[Medical certification from physicians for health insurance purposes].
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Ethics, Medical↗
Biomedical subjects
T Høverstad
Publications and source records attributed to T Høverstad.
Abnormal intestinal motor patterns explain enteric colonization with gram-negative bacilli in late radiation enteropathy.
BACKGROUND & AIMS: Bacterial overgrowth and intestinal pseudo-obstruction may succeed abdominal radiotherapy, and absence of intestinal migrating motor complex (MMC) has been reported in bacterial overgrowth. The aims of this study were to address the relationship between intestinal patterns of motility and gastrointestinal microflora and to elucidate the pathogenesis of late radiation enteropathy. METHODS: Forty-one consecutive female patients with symptoms of late radiation enteropathy were examined by prolonged ambulatory manometry, culture of gastric and duodenal samples with quantification of gram-negative bacilli (GNB) by the glucose gas test, the [14C]D-xylose breath test, and determination of pH and short-chain fatty acids in gastric juice. RESULTS: The intensity of MMC explained 61% (P < 0.001) and 71% (P < 0.001) of the variability of GNB in the stomach and duodenum, respectively, corresponding to the severity of disease. Abnormal MMC index and presence of irregular bursts were the best predictors of GNB (86%; P < 0.001, multiple regression). Fasting gastric pH explained gastric bacterial counts (63%; P < 0.001) but did not predict GNB. CONCLUSIONS: Impaired motility emerges as a causal factor for gastrointestinal colonization with GNB, whereas hypochlorhydria facilitates unspecific gastric colonization. Abnormal motility and GNB in the proximal small intestine are essential factors in the pathogenesis of severe late radiation enteropathy.
Adult↗
[Intervention against sick-leave in an industrial company].
We have studied the effect of an intervention programme to reduce absenteeism due to illness at a Norwegian industrial enterprise. The sample comprised 100 production line workers at a Norwegian electronic equipment manufacturing company. The measures included bringing the absenteeism to light (awareness raising), improving the working environment and supporting employees on sick leave. This type of absenteeism dropped from 11.7% in the year before the intervention to 8.4% during the year of intervention (p < 0.01), and was 8.7% the year after. Sick leave among the control group (about 210 production workers) was 8.5%, 10.0% and 9.7% for the three corresponding years. The study indicates that sick leave among the employees at an enterprise can be reduced through cooperation between the company health service, the management and the employees themselves.
Absenteeism↗
Topical metronidazole treatment in pouchitis.
Patients with pouchitis usually respond to oral metronidazole treatment, but side effects of the treatment are common. Eleven patients with pouchitis were given local treatment by instillation of metronidazole in doses of 40-160 mg daily into the reservoir. The effects of the treatment on the bacterial flora and short-chain fatty acids in reservoir contents, morphology of the ileal mucosa, and serum concentrations of metronidazole were studied. All patients responded to local administration of metronidazole. Three patients with chronic pouchitis remained well for 6 months, 3 years, and 4 years, taking 40 mg metronidazole daily. Three patients had one single treatment course, and four had repeated courses when they had recurrences. In one patient a continent reservoir had to be removed owing to a persistent ulcer causing chronic blood loss. The bacterial flora of reservoir contents showed no significant differences between patients with and without pouchitis. The number of anaerobic microorganisms and the concentration of short-chain fatty acids were reduced after metronidazole treatment. Serum concentrations of metronidazole were very low, and no patients experienced any side effects of the treatment. In conclusion, topical application of small doses of metronidazole relieved symptoms in most cases of pouchitis and was well tolerated, even as long-term treatment.
Adenomatous Polyposis Coli↗
Fasting hypochlorhydria with gram positive gastric flora is highly prevalent in healthy old people.
