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Biomedical subjects

W K Clarkston

Publications and source records attributed to W K Clarkston.

18 recordsLinked to original sources
PubMed1999

Both massive upper and lower gastrointestinal hemorrhage secondary to tuberculosis.

We report a case of gastrointestinal tuberculosis, presenting with both massive upper and lower gastrointestinal bleeding that required two emergency operations. Massive bleeding is rare in gastrointestinal tuberculosis because of associated obliterative endarteritis. Tuberculosis should be considered in the differential diagnosis of massive gastrointestinal bleeding in the appropriate clinical setting even in an immunocompetent patient.

Adult↗
PubMed1999

A double-blind placebo controlled trial of oral midazolam as premedication before flexible sigmoidoscopy.

OBJECTIVE: We aimed to determine the efficacy of oral midazolam as premedication to improve tolerance of flexible sigmoidoscopy. METHODS: Ninety-nine patients were randomized to receive 7.5 mg of oral midazolam solution mixed with apple juice or placebo (apple juice), 20 min before sigmoidoscopy. Patients' anxiety and pain experienced before sedation, before the procedure, and during the procedure were assessed using a 10-cm visual analog scale (VAS) by both patients and physicians (0 = no pain, anxiety, 10 = severe pain, anxiety). Extent of sedation, amnesia, overall tolerance, adequacy of sedation, and willingness to repeat the procedure were assessed, and changes in vital signs and oximetries were recorded. RESULTS: Fifty-one patients received midazolam and 48 patients received placebo. Patients reported less pain and anxiety (VAS 2.56, 1.64) compared with placebo (VAS 4.62, 4.16) during the procedure (p < 0.005, p < 0.0005). Physicians observed less pain and anxiety (VAS 2.19, 1.52) with midazolam than placebo (VAS 5.00, 3.97) during the procedure (p < 0.0001, p < 0.0001). A significantly greater number of patients judged tolerance of the procedure to be "excellent" using midazolam (p < 0.005) compared with placebo. A majority of patients in both groups was willing to repeat the procedure if recommended. Two patients in the midazolam group had transient asymptomatic hypotension during sigmoidoscopy, but no patients were observed to have desaturation by oximetry. CONCLUSIONS: Oral midazolam significantly reduces anxiety and pain during flexible sigmoidoscopy as assessed by both patients and physicians. Oral midazolam is a safe and effective premedication before flexible sigmoidoscopy in patients who require or prefer sedation.

Administration, Oral↗
PubMed1998

Role of Mycobacterium paratuberculosis in Crohn's disease: a prospective, controlled study using polymerase chain reaction.

PURPOSE: Mycobacterium paratuberculosis has been proposed as a causative agent in patients with Crohn's disease. The purpose of this study was to determine whether M. paratuberculosis was present in tissue from patients with Crohn's disease in a defined geographic area. METHODS: We prospectively evaluated, using polymerase chain reaction and culture, whether M. paratuberculosis was present in 44 specimens (37 from intestinal mucosal biopsies and 7 from surgical resections) from patients with Crohn's disease, ulcerative colitis, or normal colonic mucosa. RESULTS: Of the 25 specimens tested from the 21 Crohn's patients, only 1 positive specimen was noted, whereas the 8 specimens from the 5 ulcerative colitis patients and the 11 specimens from the 11 control patients failed to demonstrate a positive result with polymerase chain reaction. Cultures of all specimens revealed no growth of M. paratuberculosis. CONCLUSION: M. paratuberculosis was only rarely detected in biopsy or surgical specimens from patients with Crohn's disease. These results do not support a common causative role of M. paratuberculosis in Crohn's disease.

Adolescent↗
PubMed1997

Evidence for the anorexia of aging: gastrointestinal transit and hunger in healthy elderly vs. young adults.

Animal studies suggest that aging is associated with anorexia and disordered gastrointestinal transit. To determine whether there is a relationship between the effects of aging on appetite and gastrointestinal transit in humans, 19 young (age 23-50 yr) and 14 elderly (age 70-84 yr) normal volunteers underwent measurements of 1) desire to eat, hunger, and fullness (visual analog scales); 2) gastric emptying (scintigraphy); 3) orocecal transit (breath hydrogen); 4) total gut transit (radiopaque markers); and 5) autonomic nerve function (cardiovascular reflexes). We found that, postprandially, elderly subjects had less desire to eat (P < 0.05) and less hunger (P < 0.05), but not a significantly greater fullness than younger subjects. Gastric emptying (50% emptying time) for solid (182 +/- 26 vs. 127 +/- 13 min, P < 0.05) and liquid (47 +/- 4 vs. 35 +/- 3 min, P < 0.05) meal components was slower in elderly subjects. Postprandial hunger was inversely related (r = -0.39, P < 0.05) to solid gastric emptying. There were no significant differences in orocecal and total gut transit times between the two groups. Autonomic nerve function was abnormal in 11 elderly but none of the young subjects (P < 0.01). We conclude that aging is associated with 1) diminished desire to eat and hunger, 2) slowing of solid and liquid gastric emptying, 3 no change in orocecal and total gut transit, and 4) autonomic nerve dysfunction. The slowing of gastric emptying may contribute to anorexia in aging subjects.

