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Biomedical subjects

P Funch-Jensen

Publications and source records attributed to P Funch-Jensen.

At least 19 recordsLinked to original sources
PubMed1992

Diagnosis of esophageal motor disorders: a prospective study comparing barium swallow, food barium mixture, and continuous swallows with manometry.

Radiography and manometry of the esophagus were compared in 77 patients consecutively referred for manometric investigation on suspicion of esophageal motility disorder. Radiography and manometry were carried out simultaneously, and the results were assessed blindly. The examination comprised barium swallow, bread barium swallow, and barium swilling. Considering manometry as the standard, the overall sensitivity and specificity of the radiologic examinations were 90.4% and 92.0%, respectively. We conclude that radiology is an excellent investigation for the separation of patients with and without esophageal motility disorders, but correct subclassification often required manometry.

Administration, Oral↗
PubMed1992

The influence of a solid and liquid bolus on food-stimulated gastroesophageal reflux.

Using a radiological method to demonstrate food-stimulated gastroesophageal reflux (GER), a comparative study was carried out employing a solid, already validated bolus versus a liquid one. One hundred and four consecutive patients received both a solid and a liquid bolus in randomized order. GER was observed in 37 (35.6%) patients receiving the solid bolus versus 28 (26.9%) with the liquid one. This means that the solid bolus provokes significantly more reflux (P less than 0.02). GER, grade II (reflux above the level of the carina), occurred equally often as a result of both types of bolus, however. The study suggests that significant, food-stimulated GER is independent of the consistency of the foodstuffs and may be detected employing a liquid bolus. This result might be used in the examination of infants for GER, using milk as a food stimulus.

Adult↗
PubMed1991

Effect of cholecystectomy on the relationship between hydrostatic common bile duct pressure and sphincter of Oddi motility.

The sphincter of Oddi (SO) motility before and after an artificial elevation of the common bile duct pressure was studied by means of endoscopic manometry in nine female subjects, seven of whom had undergone previous cholecystectomy. An increase in the hydrostatic common bile duct pressure resulted in total inhibition of the phasic SO contractions in the two patients with gallbladders in situ, as well as in four of the cholecystectomized patients. The results thus indicate that the inhibitory effect of hydrostatic common bile duct pressure on the SO motility previously demonstrated in the cat is also present in man. On the other hand, as the inhibition of the phasic contractions failed to occur in three of the postcholecystectomy patients, the findings also suggest that cholecystectomy may result in altered regulation of SO motility in some patients. This mechanism could then contribute to development of pain in susceptible subjects postcholecystectomy. Finally, the results also showed that pain experienced by some patients upon contrast injection during ERCP bears no relationship to SO motility, but is due to an interindividually variable sensitivity of the bile duct wall to the intraluminal pressure variation.

Abdominal Pain↗
PubMed1991

Experimental gastrointestinal motility: where to go.

Gastrointestinal motility is a major field of research. However, despite a huge amount of data available in the literature, its exact role has yet to be defined. This paper deals with the choice of animal research models for motility studies.

Animals↗
PubMed1991

Influence of graded distension of the gallbladder on sphincter of Oddi activity in dogs.

In this study the relationship between the gallbladder pressure (GBP) and sphincter of Oddi (SO) activity was studied in dogs. The GBP was modulated by varying the volume content in a reservoir placed within the gallbladder at ranges corresponding to physiological GBP ranges. For SO manometry a low compliance high fidelity system was used. Firstly the influence of alternating gallbladder emptying and filling on SO activity was studied. A clear relationship was seen in all dogs so that an increase in GBP inhibited SO activity. Subsequently, stepwise increases in GBP from 0 to 38 mm Hg in consecutive 10-min measuring periods showed a definite inverse relationship between GBP and SO frequency, baseline pressures and wave amplitude. It is concluded that a reflex relationship between the gallbladder and the SO exists, operating within physiological ranges of GBP so that increased GBP inhibits SO activity. The importance of this relationship in bile flow dynamics and the possible consequence in the postcholecystectomy state is mentioned.

