Biomedical subjects

R Burakoff

Publications and source records attributed to R Burakoff.

At least 37 records · Page 2Linked to original sources

PubMed1995

Pregnancy and nursing.

The IBD patient should be optimistic about a potential pregnancy. Inactive IBD is not associated with decreased fertility. Inactive IBD does not affect the course of pregnancy; however, IBD has been associated with increased preterm deliveries. Active IBD during pregnancy is associated with increased stillbirths and spontaneous abortions but not with increased congenital abnormalities. Pregnancy does not cause exacerbation of previously quiescent IBD. If the disease is active at conception, it remains active or worsens in approximately two thirds of patients. Corticosteroids, sulfasalazine, and 5-ASA drugs are safe and should be used to maintain or induce remission. Antimetabolites may possibly be proved safe in the future during pregnancy but cannot yet be recommended. Both enteral nutrition and total parenteral nutrition can and should be used safely and effectively during pregnancy. Radiographs are to be used in diagnosis if an emergent condition, such as perforation or toxic megacolon, is suspected. The chance of an offspring developing IBD is about 9% but rises to 34% if both parents have IBD.

Abortion, Spontaneous↗

PubMed1994

Effects of rotavirus on epithelial transport in rabbit small intestine.

The present study investigated changes in small intestinal epithelial transport in rabbits infected with rotavirus. The crypt depth-villus height ratio was increased in infected ileal tissue as a result of a significant increase in crypt depth and patchy shortening of the villi. Similar villus damage was seen in the jejunum. Despite these histological changes, basal fluid absorption by both the ileum and jejunum of infected animals was unaltered. Values for basal short-circuit current and resistance were similar; however, the increase in short-circuit current evoked by prostaglandin E2 was significantly smaller in rotavirus-infected tissues than in controls. The apparent Vmax for electrogenic glucose and alanine uptake by the jejunum was significantly increased following inoculation with rotavirus. Reduced responsiveness to the secretory effect of prostaglandin E2 and increased nutrient uptake may limit diarrhea that would otherwise be expected to occur as a result of the changes in mucosal architecture. This has important implications on the clinical treatment of rotavirus diarrhea, suggesting that oral rehydration therapy, which depends on the active transport of nutrients, may provide a more effective treatment than the use of cyclooxygenase inhibitors.

Alanine↗

PubMed1994

Nutritional support of the elderly patient in an intensive care unit.

Critically ill elderly patients are at high risk to develop protein-energy malnutrition as well as micronutrient deficiencies. They have characteristic metabolic alterations which must be understood in order to provide nutritional support. Current nutritional status can be assessed by clinical and laboratory parameters. The enteral and parenteral routes of administering nutrition and their advantages, disadvantages, complications, and monitoring are discussed.

Age Factors↗

PubMed1993

Defective stimulation of cyclic AMP by prostaglandin E2 in colonic epithelial cells in colitis.

The present study investigated the effect of vasoactive intestinal peptide and prostaglandin E2 on cyclic adenosine monophosphate levels in isolated colonocytes during experimental colitis. Intra-rectal trinitrobenzenesulfonic acid induced a colitis-like inflammation in the rabbit distal colon. Basal levels of cyclic adenosine monophosphate were similar in control and colitic colonocytes. Levels were increased by prostaglandin E2 and vasoactive intestinal peptide in control cells. Colonocytes from colitic tissue responded to vasoactive intestinal peptide normally, but exhibited an attenuated response to prostaglandin E2. We conclude during colitis the epithelium exhibits a specific alteration in prostaglandin E2 receptor number, affinity or adenylate cyclase coupling.

Animals↗

PubMed1993

In vitro changes in the properties of rabbit colonic muscularis mucosae in colitis.

