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At least 181 records · Page 10Linked to original sources

PubMed1994

Treatment of cancer-related pain: when orally administered medications fail.

OBJECTIVE: To summarize the available pain-relieving interventions other than oral medications for cancer-related pain. DESIGN: The pertinent literature is reviewed, and the various options for treating pain in patients with cancer are discussed. MATERIAL AND METHODS: The appropriate situations for use of parenteral administration of opioids, spinal analgesia, neural blockade, and neurosurgical treatment are outlined, and the potential problems and complications associated with these techniques are described. RESULTS: The basic approach to the management of pain in patients with cancer is to begin treatment with less potent analgesic agents early and to progress toward use of more potent pharmaceutical agents, adjuvant drugs, and invasive procedures as needed for alleviation of pain. With parenteral administration of opioids, the dosage can be adjusted rapidly, and therapy can be continued even though a patient may have gastrointestinal dysfunction. A portable ambulatory infusion pump can be used in selected patients. The major advantage of spinal opioid analgesia is the intense analgesia provided with minimal side effects. The potential complications and the availability of treatment alternatives have limited the use of neurolytic blocks, which usually provide only temporary relief of pain. In carefully selected patients with pancreatic or other upper gastrointestinal neoplasms, however, neurolytic celiac plexus and splanchnic nerve blocks are effective. Patients who fail to respond to conservative interventions may be candidates for neurosurgical procedures, such as spinal cord, cortical, or brain-stem stimulation or neuroablative operations (most commonly, cordotomy). CONCLUSION: Cancer-related pain continues to be a major problem, and clinicians should be aware of the availability of effective treatment strategies and techniques. When orally administered medications fail to control pain or cause excessive side effects, patients should be referred to an appropriate specialist or medical center for consideration of other pain-relieving techniques.

Analgesia↗

PubMed2000

Plasma endotoxin concentrations during cardiac surgery may be related to atherosclerosis.

Systemic endotoxemia develops during cardiopulmonary bypass, probably due to intestinal ischaemia. Differences in endotoxaemia among various cardiac operations and the relationship between endotoxemia and postoperative complications were studied in high-risk patients. Blood samples were obtained at termination of bypass in 136 adults undergoing elective cardiac surgery. Postoperative complications were registered prospectively. Plasma endotoxin was quantified by a kinetic limulus amebocyte lysate assay. Mean endotoxin concentrations were significantly lower in patients undergoing isolated valve replacement (89 ng/l) than in patients undergoing coronary artery bypass grafting alone (234 ng/l), or combined with valve replacement (278 ng/l) or carotid artery surgery (321 ng/l) (p < 0.05). In multivariate linear regression, only the number of grafts (0, 1-3, 4-5) was significantly correlated to endotoxin concentrations (p < 0.0005). Endotoxin concentrations were related to development of gastrointestinal dysfunction (p = 0.03), but not to mortality (p = 0.24) or other complications (p = 0.62).

Aged↗

PubMed2004

Experience of post-pyloric feeding in seriously ill patients in clinical practice.

BACKGROUND: Maintaining nutrition is an integral part of patient care and when it is possible enteral nutrition is regarded as superior to parenteral nutrition. Post-pyloric feeding may enable enteral feeding to be maintained in patients who cannot tolerate nasogastric feeding. The success of post-pyloric feeding in routine clinical practice is uncertain. METHODS: One hundred and forty six consecutive patients who had 150 separate episodes of post-pyloric feeding were identified. Casenotes were reviewed to assess indication for post-pyloric feeding, prior use of alternative methods of feeding, success of achieving nutritional requirements and patient outcome. RESULTS: A post-pyloric tube was successfully placed in 138 (92%) and nutritional requirements were met by post-pyloric feeding alone in 124 (83%). Post-pyloric feeding was used for between 2 and 254 days (median 14 days). Conditions for which post-pyloric feeding was used to administer nutritional support included burn injury, pancreatitis, sepsis, post-operative gastric stasis, bone marrow transplantation and chemotherapy induced vomiting. Fifty (33%) patients had an attempt at nasogastric feeding and 33 (22%) were on total parenteral nutrition before post-pyloric feeding was commenced. There was one major complication of a jejunal ulcer bleed in the series. Minor complications included displacement of the nasojejunal tube and failure to absorb feed related to gastrointestinal dysfunction. CONCLUSIONS: Post-pyloric feeding can be successfully used to maintain enteral nutrition in patients who would otherwise require parenteral nutrition.

Critical Illness↗

PubMed1998

Effect of orthotopic liver transplantation on the progression of familial amyloidotic polyneuropathy.

