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PubMed1989

Toxicology of oil field wastes. Hazards to livestock associated with the petroleum industry.

In oil-producing states, the proximity of livestock to drilling operations and production sites often results in poisoning of animals from ingestion of crude oil, condensate, salt water, heavy metals, and caustic chemicals. The heavy metals encountered most frequently are lead from pipe joint compound and arsenicals and chromates used as corrosion inhibitors. Numerous toxic and caustic chemicals are used in drilling muds and fluids. Crude oil and salt water spills are common occurrences around production sites. Pipeline breaks may result in exposure of livestock to crude oil or refined petroleum hydrocarbons. Ingestion of petroleum hydrocarbons may result in sudden death from peracute bloat. The most common cause of illness or death following exposure to petroleum hydrocarbons is aspiration pneumonia, which may cause a chronic progressive deterioration of health, with death after several days or weeks. Cases in which livestock are exposed to oil, salt water, or caustic chemicals, but do not die acutely or from aspiration pneumonia are more frustrating to diagnose. In these cases, parasitism, poor nutrition, and other debilitating diseases must be considered. Anorexia, weight loss, and decreased rumen motility may be caused by a disruption of normal rumen function. Petroleum hydrocarbons, salt water, and caustic chemicals have the potential of altering rumen flora and enzymatic processes as well as damaging the ruminal and gastrointestinal epithelium. The toxicity of petroleum hydrocarbons appears to be related more closely to the volatility and viscosity of the product than to other factors. The more volatile straight chain and aromatic petroleum hydrocarbons have a greater potential for aspiration pneumonia and may produce an anesthetic-like action if absorbed systemically. The more volatile petroleum hydrocarbons also are more irritating to skin and mucous membranes and appear to be more damaging to rumen flora. Treatment of petroleum hydrocarbon ingestion is aimed at preventing aspiration pneumonia and the animal's absorption of highly volatile components. Activated charcoal slurries and, in some instances, vegetable oil may be used to absorb the ingested petroleum or alter its viscosity to minimize absorption and aspiration. These procedures should be followed by the administration of rumenatories or saline cathartics to hasten the evacuation of the gastrointestinal tract. Chronic poor performance animals with anorexia and rumen dysfunction may respond to fresh rumen inoculant, intravenous glucose, and B-complex vitamins. Prognosis primarily hinges on whether or not aspiration pneumonia has occurred. Treatment of aspiration pneumonia rarely is effe

Animals↗
PubMed1983

Acute and subacute toxicity of piperine in mice, rats and hamsters.

Piperine is acutely toxic to mice, rats and hamsters. The LD50 values for a single i.v., i.p., s.c., i.g. and i.m. administration of piperine to adult male mice were 15.1, 43, 200, 330 and 400 mg/kg body wt, respectively. The i.p. LD50 value was increased to 60 mg/kg body wt in adult female and 132 mg/kg body wt in weanling male mice. In adult female rats, the i.p. LD50 value was 33.5 mg/kg body wt whereas the i.g. LD50 value was increased to 514 mg/kg body wt. Most animals given a lethal dose died of respiratory paralysis within 3-17 min. In subacute toxicity studies, the rats died within 1-3 days after treatment. Histopathologic changes included severe hemorrhagic necrosis and edema in gastrointestinal tract, urinary bladder and adrenal glands. Death of these animals may be attributable to multiple dysfunctions in their organs.

Adrenal Gland Diseases↗
PubMed1991

The effect of cisapride on gastro-oesophageal dysfunction in systemic sclerosis: a controlled manometric study.

1. Cisapride is a novel prokinetic drug which facilitates or restores motility throughout the gastrointestinal tract. Its mechanism of action is thought to involve enhancement of acetylcholine release in the myenteric plexus of the gut. 2. The effect of intravenous cisapride 10 mg on gastro-oesophageal dysfunction was investigated in 20 patients with systemic sclerosis, using a double-blind, randomised, cross-over, placebo-controlled manometric study design. 3. The increase in lower oesophageal sphincter pressure was significantly higher after cisapride (mean +/- s.e. mean, 8.3 +/- 2.1 cm H2O) than after placebo (mean +/- s.e. mean. 0.1 +/- 0.3 cm H2O) (P less than 0.001). The increase in the number of fundic gastric contractions during the 30 min study period was significantly higher after cisapride (mean +/- s.e. mean, 7.7 +/- 2.3) than after placebo (mean +/- s.e. mean, 0.9 +/- 0.6) (P less than 0.01). 4. No serious clinical adverse effects were observed. 5. The study demonstrates that intravenous cisapride induces a significant increase in lower oesophageal sphincter pressure and in the number of fundic gastric contractions, which may be beneficial in the treatment of scleroderma gastro-oesophageal dysfunction. Further long-term studies of the effect of oral cisapride in patients with systemic sclerosis are warranted.