BACKGROUND: The muscularis mucosae is the muscle layer closet to the site of elevated inflammatory mediator production in inflammatory bowel disease. Thus, it is the first muscle layer subject to their influence. METHODS: Using a rabbit trinitrobenzene sulfonic acid model of colitis, changes in the properties of the muscularis mucosae resulting from the inflammatory process were studied in vitro. RESULTS: Animals developed a mild colitis-like inflammation that was confined to the epithelium, lamina propria, and submucosa. Colitic muscularis mucosae contractile responses to leukotriene D4 and prostaglandins E2 and F2 alpha were significantly attenuated relative to the maximum tissue response to acetylcholine, whereas responses to histamine, substance P, and vasoactive intestinal polypeptide were unchanged. In addition, the stress-generating capacity of the colitic muscularis mucosae was compromised in a stimulus-independent manner and passive tension increased relative to active tension. CONCLUSIONS: The muscularis mucosae undergoes two significant alterations in colitis: (a) a selective desensitization to the effects of arachidonic acid metabolites and (b) an impairment of its excitation-contraction coupling mechanism. A loss of the ability of the muscularis mucosae to cause mucosal movement and alter luminal surface area may be an important early stage in the pathophysiology of inflammatory bowel disease.

Animals↗

PubMed1993

Infarction of an epiploic appendage. Review of the literature.

Disease of the epiploic appendage remains a diagnostic challenge. We have seen a patient whose main preoperative findings were limited to an abnormal small bowel loop with thickened folds on a small bowel series, an association not previously reported, to our knowledge. We review the pertinent medical and radiological literature.

Adult↗

PubMed1993

Pharmacological basis of contractile effects of peptidoleukotrienes on rabbit colonic muscularis mucosae.

The present study was designed to determine the mechanism(s) underlying the excitatory effects of several sulfidopeptide leukotrienes (LTs) on the muscularis mucosae in three regions of the rabbit colon. Proximal colonic muscularis mucosae was refractory to LTs C4, D4, and E4. In addition, it exhibited no responses to prostaglandin (PG) E2 and only a minimal contractile response to PGF2 alpha. Mid and distal colonic muscularis mucosae each responded to LTs C4, D4, and E4 and PGs E2 and F2 alpha with concentration-dependent contractions. In both regions, responses to LTD4 and LTE4 were abolished by indomethacin (10(-6) M) pretreatment. LTC4-induced responses were reduced approximately 50% by this procedure. The residual contraction to LTC4 was resistant to both tetrodotoxin (10(-6) M) and atropine (10(-6) M). In separate experiments, responses to LTC4 were also reduced by approximately 50% if LTC4 conversion to LTD4 and LTE4 was first prevented by L-serine borate (45 mM) in combination with L-cysteine (10 mM). It is concluded that proximal colonic muscularis mucosae lacks the appropriate functional excitatory LT and PG receptors. On mid and distal colonic muscularis mucosae, the actions of LTD4 and LTE4 and, in part, LTC4 are the result of PG production, whereas LTC4 has an additional direct action, possibly mediated through a selective LTC4 receptor.

Animals↗

PubMed1993

Defective modulation of colonic secretomotor neurons in a rabbit model of colitis.

The present in vitro study was conducted to investigate possible alterations in the control of colonic electrolyte transport in an experimental model of colitis. Intrarectal administration of trinitrobenzenesulfonic acid induced a colitis-like inflammation in the rabbit distal colon. Responses to amiloride and residual short-circuit current after this treatment were unchanged, suggesting that the absorptive and secretory mechanisms remained intact. Electrical field stimulation and vasoactive intestinal polypeptide, a candidate secretomotor neurotransmitter, both elicited similar responses in control and colitic tissue. This suggests that communication at the neuroepithelial junction was unimpaired. In untreated tissue, the effects of prostaglandin E2 (PGE2) and of acetylcholine were attenuated by tetrodotoxin, suggesting, therefore, that both play a role in the modulation of secretomotor neurons. In addition, PGE2 had an appreciable direct epithelial effect. Responses to both of these agonists were absent in colitis. The effects of N6,2'-O-dibutyryladenosine 3',5'-cyclic monophosphate were unchanged in colitis, suggesting that altered PGE2 responsiveness may involve changes in epithelial receptor number, affinity, or in their ability to mediate an increase in adenosine 3',5'-cyclic monophosphate levels. It is concluded that this rabbit model of colitis exhibits 1) defects in the modulation of secretomotor neurons by acetylcholine and PGE2 and 2) an attenuated epithelial response to PGE2.

