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PubMedDate not supplied

Surgical intervention for acute intestinal ischemia: experience in a community teaching hospital.

The aim of this study was to evaluate the current management of acute mesenteric ischemia secondary to thrombotic or embolic occlusion of visceral vessels in a community teaching hospital. Between October 1997 and July 2000, a review of all hospital discharges revealed 83 patients with a discharge diagnosis of "acute vascular insufficiency-intestine." Among these 83 patients, 22 cases of acute mesenteric ischemia were confirmed. Management of these 22 patients was divided into 2 groups for analysis. In Group A, 14 patients were aggressively treated with visceral angiography (n=10), visceral artery bypass (n=8), visceral embolectomy (n=4), and bowel resection (n=7). In 8 of 14 of these patients, surgical intervention occurred in less than 24 hours from presentation. In Group B, 8 patients were managed with supportive care because of advanced age (mean age = 86 +/- 7 years), comorbid conditions, or patient and family preference. Postoperative morbidity in Group A consisted of cardiac events (n=3), pulmonary insufficiency (n=5), and prolonged gastrointestinal tract dysfunction (n=3). Twelve of 14 patients in Group A survived and were discharged, whereas only 2 of 8 patients in Group B survived and were discharged from the hospital. Although the literature suggests that there can be a significant delay in the diagnosis and treatment of acute mesenteric ischemia, the early recognition and aggressive treatment of acute mesenteric ischemia resulted in a good survival rate. Supportive management of very elderly and debilitated patients needs to be considered on a case-by-case basis. Although the outlook for such patients is dismal, survivors are possible as demonstrated by this series.

Abdominal Pain↗
PubMed1985

High-dose cytosine arabinoside therapy with and without anthracycline antibiotics for remission reinduction of acute nonlymphoblastic leukemia.

Seventy-eight patients with acute nonlymphoblastic leukemia in relapse were treated with high-dose cytosine arabinoside (3 g/m2 intravenously (IV) every 12 hours for 12 doses) alone, or with three days of anthracycline antibiotics (doxorubicin 20 mg/m2 or daunorubicin 30 mg/m2 IV daily) after completing the course of cytosine arabinoside. Consolidation and maintenance therapy was not given. When anthracyclines were added there was no increase in frequency or severity of nonhematologic toxicity including conjunctivitis, photophobia, dermatitis, cerebellar dysfunction, and gastrointestinal disturbance. All 78 patients achieved aplasia of the bone marrow. Five patients in each group died before bone marrow recovery. The use of anthracyclines did not prolong bone marrow recovery, with both groups demonstrating adequate granulocyte and platelet counts about four weeks after beginning treatment. Forty-one (53%) of the total 78 patients achieved a complete remission. In patients not clinically resistant to conventional-dose cytosine arabinoside, both regimens were equally effective inducing a complete remission (high-dose cytosine arabinoside alone, 12/19 [63%]; with anthracycline, 11/17 [65%], P = .270); in patients clinically resistant, the regimen including anthracycline was superior (15/27 [56%] v 3/15 [20%], P = .022). The duration of unmaintained response was similar (median, five months), but the longest remissions occurred when anthracyclines were used. Thus, high-dose cytosine arabinoside is effective in producing remissions in relapsed patients with acute nonlymphoblastic leukemia, and the addition of an anthracycline enhances this effect.

Acute Disease↗
PubMed1993

[Seven patients with hyperparathyroid crisis: emphasis on prompt parathyroidectomy].

