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PubMed1985

[High-dose treatment].

High dose administration of anticancer drugs was discussed putting an emphasis on methotrexate and cytosine arabinoside. High dose methotrexate in combination with leucovorin rescue was effective on various kinds of cancer which had become resistant to conventional doses of anti-cancer drugs. The administration of high-dose methotrexate, however, should be performed with meticulous precautions to prevent serious side effects. Side effects included gastrointestinal mucositis, hepatic dysfunction, nausea and vomiting. Central nervous system manifestations were sometimes observed. High-dose cytosine arabinoside of 3 g/m2 per 12 hours X 12 was given by 2-hours infusion to patients with acute leukemia who had become resistant to conventional combination chemotherapy, or to relapsed patients. This regimen in combination with L-asparaginase or anthracyclines resulted in a fairly high remission rate among those intractable cases. High-dose cytosine arabinoside in combination with anthracyclines has recently been tried on patients with acute leukemia as an initial treatment for remission induction and consolidation. In this case, no intensification treatment was performed to maintain remission. Patients treated with this regimen as an initial medication showed a high remission induction rate and long remission duration. Forty percent of the patients were still alive after 3 years.

Acute Disease↗
PubMed1985

Pharmacologic principles of cardiovascular drug administration to the critically ill.

The critically ill patient presents a pharmaceutical dilemma, with the clinical condition often necessitating the administration of potent medications. The underlying disease process often includes or produces multi-system failure, which will subsequently alter the response to drugs, with the potential to further compromise the acutely ill patient. In summary, the interplay of patient and drug provides a challenge to the medical staff in the provision of effective pharmacotherapy. Several steps can be followed to facilitate the achievement of optimal drug therapy at minimal toxicity. These include the following. 1. Drug Choice. The agent to be administered must be assessed by the practitioner with respect to efficacy in the particular disease state. 2. Patient Variables. Patients must also be evaluated for the presence of factors such as cardiovascular compromise, renal or hepatic dysfunction, pulmonary disease, gastrointestinal integrity, and hypoalbuminemia, all of which are known to alter drug kinetics or dynamics. Concurrent drug therapy must be reviewed to identify those drugs with the potential to interact with the agent to be administered. 3. Dose of the Selected Agent. The dose of the drug must be altered commensurate with those diseases observed. In the presence of multiple organ involvement, further alterations in dosage may be required. 4. Route of Administration. The drug in the selected dose must be given by a route that will result in reliable blood concentrations. Intravenous therapy is usually the route of choice. 5. Monitoring of Therapy. Therapeutic endpoints of the individual agents must be clearly defined and will include variables such as control of arrhythmias, determination of systolic and diastolic blood pressure, heart rate, and so forth. Dose-related toxicity serves as a warning sign of excessive drug doses. Patients must be monitored carefully to insure early detection of adverse effects and subsequent dose reduction by the practitioner. The monitoring of serum concentrations of drugs that possess a well defined therapeutic or toxic range is useful, if the limitations of this practice are remembered. Determinations of plasma concentration must be readily and routinely available to the practitioner to be useful in guiding dosage alterations, especially in emergency situations. The availability of this laboratory service is often a limiting factor. Additionally, standard methods of quantifying serum levels of drugs measure both free and bound drug together, providing one value. Changes in the pharmacologically active free fraction may therefore be undetected.(ABSTRACT TRUNCATED AT 400 WORDS)

Cardiovascular Agents↗
PubMed1979

Surgical manipulation of portosystemic shunts in dogs.

Surgical manipulation to achieve stenosis or occlusion of portocaval shunts in 7 dogs resulted in disappearance of signs of central nervous, gastrointestinal, or urinary dysfunction. Results of blood chemical analyses and hepatic function studies as well as hepatic cellular architecture returned to normal or near normal within several months. Cranial mesenteric angiography was done on 4 dogs following corrective surgery; there was evidence of improved hepatic-portal circulation in 3 of the dogs and complete shunt obstruction in 1 dog.

