PubMed Health⌕ Search

Biomedical subjects

N H Gilinsky

Publications and source records attributed to N H Gilinsky.

At least 19 recordsLinked to original sources
PubMed1992

A multicenter, double-blind, randomized, placebo-controlled comparison of nocturnal roxatidine in the treatment of active duodenal ulcer disease. Multicenter Roxatidine Cooperative Study Group.

This multicenter randomized, double-blind, 4-wk study compared the new H2-receptor antagonistic roxatidine (R) to placebo (P) for treatment of endoscopically diagnosed active duodenal ulcer disease. Subjects were evaluated after 2 and 4 wk of treatment. Those whose ulcer was unhealed at 2 wk received 2 more weeks of treatment before final evaluation. Ulcer healing (endoscopically determined) with roxatidine was more effective than placebo at both wk 0-2 (R = 33.9%, P = 21.9%, p = 0.018) and wk 2-4 (R = 68.2%, P = 29.7%, p less than 0.001), with an overall 4-wk effectiveness of 78.9% compared to 44.8% (p less than 0.001). At the end of treatment, average maximum ulcer diameter diminished 83% in R and 50% in P (p less than 0.001). Roxatidine was also more effective than placebo in decreasing abdominal pain (p less than 0.001), decreasing the number of antacid tablets taken for pain relief (p less than 0.001), improving dyspeptic symptoms (p less than 0.001), and permitting return to a normal routine for subjects with previous illness-imposed restrictions on work and/or other daily activities. The profile of laboratory values and adverse experiences demonstrated roxatidine to be safe and well-tolerated. The efficacy of roxatidine as evaluated by the healing rate of duodenal ulcer and reduction in abdominal pain emphasize its value as an addition to the family of H2-receptor antagonists.

Abdominal Pain↗
PubMed1991

Lipid responses of hypercholesterolemic men to oat-bran and wheat-bran intake.

The hypocholesterolemic effects of oat bran (OB) have been recently challenged. To carefully document the hypocholesterolemic effects of OB, 20 hypercholesterolemic men admitted to a metabolic ward were randomly allocated to either OB or wheat bran (WB) for 21 d after a 7-d control-diet period. Control and treatment diets were designed to be identical in energy content and nutrients, differing only in the amount of soluble fiber. After 21 d, OB significantly decreased total cholesterol by 12.8% (P less than 0.001), low-density-lipoprotein cholesterol by 12.1% (P less than 0.004), and apolipoprotein B-100 by 13.7% (P less than 0.001) whereas WB had no significant effect. High-density-lipoprotein cholesterol and apolipoprotein A-I did not change significantly in either group. Serum triglycerides decreased by 10% in both groups but the decrease was only significant (P less than 0.04) in WB subjects. OB but not WB significantly reduced total cholesterol and other atherogenic lipoprotein fractions independent of other dietary changes.

Adult↗
PubMed1991

Gaucher's disease complicated by bleeding esophageal varices and colonic infiltration by Gaucher cells.

We report a 10-yr-old child with Gaucher's disease who developed upper gastrointestinal bleeding from esophageal varices, as well as hemorrhage from a colonic polyp infiltrated with Gaucher cells. Both the varices and polyp were treated endoscopically, and the outcome was successful. Although gastrointestinal hemorrhage due to portal hypertension is considered a rare complication of Gaucher's disease, colonic infiltration with Gaucher cells has not been recognized previously.

Biopsy↗
PubMed1990

Right ventricular thrombosis after peritoneovenous shunt: nonoperative treatment with successful outcome.

Complications of peritoneovenous shunt for intractable ascites include a high propensity to malfunction, facilitation of infection, and the induction of coagulopathies. Right heart thrombosis is a rarely encountered adverse effect, the management of which has not yet been defined. We report a patient with an extensive right heart thrombus in the setting of a blocked peritoneovenous shunt that was discovered incidentally and treated expectantly with subsequent complete resolution and satisfactory outcome.

Adult↗
PubMed1990

Peptic ulcer disease in the elderly.

Peptic ulcer disease in the elderly poses challenges to the physician distinct from those encountered in younger individuals. Factors predisposing to the more aggressive natural history of peptic ulcer disease in the elderly are examined. These are of great importance in considering diagnostic investigations, the choice of therapeutic agents, and the management of complications. Despite advances in operative technique and care, surgery, particularly when emergent, is attended by a high mortality in this group. The utility of diagnostic and therapeutic endoscopy is discussed, and strategies for short and longer term medical treatment are presented.

Age Factors↗
PubMed1989

Pancreatic function testing. Methods to identify exocrine insufficiency.

