Biomedical subjects
Publications and source records attributed to M G Moshal.
A case is discussed of a 30-year-old Black woman who developed a massive pseudocyst of the pancreas while under investigation in hospital for a left pleural effusion. An internal pancreatic fistula to the pleural space was demonstrated at endoscopic retrograde cholangiopancreatography. The patient recovered completely after distal pancreatectomy with splenectomy.
The effect of long-term cimetidine therapy on the ultrastructure of human parietal cells was investigated in 2 subjects. It was found that after cimetidine therapy for 1 year: (i) the ultrastructural appearance of the parietal cells was normal, and (ii) the parietal cells responded normally to stimulation by pentagastrin. Evidence in favour of a membrane flow mechanism involved in acid secretion is presented.
Although heartburn, thought to indicate reflux of gastric contents into the oesophagus, occurs frequently in pregnant women during the last trimester, its aetiology is not clear. Prolactin blood concentrations rise progressively during pregnancy and heartburn is known to disappear spontaneously during the last weeks of pregnancy. In view of this and other factors, motility studies and estimation of serum prolactin levels were carried out on 20 pregnant Black women. Results show that patients with prolactin levels over 3,000 microunits/ml had significantly higher mean barrier presures (sphincter pressure-gastric pressure) than the patients with hormone levels of less than 3,000 microunits/ml (P less than 0,02). No direct correlation could, however, be demonstrated between barrier pressures and prolactin levels (r = 0,3494). It is concluded that further studies would seem to be indicated on an animal model to establish the importance of prolactin in the regulation of the lower oesophageal sphincter tone.
Duodenal ulceration among Black and Indian patients admitted to King Edward VIII Hospital, Durban, over a 26-year period (1950-1976) was studied. Analysis was made over a series of time intervals within this period, and expressed as the number of admissions for duodenal ulcer per 1,000 total admissions (excluding obstetric and gynaecological patients). Admissions for duodenal ulceration increased 2,4-fold among the Indians and 11,9-fold among the Blacks from 1950 to 1976. The disease appears to have become commoner among women in both race groups. The peak age for Indian men is the 3rd decade, but for Indian women the peak age incidence has changed from the 4th to the 6th decade. There is now a peak in the 3rd decade for Black men, compared with the 4th decade, as reported 20 years ago. The pattern is similar in Black women. The clinical presentation is similar in the two groups, although it is significant that haemorrhage occurs more frequently among the Black patients.
The effect of intravenous ergometrine 0.5 mg during general anaesthesia for Caesarean section on lower oesophageal sphincter (LOS) function was investigated in eight patients. Ergometrine increased the LOS pressure markedly (p less than 0.005).
Twenty adult Indian patients suffering from the spastic form of irritable colon, i.e. abdominal pain and constipation, were given trimebutine (Mebutin), 2-phenyl, 2-dimethylamino-n-butyl 3, 4, 5-trimethoxybenzoate. Patients were given treatment with 200 mg trimebutine three times daily, or placebo for 4 weeks, and then crossed over. In addition, stool transit times were assessed by the single stool transit time (SST) method of Cummings. Results showed a statistical improvement in abdominal pain and constipation with both trimebutine and placebo after 4 weeks, but only with trimebutine after 8 weeks. Single stool transit time was significantly reduced after trimebutine.
Five hundred and twenty-two African and Indian patients were studied, including 206 with duodenal ulcers, 25 with irritable colon, 51 with oesophagitis, 31 with pancreatitis, 14 with ulcerative colitis or Crohn's disease, 71 miscellaneous gastrointestinal diagnoses and 124 controls. The mean ages were similar in each group. Every patient underwent endoscopy and a detailed psychosocial questionnaire was applied. Comparison of occupations of patients and their patients was investigated on 3 scales, for Status/Prestige (9 levels), Responsibility (5 levels) and Control over Others (10 levels). Significantly more patients with duodenal ulcers were in the lowest group in terms of occupational authority compared to other diagnoses and controls. Similar number of all groups had been urban for their entire life. Stress was present in the 10 days preceding an attack in significantly more Indian males with duodenal ulcers compared to controls. Upward shifts in prestige had not occurred in African male patients with duodenal ulcers when compared to their parents but had occurred among Indian men. More duodenal ulcer patients were in the very lowest occupational authority category compared to other groups. It may thus not be occupational prestige as such that is important, but factors associated with it, such as lack of control over others and, among Indian men, stresses associated with social disruption following upon occupation mobility.
After six weeks therapy with the bismuth-containing substance Denol, the ultrastructure of the duodenal cell is normal in most cases. Following therapy with the histamine-2 receptor antagonist (cimetidine), for the same period and even after one year continuous therapy, the denodenal cell remains abnormal in most instances. This may explain the frequent relapse of duodenal ulcers after cimetidine treatment.
