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At least 829 records · Page 46Linked to original sources
PubMed1988

Graft transection and warm perfusion in situ in canine partial orthotopic liver transplantation.

Liver transplantation is now proven therapy for various forms of end-stage liver disease in children; however, the problem of donor liver shortage remains. To investigate the feasibility of graft procurement from living, genetically related adult donors without injury to either donor or recipient, partial orthotopic liver transplantation (PLT) using a graft transected and warm perfused in situ was evaluated in beagles; the viability of the graft was assessed in terms of energy metabolism, including blood ketone body ratio (KBR), as well as of recipient survival. PLT was performed in two groups with venovenous bypass. The left half of the donor liver was transected in situ, flush perfused with 2 l lactated Ringer's solution (4 degrees C in group A, 20 degrees C in group B), and immediately implanted into the recipient, who was totally hepatectomized, care having been taken to leave the inferior vena cava intact. Four of seven dogs survived for 5 days or longer (longest, 8 days) in group A and six of eight dogs (longest, 20 days) in group B. Causes of death were gastrointestinal bleeding, intussusception, or infection but not graft dysfunction. In both groups the KBR decreased significantly during the anhepatic period, recovered rapidly to the pre-anhepatic level after revascularization, and was maintained within a normal range thereafter. No significant differences in the time course of changes in KBR were seen between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2004

Effects of Seizures on Autonomic and Cardiovascular Function.

Parial and generalized seizures often affect autonomic function during seizures as well as during the interictal and postictal periods. Activation or inhibition of areas in the central autonomic network can cause cardiovascular, gastrointestinal, cutaneous, pupillary, urinary, and genital manifestations. Autonomic dysfunction during or after seizures may cause cardiac and pulmonary changes that contribute to sudden unexplained death in epilepsy.

Journal Article↗
PubMed2001

Generalized intestinal dysmotility in a patient with syringomyelia.

Syringomyelia is a rare degenerative disorder of the spinal cord that causes progressive neurological dysfunction. Patients with syringomyelia have a variety of gastrointestinal symptoms although there are limited data on the frequency or the severity of these complaints. In this case report we describe a 65-yr-old man with syringomyelia and gastrointestinal dysmotility at multiple levels as documented by esophageal motility study, gastric emptying scan, antroduodenal motility study, and anorectal manometry. The patient's nausea, recurrent vomiting, and fecal incontinence were treated successfully with dietary changes, a promotility agent, and a bowel training regimen. This report highlights the need for more objective studies of gastrointestinal motility in patients with syringomyelia.

Aged↗
PubMed1985

[Non-hematologic toxicity in high-dose cytarabine therapy].

The hence reported non-haematologic toxicity in high-dose cytarabin mainly concerned CNS (cerebellar dysfunction), eyes (keratitis and conjunctivitis), skin (erythema), and gastrointestinal tract (vomiting, diarrhea). It partly depends on dosage and partly on duration of treatment. A dose of 48 g/sq m within one cycle apparently represents a critical upper limit as hence especially the risk of irreversible brain damage increases. Considering the fact that the indication for high-dose cytarabin is given mainly for poor prognostic failures and relapses in acute leukemias toxicity seems to be acceptable.

Acute Disease↗
PubMed1993

Diagnosis and management of salivary dysfunction.

Salivary gland dysfunction may occur as a result of common medications, cancer therapy, or Sjögren's syndrome. Affected patients may develop significant oral, dental, and upper gastrointestinal sequelae. This article reviews the basic elements in diagnosis of salivary dysfunction, including initial evaluation and specialized diagnostic procedures. Patient management depends primarily on the severity of salivary dysfunction. More severe permanent forms of dysfunction, such as radiation-induced and Sjögren's syndrome, require long-term care, with preventive measures to maintain the dentition and therapeutic attempts to increase oral fluids.

Humans↗
PubMed1980

Shy-Drager syndrome: diagnosis and treatment of cholinergic dysfunction.