The diagnosis of chronic pancreatitis is ideally established by an appropriate clinical history and confirmatory radiologic imaging. However, in cases where imaging results are normal or equivocal, pancreatic function testing is necessary. Direct (intubation) tests are generally accepted as the best methods for study of pancreatic exocrine capacity, but indirect tests, which are well tolerated and generally simple to perform, are gaining interest. Their shortcoming is that they are too insensitive to reliably differentiate patients with early exocrine dysfunction (ie, before malabsorption has occurred) from controls. Sensitivity is not improved by combining two or more studies. However, several modified tests (eg, two-stage paraaminobenzoic acid test, pancreolauryl test) have improved specificity and are able to distinguish pancreatic from other causes of steatorrhea. Their reproducibility in individual cases is of value in sequential studies and in patients with established pancreatic exocrine deficiency to seek evidence of improvement or deterioration in function and to determine patient compliance with replacement therapy.

4-Aminobenzoic Acid↗
PubMed1988

Peptic ulcer disease in the elderly.

The elderly are a growing minority; they comprise approximately 12% of the population but consume an increasing proportion of health care resources. Disease in the aged is unique in many ways, demanding special attention and study. This is particularly evident with regard to peptic ulceration, which is a more serious disorder in the elderly than in younger individuals, often presenting in an atypical manner and having a greater propensity to complications. Management traditionally tends to be conservative, enthusiasm often being tempered by the presence of frailty and associated disease. Despite technologic and pharmacologic advances, the elderly continue to account for a disproportionate number of deaths from this disorder. This paper will review the peculiarities of peptic ulcer disease of the elderly and examine currently emerging trends which may influence evolving management policies.

Aged↗
PubMed1988

Fatal amiodarone hepatoxicity.

The antiarrhythmic agent amiodarone is associated with numerous adverse effects, but clinically significant liver disease is rare. A patient is described who presented with muscle weakness, hepatomegaly, and ascites following 28 months of amiodarone usage. His condition deteriorated despite discontinuation of amiodarone therapy. A postmortem liver biopsy demonstrated necrosis, fibrosis, hyalin, and phospholipid-laden lysosomal lamellar bodies. Resolution of hepatic dysfunction may not necessarily occur on withdrawal of amiodarone if irreversible damage is already established. We speculate as to the reasons for the reportedly low incidence of overt liver disease, and suggest that hepatic enzyme levels, as well as other indicators of hepatic function, such as the serum albumin concentration, be monitored indefinitely in all patients while taking amiodarone.

Aged↗
PubMed1987

Nocturnal dosage regimen of sucralfate in maintenance treatment of gastric ulcer.

Sixty-six patients with recently healed gastric ulcers were entered into a double-blind, placebo-controlled, six-month maintenance trial to determine whether sucralfate 2 g at night reduces the liability to recurrent ulceration. Thirty-three patients were randomly assigned to treatment with sucralfate and 33 were assigned to placebo. Endoscopy was performed at the time of entry into the study and at 24 weeks, or earlier if clinical relapse occurred during this period. Of the patients available for analysis, endoscopic recurrences were found in eight of the 29 patients (28 percent) randomly assigned to sucralfate and in 15 of the 27 patients (56 percent) assigned to placebo. Eight of the recurrences noted at 24 weeks were asymptomatic and, of these, five were in the placebo-treated group. The cumulative relapse rate at 24 weeks was significantly lower in the sucralfate-treated group (p less than 0.05), and the Cox-Mantel text showed a significant difference between the cumulative relapse curves of the two treatment groups over the 24-week period (p less than 0.05). The results indicate that a single maintenance dose of sucralfate 2 g at night reduces the relapse rate in patients with recently healed gastric ulceration.

Antacids↗
PubMed1987

The role of pancreatic function testing in the 1980s.

The recent advent of non-invasive imaging techniques and tubeless pancreatic function tests has revolutionised the investigation of patients with suspected chronic pancreatic disease. The current diagnostic role of the conventional pancreatic function test is evaluated and the practical usefulness of alternative modalities is reviewed.

Chronic Disease↗
PubMed1987

Annular pancreas associated with diffuse chronic pancreatitis.

A patient with longstanding diabetes and renal failure presented with painless vomiting due to duodenal obstruction was found to have an annular pancreas. Initial operative evaluation, later pathologically confirmed, demonstrated involvement of not only the annulus, but also the entire gland by diffuse atrophic chronic pancreatitis. We speculate on the possible influence of the underlying diabetes and renal disease on the pathogenesis of the unusual generalized chronic inflammatory changes and the precipitation of duodenal obstruction in this patient.