BACKGROUND: Familial amyloidotic polyneuropathy (FAP) is an autosomal dominant inherited disease associated with a mutant form of the protein transthyretin (TTR). It is characterized clinically by the systemic deposition of amyloid fibrils resulting in organ dysfunction and, ultimately, death. The majority of TTR is produced in the liver, and transplantation of the liver has been shown to ameliorate this source of mutant TTR, arresting the progression of this fatal disease. METHODS: Thirteen patients with FAP have undergone successful liver transplant surgery at our center since 1992. The impact of liver transplantation on amyloid-related polyneuropathy, cardiovascular, and gastrointestinal dysfunction is reported in this study. Three patients who died before cardiovascular and neurological follow-up are excluded from the analysis. RESULTS: Ten of 13 patients (77%) remain alive an average of 49 months (range, 17-64 months) after transplantation. Three patients suffered sudden death, with autopsy documentation of amyloid deposits involving the conduction system of the heart. Liver transplantation was performed more quickly, required less blood, and a shorter postoperative hospital stay in these patients, compared with patients with cirrhosis. Neurological and nutritional symptoms improved in the majority of affected patients. Those patients with echocardiographic evidence of ventricular wall and valve thickening before transplantation progressed postoperatively despite neurologic improvement. CONCLUSIONS: Liver transplantation offers the only cure for the genetic defect causing FAP and appears to result in subjective and objective improvement in neurological dysfunction. Patients with preexisting cardiovascular abnormalities progress despite transplantation; therefore, consideration for combined heart-liver transplantation may be warranted in this subset of patients.

Adult↗

PubMed1991

Effect of sublethal lead exposure on gastric motility of red-tailed hawks.

In order to determine the effects of low level lead exposure on gastric motility in raptors, strain gage transducers were surgically implanted on the serosal surface of the muscular stomach of three red-tailed hawks. The frequency and amplitude of gastric contractions during ingestion and early digestion were monitored for 1 week under control conditions and for 3 weeks while the birds were fed 0.82 or 1.64 mg lead (as lead acetate) per kg body weight each day. Exposure to these doses did not appreciably affect either the frequency or amplitude of gastric contractions in these birds. This low level lead exposure also had no consistent effect on the regular egestion of pellets of undigested material by hawks. Daily exposure to doses up to 6.55 mg lead/kg body weight did not affect the frequency or timing of pellet egestion, and exposure to 1.64 mg lead/kg did not affect the gastric contractions associated with pellet egestion. Although gastrointestinal dysfunction is often associated with clinical cases of acute lead toxicity, chronic exposure to these low levels of lead acetate did not significantly alter gastric motility in red-tailed hawks.

Animals↗

PubMed1994

Hirschsprung's disease associated with Ondine's curse: report of three cases and review of the literature.

The cases of three full-term infant girls with both Hirschsprung's disease (HD) and Ondine's curse (OC) are presented, and the relevant literature is reviewed. All three patients required endotracheal intubation and assisted ventilation during the first 24 hours of life because of respiratory distress. The diagnosis of HD was subsequently established at age 13, 16, and 20 days, respectively. The aganglionic segment was confirmed to the rectum in one case, extended to the splenic flexure of the colon in the second case, and involved the terminal ileum in the third. The definitive treatment (endorectal pull-through) was completed successfully in all three patients, and the postoperative follow-up period was 3 to 34 months. All of them presently have tracheostomies and are maintained on home ventilation. They tolerate being off the ventilator while awake, and have nearly normal bowel habits and growth curves. Two have bilateral ciliary ganglion dysfunction, and one has strabismus. Based on this review, the authors conclude the following. (1) The incidence of the HD associated with OC may be more common than is generally believed (1.8% of all their HD patients have OC). (2) OC should be suspected in any newborn with HD who requires assisted ventilation in the absence of major cardiopulmonary abnormalities. Likewise, HD should be ruled out in any OC case with gastrointestinal dysfunction. (3) Contrary to the previous impression from the literature, the combination of OC and HD should not be considered fatal, because most such patients can be managed successfully and have a reasonable quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗

PubMed2000

An overview of special considerations in the evaluation and management of the geriatric patient.

As the population ages, physicians will care for increasing numbers of older patients. Promoting independence is a major goal of care. Gastrointestinal dysfunction is often caused by chronic disease, medications, and lifestyle exposures, rather than to age alone. A useful approach to the older patient focuses on maintaining function and avoiding complications.