Adult↗
PubMed1997

No harm was done.

Explore the source record for details and available documents.

Adjuvants, Anesthesia↗
PubMed1996

Intravenous ketorolac tromethamine versus meperidine for adjunctive sedation in upper gastrointestinal endoscopy: a pilot study.

BACKGROUND: Meperidine is commonly used with a benzodiazepine to achieve conscious sedation but may potentiate respiratory depression. Ketorolac tromethamine has few sedative effects and no respiratory depression. The purpose of this study was to compare ketorolac to meperidine as adjuncts in conscious sedation for upper gastrointestinal endoscopy (EDG). METHODS: Patients undergoing diagnostic EGD (n = 47) were randomly assigned to receive normal saline solution or 50 mg meperidine or 30 mg ketorolac intravenously. Midazolam was subsequently administered (as needed, to achieve adequate conscious sedation) by endoscopists who were blinded to the test substance given before the procedure. RESULTS: For all treatment groups, there was no significant difference in extent or adequacy of sedation, incidence of oxygen desaturation, patient amnesia, time of procedure, or vital signs (except for a relative procedural tachycardia in the ketorolac and placebo groups as compared to baseline). The ketorolac group experienced more pain and anxiety. The meperidine group experienced less gagging, a shorter sedation time, less midazolam usage, and more discomfort at the intravenous site. Meperidine seemed to offer a "protective" effect against procedural tachycardia. CONCLUSION: There is no benefit to ketorolac as an adjunct in conscious sedation for EGD. Meperidine had several benefits; however, discomfort at the intravenous site was common.

Adjuvants, Anesthesia↗
PubMed1996

Oral sodium phosphate versus sulfate-free polyethylene glycol electrolyte lavage solution in outpatient preparation for colonoscopy: a prospective comparison.

BACKGROUND: Biochemical abnormalities induced by oral sodium phosphate and the risk of cardiac arrhythmias as potential sequelae have yet to be investigated. METHODS: We studied 98 outpatients scheduled to undergo diagnostic colonoscopy and prospectively randomized them to receive oral sodium phosphate or sulfate-free polyethylene glycol electrolyte lavage solution (SF-PEG-ELS) as recommended by the manufacturers. RESULTS: Forty-nine patients received sodium phosphate and 49 received SF-PEG-ELS. There was no significant difference in tolerance or quality of preparation as judged by blinded endoscopists. Significant changes in serum sodium, potassium, chloride, calcium, ionized calcium, and inorganic phosphorus levels were noted following sodium phosphate preparation when compared to values before preparation. A significantly greater number of patients who received sodium phosphate preparation had serum potassium and ionized calcium levels that fell into the abnormal range. Ambulatory electrocardiogram monitors placed 24 hours before the preparation and removed after colonoscopy showed no increase in ventricular premature contractions or other serious arrhythmias in either group during preparation or colonoscopy. CONCLUSIONS: (1) Sodium phosphate and SF-PEG-ELS are equally well tolerated and effective in preparation for outpatient colonoscopy, and (2) sodium phosphate preparation at the recommended dose causes significant alterations in serum sodium, potassium, chloride, calcium, ionized calcium, and phosphorus levels.

Adult↗
PubMed1996

Endoscopic nasoenteral feeding tube placement following cardiothoracic surgery.

UNLABELLED: Our purpose was to evaluate the safety and efficacy of nasoenteral feeding tube placement in the cardiothoracic surgery patients. This is a retrospective analysis of 15 critically ill cardiothoracic surgery patients who underwent endoscopic placement of an enteral feeding tube beyond the proximal duodenum for maintenance of nutrition. Twenty-five entriflex 10-F nasoenteral tubes were placed endoscopically using a modified technique far into the distal duodenum, and the placement was confirmed radiographically. Mean patient age was 71 years. Seven were males and 8 were females. Eleven had undergone coronary artery bypass surgery, two aortic valve replacement, and two aortic aneurysm repair. The mean duration of tube function was 8.5 days and mean duration of tube feeding was 15.7 days. Of the total 15 patients, 7 required replacement due to various reasons, the most common being self extubation by the patient and malpositioning after initial placement. No cardiac complications or any other complications were noted directly related to the endoscopic procedure. In eight patients, the mean serum albumin level did not change [before: 2.5mg/dL, after: 2.6mg/dL] for the short time (avg. 8.5 days) the tube was functional. CONCLUSIONS: 1) Endoscopic placement of the nasoenteral tubes is a safe method of providing enteral nutrition in critically ill cardiothoracic surgery patients. 2) Benefits of nasoenteral tubes compared to nasogastric tubes remain unproven, and frequent repositioning of nasoenteral tubes is required. 3) A prospective comparison of nasoenteral and nasogastric tubes is warranted.