Cisapride↗
PubMed2006

Medical complications of anorexia nervosa and bulimia nervosa.

PURPOSE OF REVIEW: This review focuses on recent publications concerning medical complications in patients with eating disorders, including anorexia nervosa and bulimia nervosa. RECENT FINDINGS: Recent literature continues to reflect that multiple organ systems are frequently affected by eating disorders. The literature underscores the frequently cited risk of premature death in those with anorexia nervosa. A plethora of dermatologic changes have been described, some signaling serious underlying pathophysiology, such as purpura, which indicates a bleeding diathesis. Much of the literature continues to delineate the fact that diabetic patients with eating disorders are at high risk of developing diabetic complications. Gastrointestinal complications can be serious, including gastric dilatation and severe liver dysfunction. Acrocyanosis is common, and patients with anorexia nervosa are at risk of various arrhythmias. Low-weight patients are at high risk for osteopenia/osteoporosis. Nutritional abnormalities are also common, including sodium depletion and hypovolemia, hypophosphatemia and hypomagnesemia. Resting energy expenditure, although very low in low-weight patients, increases dramatically early in refeeding. SUMMARY: Medical complications are common and often serious in patients with eating disorders, particularly those with anorexia nervosa.

Anorexia Nervosa↗
PubMed1983

Congenital dysautonomia with secretory diarrhea.

A 1-year-old boy was evaluated because of failure-to-thrive and persistent diarrhea. His illness was characterized by autonomic dysfunction sharing some features of both familial dysautonomia and congenital sensory neuropathy with anhidrosis, but was consistent with neither diagnosis. The gastrointestinal tract was involved: esophageal motility was abnormal and moderate secretory diarrhea was present. This report documents an unusual case of congenital autonomic dysfunction with secretory diarrhea.

Autonomic Nervous System Diseases↗
PubMed1996

Prophylaxis against postoperative complications in gastroenterology.

Gastrointestinal surgery results in pain, profound endocrine metabolic changes and organ dysfunction, immunosuppression and decreased resistance to infection, fatigue and convalescence. The main pathogenetic mechanism is the surgical stress response, which may be reduced by minimal invasive (laparoscopic) surgical techniques and afferent neural and perhaps humoral mediator blockade. Subsequently, these techniques have been documented as reducing a variety of postoperative morbidity parameters. A unifying concept for control of the postoperative period is presented as a combined effort to enhance preoperative information, stress reduction and sufficient functional pain relief allowing early mobilization and oral nutrition. Preliminary data, in combination with laparoscopic surgery, suggest that this approach improves outcome significantly.

Antibiotic Prophylaxis↗
PubMed1987

Action of centrally mediated autonomic stimulation on human upper gastrointestinal transit: a comparative study of two stimuli.

Two well established experimental stressors, hand immersion in cold water, and mental stimulation with dichotomous listening, were applied to 37 normal subjects after the ingestion of a standard meal. Orocaecal transit was measured by serial exhaled breath hydrogen sampling. Cold water significantly delayed transit compared with warm water control (warm water 71.8 +/- 3.6 mins v cold water 93.2 +/- 5.7 mins p less than 0.01), with significant rises in blood pressure pulse rate perceived discomfort and plasma catecholamines. In contrast mental stimulation was unaccompanied by any change in transit (control; 67.4 +/- 4.7 v test 64.3 +/- 5.3 mins p greater than 0.1) despite a significant rise in pulse rate, skin conductance and plasma catecholamines. Repeated cold water immersion studies in eight individuals produced consistent orocaecal transit and autonomic responses, whereas mental stimulation showed reduced autonomic responses on repeat testing, suggesting that tolerance to the stimulus had occurred. The results of these studies show stimulus specific gastrointestinal response patterns to autonomic stimuli, and appear to have important implications for the design of future studies of human gastrointestinal autonomic physiology and for the investigation of patients with stress related gut dysfunction.