Fifteen healthy old people mean age 84 years (range 80-91 years), were examined to assess the effect of advanced age on the microecology of the upper gastrointestinal tract. Twelve of 15 (80%) were hypochlorhydric with pH 6.6 (0.3) (mean (SEM) and a mean bacterial count of 10(8) colony forming units (CFU) per ml (range 10(5)-10(10)) in fasting gastric aspirate. Normochlorhydric subjects had low counts (< or = 10(1) CFU/ml). The microbial flora was dominated by viridans streptococci, coagulase negative staphylococci, and Haemophilus sp. Only one subject harboured significant concentrations of Gram negative bacilli with Escherichia coli (10(4-5) CFU/ml) and Klebsiella (10(4-5)). Strict anaerobes were not found. The total concentration of short chain fatty acids in gastric aspirate was 10.6 (2.9) mmol/l (mean (SEM). Absence of significant, intraluminal fermentation of xylose to CO2 was shown by the 14C-d Xylose breath test, and ambulatory manometry showed preserved fasting motility pattern of the small intestine. Serum immunoglobulins were normal. Advanced age is accompanied by fasting hypochlorhydria and colonisation with mainly Gram positive flora in the upper gut. Other factors than old age and fasting hypochlorhydria are required for colonisation with Gram negative bacilli.
Achlorhydria↗
[Focus groups--presentation of a qualitative research method].
The Focus Group is a qualitative research method based on group dynamics. The group participants are chosen by random sampling from the study population. They all have something in common in regard to the question being focused on. Well planned discussions provide knowledge on a specific topic. The method is not very expensive, and does not take too much time. Focus Groups have been used in marketing, and in sociological and psychological research. The authors conclude that the method is of interest for medical research.
Evaluation Studies as Topic↗
Use of focus groups to study absenteeism due to illness.
Reasons for sick leaves are often complex and influenced by nonmedical factors. We have used focus groups, a qualitative research method, to study the relationship between working conditions and absenteeism due to illness in both an industrial company and an insurance company. We organized 10 focus groups within each company, with participants randomly selected from departments having similar work tasks within each company. According to the groups, the most important working conditions that influenced absenteeism were (a) feeling of well-being at work (mainly defined as security in social relations), (b) the organization of the work, and (c) the department leader. Factors considered to be less important included: number of employees, male/female ratios, group norms for absenteeism, age distribution, work-related illness, substance abuse, and work loads. There was substantial agreement between the groups, indicating that our findings may be relevant to other companies.
Absenteeism↗
Short-chain fatty acids and other intestinal microflora-associated characteristics in faeces of patients with severe B-cell immunodeficiency.
The intestinal microflora of 18 patients with severe B-cell immunodeficiency was studied by determination of short-chain fatty acids (SCFAs) and other intestinal microflora-associated characteristics in the faeces. Glucose-hydrogen (H2) breath test was also performed. The results were within normal values in most of the patients, indicating no major pathologic changes in the intestinal bacterial microflora. These findings do not indicate any important role of the mucosa-associated B-cell system in the regulation of the composition and metabolic activity of the intestinal microflora.
Adolescent↗
Short-chain fatty acids in seven sterile thioglycollate media.
Short-chain fatty acids (SCFAs) were analysed by gas chromatography in 7 sterile fluid thioglycollate media. The total SCFA concentration varied from 250 mumol/l to 1720 mumol/l. Acetic acid (52.0%-91.3% of total SCFA concentration) and n-butyric acid (5.8%-48.0% of total concentration) were the main acids in all sterile media; low concentrations of propionic, isobutyric, isovaleric, and n-valeric acid were present in most media. In studies of bacterial metabolism, or when analyses of SCFAs are used for identification of bacteria, testing of the sterile medium is necessary.
Chromatography, Gas↗
[Dietary fiber tablets and intestinal function].
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Adult↗
Influence of antibiotics on intestinal mucin in healthy subjects.
To determine the effect on microbial breakdown of intestinal mucin healthy volunteers were treated orally with ten different antibiotics. The most pronounced effects were seen after administration of bacitracin, clindamycin or vancomycin: the electrophoretic mucin pattern in faeces changed from a normal conventional pattern to a specific pattern similar to that found in germ-free rats. Disturbed patterns were also observed in some of the subjects treated with ampicillin, doxycycline, erythromycin, metronidazole or nalidixic acid. In most cases the electrophoretic mucin pattern normalized within five weeks after the end of treatment. There were no effects on the microbial breakdown of intestinal mucin in the groups treated with ofloxacin or trimethoprim/sulfamethoxazole. Thus, administration of antimicrobial drugs in clinically recommended doses may cause long-term disturbances in one microflora-associated characteristic, the breakdown of intestinal mucin.