Although hyperparathyroid crisis is rare, the management of this disease remains controversial. We analyzed the clinicopathological features and treatment outcome of this disease to evaluate the significance of prompt parathyroidectomy. Seven patients with an episode of hyperparathyroid crisis who consisted of 2.3% of all surgical patients of primary hyperparathyroidism were treated from 1981 to 1992 at the Department of Endocrine Surgery, Tokyo Women's Medical College. They all showed grave hypercalcemia greater than 15mg/dl, renal dysfunction and gastrointestinal toxicity. Their ages ranged between 33 and 75 years (mean age 49.7 years); two patients were men and five were women. Six patients had an adenoma, and only one had a carcinoma. The weights of the parathyroid tumors ranged between 3.5g and 11g, and ultrasonography disclosed an enlarged parathyroid gland in all patients. All of the seven patients underwent prolonged medical treatment (mean of durations 52 days), but four of them remained with hypercalcemia greater than 15mg/dl. On the other hand, the serum calcium levels of all patients returned to normal within five days after their operations without any surgical complication. Therefore, we recommend prompt parathyroidectomy for hyperparathyroid crisis, since medical treatment requires a prolonged clinical course and sometimes fails to control grave hypercalcemia.

Adenoma↗
PubMed2004

Gastrointestinal pain in functional bowel disorders: sensory neurons as novel drug targets.

Functional bowel disorders (FBDs) are defined by symptoms of gastrointestinal (GI) dysfunction, discomfort and pain in the absence of a demonstrable organic cause. Since the prevalence of FBDs, particularly functional dyspepsia and irritable bowel syndrome, can be as high as 20%, FBDs represent a significant burden in terms of direct healthcare and productivity costs. There is emerging evidence that the discomfort and pain experienced by many FBD patients is due to persistent hypersensitivity of primary afferent neurons, which may develop in response to infection, inflammation or other insults. This concept identifies vagal and spinal sensory neurons as important targets for novel therapies of GI hyperalgesia. Sensory neuron-specific targets can be grouped into three categories: receptors and sensors at the peripheral nerve terminals, ion channels relevant to nerve excitability and conduction and transmitter receptors. Particular therapeutic potential is attributed to targets that are selectively expressed by afferent neurons, such as the transient receptor potential channel TRPV1, acid-sensing ion channels and tetrodotoxin-resistant Na + channels.

Analgesics↗
PubMed1997

Prevalence and determinants of solid and liquid gastric emptying in unstable type I diabetes. Relationship to postprandial blood glucose concentrations.

OBJECTIVE: To compare postprandial blood glucose levels with gastric emptying (GE) time after intake of a solid and a nutrient liquid meal in patients with unstable, type I diabetes. RESEARCH DESIGN AND METHODS: The subjects studied were 15 patients with long-standing type I diabetes who during the last year repeatedly reported unexplained episodes of instability in their blood glucose regulation, including postprandial hypoglycemia. All patients were on a meal-administered, fast-acting insulin regimen. As control group, 19 healthy subjects were studied. GE was measured at two separate occasions, using a gamma camera after intake of either a solid or a nutrient liquid, isotope-labeled meal. Measurement of GE was done directly after meal completion and at 30-min intervals for 2 h. Insulin was taken 30 min before intake of the meal. Blood glucose was measured 30 min before the meal, after meal completion and at 30, 60, 90, and 120 min after start of the meal. All patients were evaluated for evidence of autonomic neuropathy and were asked for signs of gastrointestinal motor dysfunction. RESULTS: Seven (44%) of the patients had significantly delayed emptying of the solid meal (three men, four women) (P < 0.01), of whom one woman also had delayed emptying of the liquid meal compared with the healthy control subjects. Changes in blood glucose concentration were correlated to GE time with, in the group with delayed GE, a significant fall after the solid meal compared with the liquid meal (P < 0.05). The lag phase was prolonged in the women compared with the men, reaching significance in the patient group (P < 0.01). The women, patients as well as control subjects, had throughout the study a prolonged emptying time compared with the men after both the solid and the liquid meal. No correlation between GE and blood glucose concentration could be found. CONCLUSIONS: Delayed GE of a solid meal is commonly found in patients with type I diabetes and may be one cause of unstable blood glucose regulation. Women, patients as well as control subjects, seem to have a more prolonged GE than men. Awareness of gastric function in patients with type I diabetes is essential, especially in patients treated with meal-administered, fast-acting insulin.