Acoustic Stimulation↗
PubMed1987

High-dose cytosine arabinoside, daunomycin and 6-thioguanine in relapsed or refractory acute nonlymphocytic leukemia.

Fifteen patients with relapsed (10) or primarily refractory (5) acute nonlymphocytic leukemia were treated with a combination of cytosine arabinoside (3 g/m2 i.v. every 12 h, 12 doses, days 1-6), 6-thioguanine (100 mg/m2 orally every 12 h, 12 doses, days 1-6) and daunomycin (60 mg/m2 i.v. on days 5 and 6 only). Complete remission was achieved in 11 patients. Eight of 10 relapsed patients and 3 of 5 primarily refractory patients entered remission. Median remission duration was 7.5 months (2-36+ months). Ten of the 11 remissions resulted from a single induction course. The time to hematologic recovery was comparable to that seen with 'standard'-dose cytosine arabinoside regimens. Nonhematologic toxicity, although considerable, was not greater than that seen with high-dose cytosine arabinoside alone. The most significant problem was gastrointestinal toxicity with diarrhea occurring in the majority of patients. Mild neurologic toxicity (reversible cerebellar dysfunction) occurred in 2 patients.

Acute Disease↗
PubMed1984

A platelet release defect induced by aspirin or penicillin G does not increase gastrointestinal blood loss in thrombocytopenic rabbits.

Gastrointestinal blood loss was compared in groups of normal and thrombocytopenic animals treated with medications known to induce qualitative platelet dysfunction. Thrombocytopenia was induced in rabbits by the intraperitoneal injection of busulphan dissolved in polyethylene glycol (PEG) at a dose of 60 mg/kg. Control animals received PEG alone; each group subsequently received daily intravenous injections of penicillin G, aspirin, sodium salicylate or isotonic saline. Mean daily gastrointestinal blood loss was determined by monitoring the appearance of 51Cr radioactivity in the faeces following the administration of 51Cr-labelled erythrocytes prior to the administration of the test and control therapies. The administration of penicillin G was not associated with increased gastrointestinal blood loss in the thrombocytopenic animals as compared with the saline treated thrombocytopenic controls. Platelet aggregation studies confirmed the presence of a mild but significant defect in platelet aggregation. Aspirin produced a more pronounced defect in platelet aggregation but did not induce increased bleeding in the normal animals as compared with the controls, nor did it exacerbate the bleeding in thrombocytopenic animals. Sodium salicylate did not produce an aggregation defect and did not significantly modify gastrointestinal blood loss. It was concluded that drug-induced qualitative platelet dysfunction does not necessarily increase bleeding through intact vessels despite previous evidence of a significant effect on platelet plug formation as monitored by the bleeding time.

Animals↗
PubMed2000

Disturbed release of gastrointestinal peptides in anorexia nervosa and in obesity.

AIM: It is commonly accepted that some neuropeptides play an important role in the control of appetite and hormonal secretion. Several gastrointestinal peptides may affect on central control of appetite via vagal and spinal nerves. The aim of this study was to evaluate the release of gastrointestinal peptides in anorexia nervosa and in obesity, because in these diseases the disturbances in the control of appetite and hormonal secretion were found. Material consisted of 30 women with anorexia nervosa aged 16-29 years (mean 22 years) and 23 women with obesity aged 19-33 years (mean 29 years) and 25 lean women of control group. METHODS: In women with anorexia nervosa as compared with control group we observed a significant increase of plasma vasoactive intestinal peptide (VIP) levels (p < 0.01) and a significant decrease of leptin (p < 0.001), beta-endorphin (p < 0.01), gastrin (p < 0.05), cholecystokinin (CCK; p < 0.05) and somatostatin (S-S; p < 0.01). In obese women we found a significant increase of neuropeptide Y (NPY; p < 0.001), leptin (p < 0.01), galanin (p < 0.001), beta-endorphin (p < 0.001), gastrin (p < 0.01), CCK (p < 0.001) and S-S (p < 0.01) and a significant decrease of VIP concentrations (p < 0.001) as compared with control group. CONCLUSION: Our results indicate that the release of gastrointestinal peptides is disturbed in obesity and in anorexia nervosa. These findings suggests that dysfunction of brain-gut axis may be also an important factor in the abnormal control of appetite axcept of hypothalamic dysfunction.

