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At least 379 records · Page 21Linked to original sources
PubMed1996

Clinical and socioeconomic predispositions to complicated thyrotoxicosis: a predictable and preventable syndrome?

PURPOSE: To identify the clinical, demographic, and hormonal features that characterize and place patients at greater risk for complicated thyrotoxicosis. PATIENTS AND METHODS: Fifty-nine patients with documented thyrotoxicosis complicated by cardiovascular, neuropsychiatric, gastrointestinal, or thermoregulatory dysfunction, were retrospectively identified among 498,000 hospital admissions between 1979 and 1992. Clinical, demographic, and hormonal information were obtained from these charts, as well as from the charts of 118 randomly selected thyrotoxic outpatients. RESULTS: Age distribution of complicated thyrotoxicosis patients was bimodal, with a median of 41 years. Forty-nine percent of patients had been previously diagnosed with thyrotoxicosis, but most had been noncompliant with prescribed medication. Cardiovascular complications were among the primary causes for admission in 46% of patients, followed by neuropsychiatric indications in 42%, fever in 34%, and gastrointestinal dysfunction in 17%. Only 8% had primary involvement of > 2 organ systems. There was high correlation between organ systems with pre-existing dysfunction and those with a complication of thyrotoxicosis (P < 0.0001). Compared to uncomplicated controls, patients with complicated thyrotoxicosis were more likely to be uninsured or covered by Medicaid (OR, 2.64; 95% CI 1.78 to 3.91); to be < 30 or > 50 years old (OR, 1.93; 95% CI 1.23 to 3.03); and to have serum T4 concentrations greater than twice the upper limit of normal (OR, 1.67; 95% CI, 1.15 to 2.44). CONCLUSIONS: Certain thyrotoxic patients are at greater risk for developing complications. By addressing the medical needs of these patients, it may be possible to reduce the likelihood of complications requiring hospitalization.

Adult↗
PubMed1997

Effects of adenosine 5'-triphosphate, adenosine and acetylcholine in urinary bladder and colon muscles from streptozotocin diabetic rats.

Bladder dysfunction and gastrointestinal disorders are common complications of diabetes mellitus and are attributed in part to peripheral neuropathy. Little is known of the mechanisms responsible for the bladder dysfunction and abnormality of the gastrointestinal tract. The effects of experimental diabetes on responses to adenosine, adenosine 5'-triphosphate (ATP) and acetylcholine (ACh) in rat bladder and colon were investigated 1 week and 8 weeks after i.v. injection of streptozotocin. Bladders from 8 week diabetic rats, but not from 1 week, were significantly larger than those from age matched controls. Relaxant and contractile responses of strips obtained from bladder body to these agonists were altered by diabetes. Relaxant responses to adenosine and ATP were also enhanced by diabetes. While maximum response and sensitivity to ATP relaxant effect were equivalent in 1 and 8 week diabetic rats as compared to age matched controls, both maximum responses to relaxant effect of adenosine and to contractile effect of ACh were reduced in colon preparations obtained from 8 week, but not from 1 week diabetic animals. The results suggest that changes in urinary bladder and colon smooth muscle function occur in diabetic rats and may contribute to the bladder dysfunction and colonic disorders seen in diabetes mellitus.

Acetylcholine↗
PubMed2005

Reliability and validity of a new scale to assess postoperative dysfunction after resection of upper gastrointestinal carcinoma.

PURPOSE: We evaluated the purpose reliability and validity of a preliminary scale, which we developed to assess postoperative dysfunction after surgery for gastric and esophageal carcinoma. METHODS: After interviews with 12 patients, reviews of previous studies, and discussions with experts, we identified the physical symptoms that develop after resection of upper gastrointestinal (GIT) carcinoma, and devised a preliminary scale comprised of 34 items. A questionnaire survey based on this scale was then sent to 283 patients. RESULTS: The questionnaire was returned by 223 patients (78.8%), and 219 responses (98.2%) were valid. Among the 219 respondents, 168 had gastric carcinoma and 51 had esophageal carcinoma. After the elimination of scale items regarded as irrelevant based on statistical considerations and the judgment of experts, factor analysis was done. Seven factors were valid, namely, limited activity due to decreased food consumption, reflux, gastric dumping, nausea and vomiting, deglutition difficulty, pain, and difficulty with passing stools, which were often poorly formed. Scale reliability was confirmed by a Cronbach alpha-coefficient of 0.924. The validity of the construction of this scale was confirmed using the known-group technique based on the operative procedures performed, and the results of factorial validity. CONCLUSION: Our preliminary scale is sufficiently reliable and valid, and will prove to be clinically useful.

