Gastrointestinal ulceration and hemorrhage from hepatic arterial infusion chemotherapy.
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Aged↗
Biomedical subjects
L P Leite
Publications and source records attributed to L P Leite.
Effects of octreotide on esophageal visceral perception and cerebral evoked potentials induced by balloon distension.
OBJECTIVE: Octreotide, a somatostatin analog, is antinociceptive and increases perception threshold in the rectum. The aim of this study was to determine whether octreotide alters esophageal sensory thresholds and cortical evoked potentials (CEPs) resulting from intraesophageal balloon distension. METHODS: Twelve healthy volunteers (six men and six women, median age 25 yr, range 21-60 yr) underwent a randomized, double-blind, placebo-controlled trial of octreotide 100 microg s.c. versus saline. A 30-mm balloon was inserted 5 cm above the lower esophageal sphincter without topical anesthesia. The balloon was inflated at a rate of 170 cc/s to a maximum of 30 cc in 2 cc steps. Both pressure and volume were recorded. Patients reported first sensation (S1) and maximally tolerated pain (S2). Two cycles were performed both preinjection and 40 min postinjection. Evoked potentials were recorded from Cz to linked ears over 50 balloon inflation cycles (volume = S2). RESULTS: Threshold volume to first sensation (S1) was significantly increased after octreotide injection [median (interquartile range): 24 (14-26) cc vs 13 (9-21) cc, p < 0.02]. No significant alteration in volume causing pain (S2) was noted after octreotide injection [29 (25-30+) cc vs 22 (19-29) cc]. Neither were volumes causing either first sensation [18 (11-24) cc vs 13 (9-18) cc] or pain [27 (23-30) cc vs 23 (21-25) cc] significantly altered by placebo injection. Neither amplitude nor latency of any of the three peaks of the evoked potential recordings differed significantly between postplacebo and postoctreotide recordings. CONCLUSION: Octreotide significantly increased esophageal perception thresholds to balloon distension. It did not alter pain thresholds, nor were cortical evoked potentials to painful stimulation altered in normal subjects.
Adult↗
Outcome of 88 pregnancies with absent or reversed end-diastolic blood flow (ARED flow) in the umbilical arteries.
OBJECTIVES: To investigate both perinatal and postneonatal morbidity and mortality in fetuses with absent or reversed end-diastolic flow (ARED flow) in the umbilical artery. STUDY DESIGN: A 5 year prospective follow-up of 88 fetuses with ARED flow. RESULTS: Sixteen stillbirths, 16 neonatal deaths, six postneonatal deaths and one death at 2 years of age were noted. Out of the 42 fetuses born alive, 36 showed a normal neurological development whereas six were mentally handicapped. Adverse prognosis was more frequently found in the group with absent end-diastolic flow at first examination and then reversed flow until delivery, compared to the groups of always absent or always reversed end-diastolic flows. CONCLUSIONS: Prompt delivery is recommended in these high-risk pregnancies in order to prevent long-term sequelae, obviously depending on the local limits of viability. Further studies appropriately designed for assessing long-term neurodevelopment of fetuses with ARED flow, although demanding, are mandatory.
Female↗
Ineffective esophageal motility (IEM): the primary finding in patients with nonspecific esophageal motility disorder.