Adolescent↗
PubMed1994

Management of tetanus: a review of 18 cases.

Eighteen patients with generalized tetanus seen during an 8-year period in three regional hospitals in Hong Kong are reviewed. Eighty-nine per cent of the patients were intravenous heroin addicts who developed a severe type of generalized tetanus with autonomic dysfunction. Pain or stiffness of the neck or back was the commonest presenting symptom, followed by trismus and dysphagia. Most of the patients developed muscle spasms within 24 h of the onset of presenting symptoms. Early ventilatory support and tracheostomy, together with intensive nursing care, were the mainstay of the treatment. Pulmonary and gastrointestinal complications were common during the course of illness and treatment of autonomic dysfunction was often unsatisfactory. The case fatality rate was 25% among the heroin addicts, but full recovery was the usual outcome for those who survived. The simultaneous administration of intrathecal tetanus immunoglobulin tends to reduce mortality.

Adult↗
PubMed2001

Probiotics in human disease.

Western civilization is facing a progressive increase in immune-mediated, gut-related health problems, such as allergies and autoimmune and inflammatory diseases, and genetic factors are an unlikely explanation for these rapid increases in disease incidence. Two environmental factors that relate to the modern lifestyle in Western societies are hygiene and nutrition. There has been a decline in the incidence of microbial stimulation by infectious diseases as a result of improved hygiene, vaccination, and antimicrobial medication. In the past, methods of food preservation involved either the natural fermentation or drying of foods; thus, the human diet once contained several thousand times more bacteria than it does today. The development of probiotic, functional foods aims to "kill two birds with one stone," which is accomplished by providing a microbial stimulus to the host immune system by means of beneficial live microorganism cultures that are characteristic of the healthy, human gut microflora, ie, probiotics. Probiotic bacteria were shown to reinforce the different lines of gut defense, which are immune exclusion, immune elimination, and immune regulation. They were also shown to stimulate nonspecific host resistance to microbial pathogens, thereby aiding in pathogen eradication. Consequently, the best documented clinical application of probiotics is in the treatment of acute diarrhea. In humans, documented effects were reported for the alleviation of intestinal inflammation, normalization of gut mucosal dysfunction, and down-regulation of hypersensitivity reactions. These data show that probiotics promote endogenous host defense mechanisms. Thus, modification of gut microflora by probiotic therapy may offer a therapeutic potential in clinical conditions associated with gut-barrier dysfunction and inflammatory response.

Diet↗
PubMed2000

Constipation: a physiological approach.

The first step in managing a patient with constipation is to understand the precise nature of the complaint. Is the onset recent? What are the frequency and form of the stools, and how much effort is required to defecate? Is constipation steady or alternating as in irritable bowel syndrome? Are there structural, metabolic or pharmacological confounders? Is the patient depressed? Has dietary fibre been tried at a sufficient dose? What are the patient's understanding and beliefs about the symptoms? Has there been sufficient and appropriate investigation? Armed with the answers to these questions, physicians can help most patients through lifestyle, dietary and pharmacological adjustments, along with supplementary fibre. Some patients may require regular doses of an osmotic laxative. Those few that fail these measures should have their transit time estimated while on a high fibre diet; if it is normal, further testing is unlikely to help. The above efforts should be re-emphasized, and reassurance should be offered. Some patients may require a psychological assessment. If transit time is prolonged and the patient may benefit from surgery for colonic inertia or biofeedback for anismus, then colon and anorectal function should be assessed. The decision to perform further tests should be made carefully, and unrealistic expectations should be discouraged. Before surgery is offered, the patient should have the benefit of receiving an expert opinion. Biofeedback helps some patients with isolated anorectal dysfunction.

Cathartics↗
PubMed1980

[Amylase excretion in the feces].