Adult↗
PubMed2000

Functions of peripheral 5-hydroxytryptamine receptors, especially 5-hydroxytryptamine4 receptor, in gastrointestinal motility.

The multiple 5-hydroxytryptamine (5-HT, serotonin) receptor subtypes are distinguished. In this article, we described mainly the 5-HT4 receptor of four subtypes of functional 5-HT receptors, 5-HT1, 5-HT2, 5-HT3, and 5-HT4, recognized in the gastrointestinal tract. In-vivo microdialysis experiments determined that activation of the 5-HT4 receptor stimulated intestinal motor activity associated with a local increase in acetylcholine (ACh) release from the intestinal cholinergic neurons in the whole body of dogs. The 5-HT4 receptor-mediated response of ACh release in the antral, corporal, and fundic strips isolated from guinea pig stomach corresponds to the presence of 5-HT4 receptor in the myenteric plexus. In-vitro receptor autoradiograms of the stomach and colon indicate that the distribution of 5-HT4 receptors in human tissues is similar to that in the guinea pig, although density of 5-HT4 receptors in the myenteric plexus of human tissues is lower than that in guinea pig tissues. The 5-HT4 receptors located in the myenteric plexus may participate in gastrointestinal motility, and thus the 5-HT4 agonists and antagonists may be available for treatment of dysfunction of gastrointestinal motility.

Animals↗
PubMed2004

[Diabetic gastroparesis and gastropathy].

Dysfunction of gastrointestinal tract affects about 30-60 % diabetic patients. The gastroparesis occurs only in part of patients. Dysfunction has different manifestations from quantitative and qualitative changes of motility to alterations of visceral sensitivity. Pathogenesis of the disturbances is multifactorial - autonomic neuropathy, quality of metabolic control, function of enteric nervous system and others. Scintigraphy is a standard for making diagnosis. Due to its multifactorial natural history, therapy is difficult. It encompasses dietary modifications, good control of diabetes, prokinetic drugs. New drugs and treatment techniques are beeing developed.

Diabetes Complications↗
PubMed1997

Complications after treatment with external-beam irradiation in early-stage prostate cancer patients: a prospective multiinstitutional outcomes study.

PURPOSE: To use data from a prospective quality-of-life study to assess differences in disease-specific and general health-related quality-of-life changes after treatment with different external-beam irradiation techniques for prostate cancer. PATIENTS AND METHODS: Patients were divided into three groups based on their pretreatment field size and planning technique: whole pelvis, small field, or conformal. Measures of bowel, urinary, and sexual function and of global health-related quality-of-life parameters (from the Health Survey Short Form [SF-36] and the Profile of Mood States [POMS]) were obtained from self-report questionnaires completed before initiation of therapy and at 3 and 12 months after therapy. RESULTS: Irritative gastrointestinal and genitourinary side effects were frequent 3 months after treatment, but were substantially improved at 12 months. Sexual dysfunction increased steadily over the study period. The POMS and the SF-36 did not demonstrate significant changes over time. Despite small patient numbers, we found trends in favor of conformal therapy across several symptom measures, including sexual function. In the fatigue, energy, and vigor subscales, patients who received whole-pelvis treatment fared significantly worse than those in the other two groups. CONCLUSION: Prospective, detailed data from a feasibility study allowed us to assess the effect of technique on quality of life following external-beam irradiation. Although limited by the small planned sample size, these results suggest that smaller radiation fields limit treatment-related complications, including, unexpectedly, sexual dysfunction. However, confirmation in a larger study is necessary.

Affect↗
PubMed1995

Role of nuclear medicine in evaluating patients with suspected gastrointestinal motility disorders.