Nonspecific esophageal motility disorder (NEMD) is a vague category used to include patients with poorly defined esophageal contraction abnormalities. The criteria include "ineffective" contraction waves, ie, peristaltic waves that are either of low amplitude or are not transmitted. The aim of this study was to identify the prevalence of ineffective esophageal motility (IEM) found during manometry testing and to evaluate esophageal acid exposure and esophageal acid clearance (EAC) in patients with IEM compared to those with other motility findings. We analyzed esophageal manometric tracings from 600 consecutive patients undergoing manometry in our laboratory following a specific protocol from April 1992 through October 1994 to identify the frequency of ineffective contractions and the percentages of other motility abnormalities present in patients meeting criteria for NEMD. Comparison of acid exposure and EAC was made with 150 patients who also had both esophageal manometry and pH-metry over the same time period. Sixty-one of 600 patients (10%) met the diagnostic criteria for NEMD. Sixty of 61 (98%) of these patients had IEM, defined by at least 30% ineffective contractions out of 10 wet swallows. Thirty-five of these patients also underwent ambulatory esophageal pH monitoring. Patients with IEM demonstrated significant increases in both recumbent median percentage of time of pH <4 (4.5%) and median distal EAC (4.2 min/episode) compared to those with normal motility (0.2%, 1 min/episode), diffuse esophageal spasm (0%, 0.6 min/episode), hypertensive LES (0%, 1.8 min/episode), and nutcracker esophagus (0.4% 1.6 min/episode). Recumbent acid exposure in IEM did not differ significantly from that in patients with systemic scleroderma (SSc) for either variable (5.4%, 4.2 min/episode). We propose that IEM is a more appropriate term and should replace NEMD, giving it a more specific manometric identity. IEM patients demonstrate a distinctive recumbent reflux pattern, similar to that seen in patients with SSc. This finding indicates that there is an association between IEM and recumbent GER. Whether IEM is the cause or the effect of increased esophageal acid exposure remains to be determined.
Adult↗
Independent effect of maternal birth weight on infant birth weight.
The relationship between the birth weights of the mother and her infant was evaluated in a sample of 106 women consecutively delivered of a single live birth. Women were included in the study if their birth weight was available in hospital files or from another reliable source. Women that were themselves a twin or had diseases complicated the course of the pregnancy were excluded. A positive significant correlation was found between mother and infant birth weights (r = 0.29, p = 0.003). This correlation remained significant (partial r = 0.22, p = 0.039) after adjusting for other covariables such as the mother's age, height, education, whether the pregnancy was planned, number of cigarettes smoked daily during pregnancy, month of first antenatal visit and number of visits, weight at end-pregnancy, gestational age and sex of the newborn. In the multiple linear regression model, mother's birth weight explained 3% of the variation observed in infant birth-weight. A weaker crude correlation was also found between mothers' birth weight and gestational age (r = 0.19, p = 0.06). This study shows that maternal birth weight is an independent predictor of infant birth weight, and confirms previous findings suggesting that this maternal factor has a stronger effect on the birth weight than on the gestational age of the newborn.
Birth Weight↗
Persistent acid secretion during omeprazole therapy: a study of gastric acid profiles in patients demonstrating failure of omeprazole therapy.
OBJECTIVE: To identify patients with gastroesophageal reflux disease (GERD) who, despite omeprazole 20 mg b.i.d., demonstrate continued abnormal gastric acid secretion. METHODS: Eighty-eight patients with GERD completed ambulatory gastric and esophageal pH monitoring for persistent symptoms on omeprazole 20 mg b.i.d.. Seventeen (19%) demonstrated abnormal gastric acid secretion (percentage time gastric pH < 4 > 50%). The 17 omeprazole failures (OF) were compared with: 1) 19 randomly selected patients with GERD (also studied on omeprazole 20 mg b.i.d. and 2) 19 normal volunteers studied on both placebo and omeprazole 20 mg b.i.d.. Total time intragastric pH < 4, 24-hr gastric pH frequency distribution, and 15-min median pH values for the 6-h period after the evening omeprazole dose were compared. RESULTS: Both the 24-hr frequency distribution for gastric pH and the 15-min median gastric pH profile for patients with GERD and volunteers on omeprazole 20 mg b.i.d. were almost identical. By contrast, gastric pH studies from the OF group receiving omeprazole 20 mg b.i.d. most closely resembled those of the normal subjects receiving placebo, with respect to these variables. Gastric pH monitoring in seven of the 17 OF patients while on omeprazole 80 mg/day demonstrated a significant decrease in the median percentage time gastric pH remained below 4 (32.8% on 80 mg/day vs 74.3% on 40 mg/day; p < 0.02). CONCLUSION: There are individuals whose intragastric acidity persists despite conventional doses of omeprazole. Although the underlying mechanism remains unclear, the majority (six of seven) (87%) demonstrated improved gastric acid control when placed on high dose omeprazole, indicating that this is often a dose-dependent phenomenon.