Two patients with Shy-Drager syndrome demonstrated unusually widespread and unequivocal cholinergic dysfunction as well as the usual evidence of adrenergic insufficiency. Progressive constipation preceded impotence, nocturia, hesitancy in micturition, anhidrosis, orthostatic hypotension, and xerostomia. Nonautonomic neurologic signs appeared several years later. Cholinergic dysfunction involved eyes, lacrimal glands, salivary glands, heart, gastrointestinal tract, urinary bladder, and sweat glands. Subcutaneous administration of bethanechol chloride--a muscarinic receptor agonist--improved tearing, salivation, sweating, and gastrointestinal and bladder functions. Daily administration of this drug resulted in symptomatic improvement of the autonomic functions, and relapse followed discontinuation of treatment.

Aged↗
PubMed2005

Familial dysautonomia: a review of the current pharmacological treatments.

Treatment of familial dysautonomia, a genetic disorder affecting neuronal development and survival, has improved morbidity and survival for this disorder. Although this is primarily a neurological disorder causing sensory and autonomic dysfunction, there are secondary systemic perturbations affecting ophthalmological, gastrointestinal, respiratory, cardiovascular, orthopaedic and renal function. Penetrance is complete, but there is marked variability in expression. Preventative and supportive treatments have included measures to maintain eye moisture, fundoplication with gastrostomy, the use of central agents such as benzodiazepines and clonidine to control vomiting and the dysautonomic crisis, and fludrocortisone and midodrine to combat cardiovascular lability. With the identification of the familial dysautonomia gene, it has been suggested that it may be possible to treat patients by modifying production and expression of the genetic product.

Dysautonomia, Familial↗
PubMed1992

Sertraline. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depression and obsessive-compulsive disorder.

Sertraline is a selective inhibitor of central serotonin reuptake. Thus, it enhances serotoninergic transmission--a property which appears to explain its antidepressant activity. Its elimination half-life (approximately 26 hours) makes it suitable for once daily administration. Although clinical experience with sertraline is limited, it appears to possess antidepressant efficacy similar to that of amitriptyline and dothiepin, marginally better than imipramine, and significantly better than placebo. Additionally, sertraline is the only antidepressant licensed in the UK for the prevention of recurrence of depression, and preliminary findings suggest that the drug may also be effective in the treatment of obsessive-compulsive disorder. Sertraline and other serotonin reuptake inhibitors possess tolerability advantages over tricyclic antidepressants. Sertraline has minimal anticholinergic activity, is essentially devoid of cardiovascular effects, has a wide therapeutic index and may be administered to elderly patients or those with underlying cardiovascular disorders. However, as with other serotonin reuptake inhibitors, sertraline has been associated with gastrointestinal disturbances (nausea, diarrhoea/loose stools) and male sexual dysfunction (primarily ejaculatory disturbance), although each of these effects is usually mild and transient, decreasing in frequency with continued treatment. As a drug class, serotonin reuptake inhibitors such as sertraline appear to provide significant advantages compared with the more established antidepressant agents, particularly in terms of tolerability. Although much broader clinical experience is required before sertraline's full therapeutic potential can be realised, if future studies confirm the encouraging initial findings, sertraline will undoubtedly become an important option in the treatment of depression.

1-Naphthylamine↗
PubMed1990

[Significance and diagnosis of autonomic neuropathy in diabetes].

The results of studies performed to date would appear to show that autonomic neuropathy (ANP) in diabetics can involve any organ system. The earliest and most common manifestation is seen in the cardiovascular system, and finds expression as orthostatic phenomena, resting tachycardia, and "rigid pulse". Simple, non-invasive tests permit accurate quantification and follow-up. ANP in the gastrointestinal tract manifests as a motility disturbance, and the resulting delay in absorption might be the cause of inexplicable blood sugar fluctuations. A phenomenon of decisive importance for the diabetic is the lowering of his awareness of a hypoglycemic state. For this reason, intensive training of the diabetic in the self-determination of blood sugar and requirement-matched insulin dosage are thus of extreme importance. Disturbances of sexual function, which are all too rarely mentioned, usually put a heavy strain on the diabetic. Medical care of diabetics prior to, during and after surgery should give due consideration to cardiac, pulmonary and gastrointestinal ANP involvement. In view of the limited therapeutic possibilities, prevention of ANP should receive top priority.