Ammonia↗
PubMed1978

Hemostatic complications in leukemic patients.

With clinical vigilance and laboratory tests of platelet and coagulation factor function, the clinician can promptly recognize and treat hemostatic disorders in leukemic patients. For example, laboratory values are strikingly abnormal in disseminated intravascular coagulation. Prompt neutralization of the underlying cause of the coagulopathy is essential. Platelet and coagulation factors may have to be replaced if the disorder is severe. Diffuse petechiae, purpura, mucous membrane bleeding, and hemorrhage around venipuncture or infusion sites indicate thrombocytopenia. Vigorous platelet replacement is necessary to prevent massive intracranial of gastrointestinal hemorrhage. Platelet dysfunction may cause spontaneous bleeding or immediate or delayed hemorrhage after surgery. The abnormality is often evident in peripheral blood smear or indicated by bleeding time or aggregation studies. If possible, sufficient autologous platelets should be infused to return the bleeding time to normal. Immune thrombocytopenic purpura may be easy to diagnose when the reduction in the circulating platelet count is compared with the normal number of marrow megakaryocytes. But attempts to increase platelet count by platelet transfusions may be frustrating. Treatment involves high doses of corticosteroids, followed by splenectomy if necessary.

Blood Coagulation Disorders↗
PubMed1982

Chronic granulomatous disease and selective IgA deficiency.

The clinical and laboratory features of a child with chronic granulomatous disease (CGD) and IgA deficiency and his family are presented. Bactericidal and NBT dye reduction studies confirmed the diagnosis of CGD in the patient and the carrier state in the mother. No other family member had IgA deficiency. The manifestations of the IgA deficiency include multiple autoimmune antibodies, progressive pulmonary dysfunction but no gastrointestinal or rheumatoid symptoms. The etiology of the IgA deficiency appears to be a failure in terminal B cell differentiation as evidenced by the presence of normal numbers of IgA bearing cells detected by a fluorescent monospecific antisera, a normal profile of T cell subpopulations, normal responses to the mitogens PHA, Con A, PWM, and antigens C. albicans, E. coli, and S. aureus, and the absence of suppressor cell activity in co-culture assays. The significance of the association of these two disorders is discussed.

Adult↗
PubMed1994

[Human ehrlichiosis. Review].

Human ehrlichiosis is a newly recognized tick-borne disease. Since 1935 Ehrlichia canis has been known as a cause of illness in dogs and other canine species, and for a few years it was related with human disease. In 1990, Ehrlichia chaffeensis was isolated from a man suspected of having ehrlichiosis. Partial sequencing of the rRNAS from the human isolate and E. canis, indicated that they are 98.7% related. More recently (May 1994) an "human granulocytic ehrlichiosis" have been reported in USA. PCR amplification and sequence of 16S rDNA, showed that the human isolate was virtually identical to those reported for E. phagocytophila y E. equi, organisms that cause ehrlichiosis in rumiant and in horses. Most patients shows fever, headache, malaise, nausea or vomiting, anorexia and in a minority of cases rash is present. Some of them have complications such as pulmonary infiltrates, gastrointestinal problems, renal dysfunction or failure, hepatoesplenomegaly, neurologic abnormalities, DIC and some times death. Leucopenia, thrombocytopenia and elevated liver enzyme values have been common findings. Tetracycline and cloramphenicol have been using in adults and children as especific theraphy.

Diagnosis, Differential↗
PubMed1996

[Amyloidosis secondary to bronchiectasis].

