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PubMed1990

Quality of life/subjective symptoms during beta-blocker treatment.

beta-receptor antagonists have for many years been considered appropriate alternatives in the primary management of mild to moderate hypertension. Generally, they have been shown to be safe with a low frequency of serious side-effects. Among the predictable and usually doserelated side-effects are bradycardia, bronchospasm, hypotension, muscle fatigue and cold extremities. Examples of unexpected side-effects are gastrointestinal symptoms such as nausea and disturbed intestinal motility, skin reactions, sexual dysfunction, as well as effects related to the central nervous system (CNS) such as emotional disturbances. The CNS-related side-effects, the mechanisms of which are unclear, consist of subtle effects on general well-being, decreased initiative, a depressed frame of mind and disturbed sleep. Generally, however, beta-blockers in therapeutic dosages do not affect the qualitative functions of the brain. Thus, all beta-blockers on the market seem to have high benefit-risk ratio, but independent of their physiochemical properties and pharmacodynamic profile, they seem to cause side-effects to about the same extent. The results so far available have been obtained by primarily using objective methods. Further comparison has now been initiated using documented subjective methods to investigate whether the objectively documented differences are of any clinical relevance to the patient's quality of life. Although it cannot be claimed with certainty, nonselective beta-blockers seem to cause CNS-related side-effects to a greater extent than beta 1-selective blockers. Differences in the degree of hydrophilicity of the beta-blocker are apparently of no clinical relevance in this respect.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1990

Septic arthritis due to group C streptococcus: report and review of the literature.

A case of polyarticular septic arthritis due to Lancefield group C streptococcus is described and the clinical details of 9 reported cases of septic arthritis due to group C streptococcus reviewed. Several features of the presentation and course of these patients, including polyarticular involvement (4/10), bacteremia (5/10), clinically important dysfunction in other systems (4/10 patients: cardiac, 3; CNS, 2; pneumonia, 1; gastrointestinal, 1), fatal outcome (3/10 patients, 2 during the course of active infection) and poor functional outcome in affected joints (4/7 surviving patients), serve to place group C streptococcus septic arthritis as a syndrome distinct from that usually expected with streptococcal septic arthritis. Specific features of the bacteriology of group C streptococcus are reviewed (including confusion with group A streptococcus when analyzed using nonserologic methods, occasional zoonotic source, and frequency of tolerance to penicillin) in order to emphasize the importance of both the specific identification of this particular streptococcal strain and the initiation of aggressive antibiotic therapy when group C streptococcus is identified as the causative agent in a case of septic arthritis.

Aged↗
PubMedDate not supplied

[Idiopathic autonomic neuropathy (pandysautonomia)].

On the basis of current literature, clinical and neuropathologic features of idiopathic autonomic neuropathy is presented. Idiopathic autonomic neuropathy is a disease characterized by acute or subacute onset, monophasic course over a period of several years, it is often preceded by an infection. The spectrum of autonomic changes ranges from cholinergic or adrenergic dysfunction to pandysautonomia, leading to heterogeneity of its clinical features. Possible sympathetic system abnormalities found in autonomic neuropathy are: poor pupillary response to light in darkness, orthostatic hypotension leading to syncope, hypotension without compensatory tachycardia, ejaculation disturbances and vasomotor instability. Possible parasympathetic dysfunctions are: salivation and lacrimation disturbances, absent pupillary constriction to light and near gaze, gastrointestinal tract immobility and impairment of gastrointestinal function, atonic bladder with large residual volume, erectile impotence. Pandysautonomia is thought to result from an immune mediated mechanism and responds well to plasmaferesis and intravenous immunoglobin therapy leading to gradual, sometimes not full, recovery. Moreover in this article we pay attention to the clinical value of many tests like cardiovascular or pharmacological studies in the diagnosis of pandysautonomia and in differentiation of pre- and postganglionic changes. In order to diagnose idiopathic autonomic neuropathy one has to rule out a large number of diseases with autonomic dysfunction e.g.: diabetes, malignant neoplasms, acute intermittent porphyria, Shy-Drager syndrome, Riley-Day's dysautonomia, Parkinson's disease, amyloidosis and others.