The amylolytic excretion in stool was determined in 100 patients with various gastroenterologic diseases and in 55 healthy subjects. The amylolytic activities were detected in disc electrophoresis. The fecal amylase elimination correlates with the weight of stool and is augmented in pancreatopathies, and in other gastroenterologic diseases. The measurement of amylase activity in stool is not suitable for the diagnosis of exocrine pancreatic dysfunction.

Amylases↗
PubMed1986

[Phase II study of (2''R)-4'-O-tetrahydropyranyldoxorubicin (THP) in patients with advanced gastrointestinal cancer--a report of the Tohoku THP Study Group].

A phase II study of THP was performed in patients with advanced gastrointestinal cancer. The dose schedule was 25 to 40 mg/m2 i.v./cycle repeated every 3 to 4 weeks. One partial (PR) and one minor response (MR) were achieved in 16 evaluable patients with stomach cancer. A case of PR had previously been shown to be resistant to doxorubicin and a case of MR resistant to aclarubicin, respectively. No objective responses were observed in 19 evaluable patients with other tumor sites in the gastrointestinal tract. Forty-eight patients were evaluable for toxic effects. Leukopenia (less than 4 X 10(3)/mm3) occurred in 54% of the patients and was dose-limiting. Thrombocytopenia (less than 10 X 10(4)/mm3) was less frequently observed (13%) than leukopenia. However, no cumulative marrow suppression was observed in repeated courses of the therapy. Non-hematologic toxic effects consisted of gastrointestinal disturbances (23%), hair loss (10%), general malaise (8%), fever (6%), ECG changes (4%) and hepatic dysfunction (2%). Further trials with a high dose schedule (40 mg/m2, q 3-4 weeks) in good-risk patients are necessary to validate the antitumor activity of THP against advanced gastrointestinal cancer.

Adult↗
PubMed1994

Mental health status as a predictor of morbidity and mortality: a 15-year follow-up of members of a health maintenance organization.

OBJECTIVES: This study sought to relate preexisting depression, worries, affect balance, and mental health symptoms to subsequent risk of morbidity and mortality. METHODS: A random sample of members of a health maintenance organization were interviewed at home in a 1970/71 survey. Baseline psychological measures from that survey were then related to 15-year mortality and first incidence of cancer, heart disease, hypertension, stroke, functional gastrointestinal disease, and hyperimmune diseases. RESULTS: Baseline depression and the Langner Mental Health Index predicted incidence of functional gastrointestinal and hyperimmune diseases. The relationship of the Langner index to hyperimmune diseases was particularly strong; mortality, cancer, heart disease, hypertension, and stroke incidence were not related to that index. Except for affect balance, which was worst in the elderly, indications of psychological dysfunction were strongest in the young. CONCLUSIONS: Psychological indices detected increased risk for functional gastrointestinal and hyperimmune diseases but were not related to mortality risk. Further research is needed to disaggregate relationships of the specific conditions that were included in the hyperimmune group. Functional gastrointestinal disease might be preventable with early attention to depressed persons and to those scoring high on the Langner index.

Adolescent↗
PubMed1992

[Behavior therapy in gastrointestinal functional disorders].

Almost all functions of the gastrointestinal tract have been shown to be under central nervous control and to respond to environmental factors such as stress. It is, therefore, not surprising that disturbed gastrointestinal functions may be altered through psychological therapy approaches. For motor dysfunctions of the esophagus and functional dyspepsia, there is a lack of behavioral therapy studies, while controlled studies utilizing relaxation techniques, stress management strategies and anxiety treatment have been shown to improve symptoms and prevent recurrence in reflux esophagitis and peptic ulcer disease despite the wide use of effective medication. Most studies have treated patients with symptoms of the irritable bowel syndrome: This approach usually combined conventional medical treatment with psychotherapy. Psychological management usually consisted of relaxation training, stress management and patient information. Additional behavioral modification, e.g. of eating and defecation behavior, is superior to pharmacological and dietary management alone. The role of biofeedback therapy in these patients remains to be clarified in the future. It is, however, therapy of choice in some patients with constipation due to spastic pelvic floor syndrome and in fecal incontinence, if the external anal sphincter is insufficient to maintain continence. There ist a systematic lack of treatment opportunities as compared to the number of patients seeking health care for functional bowel disorders.

Behavior Therapy↗