A 77-year-old woman was hospitalized repeatly due to frequent hemoptysis and production of bloodly sputum for several years. Bronchography in 1989 revealed bronchiectasis. She had complained of abdominal pain and diarrhea since 1991, and her urine was first positive for protein in 1992. She was admitted to our hospital in October 1992 because of edema, anemia, and hypoproteinemia. Despite treatment, renal dysfunction and the gastrointestinal disorder progressed and she died in January 1993. An autopsy revealed diffuse depositions of amyloid in many organs, especially in the kidney and the gastrointestinal tract. This amyloid protein was identified as AA protein, which was suggestive of secondary amyloidosis. Bronchiectasis appears to have been the disease underlying this patient's amyloidosis.

Aged↗
PubMed1998

[Analysis of 18 breast cancer patients with hypercalcemia].

A total of 91 breast cancer patients died of advanced and recurrent breast cancer at the Osaka Teishin Hospital from 1986 to 1996. There were 18 cases (19.8%) among them showing hypercalcemia (serum corrected Ca > or = 11.0 mg/dl). These 18 cases were analyzed to determine the incidence of hypercalcemia and to find a more effective treatment. All these patients had multiple bone metastases during their clinical course, and six patients (33.3%) had pathologic bone fracture just before the occurrence of hypercalcemia. Their common symptoms were general fatigue, gastrointestinal symptoms, renal dysfunction or neurological symptoms. There was no definitive correlation between clinical signs and serum calcium values. Among various therapies, the use of pamidronate disodium (Aredia) in combination with hydration, steroid and calcitonin was found to be the most effective treatment for hypercalcemia. The survival time from the diagnosis of hypercalcemia in the patients undergoing treatment with Aredia was significantly better than without it (p < 0.01). This suggests that Aredia should be effective and useful for advanced breast cancer patients with hypercalcemia.

Adult↗
PubMed1996

Diffuse neuroendocrine system: structural and functional effects of radiation injury to amine precursor uptake and decarboxylation (APUD) cells.

The paper presents a review of the results obtained by the authors on the study of external (gamma) and internal (I-131) radiation effects on the functional morphology and linkage of the diffuse neuroendocrine system (DNES) and amine precursor uptake and decarboxylation (APUD) cells of the stomach and duodenum. The investigations performed enabled us to determine that the morphological changes noted in APUD cells had a dose and time dependency. The present study supports the point of view that the radiation initiates serotonin release from APUD cells, which appears to initiate the mechanism of early postirradiation dysfunctions of the gastrointestinal tract and the subsequent adaptive response of DNES. Analysis of our results, together with a review of the literature, indicates that APUD cells actively participate both in pathogenesis of radiation injury and development of organ and tissue radiosensitivity.

APUD Cells↗
PubMedDate not supplied

Liver transplantation for familial amyloid polyneuropathy.

Familiar Amyloid Polyneuropathy (FAP), an autosomal dominant inherited multisystemic disorder was first observed by Corino de Andrade, a Portuguese neurologist, in 1939. This disease of Portuguese origin was probably spread by fishermen, mainly to Sweden and Japan. It is characterized by a progressive peripheral polyneuropathy and autonomic neuropathy (erectile sexual disfunction, gastrointestinal disfunction, bladder dysfunction and cardio vascular disease) and malnutrition. There are neural and systemic amiloid deposits. Type I FAP, of Portuguese origin, is the most common variety. The amyloid protein is the variant transthyretin (TTR) in which methionine (MET) is a substitute for valine in position 30 (TTR MET 30). It is mainly produced by the liver (90%) and, in small amounts, by the choroidal plexus. Symptoms usually start in the 3rd and 4th decade of life and the patients usually die within 10-15 years. From the therapeutic options--plasmapheresis, immunoadsorption and liver transplantation; the latter seems to be the only one, which stops the production of TTR MET 30 in a permanent way, by means of the liver. The lack of any other effective therapy and the success of the first liver transplantation performed in Sweden arouse great hope. So far, around 300 patients have been transplanted all over the world. A hundred and thirty of them were transplanted in Portugal. A Kaplan Meier survival curve of the Portuguese patients shows a survival rate of 78% at 5 years. However, in spite of the progression of the disease being halted, the irreversibility of some neurological lesions seems to persist. This fact raises the problem of the timing of the transplantation. It seems that the patients should be transplanted as soon as the symptoms start, since mortality and severe morbidity seems to mainly involve those in whom symptomatic disease has lasted longer than six years. As the explanted liver is a morphologic normal liver, a sequential (domino) transplant has been carried out in 16 cases so far done--by one of the authors (ALF) on patients with either hepatocellular carcinoma or liver metastatic disease.