Functional symptoms caused by gastrointestinal motility disorders are relatively common in the general population. Knowledge of the relationship between symptoms and the underlying gastrointestinal dysmotility provides physicians with a framework for successful evaluation and treatment of patients with possible motor disorders of the gastrointestinal tract. Scintigraphy provides for noninvasive and quantitative assessment of physiological transit throughout the gastrointestinal tract, and it is extremely useful for diagnosing gastrointestinal motor dysfunction. The wide range of scintigraphic studies now available supplement other diagnostic tests for evaluation of all segments of the gastrointestinal tract.

Colon↗
PubMed1992

Effect of hyperglycemia on gastrointestinal and gallbladder motility.

Gastrointestinal motor abnormalities occur frequently in patients with diabetes mellitus. The gastrointestinal motor dysfunction in these patients has been associated with the presence of autonomic neuropathy. Recently, however, several studies have shown that the gastrointestinal motor responses to various stimuli are impaired during acute hyperglycemia in both healthy subjects and diabetic patients. It has been demonstrated that acute hyperglycemia impairs esophageal peristalsis, reduces the lower esophageal sphincter pressure, delays gastric emptying, slows intestinal transit, and reduces the gallbladder contraction in response to various stimuli in healthy subjects. In diabetic patients gastric emptying and gallbladder contraction have been shown to be impaired during hyperglycemia. With regard to the mechanisms of action, it has been suggested that hyperglycemia may affect gastrointestinal function through vagal-cholinergic inhibition, by alterations in serum osmolality, or perhaps by alterations in gastrointestinal hormone secretion.

Diabetes Mellitus↗
PubMed1996

Gastrointestinal angiodysplasia in congenital platelet dysfunction.

We herein report three cases of repeated massive bleeding from the stomach and small bowel. One patient suffered from both thrombasthenia (type II) and von Willebrand disease (type 1) simultaneously. Two others had Bernard-Soulier's syndrome (BSS). One patient with BSS had bleeding from gastric angiodysplasia and was treated endoscopically by clipping. The other patients had massive bleeding from the small intestine, and had partial resection of the affected small intestine. Histologically, irregular dilatation and proliferation of the blood vessels were demonstrated in the submucosa in bleeding spots from a resected small intestine, and these findings were consistent with the features of acquired angiodysplasia. The development of gastrointestinal angiodysplasia may not only be associated with a dysfunction of von Willebrand factor but also with that of platelets.

Adult↗
PubMed2005

Effects of mosapride, a 5-hydroxytryptamine 4 receptor agonist, on electrical activity of the small intestine and cecum in horses.

OBJECTIVE: To examine the effects of various doses of mosapride, a 5-hydroxytryptamine 4 receptor agonist, on motility of the small intestine and cecum in horses by use of electrical activity and to determine the dose that provides the optimal response. ANIMAL: 6 healthy adult Thoroughbreds. PROCEDURE: Electrical activity of the small intestine and cecum was recorded before and after mosapride administration by use of an electrogastrograph. Mosapride (0.5, 1, 1.5, and 2 mg/kg) was dissolved in 200 mL of water and administered orally to horses through a nasogastric tube. Three hours after drug administration, mean amplitude of electrical activity calculated for a period of 30 minutes was expressed as the percentage of the mean amplitude of electrical activity for a period of 30 minutes before drug administration. RESULTS: Mosapride administered orally increased the percentage of the mean amplitude of electrical activity in the small intestine and cecum in a dose-dependent manner. Mean +/- SD values differed significantly for 1, 1.5, and 2 mg/kg (127.0 +/- 12.5%, 137.7 +/- 22.2%, and 151.1 +/- 24.0%, respectively) in the small intestine and for 1.5 and 2 mg/kg (130.1 +/- 34.5% and 151.6 +/- 45.2%, respectively) in the cecum. CONCLUSIONS AND CLINICAL RELEVANCE: Analysis of results of this study clearly documents that mosapride promotes motility in the small intestine and cecum of horses and that the optimal orally administered dosage is 1.5 to 2 mg/kg. Therefore, mosapride may be useful for treatment of horses with gastrointestinal tract dysfunction.

Animals↗
PubMed1983

Diagnosis of maternal cystic fibrosis during pregnancy.