Adult↗
PubMed2000

Acute ibuprofen toxicosis in a ferret.

A 20-month-old 1.44-kg (3.2-lb) castrated male ferret was examined because of vomiting, defecating in an abnormal location, dyspnea, and signs of depression. Within 5 minutes of initial evaluation, the ferret became nonresponsive to all stimuli except deep pain. Despite intensive supportive treatment, the ferret died. Toxicologic analyses for ibuprofen were performed on serum, urine, and liver, using gas chromatography and mass spectrophotometry. Serum ibuprofen concentrations were 245 micrograms/g before and 269 micrograms/g after death. Acute ibuprofen toxicosis may cause severe lethargy progressing to coma, apnea, and death in ferrets. Ibuprofen toxicosis should be considered in differential diagnoses for ferrets with signs of depression, with or without clinical signs of gastrointestinal tract dysfunction.

Analgesics, Non-Narcotic↗
PubMed1992

[Cushing's syndrome found during long-term glucocorticoid treatment of rheumatoid arthritis in an elderly woman].

A 69-year-old female patient had been treated with glucocorticoid for eight years because of rheumatoid arthritis. She showed characteristic Cushingoid features such as central obesity, moon face, and fragility of skin and vessels. She was disabled because of spinal compression fracture and muscle weakness. The blood pressure was 186/100 mmHg and the laboratory tests revealed serum K: 2.8 mEq/l, WBC: 15, 510/mm3, total cholesterol: 310 mg/dl. These suggested that she had iatrogenic Cushing's syndrome. After discontinuation of glucocorticoid, however, the serum cortisol level remained high. This fact prompted us to conduct further examinations for Cushing's syndrome. Oral dexamethasone administration did not suppress the plasma cortisol level and a left adrenal adenoma was found on abdominal CT scan. Because of the presence of bleeding diathesis, operation for adenoma was contraindicated. Though we tried to treat her with metyrapone, trilostane or opeprim (OP'-DDD), we had to abandon specific treatment because of severe side effects such as acute adrenal dysfunction and gastrointestinal problems. Decrease in the endogenous cortisol level after metyrapone treatment caused exacerbation of symptoms of rheumatoid arthritis. This is a peculiar case in which the long-term administration of glucocorticoid for rheumatoid arthritis might have concealed Cushing's syndrome, and conversely the increased intrinsic adrenal steroid hormone might have suppressed the activity of the rheumatoid arthritis.

Aged↗
PubMed1996

Follow-up after therapy for prostate cancer. Treating the problems and caring for the man.

With prostate cancer being diagnosed and treated in more than 300,000 men each year, the pool of long-term survivors is dramatically increasing. Because these patients are usually elderly, they are often receiving follow-up care for unrelated problems in a primary care setting. This offers the physician an excellent opportunity to assist in management of any long-term complications of therapy and in monitoring for cancer recurrence. In addition to performing follow-up evaluations, the physician can provide counseling about a number of testing and treatment issues, including the variability of prostate-specific antigen levels, the appropriateness of a watchful waiting approach to some cancers, and the management of treatment-induced incontinence and impotence, which often have a deleterious effect on quality of life but may be amenable to therapy and psychosocial support.

Aftercare↗
PubMed1992

The irritable bowel syndrome: review and a graduated multicomponent treatment approach.