Adult↗
PubMed1989

Colonic and anorectal dysfunction associated with multiple sclerosis.

Gastrointestinal symptoms are common in patients with multiple sclerosis. In a recent survey of 280 unselected patients with multiple sclerosis, 68% reported constipation and/or fecal incontinence. In contrast to bladder dysfunction which has been extensively studied, bowel dysfunction in this disease has received relatively little attention. This review outlines the clinical features and pathophysiology of constipation and fecal incontinence in multiple sclerosis and presents treatment options and suggestions for investigation of colonic and anorectal dysfunction in this population.

Colon↗
PubMed1986

Scintigraphic techniques for the study of gastrointestinal motor function.

A variety of scintigraphic techniques has been added to the gastroenterologist's armamentarium for the evaluation of motor dysfunction of the upper gastrointestinal tract and hepatobiliary tree. These methods include: esophageal transit scintigraphy for the measurement and quantitation of aboral movement of liquids through the esophagus, and for the measurement of esophageal clearance; gastroesophageal reflux scintigraphy for the detection and quantitation of gastroesophageal reflux, gastric scintigraphy for the physiological measurement of the simultaneous rates of emptying of liquids and solids from the stomach; hepatobiliary scintigraphy for the detection of acute cholecystitis, biliary tract obstruction, bile leaks; and enterogastric reflux scintigraphy for the detection and quantitation of bile reflux from the small bowel into the stomach. Each of these methods is relatively physiologic in comparison to other modalities in that none requires intubation or other nonphysiologic maneuvers. Each offers the practicing internist, surgeon, and gastrointestinal physiologist, the ability to measure normal and abnormal function in patients. Because of the low radiation burdens involved and high patient acceptance, these methods are suitable for serial studies in the same patient, particularly before and after the application of various therapeutic modalities.

Biliary Tract Diseases↗
PubMed1985

[Preliminary report of adjuvant chemo-endocrine therapy for breast cancer].

Preliminary analysis of adjuvant chemo-endocrine therapy for 193 breast cancer patients was performed. The patients consisted of 38 cases of Stage I, 124 cases of Stage II and 31 cases of Stage III. Therapeutic regimen was randomly divided into three groups; (1) Tamoxifen (TAM), (2) TAM + ftorafur (FT-E) and (3) TAM + FT-E + Adriamycin. Side effects among the three therapeutic groups were comparatively studied. Anorexia and nausea were observed in 1.4%, 17.1% and 60% of the patients, respectively. Leucopenia of less than 3,000 and alopecia were remarkably seen in the patients treated with regimen 3. Liver dysfunction was observed in 10.9% of group 1, 29.5% of group 2 and 13.3% of group 3, respectively. Gastrointestinal symptoms and liver dysfunction were important side effects.

Adult↗
PubMed2007

Rapid gastric emptying is more common than gastroparesis in patients with autonomic dysfunction.

