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Biomedical subjects

L M Akkermans

Publications and source records attributed to L M Akkermans.

At least 127 records · Page 7Linked to original sources
PubMed1989

[The value of ambulatory 24-hour esophageal manometry in the diagnosis of retrosternal pain of non-cardiac origin].

The clinical relevance of a system of ambulatory 24-hour oesophageal pressure and pH recording with automated data analysis was investigated in 33 unselected patients with non-cardiac chest pain. After conventional manometry with edrophonium (Tensilon) provocation, 24-hour oesophageal pH and pressure monitoring was performed. In 17 patients conventional manometry, edrophonium provocation and 24-hour pH recording revealed an oesophageal origin of the symptoms: 6 patients had oesophageal motility disorders, 3 were positive responders to edrophonium and 8 had chest pain associated with gastro-oesophageal reflux. In none of the patients who had a pain attack during prolonged oesophageal pressure recording, was a new motility disorder detected.

Chest Pain↗
PubMed1989

Gastric and oesophageal emptying in patients with type 2 (non-insulin-dependent) diabetes mellitus.

Gastric emptying of a digestible solid and liquid meal and oesophageal emptying of a solid bolus were measured with scintigraphic techniques in 20 randomly selected Type 2 (non-insulin-dependent) diabetic patients receiving oral hypoglycaemic therapy and 20 control subjects. In the diabetic patients, the relationships between oesophageal emptying, gastric emptying, gastrointestinal symptoms, autonomic nerve function and glycaemic control were examined. The percentage of the solid meal remaining in the stomach at 100 min (p less than 0.001), the 50% gastric emptying time for the liquid meal (p less than 0.05) and oesophageal emptying (p less than 0.05) were slower in the diabetic patients compared to the control subjects. Scores for upper gastrointestinal symptoms and autonomic nerve dysfunction did not correlate significantly (p greater than 0.05) with oesophageal, or gastric emptying. The 50% gastric emptying time for the liquid meal was positively related (r = 0.58, p less than 0.01) to the plasma glucose concentration at the time of the performance of the gastric emptying test and the lag period, before any solid food emptied from the stomach, was longer (p less than 0.05) in subjects with plasma glucose concentrations during the gastric emptying measurement greater than the median, compared to those with glucose concentrations below the median. These results indicate that delayed gastric and oesophageal emptying occur frequently in Type 2 diabetes mellitus and that delayed gastric emptying relates, at least in part, to plasma glucose concentrations.

Aged↗
PubMed1989

Physiological gastroesophageal reflux and esophageal motor activity studied with a new system for 24-hour recording and automated analysis.

Gastroesophageal reflux and esophageal motility were studied for 24 hr in 32 ambulatory healthy volunteers (20-73 years old), using a newly developed system, consisting of a microprocessor-based data recorder and algorithms for fully automated data analysis. Physiological reflux was more extensive than expected on the basis of widely used normal values. The percentage of time with pH less than 4 and the duration of the reflux episodes increased with age. Of the more than 2000 esophageal contractions occurring per day, peristaltic contractions constituted 50.9 +/- 2.0%. Their amplitude was significantly lower between meals than during meals and during the night. The duration of the peristaltic contractions increased with age. Simultaneous contractions constituted 10.4 +/- 1.2% of the esophageal contractions. Their incidence increased with age. We conclude that continuous ambulatory 24-hr recording with automated analysis of esophageal motility and pH profile is feasible, that the upper limits of normal in ambulatory esophageal pH recording are higher than previously accepted, and that age, meals, and body position must be taken into account in the interpretation of both 24-hr esophageal pH and pressure data.

Adult↗
PubMed1989

Microcomputer-based system for 24-hour recording of oesophageal motility and pH profile with automated analysis.

A system developed for long-term simultaneous recording of oesophageal motility and pH in the ambulant patient is described. The system consists of a microprocessor based data-acquisition and preprocessing device, a personal computer for postprocessing, report generation and data storage, a miniature two-sensor pressure catheter and a pH electrode. Identification and classification of oesophageal contractions are performed in separate steps, using online preprocessing software for identification and offline postprocessing software for categorisation, classification and report generation. Contractions are categorised as peristaltic, simultaneous or nontransmitte and classified according to their amplitude, duration and propagation velocity. The method described reduces the amount of data from 870 kbyte to approximately 40 kbyte per 24 hours in a multiparameter recording device, and offers the opportunity for offline postprocessing with different sets of criteria. The system has been found to be accurate and reliable in 24-hour studies in both healthy volunteers and patients with non-cardiac chest pain.

Adult↗
PubMed1988

Effect of ICS 205-930 (a specific 5-HT3 receptor antagonist) on gastric emptying of a solid meal in normal subjects.