Acetylcholine↗

PubMed1993

Food allergy and intolerance.

Adverse reactions to foods and food additives are common problems. True food allergy involving an immunological mechanism is less common; these allergies affect approximately 10% of the United States population. Most food allergies are immunoglobulin E-mediated; systemic anaphylaxis is the most serious complication. Diagnosis is based on history and physical examination. In vivo diagnostic studies involve skin testing and food challenges (blinded and unblinded). In vitro testing (most commonly radioallergosorbent test [RAST]) is widely used. Treatment is best accomplished by identifying and avoiding the offending allergen.

Celiac Disease↗

PubMed1992

Dietary supplementation with fish oil in ulcerative colitis.

OBJECTIVE: To determine the efficacy of fish oil supplementation in patients with active ulcerative colitis. DESIGN: Multicenter, randomized, double-blind, placebo-controlled, crossover trail with 4-month treatment periods (fish oil and placebo) separated by a 1-month washout. SETTING: Four gastroenterology divisions. PATIENTS: Twenty-four patients with active ulcerative colitis entered the study. Five dropped out, and one was noncompliant. Eighteen patients completed the study. All patients had active disease as manifested by diarrhea and rectal inflammation. INTERVENTIONS: Treatment with prednisone and sulfasalazine was continued. Fish oil supplementation consisted of 18 Max-EPA (eicosapentaenoic acid) capsules daily (eicosapentaenoic acid, 3.24 g; and docosahexaenoic acid, 2.16 g). Placebo supplementation consisted of 18 identical capsules containing isocaloric amounts of vegetable oil. MEASUREMENTS: Patients were evaluated at study entry and after each diet period. Evaluations included a review of symptoms, flexible sigmoidoscopy, rectal biopsy, and rectal dialysis to measure prostaglandin E2 and leukotriene B4 levels. RESULTS: Fish oil supplementation resulted in a significant decrease in rectal dialysate levels of leukotriene B4 from 71.0 to 27.7 pg/mL (average change, -43.3 pg/mL; 95% CI, -83 to -3.6). Significant improvements were seen in acute histology index (average change, -8.5 units from a baseline of 10.5 units; CI, -12.9 to -4.2) and total histology index (average change, -8.5 units from a baseline of 14.80; CI, -13.2 to -3.8) as well as significant weight gain (average weight gain, 1.74 kg, CI, 0.94 to 2.54). No significant changes occurred in any variable during the placebo period. Seven patients received concurrent treatment with prednisone. During the fish oil supplementation period, the mean prednisone dose decreased from 12.9 mg/d to 6.1 mg/d and rose from 10.4 mg/d to 12.9 mg/d during the placebo diet period (P greater than 0.20). CONCLUSIONS: Four months of diet supplementation with fish oil in patients with inflammatory bowel disease resulted in reductions in rectal dialysate leukotriene B4 levels, improvements in histologic findings, and weight gain.

Adult↗

PubMed1992

Studies in vivo and in vitro on effects of PGE2 on colonic motility in rabbits.