OBJECTIVES: Autonomic dysfunction is associated with a wide variety of gastrointestinal symptoms. It is unclear how many patients with autonomic dysfunction have slow or rapid gastric emptying. The aim of this study was to determine the prevalence of rapid and delayed solid phase gastric emptying in patients with autonomic dysfunction referred for evaluation of gastrointestinal symptoms and the association of emptying rate with clinical symptoms. METHODS: Retrospective review of all patients with autonomic dysfunction who had a gastric emptying test from January, 1996 to March, 2005. Demographic data, clinical symptoms, composite autonomic scoring scale (CASS) score, and gastric emptying parameters were analyzed. RESULTS: Sixty-one subjects (women 49, age 42 [16-74] yr) with autonomic dysfunction were reviewed. Patients had mild-to-moderate (mean CASS score 3) autonomic dysfunction. Twenty-seven, 17, and 17 patients had rapid, normal, and delayed gastric emptying t(1/2), respectively. In addition, 10 patients had initially rapid emptying in phase 1, with subsequent slowing in phase 2 to produce an overall normal or delayed t(1/2). There was no difference in demographic data or CASS score among the three groups. More patients with initial or overall rapid emptying had diarrhea (70%) compared to patients with normal (33%) or delayed (33%) emptying (P= 0.018). CONCLUSIONS: Unexpectedly, more patients with autonomic dysfunction have rapid rather than delayed gastric emptying. The presence of diarrhea in patients with autonomic symptoms should prompt consideration for the presence of rapid gastric emptying. Conversely, the finding of rapid gastric emptying in patients with gastrointestinal symptoms should prompt consideration for the presence of underlying autonomic dysfunction.

Adolescent↗
PubMed2005

Immunotherapy for refractory pulmonary infection after adult cardiac surgery: immune dysregulation syndrome.

BACKGROUND AND AIM OF THE STUDY: Pulmonary dysfunction/multiorgan failure (PD/MF), usually due to refractory pulmonary infection, is an important cause of mortality and morbidity after cardiac operations. Moreover, the incidence of PD/MF may be increasing due to the emergence of antibiotic-resistant pathogens. METHODS: Fifteen consecutive patients (median age 69 years) who were developing antibiotic-refractory PD/MF were administered 24 g per day intravenous immunoglobulin (IV-IgG; Carimune) for five days. Ten patients had undergone complex valve surgery, and five coronary bypass. Preoperatively, 93% of patients had significant comorbidity, 73% presented acutely, 53% were hypoalbuminemic and 47% had antecedent acute pulmonary derangement. Clinical variables were assessed by retrospective chart review for three days prior to (-3) the start of IV-IgG (day 0) and for five days afterwards (+5). A postoperative morbidity index (PMI) was generated as a weighted sum of: worsening lung infiltrates (I); leukocytosis (L); pulmonary dysfunction (P); ventilator requirement (V); septic shock (S); renal (R), gastrointestinal (G), or hepatic (H) dysfunction; thrombocytopenia (T); and delirium (D). RESULTS: At day 0, all patients were refractory to major antibiotics, with morbidities of: 1-100%, L-93%, P-93%, V-60%, S-27%, R-67%, G-40%, H-13%, T-27%, and D-20%. Using regression analysis, IV-IgG administration was associated with a statistically significant fall in white blood count and improvement in PMI (p <0.006). Fourteen patients (93%) recovered uneventfully, and one patient (7%) died from progressive sepsis. No complications of IV-IgG therapy occurred. CONCLUSION: Given the high predicted mortality of PD/MF patients, these data suggest that IV-IgG is a safe and efficacious adjunct to antibiotics in this setting. Further studies, including a randomized trial and investigation of immunomodulatory mechanisms, seem indicated.

Adult↗
PubMed1993

[Non-ulcer dyspepsia syndrome].

In one thousand of 1500 examinees with nonulcerous dyspepsia the syndrome was due to chronic gastritis, duodenitis and gastroduodenitis, in five hundred of them it was attributed to probable dysfunction of the upper gastrointestinal tract. Morphological evidence of chronic gastritis activity is essential but not the only factor affecting the dyspepsia syndrome. Of importance are also motor dysfunctions: high intragastric and/or intraduodenal pressure, unbalance of intracavitary pressure parameters, gastroesophageal and duodenogastric refluxes. A significant contamination of antral mucosa with Helicobacter pylori aggravated dyspeptic manifestations.

Chronic Disease↗