Adolescent↗
PubMed2001

Characterization of multiple organ dysfunction syndrome in very low birthweight infants: a new sequential scoring system.

To define multiple organ dysfunction in newborns, we established a sequential scoring system NEOMOD (Neonatal Multiple Organ Dysfunction Score). It was developed to describe the process of increasing physiologic derangement in critically ill newborns. It provides, during the first 28 days of life, information concerning function of organ systems having a primary influence on mortality in very low birth weight (VLBW) infants. Our scoring system has been used in 142 VLBW infants. It evaluates moderate (1 point) or severe dysfunction (2 points) in 7 organ systems (central nervous system, cardiovascular, renal, respiratory, and gastrointestinal systems, and hemocoagulation and acid-base balance) in 24-h intervals from day 1 to 28 of life. Maximum possible value of NEOMOD was 14 points. Receiver operating characteristic curve was used for assessing predictive accuracy of maximum NEOMOD score obtained by daily scoring for mortality rate. AUC (area under curve) attained by NEOMOD was 0.95 for mortality within the first 28 days and 0.91 for hospital mortality, respectively. In the study group, NEOMOD score of > or = 9 was associated with 100% mortality. An analysis of specific organ dysfunctions in the non-survivors group (n = 16) disclosed, in all patients, dysfunction of more than two organ systems 24 h before death. Similar to critically ill adults, secondary multiple organ dysfunction can be described also in a majority of critically ill VLBW infants. NEOMOD scores may help to evaluate daily the severity of the syndrome and risk of death.

Female↗
PubMed1999

New and future drugs in nerve-gut dysfunction.

There is increasing evidence that modifications in brain-gut communications are responsible for the occurrence of Functional Bowel Disorders. Based on various experimental models of modified gut sensitivity and the emergence of new pharmacological tools, it is now possible to identify new targets for the corrections of altered brain-gut communications and to improve our understanding of functional gastrointestinal disorders. Both local inflammatory related components and central nervous system acting factors are associated to trigger dysfunctioning and neuropeptides such as tachykinins, bradykinin and calcitonin gene-related peptide are involved in peripheral and spinal sensitization of afferent neurons. Serotonin released from entero chromaffin cells, mast cells, platelets or nerves also play a role, through different receptor subtypes, in initiating gut hypersensitivity. Brain modulation of impaired ascending messages also appears to be an important approach for the correction of symptoms related to gut hyper-responsiveness.

Animals↗
PubMed2004

Decompressive percutaneous endoscopic gastrostomy in nonmalignant disease.

BACKGROUND: Percutaneous endoscopic gastrostomy is the standard for long-term enteral access. It can provide enteral nutrition or gastrointestinal decompression. Utilization of the gastrostomy for decompression has traditionally been reported in the setting of malignant obstruction. However, decompressive gastrostomy can play a role in the treatment of nonmalignant bowel dysfunction as well. METHODS: Over a 2-year period, 20 of 121 percutaneous endoscopic gastrostomies attempted by this surgical endoscopist were for gastrointestinal decompression. RESULTS: Eleven of 18 gastrostomies successfully placed for decompression were for benign conditions. In 5 patients with fistulous disease, the purpose of decompression was to divert the gastrointestinal tract until operative repair. Four of these patients have since undergone definitive surgery. CONCLUSIONS: This series presents the successful use of the percutaneous endoscopic gastrostomy for decompression of nonmalignant conditions. In such scenarios, the drainage gastrostomy can be employed as a bridge to future surgery, or as a means of long-term decompression for bowel dysfunction.

Adult↗
PubMed1998

[Repercussion of postoperative pain, benefits attending to treatment].