Administration, Oral↗
Short-chain fatty acids in germfree mice and rats.
The short-chain fatty acids (SCFAs) have been analyzed in small intestinal and cecal content of 10 germfree and six conventional mice from a Norwegian laboratory, in cecal content and serum of five germfree rats and two germfree mice from a Swedish laboratory and in Norwegian and Swedish autoclaved, nonpurified rodor diets. The mean total SCFA concentration was 1020 mumol/kg in cecum and 1010 mumol/kg in small intestine of Norwegian germfree mice; 124,600 mumol/kg in cecum and 6,250 mumol/kg in small intestine of conventional mice; 490 mumol/kg in cecum and 370 mumol/L in serum of Swedish rats; 360 mumol/kg in cecum and 290 mumol/L in serum of Swedish mice; 31.4 mmol/kg in Norwegian and 19.5 mmol/kg in Swedish nonpurified diets. Acetic acid accounted for more than 90% of the total concentration in all samples from germfree animals and diet, but detectable concentrations of propionic, isobutyric, n-butyric, isovaleric and n-valeric acid were also present. Thus, germfree animals have low, but measurable, concentrations of SCFAs in intestinal content compared to conventional animals. Most probably these acids originate mainly from the diet.
Animals↗
Influence of peroral antibiotics upon the biotransformatory activity of the intestinal microflora in healthy subjects.
The effects of ampicillin, clindamycin or metronidazole, given perorally for 6 days to eighteen healthy volunteers, upon the following intestinal microflora-associated characteristics (MACs) were evaluated: breakdown of mucin, formation of coprostanol, hydrolysis of bilirubin conjugates, formation of urobilinogen, and of some short chain fatty acids (SCFAs), presence of beta-aspartylglycine and inactivation of trypsin. Clindamycin markedly influenced the expression of all characteristics, but trypsin and beta-aspartylglycine, resulting in a pattern very much alike what has been found in germ-free animals. Ampicillin caused a significant reduction in total amount of SCFAs (P less than 0.05) and urobilinogen (P less than 0.05) present in the faecal samples. Metronidazole caused a significant reduction in the formation of coprostanol and the deconjugation of bilirubin (P less than 0.05). We conclude that orally given antibiotics may cause major alterations in several parameters reflecting the normal biotransformatory activity of the intestinal microflora, probably caused by severe disturbances in the intestinal ecosystem.
Administration, Oral↗
Influence of antibiotics on the faecal excretion of bile pigments in healthy subjects.
We have evaluated the effects of 10 antibiotics, given orally for 6 days to healthy subjects, on faecal excretion of urobilinogen. Intake of bacitracin, vancomycin, clindamycin, erythromycin, and ampicillin resulted in a pronounced suppression of the faecal excretion of urobilinogen (p less than 0.05). Intake of doxycycline, metronidazole, nalidixic acid, ofloxacin, and trimethoprim/sulphamethoxazole had no significant effect. The effects of three antibiotics-ampicillin, clindamycin, and metronidazole--on faecal excretion of conjugated bilirubin were similarly evaluated. Intake of clindamycin led to a marked increase of conjugated bilirubin (p less than 0.05) in the faeces, and the pattern of separated azopigment derivatives of the bilirubin conjugates became altered. Intake of ampicillin and metronidazole resulted in far less alterations in faecal conjugated bilirubin, although a significant change was observed in the subjects receiving metronidazole (p less than 0.05). The differences between the antibiotics with regard to altered intestinal bile pigment metabolism may be due to differences in antimicrobial spectra and/or intestinal concentrations of the drugs. Our findings indicate that orally taken antibiotics may cause a suppression of the microbial deconjugation of conjugated bilirubin and urobilinogen formation, respectively. This may reflect a pronounced disturbance of the intestinal microflora.
Adult↗
Influence of oral intake of seven different antibiotics on faecal short-chain fatty acid excretion in healthy subjects.