Activities of Daily Living↗

PubMed1992

Gastrointestinal tissue cultures for HIV in HIV-infected/AIDS patients. The University of Calgary Gastrointestinal/HIV Study Group.

OBJECTIVE: To determine the prevalence of HIV in endoscopic biopsies from the esophagus, stomach, duodenum, and rectum of homosexual and bisexual men at various stages of HIV infection as part of a comprehensive study of gastrointestinal dysfunction in HIV infection. METHODS: After repeated washings and mechanical disruption, biopsies obtained from 58 volunteers were individually cocultured with pooled peripheral blood lymphocytes from healthy HIV-seronegative blood donors. RESULTS: HIV was isolated from at least one site in 40 out of 49 patients. Esophageal biopsies were most frequently found positive (46%), followed by duodenal biopsies (44%), rectal biopsies (43%), and gastric biopsies (27%). Recovery of HIV was not related to any gastrointestinal signs or symptoms. HIV was recovered in the biopsies both from asymptomatic patients with CD4 lymphocyte counts greater than 500 x 10(6)/l and also from patients with more advanced disease receiving zidovudine therapy. CONCLUSIONS: The entire gastrointestinal tract appears to be a target site throughout the course of HIV infection in homosexual and bisexual men.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Indolent anti-Hu-associated paraneoplastic sensory neuropathy.

Paraneoplastic sensory neuropathy (PSN) usually runs a subacute progressive course, leaving the patient with severe sensory dysfunction in weeks to months. We describe five patients with PSN, high titers of anti-Hu antibodies (type 1 antineuronal nuclear autoantibodies), and an indolent clinical course. The patients had a median age of 55 years (range, 41 to 72). Four had small-cell (3) or undifferentiated large-cell (1) lung cancer. Patients presented with mild, asymmetric sensory symptoms; in two, the neuropathy was predominant in the arms. Two patients also had a visceral neuropathy causing gastrointestinal dysfunction. The PSN was stable or progressed very slowly without treatment for a median of 18 months (range, 5 to 32) and remained so after treatment with immunoglobulins (1 patient), chemotherapy (3), or both therapies (1). All patients were ambulatory, leading an independent life up until the time of the last visit or until death from the tumor (2 patients). The median follow-up was 36 months (range, 22 to 52). A paraneoplastic origin should be considered in patients with mild, very slowly progressive sensory neuropathies.

Adult↗

PubMed2026

Clinical and genetic analysis of a family with 16p11.2 microduplication syndrome and variable multisystem manifestations.

16p11.2 microduplication syndrome (OMIM #614671) is a pathogenic recurrent copy-number gain at the 16p11.2 locus and is associated with variable expressivity across neurodevelopmental, growth, and medical phenotypes. Gastrointestinal symptoms have been reported in carrier cohorts, but detailed documentation of gastrointestinal motility and neuromuscular findings remains limited. We performed clinical and genetic analyses in a multigenerational family in which the proband (III1) presented with limb muscle pain, exercise intolerance, and chronic gastrointestinal symptoms. Next-generation sequencing (NGS), low-pass whole-genome sequencing (lpWGS)-based CNV analysis, Sanger sequencing, and qPCR validation identified a 0.8 Mb microduplication at 16p11.2 (BP4-BP5), involving 44 genes including TBX6, inherited from the mother (II2). The proband's clinical manifestations included developmental delay, pointed chin, low body mass index, gastrointestinal dysfunction (chronic abdominal pain, diarrhea, esophageal motility disorder, and rectal prolapse), forward-leaning gait, mild scoliosis, and limb muscle atrophy with inflammatory muscle involvement. Four family members (II2, III1, III2, and III4) carried the microduplication, but their available clinical features varied in severity and system involvement. The proband's twin brother (III2) had left ear deafness and epilepsy, individual II2 had blindness from cone-rod dystrophy, and III4 showed more pronounced scoliosis. This family provides a detailed clinical and genetic description of 16p11.2 microduplication carriers with prominent gastrointestinal motility and neuromuscular manifestations, thereby enriching the clinical characterization of this recurrent CNV and supporting substantial intrafamilial phenotypic heterogeneity.

16p11.2 microduplication syndrome↗

PubMed1978

Rocky Mountain spotted fever: gastrointestinal and laboratory manifestations.

Sixty-six cases of serologically documented Rocky Mountain spotted fever (RMSF) from North Carolina are reviewed. Gastrointestinal manifestations were present in 80% of these patients. Because other common expressions of RMSF occasionally do not accompany severe gastrointestinal dysfunction, improper diagnosis and therapy can result. Sixty percent of the patients had hyponatremia and thrombocytopenia. Over 70% of those who had liver or muscle enzyme evaluations had at least one abnormality. RMSF should be strongly considered in the differential diagnosis of patients with a combination of these findings.

