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Biomedical subjects

R D Rothstein

Publications and source records attributed to R D Rothstein.

At least 19 recordsLinked to original sources
PubMed2000

Irritable bowel syndrome.

Patients with IBS need an integrated, individualized approach to treatment, with a foundation based on a successful patient-physician relationship. The emotional and psychologic needs of the patients need to be considered in a successful management plan. Further advances in the pathophysiology of disease are essential to develop suitable and more comprehensive treatment options.

Abdominal Pain↗
PubMed1998

Nutrient pharmacotherapy for gut mucosal diseases.

The use of nutrients for pharmacotherapy is a recent advance in the treatment of gastrointestinal disorders or alterations of gut function and structure. Nutrients may have a direct effect on the gut, or may enhance the response to medications. Alternatively, pharmacologic agents may improve the absorption of nutrients. Potentially, pharmacotherapy may be an adjunct to the traditional approach used in the treatment of compromised patients.

Animals↗
PubMed1997

A systematic approach to the patient with dysphagia.

The workup includes attention to history and tailoring of diagnostic studies to individual complaints. Cerebrovascular disease is a common cause of oropharyngeal dysphagia, while malignancy and peptic stricture are frequent in esophageal dysphasia.

Deglutition Disorders↗
PubMed1997

Perforated villous adenoma of the cecum: report of a case.

Villous adenomas are common neoplasms of the colon, often causing anemia or hemoccult positive stools. Less typically, these lesions may result in abdominal pain, melena, obstruction, or change in bowel habits. Intussusception may occur, but this complication is unusual in adults. Spontaneous bowel perforation attributable to colonic polyps has not been previously reported. We present here the first reported case of an adenomatous polyp with bowel perforation and bladder involvement.

Adenoma, Villous↗
PubMed1996

Use of positron emission tomography and evoked potentials in the detection of cortical afferents from the gastrointestinal tract.

OBJECTIVE: Positron emission tomography permits precision identification of the cerebral regions involved in physiologic functions. As the cerebral localization for visceral sensation has not been identified, our aim was to examine the cerebral viscerotopic representation for rectal sensation. METHODS: Cerebral-evoked potentials were measured in five healthy volunteers who underwent rectal balloon distension. Simultaneously, cerebral blood flow was measured using positron emission tomography with 15H2O. RESULTS: A cerebral-evoked potential occurred with rectal balloon distension. An increase in cerebral blood flow was noted in the pre- and postcentral gyrus and the thalamus. CONCLUSION: The techniques for measuring cerebral-evoked potentials and cortical blood flow are useful in the delineation of the cerebral regions subserving visceral sensation.

Brain↗
PubMed1996

Cytomegalovirus cecal ulcer in a patient awaiting cardiac transplantation.

We report a case of a bleeding cecal ulcer caused by the cytomegalovirus in a patient awaiting cardiac transplantation. We discuss the predisposing conditions that are typically associated with the development of a cytomegalovirus cecal ulcer and then further elaborate on the possible causes of cytomegalovirus disease in a patient without any of the readily known risk factors.

Causality↗
PubMed1996

Gastroparesis: a potential pitfall of laparoscopic Nissen fundoplication.

We report a case of a patient who developed gastroparesis after laparoscopic Nissen fundoplication. The development of postoperative gastroparesis after either an open or laparoscopic Nissen fundoplication is uncommon but may result in significant morbidity. With greater numbers of laparoscopic fundoplications being performed, the complication of gastroparesis may be noted more frequently.

Adult↗
PubMed1995

Signet-ring carcinoma in Crohn's disease presenting as a neck mass.

We report a case of signet cell carcinoma of the colon in a patient with Crohn's disease. Signet cell carcinoma, also termed linitis plastica, is an unusual malignancy of the colon and is rarely associated with Crohn's disease. In general, metastatic disease is evident at the time of diagnosis, and the prognosis is uniformly poor. The radiographic, endoscopic, and histological features are discussed.

Carcinoma, Signet Ring Cell↗
PubMed1993

Effect of extracorporeal shock wave lithotripsy and ursodeoxycholic acid on gallbladder motility.