The effects on gastric emptying of a solid meal of the specific 5-HT3-receptor antagonist ICS 205-930, 10 mg and 20 mg intravenously were assessed with a scintigraphic technique in 12 normals. The 50% emptying time was less, the lag phase was shorter and the post lag emptying rate was faster after 20 mg ICS 205-930 (p less than 0.02). After 10 mg ICS 205-930 the lag phase was significantly shorter compared with placebo (p less than 0.04). These results suggest that 5-HT3 receptors may be involved in the regulation of gastric emptying in man.

Adult↗
PubMed1987

Computer aided analysis of electrical and mechanical activity of stomach and duodenum.

In studies of gastroduodenal motility several imaging techniques and also recordings of signals of implanted transducers are used. Combination of methods and prolonged observation times produce so much information that an automatic analysis is advantageous, the more so because more complex parameters can be analysed. Using a desktop computer, it is possible to analyse long time-series of antral and duodenal signals, obtained with implanted electrodes and strain gauges. The developed program can discriminate between the signal and the majority of artefacts. An easy manual interaction on the computer display enables the operator to either accept or adjust the indicators of recognized signals. The times of occurrence and the amplitudes of the detected peaks are retained for further analysis e.g. production of histograms of interval time, amplitude, antroduodenal time lag, or calculation of coordination parameters.

Animals↗
PubMed1987

The effect of changes in dietary sodium content on complaints and clinical parameters of volume depletion in patients with a permanent ileostomy.

In seven patients with an ileostomy the volume and electrolyte composition of ileal effluent and urine were studied at the end of 7-day periods on a free diet (mean total sodium excretion 180 mmol/day) and on diets with a fixed sodium content ranging from 120 to 350 mmol/day. At the same time, complaints were scored and the plasma aldosterone concentration, renal aldosterone excretion, and ileal transmucosal potential difference were determined. On a free diet, all of the patients had one or more complaints. These tended to disappear when intake was increased. Changes in dietary sodium led to only minor changes in the volume and composition of the ileal effluent. Significant associations were found between sodium intake and complaints, the urinary sodium/potassium ratio, plasma aldosterone concentration, and aldosterone excretion. The ileal transmucosal potential difference showed the same tendency. Mean sodium intake on a free diet appeared to be suboptimal. The well-being of many ileostomists can be improved by increasing the dietary sodium intake to a level higher than 250 mmol/day.

Adult↗
PubMed1987

Gastric emptying and postprandial symptoms after Billroth II resection.

Gastric emptying was studied in 18 symptomatic and 16 asymptomatic patients after Billroth II (BII) resection (without vagotomy) and the possible relationships between emptying and postprandial symptoms in these patients were assessed. The BII patients were compared with 20 nonoperated patients who had duodenal ulcer disease and 16 healthy subjects. Gastric emptying of two test meals (a semisolid porridge meal and a solid pancake meal) was measured with a radionuclide technique. The major difference between the BII patients and control subjects and duodenal ulcer patients was an increased rate of emptying of the semisolid meal in the first 5 minutes after meal consumption. The percentage of the meal remaining in the stomach at 5 minutes after completion was significantly less in the symptomatic (45.3% +/- 4.3%) than in the asymptomatic BII patients (79.4% +/- 2.6%). A positive correlation was demonstrated between the initial emptying rate of semisolids and the intensity of postprandial nausea (p less than 0.01), vomiting (p less than 0.05), and vasomotor symptoms (p less than 0.001). The duration of the lag phase for solid and semisolid meals was shorter in BII patients than in healthy subjects but was as short in nonoperated duodenal ulcer patients. The duration of the lag phase for solid food in the BII patients correlated positively with the score for postprandial epigastric pain (p less than 0.001). The rate of emptying of the solid meal was lower in symptomatic BII patients (28.1% +/- 3.6% per hour) than in asymptomatic patients (47.8% +/- 7.2% per hour) and correlated with the severity of postprandial fullness and nausea. The emptying of the solid meal was inversely related to the initial emptying rate of the semisolid meal (p less than 0.05). Therefore, the results of this study support the assumption that many of the postprandial symptoms occurring after BII resection reflect alterations in gastric emptying. Some of the emptying abnormalities present after BII resection may be related to duodenal ulcer disease rather than to the surgical procedure.

Adolescent↗
PubMed1986

Electrical stimulation of bone growth with direct current.

Electrical stimulation of osteogenesis was studied in rabbit femora in: (A) a transcortical electric field with a cortex-depolarizing or hyperpolarizing orientation derived from an intramedullary electrode and a ring-shaped counter electrode encircling the femoral shaft; and (B) an electric field derived from an electrode located in the medullary canal and the counter electrode in the abdominal wall. Electrodes were made of platinum. A direct current of 20 microA was applied during six weeks. Contralateral femora with dummy electrodes served as controls. Results were analyzed by optical densitometry of roentgenograms and histomorphometry of histologic slides. Under the conditions of these experiments bone growth was not stimulated by applying a cortex-depolarizing electric field. Significant stimulation of bone growth was only observed at an intramedullary cathode, when the anode was placed at a distance.