Faecal excretion of short-chain fatty acids (SCFAs) has been measured by gas chromatography in groups of six or seven healthy subjects before, during, and after they received the antibiotics bacitracin, co-trimoxazol, doxycycline, erythromycin, nalidixic acid, ofloxazin, or vancomycin orally for 6 days. Intake of bacitracin and vancomycin had pronounced effects on faecal SCFAs excretion and reduced median total concentration of SCFAs from 105.4 mmol/kg to 21.8 mmol/kg and from 69.3 mmol/kg to 19.4 mmol/kg, respectively (p less than 0.05). Erythromycin had moderate effects on the faecal SCFAs excretion, whereas small or no changes were seen during intake of co-trimoxazol, doxycycline, nalidixic acid, and ofloxacin. 2-Methylbutyric acid, a SCFA not previously seen in human faeces, was found in the faeces of all subjects (median concentration before intake of antibiotic, 1.3 mmol/kg). Bacitracin, erythromycin, nalidixic acid, and vancomycin were detected in high concentrations in faeces during therapy, whereas trimethoprim, doxycycline, and ofloxacin were found in relatively low concentrations. In conclusion, some, but not all, peroral antimicrobials induce changes in faecal SCFAs, most likely reflecting changes in the colonic ecosystem.
Administration, Oral↗
Studies of short-chain fatty acid absorption in man.
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Breath Tests↗
Influence of ampicillin, clindamycin, and metronidazole on faecal excretion of short-chain fatty acids in healthy subjects.
The faecal excretion of short-chain fatty acids (SCFAs) has been measured in groups of six healthy subjects before, during, and after they received the antibiotics clindamycin, ampicillin, or metronidazole perorally for 6 days. Intake of clindamycin reduced the median total concentration of SCFAs from 62.9 mmol/kg faeces (wet weight) to 7.3 mmol/kg (p less than 0.05). During therapy the relative amounts of acetic acid increased from 50% to 90% of the total concentration (p less than 0.05). Ampicillin reduced the median SCFAs concentration from 62.4 mmol/kg to 47.8 mmol/kg (p less than 0.05), whereas metronidazole did not change the SCFAs concentrations significantly. The SCFAs concentrations returned to normal within 5 weeks after the treatment in all subjects. Clindamycin was detected in high concentrations in faeces during therapy. Ampicillin was detected in only one faecal sample, which was from the only subject in the ampicillin group without detectable beta-lactamase activity in faeces. Metronidazole could not be detected in faeces from any subjects receiving this drug. Clindamycin and ampicillin, but not metronidazole, induce pronounced changes in faecal SCFAs, most likely reflecting severe changes in the colonic ecosystem. An antibiotic's influence on the colonic microflora may in part depend on its antimicrobial spectrum and the concentration of antimicrobially active drug in the gut.
Administration, Oral↗
Short-chain fatty acids in the small-bowel bacterial overgrowth syndrome.
The short-chain fatty acids (SCFAs) have been measured by gas chromatography in fasting jejunal secretions, saliva, and feces from 8 patients with the small-bowel bacterial overgrowth syndrome (BO) and 9 control patients; in jejunal secretions and saliva from 6 healthy subjects; and in feces from 20 healthy subjects. The concentrations of SCFAs (median (range), mumol/l) in jejunal secretions of BO patients were as follows: total, 990 (210-12,370); acetic acid, 650 (170-6770); propionic acid, 110 (16-3070); isobutyric acid, 26 (1-310); n-butyric acid, 90 (12-1340); isovaleric acid, 35 (2-680); n-valeric acid, 7 (3-200). In BO patients the total concentration of SCFAs in jejunal secretions was approximately four times higher than in control patients (p less than 0.01) and in healthy subjects (p less than 0.025). The relative distribution of the acids resembled the distribution found in feces more than that of saliva or the normal jejunal secretions. These findings indicate that patients with BO have a colon-like flora in the small intestine and that the main part of the SCFAs in the jejunal secretions of these patients is produced by the altered microbial flora in the jejunum. Combined with other tests, analyses of intestinal SCFAs may prove to be valuable in the diagnosis of small-bowel bacterial overgrowth.
Adult↗