Prostaglandins (PG) of the E series are synthesized throughout the gastrointestinal tract, and their elevated levels have been reported in many diarrheal states, including inflammatory bowel disease. It is already known that PGE2 has region-specific and muscle layer-specific effects in different areas of the intestine. The aim of this study was to evaluate possible dose-related motor effects of PGE2 on rabbit proximal and distal colon both in vivo and in vitro. We found that, in the proximal colon in vivo, PGE2 caused inhibition of myoelectric and mechanical activity at low doses but at higher doses caused marked excitation. Under the same experimental conditions, PGE2 caused only excitation in the distal colon, a phenomenon associated with an increase in antegrade contractions and diarrhea. In vitro, PGE2 caused excitation of both proximal and distal colonic longitudinal muscle and relaxation of the circular muscle. Its actions, however, were much more pronounced in the distal region. It is concluded that PGE2 has profound effects on colonic motility that are concentration dependent and that differ with the region of the colon under study. Furthermore, the evidence also suggests that elevated PGE2 levels in disease states may play a significant role in abnormal colonic motility and may facilitate the onset of diarrhea.

Acetylcholine↗

PubMed1992

Enterococcus avium bacteremia in association with ulcerative colitis.

The enterococci are common human pathogens. Enterococcus avium is a rare cause of infection in humans. A variety of immunological alterations in the intestinal mucosa of patients with ulcerative colitis may predispose them to unusual organisms. We report the first case of E. avium bacteremia in a patient with ulcerative colitis.

Adult↗

PubMed1992

A case of diversion colitis treated with 5-aminosalicylic acid enemas.

An 85-yr-old female presented with diversion colitis after surgery with a resultant colostomy and excluded rectal segment. Treatment with 5-aminosalicylic acid (Rowasa) enemas resulted in both endoscopic and histological resolution. This is the first case of diversion colitis treated with 5-aminosalicylic acid enemas.

Aged↗

PubMed1991

Medical treatment of esophageal achalasia. Double-blind crossover study with oral nifedipine, verapamil, and placebo.

Calcium channel blockers have been previously shown to decrease lower esophageal sphincter (LES) pressure and improve symptoms in achalasia. We performed a placebo-controlled, double-blind, crossover study to assess the effects of oral nifedipine and verapamil on LES pressure, amplitude of esophageal body contraction, and clinical symptomatology in eight patients with symptomatic achalasia diagnosed by endoscopy, barium swallow, and manometry. Patients were randomized to receive up to 20 mg nifedipine, 160 mg verapamil, or placebo and underwent esophageal manometry before (baseline) and after four weeks on each drug. Diary cards were kept to record and grade symptoms and drug plasma level determinations were correlated with manometric and clinical findings. Both nifedipine and verapamil caused a statistically significant decrease in mean LES pressure, but only nifedipine caused a significant decrease in the amplitude of contractions of the smooth muscle portion of the esophagus. No statistically significant differences in the overall clinical symptomatology were noted with any of the drugs, although some individual improvements in dysphagia and chest pain were noted. We conclude that, despite the reduction in LES pressure and contraction amplitude of the distal esophageal body, oral nifedipine and verapamil do not significantly alter the clinical symptomatology of patients with achalasia.

Administration, Oral↗

PubMed1990

A comparison in vitro of human and rabbit distal colonic muscle responses to inflammatory mediators.

The present study compared in vitro the motor responses of human and rabbit distal colonic longitudinal and circular muscle to acetylcholine, histamine, leukotrienes B4 and D4, and prostaglandins E2 and F2 alpha. The active and passive mechanical properties of these muscles were also evaluated. All muscle types were contracted by acetylcholine and histamine. Longitudinal muscle from both species was contracted by prostaglandin E2 and prostaglandin F2 alpha, although rabbit muscle was more sensitive. Prostaglandin E2 relaxed the majority of both human and rabbit circular muscle preparations that were studied. Prostaglandin F2 alpha first relaxed and then contracted circular muscle from both species. Leukotriene B4 had no effect on any tissue studied. Leukotriene D4 caused transient relaxations in a proportion of all muscle types, but the relaxations were not concentration-related. Contractile responses did not differ under isotonic recording conditions, but relaxations were much more clearly defined. Based on experiments using atropine, phentolamine and propranolol, and pyrilamine or tetrodotoxin, it was concluded that the responses of both human and rabbit distal colonic muscles to these inflammatory mediators have a similar pharmacological basis. All muscle types exhibited low passive tension and developed active tension in the range 0.8-1.2 Lo. These data strongly support the belief that after the onset of an induced colitis, the rabbit colon has value as a predictive model for the study of inflammatory mediator-induced colonic motility changes in humans.