Adolescent↗

PubMed1994

Intensive care of acute Guillain-Barré syndrome.

Guillain-Barré syndrome causes, in addition to paralysis and respiratory failure, many general medical problems that have great bearing on outcome. The main features of daily care that require attention are: respiratory and urinary tract infections, gastrointestinal dysfunction, hyponatremia, pain control, and the potential for pulmonary embolism. Dysautonomic problems that arise specifically in the intensive care unit include: hyper- and hypotension, cardiac arrhythmias, and ileus. Throughout the illness, certain psychological aberrations and communication problems must be addressed. The experience reviewed herein provides a practical approach to these problems.

Acute Disease↗

PubMed1989

Motility disorders and stress.

The association between emotion and gastrointestinal dysfunction has been postulated for centuries, and all practicing clinicians have anecdotal experience of the association between stress and irritable bowel syndrome (IBS). However, definite proof of an etiologic link between stress and gut motor dysfunction remains elusive, despite the large number of publications on this topic. A critical appraisal of methodology, use of controls, data interpretation, and significance of findings in the published literature is necessary to assess the present state of knowledge and to develop more meaningful studies in the future. This review attempts to summarize these perspectives.

Colon↗

PubMed1999

Feeding difficulties and foregut dysmotility in Noonan's syndrome.

PURPOSE: Noonan's syndrome is a common dysmorphic syndrome in which failure to thrive and gastrointestinal symptoms are frequent but poorly understood. DESIGN: Twenty five children with Noonan's syndrome were investigated by contrast radiology, pH monitoring, surface electrogastrography (EGG), and antroduodenal manometry (ADM). RESULTS: Sixteen had poor feeding and symptoms of gastrointestinal dysfunction. All 16 required tube feeding. Seven of 25 had symptoms of foregut dysmotility and gastro-oesophageal reflux. In the most symptomatic children (four of seven) EGG showed fasting frequency gradient loss along the stomach fundus and pylorus with antral postprandial frequency loss. ADM showed shortened fasting cycle length, with abnormal phase III and shortened postprandial activity containing phasic contractions. IMPLICATIONS: Gastroduodenal motor activity was reminiscent of 32-35 week preterm patterns. The feeding difficulties appear to resolve as gut motility matures. In Noonan's syndrome, feeding problems appear to be the result of delayed gastrointestinal motor development.

Barium Sulfate↗

PubMed1987

Psychiatric correlates of chronic solvent abuse.

Eleven chronic solvent abusers admitted for inpatient treatment were retrospectively identified and their records reviewed to determine associated medical and psychiatric illness and other substance abuse. Antisocial personality disorder and narcotics abuse were common in the group, as were symptoms suggesting neurological or gastrointestinal dysfunction. The patients' response to substance abuse treatment was poor. The findings indicate that persons who abuse solvents over a long period tend to have associated behavioral patterns that may contribute to poor social adjustment and to poor response to the treatment of their substance-abuse problems.

Adult↗

PubMed2005

Fructose intake at current levels in the United States may cause gastrointestinal distress in normal adults.

OBJECTIVE: Fructose intake has increased considerably in the United States, primarily as a result of increased consumption of high-fructose corn syrup, fruits and juices, and crystalline fructose. The purpose was to determine how often fructose, in amounts commonly consumed, would result in malabsorption and/or symptoms in healthy persons. DESIGN: Fructose absorption was measured using 3-hour breath hydrogen tests and symptom scores were used to rate subjective responses for gas, borborygmus, abdominal pain, and loose stools. SUBJECTS/SETTING: The study included 15 normal, free-living volunteers from a medical center community and was performed in a gastrointestinal specialty clinic. INTERVENTION: Subjects consumed 25- and 50-g doses of crystalline fructose with water after an overnight fast on separate test days. MAIN OUTCOME MEASURES: Mean peak breath hydrogen, time of peak, area under the curve (AUC) for breath hydrogen and gastrointestinal symptoms were measured during a 3-hour period after subjects consumed both 25- and 50-g doses of fructose. STATISTICAL ANALYSES: Differences in mean breath hydrogen, AUC, and symptom scores between doses were analyzed using paired t tests. Correlations among peak breath hydrogen, AUC, and symptoms were also evaluated. RESULTS: More than half of the 15 adults tested showed evidence of fructose malabsorption after 25 g fructose and greater than two thirds showed malabsorption after 50 g fructose. AUC, representing overall breath hydrogen response, was significantly greater after the 50-g dose. Overall symptom scores were significantly greater than baseline after each dose, but scores were only marginally greater after 50 g than 25 g. Peak hydrogen levels and AUC were highly correlated, but neither was significantly related to symptoms. CONCLUSIONS: Fructose, in amounts commonly consumed, may result in mild gastrointestinal distress in normal people. Additional study is warranted to evaluate the response to fructose-glucose mixtures (as in high-fructose corn syrup) and fructose taken with food in both normal people and those with gastrointestinal dysfunction. Because breath hydrogen peaks occurred at 90 to 114 minutes and were highly correlated with 180-minute breath hydrogen AUC, the use of peak hydrogen measures may be considered to shorten the duration of the exam.