Adult↗
PubMed1987

Immunoproliferative small-intestinal disease: clinical features and outcome in 30 cases.

Experience with 30 patients with immunoproliferative small intestinal disease followed prospectively between 1971 and 1986 is described. All presented with malabsorption or growth retardation and had similar clinical, biochemical, and radiological features, irrespective of the presence of lymphoma or immunological abnormality. Alpha-chain disease protein was detected in 4 of the 11 patients who had a non-lymphomatous, predominantly plasmacytic infiltration of the small bowel; and in 5 of the 19 cases with diffuse intestinal lymphoma. The importance of exploratory laparotomy to include full-thickness intestinal biopsy in patients who have a benign infiltrate on peroral biopsy is demonstrated by the finding of lymphoma in operative specimens in 9 of 15 patients with mature, lymphoplasmacytic cells, and 5 of 8 patients with atypical, lymphoplasmacytic cells. The majority of patients with fully established benign disease, even those elaborating alpha-chain disease protein, appeared to have a good prognosis. No patient with immunoproliferative small intestinal disease developed immunologically demonstrated alpha-chain disease or frank lymphoma, when this was not found initially at explorative laparotomy.

Adolescent↗
PubMed1986

Comparison of pirenzepine with cimetidine in duodenal ulcer disease. A short-term and maintenance study.

Sixty-seven patients with endoscopically proven duodenal ulceration were entered into a double-blind study and randomized to treatment with pirenzepine (PZ) (Gastrozepin; Boehringer Ingelheim) 50 mg twice daily or cimetidine (CM) (Tagamet; Smith Kline & French Laboratories) 400 mg twice daily, given 30 minutes before breakfast and supper. Patients underwent endoscopic examination before entry, at 4 weeks, and at 8 weeks if unhealed at 4 weeks. Once healing was achieved, 43 patients were entered into a single-blind maintenance study with either PZ 50 mg at night or CM 400 mg at night according to their original randomization. CM had a slight, but not significant, advantage over PZ after 4 weeks, but the 8-week data showed identical healing rates. The relapse rate appeared to be higher in the PZ-treated group, but this difference was also not significant. It is suggested that the evening dose of PZ be amended to 50 or perhaps 100 mg before bed in the short-term treatment of duodenal ulcer, and that a dose of 100 mg at night be considered for maintenance therapy in certain high-risk populations.

Adult↗
PubMed1986

Tuberculous perforation of the bowel. A report of 8 cases.

Eight patients with tuberculous perforation of the bowel, representing 15% of all cases of intestinal tuberculosis, were seen over a 13-year period. A wide spectrum of presentations was encountered. A history of acute abdominal pain was not always obtained, but it could be the first indication of the presence of associated intestinal involvement in a patient receiving treatment for pulmonary tuberculosis. Free subdiaphragmatic air was detected radiologically in only 2 cases (25%). It is suggested that emergency surgery should be limited to dealing with only the perforated and any obviously obstructed bowel, and the advantages of delaying additional procedures are stressed. Despite the invariable accompanying suboptimal nutritional status and associated medical problems found in this group of patients, only 2 died.

Adolescent↗
PubMed1986

Immunoproliferative small-intestinal disease with lymphoma--diagnostic difficulties and pitfalls. Case reports.

Immunoproliferative small-intestinal disease and related diffuse intestinal lymphoma is a debilitating illness prevalent in South Africa. Case reports are presented to illustrate that the early course may be deceptively prolonged and 'benign'; diarrhoea is not invariable, and an initial clinical response to antibiotics may occur. The combination of villous atrophy and a predominantly plasma cell infiltration of the lamina propria in jejunal biopsy specimens may indicate lymphoma in adjacent bowel or regional lymph nodes.

Adult↗
PubMed1986

Diagnostic yield of endoscopic retrograde cholangiopancreatography in carcinoma of the pancreas.

The results of 117 consecutive endoscopic retrograde cholangiopancreatographic (ERCP) examinations in patients with adenocarcinoma carcinoma of the pancreas, performed over a six year period, are reported. The diagnostic accuracy of this procedure (80.3 per cent) was higher than that of computed tomography (63.6 per cent) and ultrasonography (54.0 per cent). Fewer false negative diagnoses were made by retrograde cholangiopancreatography (7.7 per cent) than with the other procedures (28 per cent each). Analysis of the total ERCP experience during the study period revealed a false positive rate for malignancy of 5.6 per cent. In situations where investigations are performed by individuals with a broad spectrum of expertise, ERCP is superior to other methods in diagnosing pancreatic carcinoma, even in areas with a high prevalence of chronic pancreatitis.

Adenocarcinoma↗