toxicology of the Patient Care Committee of the American College of Gastroenterology has reviewed potential effects of exposures to occupational and industrial hazards on the gastrointestinal tract, liver and pancreas. This review is presented to 1) share clinical data concerning gastrointestinal toxicology, 2) emphasize the paucity of available information to the practicing clinician, and 3) stimulate basic research interest in this field.

Digestive System Diseases↗
PubMed1990

Constipation in the long-term care facility.

In the long-term care facility, constipation is a problem of clinical significance. An awareness of the types and specific causes of constipation, such as underlying medical conditions and side effects of medication, can facilitate management of these patients. Problems unique to long-term care patients also need to be addressed. This review emphasizes that constipation in these patients needs to be addressed individually and that regular inservice education can optimize nursing care.

Constipation↗
PubMed1989

Enzyme replacement for lactose malabsorption using a beta-D-galactosidase.

We evaluated 10 healthy symptomatic lactose malabsorbers for effect of an oral beta-D-galactosidase derived from Aspergillus oryzae (Lactrase, Kremers Urban Company, Milwaukee, WI, U.S.A.) on symptom and breath hydrogen response to challenge with 50 g lactose. Basally and at 30-min intervals for 8 h after lactose challenge, end-alveolar breath samples were collected and analyzed for hydrogen using gas chromatography. Symptoms were scored at 30 min and hourly for 8 h, rating bloating, cramps, nausea, pain, diarrhea, and flatulence. Four challenges were performed on 4 separate days with at least 3 days between challenges. The first two challenges served as baselines. Just before ingestion of 50 g powdered lactose dissolved in 200 ml water, beta-D-galactosidase capsules were given orally as a 250-mg dose for the third challenge and a 500-mg dose for challenge 4. Hydrogen excretion, quantified by using a trapezoidal method for computing area under the discontinuous curve of breath hydrogen concentration, was decreased in subjects receiving beta-D-galactosidase (base-line I, 346.0 ppm/h; baseline II, 367.2 ppm/h; 250-mg galactosidase 208.2 ppm/h; 500-mg galactosidase, 178.0 ppm/h; p less than or equal to 0.05). Other analyzed parameters of H2 excretion were also decreased. Analysis of symptom response scores showed a dose-related decrease for bloating and flatus (p less than or equal to 0.05) and no statistical difference in the other assessed symptoms. We conclude that beta-D-galactosidase from Aspergillus oryzae, when given just before ingestion of lactose by lactose malabsorbers, can produce a dose-dependent reduction (statistically significant for the 500-mg dose) in breath hydrogen excretion, bloating, and flatus.

Adult↗
PubMed1989

Colon cleansing for diagnostic and surgical procedures: polyethylene glycol-electrolyte lavage solution.

Recent work has shown that polyethylene glycol-electrolyte lavage solutions provide adequate cleansing in preparation for colonoscopy, barium enema, intravenous pyelography, and colon surgery. It is safe and well tolerated by patients, and seems ideal for those with renal or cardiovascular disease who must undergo colon cleansing. We review the development of polyethylene glycol-electrolyte lavage solution and the clinical experience with various colon-cleansing preparations.

Colon↗
PubMed1988

Prediction of lactose malabsorption in referral patients.

Two hundred forty-two patients referred for various gastrointestinal complaints were evaluated for clinical parameters that would predict findings of lactose malabsorption. Breath hydrogen and blood glucose lactose tests were performed after ingestion of 50 g lactose. Presenting complaints, duration of symptoms, and patient demographics such as age, sex, and ethnic heritage were not different between lactose malabsorbers and absorbers as defined by the breath hydrogen lactose test. Food-related symptoms in general and after specific foods such as milk, ice cream, cheese, and yogurt were also similar between groups. Prior to testing, 30% of malabsorbers (N = 161) and 36% of absorbers (N = 81) reported lactose-related symptoms (P = NS). The blood glucose response to lactose was abnormal in 60% of malabsorbers and 15% of absorbers. This study confirmed our impression that it is difficult to predict lactose absorption status by clinical parameters. The majority of our lactose malabsorber patients were unaware of lactose-associated symptoms. Furthermore, symptom assessment, demographics, food history, and blood glucose testing did not predict abnormal hydrogen responses to lactose.

Adult↗
PubMed1988

All yogurts are not created equal.

Because of autodigestion of lactose by its endogenous bacteria, the lactose in yogurt is better absorbed than other sources of lactose in lactase-deficient subjects. To investigate possible differences among brands of yogurt in this autodigesting capacity, we challenged eight lactose-malabsorbing subjects with 20 g oral lactose and three different brands of yogurt (Borden, Dannon, and Royal Maid). As a quantitative measure of carbohydrate absorption, end-alveolar breath samples were collected for 8 h and assayed for hydrogen gas. Symptoms were scored by questionnaire every 30 min for 8 h. The cumulative breath H2 and the area under the discontinuous curve of breath-H2 concentration decreased relative to lactose results after ingestion of Dannon and Royal Maid but not after Bordon yogurt. no correlation of symptoms with the degree of carbohydrate malabsorption was demonstrated. We conclude that the lactase activity of yogurt cultures varies among brands.

Adult↗
PubMed1988

Comparison of a new colon lavage solution (Golytely-RSS) with a standard preparation for air-contrast barium enema.