Abdominal Pain↗

PubMed2003

Nutritional factors contributing to the development of cholestasis during total parenteral nutrition.

Parenteral nutrition-associated cholestasis is a major clinical problem in pediatrics, particularly during infancy in children with short bowel syndrome who require long-term use of total parenteral nutrition (TPN) for survival. Multifactorial theories regarding the origin of parenteral nutrition-associated cholestasis have not yet defined its pathogenesis or resulted in a solution to the problem. However, our knowledge of risk factors has helped develop new hypotheses as to the mechanisms of this disease. In this review, we consider the following potential risk factors that influence the development of this condition: (1) the gastrointestinal dysfunction associated with the absence of enteric nutrients while receiving TPN; (2) components of TPN solutions as potential hepatotoxins; and (3) the contribution of the underlying disease necessitating TPN for adequate nutrition. It is hoped that a better understanding of factors affecting hepatocyte secretion and bile formation and flow will help to prevent this life-threatening complication of TPN.

Child↗

PubMed2003

A phase II study of intravenous exatecan mesylate (DX-8951f) administered daily for 5 days every 3 weeks to patients with advanced ovarian, tubal or peritoneal cancer resistant to platinum, taxane and topotecan.

BACKGROUND: DX-8951f is a water-soluble camptothecin derivative with greater in vivo and in vitro activity than topotecan or irinotecan. The objectives of this phase II study were to determine the antitumor activity, safety and pharmacokinetic profile of DX-8951f administered intravenously for five consecutive days, every 3 weeks in patients with advanced ovarian, tubal and peritoneal cancer resistant to platinum, taxane and topotecan. METHODS: Enrolled in the study at The University of Texas M. D. Anderson Cancer Center were 16 patients with measurable cancer resistant to platinum, taxane and topotecan. All 16 patients were assessable for safety and 15 for efficacy analyses. Treatment consisted of a daily infusion of DX-8951f at 0.3 mg/m(2) per day (except for one minimally pretreated patient who started at 0.5 mg/m(2) per day) over 30 min for five consecutive days every 3 weeks. The pharmacokinetic and excretory profiles of DX-8951, the anhydrous form of DX-8951f, were also characterized. RESULTS: Disease was stable in 7 of 16 patients (44%) (4 minor response and 3 stable disease). The median time to tumor progression was 43 days (95% CI 37-92 days). The median overall survival was 117 days (95% CI 90-279 days). The main toxic effect was neutropenia and leukopenia with 50% of patients experiencing grade 3 or 4 neutropenia and leukopenia. One episode of neutropenic fever was observed. Grade 3 or more anemia and thrombocytopenia were seen in 25% and 13% of patients, respectively. Grade 3 nonhematologic side effects included nausea (25% of patients) and fatigue (19%). Other side effects were not more than grade 2, and included gastrointestinal dysfunction, stomatitis, dermatitis, alopecia, liver dysfunction and drug fever. DX-8951 displayed linear pharmacokinetic characteristics at the doses administered. The average plasma clearance, total volume of distribution, and terminal elimination half-life were 2.1 l/h per m(2), 20 l/m(2) and 9.5 h, respectively. CONCLUSIONS: DX-8951f administered parenterally as a single agent daily at a dose of either 0.5 or 0.3 mg/m(2) per day for 5 days is feasible in patients with advanced ovarian, tubal and peritoneal cancer resistant to platinum, taxane and topotecan. Although no responses were observed, a significant number of patients had stable disease with a decrease in CA-125 levels. In this heavily pretreated population, DX-8951f has clinically relevant hematologic and gastrointestinal toxicities in about 25% of patients. DX-8951 appeared to have linear pharmacokinetic characteristics on the basis of multiple administrations.

Adult↗