The irritable bowel syndrome is a common chronic disorder having a broad clinical spectrum of severity. Although only a small proportion of those afflicted seek medical help for their symptoms, a subset have severe and intractable symptoms. A positive diagnosis should be established from the history and physical examination; endoscopic and radiologic investigations should be minimized. We suggest that the physician also assess the severity of the illness based on its symptomatic and functional features and the patient's behavioral response. Classifying the disorder in this manner permits a graduated treatment approach that emphasizes education, reassurance, and dietary adjustment for mild symptoms. Moderate symptom severity requires, in addition, identification and modification of factors exacerbating symptoms, psychotherapeutic and behavioral techniques and, if a certain symptom type predominates, pharmacologic agents directed toward the presumed gastrointestinal motor dysfunction. For severe symptoms, physician-based behavior modification and psychopharmacologic agents are helpful. When the disorder is intractable, referral may be needed, for example, to a pain treatment center. In all cases, the skillful physician must ensure continued psychosocial support to enhance coping and continued focus on the palliative aspects of care rather than on cure.

Colonic Diseases, Functional↗
PubMed1999

Nematode-induced jejunal inflammation in the ferret causes long-term changes in excitatory neuromuscular responses.

Enteric infections in animals and humans have proven the link between mucosal inflammation and gastrointestinal motor dysfunction. The goal of the present investigation was to study the long-term effects of mucosal inflammation on the neuromuscular functions of the small intestine in a ferret model of primary Trichinella spiralis infection. Myeloperoxidase activity and isometric contractions of isolated jejunal muscles were studied on days 8, 30, and 60 postinfection (PI). The peak increase in myeloperoxidase activity seen on day 8 PI returned to normal levels by day 60 PI. Contractions of the longitudinal and circular muscles evoked by electrical field stimulation of enteric nerves on day 8 PI showed no difference when compared with uninfected controls. However, during this enteric phase of the infection, neurally mediated responses were characterized by a disturbance in the balance between cholinergic and nonadrenergic, noncholinergic (NANC) excitation with both a reduction of cholinergic and a reciprocal enhancement of NANC neurotransmission. On days 30 and 60 PI the amplitude of neurally mediated responses and the balance between cholinergic and NANC excitation were restored in the circular but not in the longitudinal muscle. In addition, there were changes in the effector function involving smooth muscle hyperresponsiveness to high K+ or carbachol on days 8, 30, and 60 PI. However, a significant reduction in EC50 for carbachol was found only on day 60 PI. The results demonstrate that T. spiralis infection results in alterations of muscle contractility and enteric neurotransmission that persist after the resolution of mucosal inflammation.

Animals↗
PubMed1999

[Superselective intra-arterial infusion chemotherapy of high-dose cisplatin for advanced paranasal sinus carcinomas].

Eighteen patients with advanced paranasal sinus carcinomas were treated by "two-route" intra-arterial chemotherapy using cis-diamminedichloroplatinum (CDDP) and sodium thiosulfate (STS) to preserve the hard palate and the eye. In these patients, 100 mg/m2 of CDDP was administered weekly through each feeding artery of the tumor superselectively at 5 mg/min. During infusion of CDDP, STS at a two-hundred fold dose of CDDP was injected through a catheter placed in the brachiocephic vein introduced via the subclavian vein. The complete and partial response rates were 14/18 (78%) and 4/18 (22%), respectively. None of the nine patients following operation showed residual tumors histologically. The peak of the mean total plasma platinum concentration was 5.5 micrograms/ml, and this concentration was rapidly reduced to 1.5 micrograms/ml in 5 hours. The peak of the plasma protein unbound platinum was 3.9 micrograms/ml. This concentration rapidly decreased to almost zero within 5 hours after IA infusion. The mean tumor platinum content achieved by superselective IA infusion was as high as 6.0 micrograms/g tumor, and this decreased rapidly to 2.4 micrograms/g tumor on the 5th day after the 1st intra-arterial infusion. All patients were free from chemotoxicity such as renal, hematological dysfunctions, or gastrointestinal symptoms. Each chemotherapy treatment could be done weekly on schedule. All but one patient was alive for 5-40 months. This new method of chemotherapy appears very effective for advanced paranasal sinus carcinomas.

Aged↗
PubMed2000

Parkinson's disease revisited.