Animals↗
PubMed1990

Effects of postganglionic nerve stimulation in oesophageal achalasia: an in vitro study.

The functional postganglionic innervation of isolated smooth muscle strips from the oesophagogastric junction was examined in specimens taken from six achalasia patients and seven controls. Muscle strips representing either the longitudinal or the circular layer were prepared and mounted in organ baths and isometric tension was recorded. Electrical field stimulation, selectively exciting nerves, was applied. Strips from the circular layer from controls relaxed during field stimulation, an effect that was the result of stimulation of noncholinergic, non-adrenergic, inhibitory nerves. Circular muscle strips from achalasia patients contracted during field stimulation, an effect that was caused by muscarinic receptor activation. In one patient, atropine reversed the contraction to a relaxation. Longitudinal muscle strips contracted in response to stimulation in both controls and achalasia patients. This response was abolished by atropine. In conclusion the function of postganglionic inhibitory nerve fibres to the circular layer of the oesophagogastric junction is severely impaired in achalasia, while there is a conspicuous, functional cholinergic innervation.

Adolescent↗
PubMed1990

Mechanical properties of isolated human esophageal smooth muscle.

Isolated smooth muscle strips from the human esophagus representing both the longitudinal and circular layers of the esophagogastric junction and the esophageal body were prepared. The strips were mounted in organ baths, and resting length was defined. By repeatedly increasing the length of the strips with 20% of resting length and recording values of resting and active tensions, length-tension relations for each muscle type were constructed. Only circular strips from the esophagogastric junction developed active, resting tension, disclosed by replacing the normal Ca2(+)-containing Krebs solution with Ca2(+)-free medium. Carbachol (10(-6) M) was used for submaximal activation of the contractile apparatus. At lengths between 180 and 260% of resting length, all strips reached optimum length (LO) where further elongation gave no further increase in active tension development. Repeated stimulations with carbachol was possible at a length of 200% of LO without affecting reproducibility. Determination of different collagen components revealed no differences between muscle types.

Calcium↗
PubMed1990

Effects of transmural field stimulation in isolated muscle strips from human esophagus.

Smooth muscle strips representing longitudinal and circular muscle layers of the esophagogastric junction (EGJ) and esophageal body (EB) of the human esophagus were prepared. The strips were mounted in organ baths and isometric tension was recorded. Square wave stimulation was applied through platinum electrodes. Only responses abolished by tetrodotoxin (TTX) were considered neurogenic. Strips taken from longitudinal muscle layers of the EB and EGJ contracted during field stimulation. The responses evoked were abolished by atropine, and optimal frequency of stimulation was 40 Hz. In strips taken from the circular muscle layer of the EB, a contraction occurred after cessation of the stimulus. Atropine inhibited 90% of this response; the optimal stimulation frequency was 40 Hz. When a tone was induced in strips from this layer, a TTX-sensitive relaxation was seen during field stimulation. During stimulation of strips from the EGJ circular muscle layer, which was the only preparation developing spontaneous active tone, a relaxation was seen. A small contraction followed after termination of the stimulus. The relaxation, which was nonadrenergic, noncholinergic, reached maximum at 10 Hz. Atropine inhibited 40% of the contraction. The results suggest that in the longitudinal muscle layer of the human lower esophagus field stimulation causes postganglionic nerves to release transmitter(s) acting on muscarinic receptors. The responses of circular muscle layers seem to be mediated through release of at least two transmitters.

Atropine↗
PubMed1990

Sphincter of Oddi motility.