Extracorporeal shock wave lithotripsy and dissolution agents are useful nonsurgical therapies for gallstones. Their effect on gallbladder emptying is unclear. We evaluated emptying by ultrasonography before and after lithotripsy in 50 patients on ursodeoxycholic acid or placebo and in nine controls. At baseline, patients had normal (68.8 +/- 3.2%) or delayed emptying (14.5 +/- 3.3%). In a subset of 24 patients, lithotripsy increased fasting volume (26.6 +/- 3.0 to 43.8 +/- 5.0 ml, P < 0.005), postprandial volume (11.3 +/- 3.1 ml to 22.9 +/- 3.0 ml, P < 0.05), and decreased ejection fraction (70.0 +/- 4.1% to 42.7 +/- 6.0%, P < 0.0005). There was an inverse linear correlation between power and ejection fraction, r = -0.43, P < 0.005. Ursodeoxycholic acid increased fasting (23.3 +/- 2.2 ml to 36.7 +/- 4.6 ml, P < 0.005) and postprandial volume (11.1 +/- 1.8 to 17.6 +/- 2.5, P < 0.005). Treatment with ursodeoxycholic acid resulted in a greater decrease in fragment size compared to placebo after lithotripsy in patients with fragment size greater than 6 mm. In conclusion, both lithotripsy and ursodeoxycholic acid have an effect on gallbladder emptying.

Adult↗
PubMed1993

Electrogastrography in patients with gastroparesis and effect of long-term cisapride.

Abnormalities in the gastric pacemaker potentials occur in patients with impaired gastric emptying. It is unclear if treatment effects the underlying rhythm or if normalization of dysrhythmias is important. We examined the effect of cisapride using surface electrogastrograms and radionuclide gastric emptying studies of patients with idiopathic and diabetic gastroparesis. Twelve of 14 patients had abnormal baseline electrogastrograms. After six months of cisapride, four patients had normalization of their electrical activity and six had improvement. Patients with idiopathic gastroparesis had an increase in gastric emptying at 120 min from 48.9 +/- 3.8% (baseline) to 70.9 +/- 6.0% (six months), P = 0.009. Patients with diabetes mellitus had a similar improvement. Patients who had normalization of the electrogastrogram had a greater gastric emptying rate than patients with continued dysrhythmias. Thus, dysrhythmias are important in the etiology for gastroparesis, but other factors need to be examined.

Adult↗
PubMed1993

Improved results of extracorporeal shock wave lithotripsy with the Dornier MPL 9000 for single gallstones.

Our aim was to compare the results of extracorporeal shock wave lithotripsy with the Dornier MPL 9000 for patients with single radiolucent gallstones less than or equal to 20-mm diameter using higher power (kV) and more shock waves during lithotripsy with our results during the Dornier National Biliary Lithotripsy Study using lower power and fewer shock waves. Nineteen patients were treated at higher power (mean +/- SE, 21.0 +/- 0.4 kV) vs 11 patients at lower power (18.8 +/- 0.5 kV). In the higher power group, the actuarial rate for complete clearance of gallstone fragments was 39 +/- 9%, 63 +/- 9% and 78 +/- 9% after 6 weeks, 3- and 6-months follow-up, respectively, versus only 19 +/- 12% after 6 months in the lower power group. We conclude that the use of higher power and more shock waves during extracorporeal shock wave lithotripsy with the MPL 9000 results in fragment clearance rates over 6 months for patients with single gallstones that are significantly higher than those previously achieved in the Dornier National Biliary Lithotripsy Study.

Cholelithiasis↗
PubMed1993

Intestinal malrotation during pregnancy.

BACKGROUND: Malrotation of the intestine is an uncommon anomaly most often seen in infants, but occasionally in adults. Rarely, symptoms from malrotation may occur during pregnancy. CASE: A 30-year-old woman, with a long history of abdominal pain and constipation, developed more frequent and severe symptoms in the second trimester of pregnancy. She was monitored closely and treated conservatively and went on to deliver a full-term, healthy infant. In the postpartum period, barium radiographs demonstrated a midgut malrotation. During exploratory laparotomy, obstructive peritoneal bands were noted and were transected. The mobile cecum and ascending colon were fixated to the abdominal wall. CONCLUSION: Symptoms from a malrotation may develop during pregnancy and may be nonspecific and vague. Although complications from malrotation can be life-threatening, a conservative approach with surgical intervention in the postpartum period may be appropriate in the proper clinical setting.

Abdominal Pain↗