Animals↗
PubMed1985

Effects of cimetidine and ranitidine on interdigestive and postprandial lower esophageal sphincter pressures and plasma gastrin levels in normal subjects.

The purpose of this study was to investigate the effects of cimetidine and ranitidine on human lower esophageal sphincter pressure (LESP) and plasma levels of gastrin in all phases of the interdigestive motor complex and after a test meal. In a random, double-blind manner, placebo, cimetidine (1.0 mg/kg X h), and ranitidine (0.16 mg/kg X h) were administered by intravenous infusion to nine healthy volunteers. By using a sleeve catheter assembly, LESP was constantly monitored, as were esophageal, fundic, antral, and duodenal pressures. Considerable minute-to-minute and interdigestive motor phase-related LESP variations were observed. Cimetidine and ranitidine decreased the interdigestive LESP, but did not abolish the gradual increase in LESP from phase I to phase III. During the first 2 h after the meal, cimetidine and ranitidine had no significant effect on LESP. Plasma gastrin levels were increased by cimetidine and ranitidine, both in the interdigestive and in the postprandial state. The results indicate that the effect of H2-blockers on LESP is not gastrin-mediated. The results further indicate that, in studies on the effects of drugs on LESP, prolonged recording of LESP in all motor states is a prerequisite.

Adult↗
PubMed1985

Effects of cisapride, a new gastrointestinal prokinetic substance, on interdigestive and postprandial motor activity of the distal oesophagus in man.

Cisapride is a newly developed substance that stimulates gastrointestinal motility, possibly enhancing acetylcholine release in the gut wall. The aim of our study was to investigate the effect of cisapride on oesophageal motor function in man. In a blind fashion and in random order six healthy volunteers received cisapride (0.5 mg/h intravenously, preceded by a three day oral loading at 10 mg tid) and matching placebo. Oesophageal contractions and lower oesophageal sphincter pressure were constantly recorded during a complete cycle of the interdigestive migrating motor complex and during two and half hours after a mixed test meal. Cisapride did not disturb the interdigestive migrating motor complex. In the fasting state the lower oesophageal sphincter pressure showed considerable interdigestive migrating motor complex phase-related variations, whereas amplitude and duration of the oesophageal contractions did not. In the dosis used cisapride was found to increase lower oesophageal sphincter pressure in the interdigestive and in the late postprandial state, but to have no effect in the early postprandial period. Amplitude and duration of oesophageal contractions were not affected by cisapride.

Adult↗
PubMed1985

Prognostic factors in surgery for duodenal ulcer.

A 5 to 12 year follow-up study of 132 patients with nonobstructive duodenal ulcer treated by HSV without a drainage procedure was done. The results of pre- and postoperative gastric emptying studies and pre- and postoperative acid secretion studies were related to recurrent ulceration and postoperative complaints. The almost 9 percent of instances of recurrent ulceration were found in the group of patients with preoperative PPAO values greater than 40 mmol/hr. In all 13 patients with preoperative PPAO values greater than 60 mmol/hr, HSV was considered a failure. It was concluded that at least the latter group should be excluded from HSV. In 4.3 percent of patients serious gastric stasis after HSV was cause for reoperation. In spite of meticulous denervation and peroperative open pH metry, inadequate vagotomy, defined as percent reduction of PIAO values after HSV less than 75 percent, was found in 33 out of 117 patients. In an experimental study, vascular occlusion alone also gives a positive Grassi test. From both facts the relative value of this test can be concluded. Symptoms after inadequate vagotomy were again clearly related to preoperative PPAO values.

Clinical Trials as Topic↗
PubMed1984

Recording of gastrointestinal electrical activity from surface electrodes.

The surface recording of electrical activities generated by the gastrointestinal tract is reviewed, with particular reference to surface recording of gastric electrical activity (electrogastrography or EGG). The available data on interdigestive and postprandial characteristics of the EGG signal in health and disease, including techniques of recording and signal analysis, are summarised.

Animals↗
PubMed1984

Radionuclide measurement of normal and disturbed gastric motility.

Techniques for the measurement of gastric emptying using radionuclides are reviewed as a basis for a discussion of gastric emptying tests. A new technique for the noninvasive quantitative measurement of antral motility is described, whereby measurements of redistribution of gastric contents between fundus and antrum and actual gastric emptying are obtained simultaneously. These tests provide more relevant insight into the pathophysiology of gastric motility disturbances than that previously obtained by conventional gastric emptying studies.

Duodenal Ulcer↗