After a short introduction (chapter 1), anatomy is described in chapter 2. The sphincter of Oddi (SO) can be divided into the choledochal, pancreatic and ampullar sphincter in addition to the intermediate fibres. In anatomic studies the pancreatic and ampullar sphincters are described in only one third and sixth respectively. This is in disaccordance with manometric studies where SO activity always is registered in the pancreatic sphincter after total biliary sphincterotomy. Chapter 3 discusses whether or not the SO is a true sphincter. Activity simultaneous with the duodenum occurs in the interdigestive phase III, but more often duodenal and SO activity is dissociated. It is concluded that the vast evidence supports the SO as a true sphincter. Chapter 4 concerns methods for investigation of the SO activity. The manometric methods are divided into direct and indirect studies, and advantages and disadvantages are discussed. The direct manometric method employing a perfusion system is highlighted, and interpretation of tracings and artifacts described. In chapter 5 physiological aspects are considered. Slow waves are present in the SO, and the activity related to the migrating motor complexes of the duodenum. Apart from interdigestive variation the food stimulated pattern is mentioned. Nervous and hormonal control as well as the relation to other parts within and outside the pancreatico-biliary system is outlined. The SO receives nervous fibres from both the sympathetic and the parasympathetic system. The alfa- and cholinergic neurons stimulate whereas the beta-neuron inhibits the SO. Furthermore inhibitory non-adrenergic, non-cholinergic neurons are present. Cholecystokinines inhibitory action on the SO are brought about via a stimulation of inhibitory neurones since the peptide has a direct stimulatory action on the SO muscle. The most important reflex regulation of the SO is elicited by gallbladder pressure increase with inhibition of the SO. Probably a similar reflex relationship exists between the common bile duct and the SO. The SO is considered important in the regulation of biliary flow, and probably also pancreatic flow, although the latter is only poorly studied. Furthermore the SO is believed to play a role in the prevention of reflux from the duodenum. In chapter 6 studies in normals, controls and patients with diseases in the biliary and pancreatic system are surveyed. In patients with gallbladder stones no changes in SO activity has been disclosed. In patients with common bile duct stones some have found increased antiperistalsis, others not.(ABSTRACT TRUNCATED AT 400 WORDS)

Ampulla of Vater↗
PubMed1990

Influence of cisapride on food-stimulated gastro-oesophageal reflux: a radiological study.

The influence of Cisapride on food-stimulated gastro-oesophageal reflux mechanisms was studied in a double-blind cross-over investigation in 24 consecutive patients selected by endoscopy, 12 with microscopical evidence of gastro-oesophageal reflux and 12 with additional macroscopic oesophagitis. 63% had food-stimulated gastro-oesophageal reflux, and Cisapride significantly reduced the tendency to gastro-oesophageal reflux and mucosal contact time between gastric content and the oesophageal mucosa in 73% of these patients. It is concluded that Cisapride could be valuable in the treatment of gastro-oesophageal reflux.

Adult↗
PubMed1990

Food-stimulated cholescintigraphy as a supplement to ERC in patients with suspected bile flow obstruction. A preliminary study.

Cholescintigraphy after food stimulation was carried out in 40 patients (13 patients with biliary enteric bypass, 14 patients with bile duct stenosis, demonstrated by ERC, 5 patients with endoprothesis and 8 patients with clinically suspected post-cholecystectomy syndrome. Biliary-bowel transit time of one hour or less was considered to be normal. In patients with biliary enteric bypass 11 had a normal transit time; however, one with a concomitant anastomotic leakage, and 2 patients had prolonged transit time and a significant obstruction by the anastomosis. All 14 patients with demonstrated biliary stricture had normal transit time. In 5 patients with endoprothesis, 2 had prolonged transit time in spite of patent endoprothesis. Finally, in the 8 patients with suspected post-cholecystectomy syndrome, 4 had normal sphincter of Oddi manometry and normal transit time, and 4 had abnormal sphincter of Oddi manometry, but only one with prolonged transit time. It is concluded that in patients with biliary enteric bypass (hepatico-jejunostomia) or biliary strictures a biliary-bowel transit time of one hour will be discriminatory between normal and abnormal conditions. This is in contrast to patients with endoprothesis and suspected sphincter of Oddi dysmotility, where a transit time of one hour only will have limited predictive value.

Adult↗
PubMed1990

HIDA-cholescintigraphy in normals. Value of interrupting the migrating motor-complex (MMC).