Anti-Ulcer Agents↗
Changes in overnight fasting intragastric pH show poor correlation with duodenogastric bile reflux in normal subjects.
BACKGROUND: Spontaneous rises in intragastric pH are a common phenomenon in patients and normal subjects who undergo prolonged ambulatory pH monitoring; however, controversy exists over their etiology. Some investigators have postulated that these events are secondary to duodenogastric bile reflux (DGBR), and others have implicated increased salivation or increased esophageal bicarbonate production. The advent of a fiberoptic system that reliably identifies the presence of bilirubin has made it feasible to qualitatively detect DGBR. We used this technology along with simultaneous ambulatory intragastric pH monitoring to evaluate the relationship between DGBR and rises in intragastric pH in normal subjects. METHODS: We studied five normal subjects for a 15-h overnight period with simultaneous intragastric pH and bilirubin monitoring. The probes were sutured together so that the pH electrode lay adjacent to the fiberoptic bilirubin sensor, then passed transnasally into the fundus of the stomach. Subjects were fasted for the entire study. Data were obtained by plotting all intragastric pH values (recorded every 4 s) and their corresponding intragastric bilirubin absorbance units (recorded every 8 s) at 5-min intervals from the beginning to the end of the study for each of the five subjects (n = 903). RESULTS: Regression analysis of the data showed poor correlation (r = 0.26) between intragastric pH and intragastric bilirubin absorbance. CONCLUSION: Rises in intragastric pH do not predict the presence of bile in normal subjects. In addition, DGBR usually does not cause alkaline shifts of intragastric pH. Although further studies are needed to fully elucidate the etiology of spontaneous rises in intragastric pH, we believe that the measurement of "alkaline reflux" with ambulatory intragastric pH monitoring alone is an outdated technique and that the Bilitec 2000 should become the standard technique for the detection of intraluminal bile.
Adult↗
Sensitization of esophageal mucosa by prior acid infusion: effect of decreasing intervals between infusions.
OBJECTIVE: To determine the effect of decreasing time intervals between acid exposures on the sensitivity of the esophageal mucosa. METHODS: Ten healthy subjects with no history of gastroesophageal reflux disease who were symptomatic during a modified Bernstein acid infusion test were recruited for the study. Hydrochloric acid solutions of pH 3, 2, and 1 were sequentially tested. The weakest pH solution that was perceived by the patient was used for the study. The same duration of acid infusions (9 ml/min for 5 min) were made but with decreasing time intervals between each subsequent acid infusion (30-0 min). Esophageal sensation during each of the infusions, the amount of distilled water required to raise intraesophageal pH > 4, and the duration of residual heartburn after pH > 4 were recorded. RESULTS: Seven of the 10 subjects (70%) were Bernstein-positive to pH 3, two to pH 2, and only one to pH 1 solution. The median time to initial heartburn was significantly reduced only between the initial infusion and the first subsequent acid exposure 30 min later (165 vs 51.5 s, p < 0.009). Subsequent reductions in the time interval between infusions did not significantly reduce the perception threshold. The water required to clear the esophagus to pH > 4 and time required for the residual esophageal sensation to disappear were not significantly altered throughout the study. CONCLUSIONS: These data suggest that some episodes of reflux may be felt sooner and perhaps more severely despite similar levels of acid burden in the esophagus when sensitization by a prior reflux episode occurs.
Adult↗
Mucosal acid exposure sensitizes a subset of normal subjects to intra-oesophageal balloon distension.