Golytely is a balanced electrolyte solution for per oral whole-gut lavage. It has been an accepted alternative to standard preparations for barium enema. Golytely-RSS is a new formulation designed to taste better through reduction in sodium and sulfate content. In addition, a slight increase in osmolality is intended to decrease further the net absorption/secretion ratio. One hundred outpatients who were to undergo air-contrast barium enema examinations were randomly assigned one of two colon-cleansing preparations. A standard 1-day diet/cathartic method was compared with Golytely-RSS plus oral bisacodyl. Radiographs were evaluated for the amount of fecal material present and the degree of mucosal coating by two radiologists independently of each other and without knowledge of the preparation used. Good to excellent feces removal was provided by Golytely-RSS in 98% of patients and by the standard method in 95% (p greater than .1, not significant). Mucosal coating also was similar between groups. Unpleasant side effects were reported significantly more often in the lavage group. Unwillingness to use the preparation a second time was reported in 36% of the Golytely-RSS group and in 8% of the standard preparation group (p = .03). Golytely-RSS is an acceptable alternative method to standard colon-cleansing methods for air-contrast barium enema and may be preferable in patients with certain renal or cardiovascular diseases. Side effects may preclude the use of this colon-cleansing regimen routinely.

Administration, Oral↗
PubMed1987

GGT test.

Explore the source record for details and available documents.

Humans↗
PubMed1987

Steakhouse spasm.

Sudden esophageal obstruction after eating poorly chewed meat has been called the Steakhouse syndrome. Some cases have demonstrable esophageal narrowing above which food impacts, but in many patients with identical symptoms no underlying obstruction is demonstrated. We report four patients with acute dysphagia who were unable to swallow liquids or solids for as long as 72-96 h. Onset occurred after eating meat in three patients and after taking psyllium in one. All had a structurally normal esophagus demonstrated by x-ray and endoscopy, but motor disorders were defined by manometry in three. We hypothesize that an underlying motor abnormality led to food impaction and call this presumed spastic variant "Steakhouse spasm." We suspect that this is a common but frequently unrecognized manifestation of esophageal dysmotility.

Adult↗
PubMed1987

Metoclopramide effect on esophageal peristalsis in normal human volunteers.

There is relatively poor documentation of the effect of metoclopramide on the human esophageal body. We, therefore, studied several parameters of esophageal function in 19 normal volunteers both before and after 20 mg intravenous metoclopramide. Contraction amplitude, wave duration, velocity, and propagation time were increased after metoclopramide. These changes were more pronounced in the distal esophagus. At the most distal manometric recording level located 2 cm above the lower esophageal sphincter, contraction amplitude increased 39% (p less than 0.01) and duration increased 22.5% (p less than 0.01) after metoclopramide. We conclude that in normal subjects metoclopramide has an effect predominant in the distal body of the esophagus.

Adult↗
PubMed1986

Urinary excretion of polyethylene glycol 3350 and sulfate after gut lavage with a polyethylene glycol electrolyte lavage solution.

Ingestion of an electrolyte lavage solution containing polyethylene glycol 3350 and sulfate is an effective method of cleansing the colon for diagnostic studies. Polyethylene glycol and sulfate are considered poorly absorbed from the gastrointestinal tract. Because of the quantities administered, concern exists about potential toxicity of absorption of even a small percentage, particularly for polyethylene glycol. We measured the urinary excretion of both polyethylene glycol and sulfate in normal subjects and inflammatory bowel patients. Absorption of polyethylene glycol can be assessed by measuring recovery in urine, as 85%-96% of an intravenous load is excreted in urine. Similarly, appreciable sulfate absorption would exceed renal tubular reabsorption and result in increased urinary excretion. Mean percent polyethylene glycol load recovered in urine was minimal and similar for normal (0.06%) and inflammatory bowel (0.09%) subjects. Urinary sulfate excretion after lavage was also similar for both groups and was not different from baseline. These results do not suggest the likelihood of toxicity due to polyethylene glycol 3350 or sulfate absorption during gut lavage with this solution.

Colitis, Ulcerative↗
PubMed1986

Primary sclerosing cholangitis associated with hyperimmunoglobulin M immunodeficiency (dysgammaglobulinemia).

Primary sclerosing cholangitis is an uncommon disorder of obliterative biliary inflammation that is exceedingly rare in childhood. Presented is a child with hyperimmunoglobulin M immunodeficiency (dysgammaglobulinemia) and primary sclerosing cholangitis. This case should focus attention on the association of primary sclerosing cholangitis and immunodeficiency syndromes, particularly in children with immune disorders and unexplained hepatic abnormalities.

Bile Ducts, Intrahepatic↗
PubMed1986

Colon cleansing: acceptance by older patients.

The influence of age on patient acceptance and adequacy of preparation was evaluated in 557 patients from our previous colon cleansing studies for colonoscopy, barium enema, and elective colon surgery. Since study design was similar for all studies, the patients were combined and stratified to those over age 60 (old) and those 60 or younger (young). Patients were previously randomized in their respective studies to polyethylene glycol electrolyte gut lavage solution (old, 105; young, 181) or standard prep (old, 71; young, 20). Patient response data were analyzed in two fashions; distribution of response scores and minimal responses. When the distribution of scores were compared, older gut lavage patients had fewer cramps but more overall discomfort than younger patients receiving the lavage preparation. Older standard prep patients had less overall discomfort than younger standard prep subjects. Comparison of responses rated as minimal showed the older lavage patients to have fewer cramps than younger lavage patients and fewer cramps than standard preparation patients of similar age. None of the other assessed symptoms was significantly different between age groups or prep method. Most patients had minimal symptoms regardless of age or prep. Age did not influence adequacy of preparation for gut lavage or standard prep methods.

Age Factors↗