Autonomic Nervous System Diseases↗
PubMedDate not supplied

[Chronic abdominal pain: a pediatric approach].

To treat chronic abdominal pain in a child is a difficult task either in a therapeutic or diagnostic point of view, by the variety of its several causes, displays and evolution. It is important not only to the clinician lent also to the child's family to try to identify the possible organic and psychic etiologies; in the organic causes there are frequently gastrointestinal and genitourinary reasons, but there are many dysfunctional mechanisms that shall not be forgotten. The author believes is useful, for a better understanding, to apply Levine and Rappaport's model, that indicates four primary intervening forces of the abdominal pain; 1. predisposition, dysfunction or somatic illness; 2. habits and life style; 3. personality and learned behavior's the necessity of a deep comprehension in the relationship between term case, sometimes frustrating.

Abdominal Pain↗
PubMed1988

Successful treatment of ciguatera fish poisoning with intravenous mannitol.

Twenty-four patients with acute ciguatera fish poisoning were treated with intravenous mannitol, and each patient's condition improved dramatically. All exhibited marked lessening of neurologic and muscular dysfunction within minutes of the administration of mannitol. Gastrointestinal symptoms disappeared more slowly. Two patients in coma and one in shock responded within minutes, with full recovery after infusion. Although these observations were empiric and uncontrolled and the mechanism of action of mannitol in this disease is unclear, mannitol should be considered for initial use in patients with significant illness and morbidity from ciguatera fish poisoning.

Adolescent↗
PubMed1983

Colonic compliance in patients with spinal cord injury.

While numerous communications have focused on urinary bladder dysfunction in the course of spinal cord injury, gastrointestinal disorders have received little attention. Abnormal bladder response to distention (automatic bladder) has been widely encountered among patients with complete thoracic spinal cord injury. To examine the similar concept in the colon, intracolonic pressure changes were measured in response to variable volumes of water introduced into the organ. Eight patients with complete spinal cord injury at the thoracic region (T6-T10) and 10 healthy volunteers were studied. Water was infused into the colon and intracolonic pressure was recorded using a rectilinear dynograph. The procedure was continued until the pressure reached 40mmHg or 2500ml of water had been administered. In spinal cord injury patients, the intracolonic pressure increased rapidly to a mean value of 35mmHg with as little as 300ml of water, whereas in normal controls this pressure was achieved only after 2200ml of water had been introduced into the colon. These findings indicate that the colon in patients with complete spinal cord injury of the thoracic region demonstrates an abnormal stretch response similar to that described in the bladder. This phenomenon could explain the frequent colonic symptoms experienced by these patients.

Adolescent↗
PubMed1995

Caudal agenesis and associated caudal spinal cord malformations.

Caudal agenesis is a rare congenital anomaly resulting from an insult to the structures of the caudal eminence. It may be associated with anomalies of other structures derived from the caudal eminence: the hindgut and the urogenital system. Patients are more likely to present first to the pediatric surgeon (for evaluation of gastrointestinal anomalies), the urologist (for urogenital malformation or dysfunction), or the orthopedic surgeon (for lower extremity abnormalities), than to the neurosurgeon. Characteristic external features of the buttocks, hips, and lower extremities may suggest the diagnosis. MR imaging is the diagnostic modality of choice and should be used in all patients with suggestive external features or other caudal anomalies. The level of bone anomaly corresponds well to the level of weakness but not sensory loss. Sensation is usually relatively preserved. The caudal spinal cord is often truncated in cases of high bone lesions and tethered, with occasional association with a dysraphic lesion, in cases of low bone lesions. Early neurosurgical intervention is preferred in all cases of recognized occult spinal dysraphism. Progressive neurologic deficits may develop later in life in patients with unrecognized tethered cord or dural stenosis and require neurosurgical repair on diagnosis. A better understanding of the embryology of the caudal region and investigation of the teratogens that may interfere with this stage of development should lead to more effective treatment and prevention of caudal agenesis and the associated caudal anomalies.