Parkinson's disease (PD) is a neurodegenerative disorder that affects an estimated 1 million persons in the United States each year. Although PD has been studied for almost 50 years, several shortcomings in management still exist. Symptom management, addressing movement disorders, psychological aspects, sexual dysfunction, and gastrointestinal concerns may all affect the person with PD.

Antiparkinson Agents↗
PubMedDate not supplied

Tamsulosin: effect on quality of life in 2740 patients with lower urinary tract symptoms managed in real-life practice in Spain.

OBJECTIVE: To investigate the influence of tamsulosin treatment on the severity of lower urinary tract symptoms (LUTS) and the impact on quality of life (QoL), including daily life activities and mental well being, in real life practice in Spain. METHODS: 2740 LUTS patients aged 45-75 years who visited a urologist office in Spain received tamsulosin 0.4 mg o.d.. At baseline, after 3 months and after 6 months of treatment a questionnaire was completed by the urologist and the patient. The urologist estimated some aspects of the patient's QoL related to his LUTS. The International Prostate Symptom Score (I-PSS) was used to assess the severity of LUTS, while the BPH-Specific Interference with Activities (BSIA) and the Total Mental Health Rate assessed the impact on daily life activities and psychological well being respectively. RESULTS: After 3 months of treatment tamsulosin significantly improved the mean total I-PSS compared to baseline. After 6 months, the mean total I-PSS was reduced by 11.0 points from a baseline score of 20.3 (> 50% reduction). Tamsulosin also significantly improved the mean total BSIA score and the mean Total Mental Health Rate. These observations were confirmed by the urologists' assessment of the patient's condition: an increase of more than 50% of patients with no or mild voiding and filling LUTS and an increase of 45% of patients with no or only a small interference of their LUTS with daily life activities. The withdrawal rate due to adverse reactions was 2.4%. CONCLUSION: This study shows that tamsulosin improves LUTS and their impact on the patient's QoL and daily life activities, in the opinion of both the patients and the urologists.

Activities of Daily Living↗
PubMed1992

[Disseminated varicella-zoster virus infection without vesicles in a patient with malignant lymphoma].

A 76-year-old man was diagnosed as having malignant lymphoma (non-Hodgkin's lymphoma, diffuse medium cell-sized, B cell type). He was treated with CHOP therapy but with no response. In the terminal stage, he had continuous high temperature despite the administration of anti-bacterial and anti-fungal agents. Paralytic ileus, liver and pancreas dysfunction, and gastrointestinal bleeding developed. No skin eruptions occurred throughout the clinical course. He died on day 36 of treatment. Postmortem examination revealed foci of hemorrhagic necrosis containing many multinuclear giant-cells some of which with intranuclear inclusion bodies (Cowdry type A), in the liver, pancreas, gastrointestinal tract, bone marrow and other organs. Electron microscopy showed viral particles in the cytoplasm but not the nuclei of infected cells which were covered with a capsule, which was characteristic of varicella-zoster virus infection. Cells of the above organs were positive for immunohistochemical staining using antivaricella-zoster antibodies. The multiorgan failure seen in the terminal stage was considered to be due to disseminated varicella-zoster infection.

Aged↗
PubMedDate not supplied

Severe esophagitis in a child with Henoch-Schönlein purpura presenting as protein-losing enteropathy.

A 4-year-old boy was seen for vomiting, diarrhea and peripheral edema. He had no evidence of nephrosis or liver dysfunction. Upper gastrointestinal endoscopy was performed for investigating the etiology of protein-losing enteropathy. It showed severe esophagitis and multiple ulcers in the descending duodenum. The symptoms and endoscopic mucosal abnormalities subsided after three weeks of hospitalization without specific therapy. Ten days after being discharged he was seen again with characteristic rash of Henoch-Schönlein purpura and arthritis without gastrointestinal symptoms. Biopsy of the skin rash revealed leukocytoclastic vasculitis.

Child, Preschool↗