The value of interrupting the migrating motor-complex (MMC) and computer-assisted technique in HIDA cholescintigraphy was studied in 10 healthy subjects. Sequential scintigrams were sufficient for evaluating biliary-bowel transit time, visualization of the gall bladder and liver wash-out. However, the point of dynamic equilibrium between net uptake and emptying of the tracer of the gall bladder and hepatic areas, required computer assisted technique. Finally, interruption of the MMC resulted in biliary-bowel transit within one hour in all, but only gall bladder visualization in 8, whereas in the fasting state the gall bladder was visualized in all, but with prolonged biliary-bowel transit in one subject.

Adult↗
PubMed1990

Final gastric emptying of solid food in healthy subjects: determined by X-ray examination and radionuclide imaging.

In ten healthy subjects final gastric emptying of solid food was measured by a new scintigraphic method, employing 99mTc labelled pellets, and compared to a radiologic method, employing food with incorporated barium suspension. Final gastric emptying of solid food, measured by the scintigraphic technique, was 5.2 hours and with the radiographic technique 5.5 hours, with no significant difference. It is concluded that significant information concerning gastric emptying of solid food can be obtained by the radiological method.

Adult↗
PubMed1989

[Oddi's sphincter dysfunction].

Dysfunction of the sphincter of Oddi (SOD) is an uncommon condition which must be considered in cases of persistent pain in the upper abdomen following uncomplicated cholecystectomy, when disease in other organs, such as gastric ulcer, esophagitis and pancreatitis has been eliminated. The pathogenesis is not fully elucidated, but it is assumed that the cholecystectomy in some cases induces an increased tendency to spasm in the sphincter of Oddi (SO), and, perhaps in connection with an increased sensitivity to pressure elevations in the biliary tree, results in attacks of pain. Whether fibrosis (stenosis) of the SO due to instrumentation or passage of stones is part of the etiology is obscure. Endoscopic retrograde cholangiopancreaticography with papillary manometry should be performed in all cases where SOD is suspected. An elevated basal pressure in SO seems to be the best indicator of SOD. In cases unresponsive to conservative treatment, endoscopic sphincterotomy may be considered. This treatment is not finally evaluated, but apparently the effect is good, especially in patients with elevated basal pressure in SO. It is emphasized that the knowledge of the behavior and regulation of SO is incomplete and that this should be remembered when criteria for SOD are applied.

Ampulla of Vater↗
PubMed1989

Severe destruction of esophageal nerves in a patient with achalasia secondary to gastric cancer. A possible role of eosinophil neurotoxic proteins.

We present a case of secondary achalasia due to an adenocarcinoma of the stomach with no tumor infiltration of the esophagus. Immunohistochemical staining revealed a massive infiltration of activated eosinophils in the muscularis of the esophagus with secretion of the highly cytotoxic and neurotoxic eosinophil cationic protein (ECP). Immunohistochemical staining for the neuropeptides VIP and substance P, as well as the histochemical demonstration of AChE, revealed a nearly total absence of all three neurotransmitters/modulators compared to control. The hypothesis is advanced that eosinophil neurotoxicity is the cause of secondary achalasia.

Adenocarcinoma↗
PubMed1989

Eosinophil infiltration in primary esophageal achalasia. A possible pathogenic role.

Smooth-muscle specimens from the lower esophagus of nine patients operated on for esophageal achalasia were examined with routine hematoxylin-eosin staining. This procedure revealed only a few eosinophils in or between the external smooth-muscle layers. Using specific immunohistochemical methods for the detection of the eosinophil cationic protein (ECP), however, varying degrees of eosinophil infiltration and extracellular deposit of ECP were disclosed in the achalasia specimens. The ECP also reacted with the monoclonal antibody, EG2, indicating secretion of the cytotoxic ECP. Few or no eosinophils were seen in the muscularis externa in specimens from six control patients without esophageal disease. In two controls many eosinophils were observed in the muscularis externa. However, no extracellular ECP was detected and very few eosinophils reacted with the monoclonal antibody (EG2), suggesting that these eosinophils were not activated. Depletion or total absence of peptidergic innervation was seen in all achalasia specimens but not in controls. Since the eosinophil cationic protein (ECP), in its activated form, is cytotoxic, we propose a pathogenic role of the eosinophil infiltration in achalasia.

Adult↗