OBJECT: To assess the effect of acid infusion on the response of normal subjects to progressive intra-oesophageal balloon distension (IOBD). METHODS: Twenty-one volunteers underwent slow IOBD. Subjects were asked to indicate the first perception of sensation (S1) and the onset of pain (S2), balloon volumes being recorded at both points. A 15-min infusion of 0.1 M HCl (8 ml/min) was then instilled proximal to the balloon. Subjects were designated as acid-sensitive if they reported chest pain or heartburn during the acid infusion. Thereafter S1 and S2 were assessed again in the same manner. RESULTS: Nine subjects were acid-sensitive, 12 were acid-insensitive. The subgroup of 12 acid-insensitive subjects had an increase of pain threshold after acid infusion (P < 0.05), whereas the nine acid-sensitive subjects showed a decrease of pain threshold after acid infusion (P < 0.05). No change of the threshold for sensation occurred in either of these groups after acid infusion. CONCLUSION: Individuals showing mucosal acid sensitivity have a lower threshold for mechanoreceptor stimulation after acid exposure.
Adult↗
The gold standard for assessing symptom associations.
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Gastroesophageal Reflux↗
Perspectives on esophageal manometry: "lumpers versus splitters".
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Esophageal Motility Disorders↗
Omeprazole for the treatment of posterior laryngitis.
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Anti-Ulcer Agents↗
Reverse end-diastolic umbilical artery blood flow at 11 weeks' gestation.
This report describes a case of reverse end-diastolic blood flow in the umbilical artery of one of the fetuses of a twin pregnancy at 11 weeks' gestation. Cytogenetic studies after amniocentesis performed at 12 weeks revealed a 45.X karyotype of this twin whose death was registered 1 week later. Spontaneous delivery of the co-twin occurred at 37 weeks; the newborn was healthy and normal. This is the earliest record of reverse diastolic flow in the umbilical artery. Even in the first trimester of pregnancy this is an ominous sign and fatal demise is expected.
Adult↗
Control of gastric acid with high dose H2-receptor antagonists after omeprazole failure: report of two cases.
Successful omeprazole therapy in patients with symptomatic gastroesophageal reflux (GER) refractory to treatment with H2-receptor antagonists has often been reported. In contrast, successful treatment of GER by H2-receptor antagonists in patients resistant to the acid-suppressing effects of omeprazole is rarely reported. We describe two patients who demonstrated therapeutic responses to high dose H2-receptor antagonists after high dose omeprazole failed to suppress gastric acidity and GER.
Adult↗
Congenital vascular anomalies of the umbilical cord: the value of color Doppler ultrasound in prenatal diagnosis.
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Comment↗
[Transvaginal endosonography and Doppler study in embryo-fetal hemodynamic assessment in the first pregnancy trimester].
Transvaginal endosonography is now currently used in obstetrics and gynecology practice and seems a promising tool for essential studies on first trimester pregnancy. High-resolution and duplex/color Doppler in vaginal probes have brought to light new chances for early investigations on embryonic-fetal haemodynamics. We report our experience in this field, together with a review of the literature, giving an overview on embryonic-fetal cardiovascular haemodynamics studied by this approach. Blood flow patterns of intracardiac flows as extra-cardiac circulation during first trimester pregnancy are reported.
Embryo, Mammalian↗
[Automated analysis of cardiotocographic signals].
Cardiotocographic signals, used as a perinatal diagnostic tool, comprise fetal heart beat signals (FHR), uterine contractions (UC) and fetal movements (FM). Visual inspection of these three signals is limited, subjective, time consuming and with low reproducibility. The present paper illustrates an application of signal processing techniques to the automatic analysis of cardiotocographic signals, allowing to overcome visual inspection limitations. Porto system of cardiotocograms automatic analysis acquires the signals from a conventional cardiotocograph. The signals are stored and processed by a personal computer. System software allows the user to perform several operations such as signal acquisition, signal storage and retrieval from files, signal analysis and display. Signal analysis is preceded by various signal conditioning operations (filtering, spike removal, etc.) and consists in the estimation of several parameters with diagnostic value: FHR baseline; FHR accelerations and decelerations; uterine contractions; long and short term FHR variability. The system prototype is working on a routine basis at the Obstetrics Department of S. João Hospital (main Oporto Hospital) and is being evaluated using a large data set. A preliminary evaluation performed by 3 experts on a 50 cases set, yielded an agreement rate with computer measurements of 98% for the baseline, 72% to 82% for accelerations and decelerations and 76% for the uterine contractions.
Cardiotocography↗