Abnormalities, Multiple↗
PubMed2006

Autonomic dysfunction in multiple sclerosis.

Multiple sclerosis (MS) is the most frequent chronic neurological disease affecting young persons in developed countries. MS is, however, considered as a secondary cause, of central origin, for autonomic dysfunction. The most common autonomic symptoms in MS are disorders of micturation, impotence, sudomotor and gastrointestinal disturbances, orthostatic intolerance as well as sleep disorders. The majority of the patients suffer at some period of the disease from lower urinary tract symptoms and sexual dysfunction. Awareness and treatment of these conditions is vital to improving health and quality of life in patients with MS. The increased understanding of the pathophysiological mechanisms in autonomic dysfunction in MS, along with technological and pharmaceutical developments has advanced our ability to treat the multiple aspects complicating autonomic failure in MS.

Autonomic Dysreflexia↗
PubMed1995

[Transjugular intrahepatic portosystemic shunt for upper gastrointestinal bleeding due to portal hypertension: 2-year results].

We performed transjugular intrahepatic portosystemic shunt (TIPS) in 25 patients with liver cirrhosis who developed upper gastrointestinal bleeding due to portal hypertension. The procedure was successful in 23 patients, in whom portal pressure decreased by 51%. Bleeding was stopped in all 5 emergency for whom other treatments, including sclerotherapy, had failed. During the follow-up period (mean: 367 days), shunt dysfunction due to stenosis was observed in 75% of the patients. However, by percutaneous transluminal angioplasty, the patency could be maintained in 85% of the cases after 1 year and 73% of the cases after 2 years. Re-bleeding was observed in 13% of the cases after both 1 and 2 years. Color Doppler ultrasonography was useful for detecting shunt dysfunction. TIPS seems to be an effective treatment of upper gastrointestinal bleeding due to portal hypertension.

Adult↗
PubMed1997

[The gastrointestinal changes in dystrophia myotonica].

Myotonic dystrophy is a multisystemic disorder inherited as an autosomal dominant trait. The secondary gastrointestinal disturbances are not well recognized. Two cases of myotonic dystrophy in a 51-year-old and 39-year-old woman with gastrointestinal symptoms disturbances are reported. One patient presented motor dysfunction in the colon and esophagus, organoaxial gastric volvulus and cholestasis. The second patient developed an acute colonic pseudo-obstruction. The patient improved with cisapride. The digestive manifestations of myotonic dystrophy and the treatment are reviewed.

Adult↗
PubMed1998

The role of gut as a cytokine-generating organ in remote organ dysfunction after intestinal ischemia and reperfusion.

OBJECTIVE: To test the hypothesis that in a rat model of acute intestinal ischemia/reperfusion injury, endotoxemia from the gastrointestinal tract would play a role in mediating tumor necrosis factor (TNF) response and remote organ dysfunction. METHODS: Wistar rats underwent 45 minutes of superior mesenteric artery occlusion followed by 6 hours of reperfusion. The rats were treated intravenously with either TNF monoclonal antibody (MoAb) or saline solution 90 minutes prior to the onset of ischemia. RESULTS: Significant elevation of plasma TNF level in both portal and systemic circulation was detected immediately after the onset of reperfusion. The level peaked at two hours after reperfusion (P < 0.01). Similarly, a remarkable TNF mRNA expression in the intestine in controls was detected at 0.5 hour post-reperfusion, and sustained a marked elevation throughout the observation period (P < 0.05-0.01). TNF elevation was found associated with gut-origin endotoxemia, and the maximal TNF response occurred approximately 0.5-2 hours after the initial appearance of endotoxin in the portal vein. Concomitantly, multiple organ dysfunction in response to local ischemic insult was also observed in untreated controls upon reperfusion, but it was significantly attenuated by pretreatment with MoAb against TNF. CONCLUSIONS: Intestinal injury can result in the gut becoming a cytokine-liberating organ. The escape of endotoxin and bacteria from the gut may be responsible for the TNF expression and release, which would be an important mechanism underlying pathophysiological alterations associated with intestinal ischemia/reperfusion injury.

Animals↗