The third and fourth cases of maternal cystic fibrosis diagnosed during pregnancy are presented. Quantitative pilocarpine iontophoresis (sweat chlorides) must be performed to establish the diagnosis. Other important findings include recurrent or persistent respiratory symptoms, chest x-ray abnormalities, abnormal pulmonary function studies, and abnormal arterial blood gases. Gastrointestinal tract dysfunction and a positive family history for respiratory disease also suggest the diagnosis. Pregnant patients with cystic fibrosis require careful and frequent cardiopulmonary and gastrointestinal surveillance. A higher incidence of premature labor is noted and all patients are best managed in tertiary referral centers. Patients should also be monitored carefully during the puerperium because maternal pulmonary decompensation may occur during this time.

Adolescent↗
PubMed2005

Understanding clinical issues in postoperative nutrition after pancreaticoduodenectomy.

Postoperative nutrition support for patients undergoing pancreaticoduodenectomy (Whipple's procedure) may be complicated due to gastrointestinal tract dysfunction (gastroparesis, dumping, and malabsorption) subsequent to the procedure. Clinical management of these patients may be adversely affected by procedure-specific knowledge deficits (method of gastrointestinal [GI] reconstruction), common and expected surgical complications, and the available route for alimentation. It is the aim of this report to provide the reader with an overview of the procedure, common postoperative nutrition issues, and available interventions.

Humans↗
PubMed1998

[Clinical and experimental study on using Cassia angustifolia extract as enema after abdominal operation].

OBJECTIVE: To investigate the curative effect and mechanism of using Cassia angustifolia extract (CAE) in treating gastrointestinal tract dysfunction after abdominal operations. METHODS: Enema administration of CAE (Clyster method) was used. RESULTS: The result of 130 patients was very effective in reducing the rate of gastrointestinal decompression, accelerating the restitution of borborygmi and the time of exhaustion. Animal experiment showed the CAE function is very obvious in enhancing the bowel movement of rats (P < 0.05). It can enhance peristalsis and contraction amplitude of vibration in the isolated ileum of rats (P < 0.05). It can push on the charcoal powder in intestinal tract of mice obviously (P < 0.05). CONCLUSION: CAE could regulate disordered function of gastrointestinal tract after abdominal operations.

Abdomen, Acute↗
PubMed1989

Increased complications and prolonged hospital stay in elderly cardiac surgical patients with low serum albumin.

Cardiac surgery in elderly patients is associated with acceptable operative mortality but an increased complication rate. Malnutrition is common in the elderly and may adversely affect surgical outcome. To determine the effect of hypoalbuminemia on postoperative complications, 92 patients greater than or equal to 75 years (range 75 to 90) undergoing a variety of major cardiac surgical procedures were evaluated. Thirteen patients (14%) had a serum albumin level less than 3.5 g/dl preoperatively. Compared to patients with normal albumin, hypoalbuminemic patients had an increased frequency of postoperative confusion, congestive heart failure, low cardiac output, renal dysfunction and gastrointestinal complications (all p less than 0.05). Mean postoperative length of stay was markedly prolonged in these patients (27 vs 12 days; p less than 0.001), and mortality also tended to be higher (31 vs 13%; p = 0.11). Using multivariate analysis, albumin less than 3.5 g/dl was the most powerful predictor of postoperative renal dysfunction (p less than 0.01), and was also an independent predictor of increased length of stay (p less than 0.01) and gastrointestinal disorders (p less than 0.05). Thus, hypoalbuminemia is a powerful indicator of an increased risk of perioperative complications in elderly patients undergoing cardiac surgery. Increased attention to nutritional factors is warranted in these patients.

Aged↗
PubMed2006

An update on autonomic neuropathy affecting the gastrointestinal tract.

Gastrointestinal symptoms and disordered gut motility occur frequently in the diabetic population and are generally regarded as manifestations of gastrointestinal "autonomic dysfunction," although the relationships between both symptoms and dysmotility with abnormal cardiovascular autonomic function are weak. It is now recognized that the blood glucose concentration is both a determinant of and determined by gastrointestinal function. An improved definition of the underlying pathophysiology should facilitate the development of therapies that are targeted more effectively.

Animals↗