Aged↗
PubMed1993

The use of GoLYTELY and Dulcolax in combination in outpatient colonoscopy.

One hundred and sixty patients were enrolled in a double-blind, placebo-controlled trial to evaluate the effectiveness of the combination of the polyethylene glycol electrolyte lavage solution GoLYTELY (Braintree Laboratories, Inc., Braintree, MA, U.S.A.) and the contact laxative bisacodyl (Dulcolax, Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT, U.S.A.) in improving outpatient preparation for colonoscopy. One hundred and fourteen patients completed the study; 59 received GoLYTELY followed by three Dulcolax capsules and 55 received GoLYTELY followed by three placebo capsules. A statistically significant improvement in the group receiving Dulcolax was noted in overall quality of preparation (p = 0.015) and amount of liquid stool present during colonoscopy (p = 0.02). We noted no significant difference in the occurrence of adverse effects. No patient in either group suffered from symptomatic orthostatic hypotension. These results suggest that an improved colonoscopy preparation can be obtained by combining a standard GoLYTELY preparation with three 5-mg Dulcolax tablets, without sacrificing patient safety or comfort.

Ambulatory Care↗
PubMed1992

Gastrointestinal foreign bodies. When to remove them, when to watch and wait.

By being aware of which patients are at high risk for ingestion or insertion of foreign bodies, physicians can be on the lookout for objects in the gastrointestinal tract and ready to institute initial care. Esophageal foreign bodies and other objects that increase the chance of perforation or obstruction may require urgent endoscopic or surgical removal. Other objects may be expelled on their own. Identification of those that require early intervention is the key to successful management.

Digestive System↗
PubMed1991

Colitis due to Histoplasma capsulatum in the acquired immune deficiency syndrome.

We present a case of colonic histoplasmosis in a young HIV antibody-positive homosexual male who presented with acute diarrhea. The diagnosis was made by flexible sigmoidoscopy with biopsy which revealed organisms morphologically consistent with Histoplasma capsulatum, and was later confirmed by fungal culture of the biopsy specimens. At colonoscopy, skip areas with plaques, ulcers, and a pseudopolyp were observed. The colitis resolved endoscopically after a 6-wk course of intravenous amphotericin B, and the patient has had no recurrence of symptoms while on maintenance therapy with amphotericin B. However, the organisms continue to be noted on biopsies of normal-appearing areas in the rectum and sigmoid 5 months after diagnosis. Colonic involvement with H. capsulatum, an organism endemic to the Midwest, may be seen more frequently as the total number of cases of HIV-infected individuals increases in this region.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Percutaneous endoscopic gastrostomy and early mortality.

To assess morbidity, mortality, and benefit associated with percutaneous endoscopic gastronomy (PEG), we retrospectively studied 42 patients who had had PEG. Mortality was exceptionally high during the first 60 days after PEG (43%), and then stabilized. In nearly half of the cases (20/42) the PEG tube was removed during the first 60 days because of either death or improvement. Patients with malignancy had a significantly higher morbidity and 60-day mortality than the neurologically impaired. We concluded that patients should be carefully selected for PEG because early mortality is high; a 60-day trial of soft nasogastric feedings should be considered before PEG, and could reduce by nearly half the number of patients failing to receive long-term benefit; and patients with malignancy have significantly greater morbidity and mortality after PEG and may not receive the same advantage from the procedure.

Adult↗
PubMedDate not supplied

Diagnosis and management of appendiceal mucoceles.

Preoperative diagnosis of appendiceal mucoceles is rare. If untreated, one type of mucoceles may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The importance of diagnosing appendiceal mucoceles is highlighted through a case presentation of a woman who had an incidental finding of mucinous cystadenoma of the appendix during colonoscopic evaluation for occult gastrointestinal bleeding. A detailed review of the medical literature regarding appendiceal mucoceles is presented, with emphasis on the pathologic, clinical, radiologic, and evolving endoscopic features. Surgical options and prognosis are discussed.

Adenoma↗