Acetylcholine↗

PubMed1990

Effects of PGF2 alpha and of indomethacin on rabbit small and large intestinal motility in vivo.

Prostaglandin F2 alpha (PGF2 alpha) has been shown to increase contractility in the small intestine and colon in vitro, and increased mucosal prostaglandin synthesis has been reported in ulcerative colitis. The purpose of this study was to determine the effects of PGF2 alpha and of indomethacin on myoelectric and contractile activity in the rabbit ileum and colon in vivo. PGF2 alpha caused an increase in spike potential frequency and contractile activity in the terminal ileum and proximal and distal colon. Indomethacin alone increased spike potential frequency and contractile activity in the terminal ileum and proximal colon but decreased myoelectric activity in the distal colon. It is concluded that PGF2 alpha may play an important role in modulating intestinal motility, especially in the distal colon but to a lesser extent in the terminal ileum and proximal colon.

Animals↗

PubMed1990

Leukotriene D4 excitation of rabbit distal colon arises in the region of the muscularis mucosae.

We previously have demonstrated in vivo that intra-arterial administration of leukotriene D4 (LTD4) causes increased myoelectric and mechanical activity in the rabbit distal colon. The aim of this study was to use both in vivo and in vitro techniques to try to elucidate the mechanism underlying this effect. In vivo the excitatory response of the rabbit distal colon to LTD4 was abolished by pretreatment with atropine (0.1 mg/kg iv) or hexamethonium (5 mg/kg iv) or the LTD4 receptor antagonist SK&F 102922 (0.8 micrograms/kg ia). In vitro neither the longitudinal nor the circular muscle layer responded to LTD4 (10(-10) to 10(-7) M) with a contractile response. Over the same concentration range, LTD4 caused contractions of the muscularis mucosae that were attenuated by either SK&F 102922 (10(-9) to 10(-7) M) or indomethacin (10(-6) M) but were unaffected by atropine (10(-6) M), pyrilamine (10(-6) M), or tetrodotoxin (10(-6) M). Full thickness segments of longitudinal muscle, circular muscle, and muscularis mucosae did not contract to LTD4. These data imply that LTD4-induced excitation of the rabbit distal colon in vivo arises as a result of the excitation of LTD4 receptors in the region of the muscularis mucosae and that this leads ultimately to the release of acetylcholine onto the muscularis propria. It is proposed that one possible mechanism leading to the latter effect is an increased excitability of intrinsic nerves resulting from a prostaglandin-induced depression of norepinephrine release from nerves impinging on the submucosal plexus.

Animals↗

PubMed1990

Dysphagia as the sole manifestation of bilateral strokes.

Dysphagia can be caused by a host of factors, most of which are structural or functional. However, despite extensive evaluations, a certain number of patients have unexplained dysphagia. We present an extremely unusual case whereby a patient with an acute left hemispheric cerebral vascular accident presents with dysphagia as his sole complaint and after extensive neurological, gastroenterological, and radiographic examinations is found to have cricopharyngeal dysfunction. The etiology of this defect was not at all clinically apparent and, ultimately, magnetic resonance imaging (MRI) was performed which revealed a chronic infarction of the right frontal lobe and a smaller acute infarction in the same location of the left. This case demonstrates that swallowing disorders may be the sole presentation of stroke and that, if extensive evaluations of such patients fail to yield an etiology, one must strongly consider MRI as a tool for diagnosis, even if a CT scan is negative.

Aged↗