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A sodium citrate preparation (Citro-Soda; Abbott) given in single doses of 4 or 12 g, satisfactorily increased the pH level of urine without affecting the systemic acid-base balance. When the sodium citrate preparation was administered in the 12-g single dose the gastric pH level was raised above 3,0 in a significant number of subjects. Similar results were obtained with both single doses (4 and 12 g) after 3 - 6 days of continuous therapy at the appropriate dose given every 6 hours. It is concluded that the urine-alkalinizing sodium citrate preparation reduced intragastric acidity significantly.
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Ninety-five patients who had megaloblastic anaemia, and who lived in a subtropical climate, were studied to elucidate the importance of puerperium, malabsorption, gastric dystrophy, diet and infection in the aetiology of the disease. All 5 factors were found to be common, and to occur in a variety of combinations, producing a wide spectrum of illness variously resembling nutritional megaloblastic anaemia, sprue, pernicious anaemia and many stages in between. It is concluded that megaloblastic anaemia in this population is a multifactorial disease, and a tentative scheme, relating the aetiological factors, is drawn up. Neither serum vitamin B(12) levels, nor folate estimation in serum or red cells emerged as very reliable guides to the underlying biochemical deficiency.
Regurgitation and inhalation of acid gastric content, with resultant chemical pneumonitis, remains a common cause of death during anaesthesia. The effects of intravenous glycopyrrolate 0.3 mg on the lower oesophageal sphincter tone was studied in normal human subjects. Glycopyrrolate decreased lower oesophageal sphincter pressure by 0.88 kPa (p less than 0.005). This finding is of clinical importance in the pre-operative preparation of patients presenting for emergency surgery. A drug which decreases lower oesophageal sphincter tone would presumably increase the hazard of gastro-oesophageal reflux and pulmonary aspiration of acid gastric content.
The effects of five antiemetic drugs on the lower oesophageal sphincter (LOS) were studied in five groups, each comprising eight healthy volunteers. Cyclizine, prochlorperazine and metoclopramide have a desirable functional effect on LOS, while promethazine and droperidol were associated with evidence of increased gastro-oesophageal reflux.
Intraluminal gastroesophageal pressure and pH studies have been performed on 8 nonpregnant women, 10 pregnant women with heartburn, and 10 pregnant women without heartburn. Each patient was tested under resting conditions and after intravenous injection of 0.6 mg atropine. In both groups of pregnant patients the intragastric pressure was found to be higher than that of the nonpregnant subjects. The stomach to lower esophageal sphincter pressure (LESP) gradient under resting conditions was least in the pregnant patients with heartburn. After the administration of atropine, a fall in the LESP occurred in all 3 groups of patients which was most profound in the nonpregnant subjects and in the pregnant patients without heartburn. These changes and the pH recordings of the lower esophagus indicate the adverse effect that atropine has on the competency of the LESP both in pregnancy and in the nonpregnant state. Atropine should therefore be used with caution as a premedicant and preferably combined with metoclopramide (Maxolon).
The effects of intravenous metoclopramide (Maxolon) on the lower oesophageal sphincter (LOS) were studied in three groups of patients, one group being normal control and the other two being pregnant females, one without heartburn and the other with. Metoclopramide increases the LOS pressure 20.5, 15.2 and 10.2 cm H2O respectively (p less than 0.005, p less than 0.005 and p less than 0.05). These findings suggest that for patients undergoing elective or emergency obstetrical anaesthesia, intravenous metoclopramide may help reduce the incidence of regurgitation of gastric contents.
Comparative ultrastructural studies were conducted on biopsy specimens taken under direct vision by endoscopy from the normal duodenum, from the edge of deep and flat duodenal ulcers, and from areas 1 cm away from such ulcers. In addition, the ultrastructure of biopsy tissue from the scar of ulcers which healed after 6 weeks' therapy with the histaminastructural studies of tissue form the edge of both flat and deep duodenal ulcers showed gross pathological changes, particularly with regard to microvilli. Cells from the edge of deep ulcers showed increased secretory activity. Epithelial tissue 1 cm from flat duodenal ulcers exhibited ultrastructural changes far more severe than cells 1 cm from deep duodenal ulcers. The epithelial tissue from the scar area after 6 weeks' treatment appeared capable of regaining a fully functional role, although it was not normal in all specimens.
A prospective double-blind study of the effects of sedation in 142 patients undergoing gastro-intestinal endoscopy was performed. Four regimens were studied (neurolept analgesia with and without topical anaesthesia, and anticholinergic and topical anaesthesia, with and without diazepam). Droperidol and fentanyl without topical anaesthesia yielded the best results as far as tolerance and side-effects were concerned. It is suggested that this form of neurolept analgesia be used for gastro-intestinal endoscopy.