Physiological responses to postoperative acute pain may impede organ functions (cardiovascular, pulmonary, coagulation, endocrine, gastrointestinal, central nervous system, etc). Pain alleviation improves patient's comfort, but also may minimise perioperative stress response, physiological responses and postoperative organ dysfunction, assist postoperative nursing and physiotherapy, enhance clinical outcome, and potentially shorten the hospital stay. Potent postoperative analgesia, especially by epidural route, may be associated with reduction in incidence and severity of many perioperative dysfunctions. Peridural analgesia using local anaesthetics is the best technique for decreasing postoperative stress after lower abdominal or lower limb surgery. Analgesia using either epidural or high doses of morphine may improve some cardiac variables such as tachycardia and ischaemia, but does not change the incidence of severe cardiac complications. For patients undergoing vascular or orthopaedic surgery, epidural analgesia can improve clinical outcome by preventing the development of arterial or venous thromboembolic complications. However, in comparative studies, the control groups did not receive adequate prophylactic treatment for thromboembolic complications. Epidural analgesia can hasten the return of gastrointestinal motility and shorten the hospital stay. Postoperative mental dysfunction is decreased using intravenous PCA morphine in the elderly. Epidural analgesia with local anaesthetics improves postoperative respiratory function but, for unknown reasons, these benefits are not associated with a decrease in respiratory complications. On balance, the mode of acute pain relief decreases adverse physiological responses and many intermediate outcome variables; however, there is inconclusive evidence that it affects clinical outcome. Major advances in postoperative recovery can be achieved by early aggressive perioperative care, including potent analgesia, early mobilisation and oral nutrition. As a result, the hospital stay may be shortened.

Analgesics↗
PubMed1981

Acquired dysfibrinogenemia in a hemophiliac with hepatoma: resolution of fibrinogen dysfunction following chemotherapy.

A 17-year-old male with previously undiagnosed congenital Factor IX deficiency (13%) presented with gastrointestinal bleeding and a hepatic mass. Prolonged thrombin and Reptilase times, which partially corrected with CaCl2 and a discrepancy between thrombin-clottable and immunoreactive plasma fibrinogen, suggested a dysfibrinogenemia. Laparotomy disclosed metastatic hepatoma. Adequate hemostasis was obtained with clotting factor replacement, but wound healing was delayed. Patient fibrinogen purified with 2.1 M glycine migrated normally on immunoelectrophoresis and 7.5% polyacrylamide-SDS gel electrophoresis. However, fibrin monomers prepared from purified patient fibrinogen displayed impaired aggregation at high and low ionic strengths when compared with fibrin monomers from normal and control Factor IX deficient subjects. Aggregation of normal monomers was delayed when mixed 1:1 with patient monomers. Fibrinopeptide release was normal, and total sialic acid content was similar to that of normal and control fibrinogens. Chemotherapy, consisting of 5-FU given via intra-arterial hepatic infusion, was accompanied by significant transient clinical improvement which coincided with correction of thrombin clotting times and fibrin monomer aggregation. Reappearance of fibrinogen dysfunction occurred with clinical deterioration prior to death from metastatic hepatoma and sepsis. This case is the first to corroborate the postulated tumor marker role of dysfibrinogenemia in a patient with hepatoma by documenting a direct relationship with response to chemotherapy.

Adolescent↗
PubMed1989

[Chronic functional dyspepsia or irritable colon].

An attempt is made to synthesize the fundamental information concerning the pathogenesis of chronic functional digestive disorders, which should be designated as "chronic functional dyspepsia". At present the term "irritable colon" does not seem justified since the disorder affects the entire gastrointestinal tract. In the development of this disorder three types of fundamental pathogenic factors apparently participate: 1. Deficient protein nutrition leading to hypotrophy of the intestinal mucosa. 2. Alterations of intestinal motility related fundamentally to neurotic dysfunction. These are hyperreactive phenomena by the smooth muscle in response to normal stimuli on a background of generalized gastrointestinal hypotonia. They seem to be due to an excess of certain neurotransmitters, principally dopamine, at the level of the myenteric plexus. 3. Infectious factors of the infectious Crohn type provoked by intestinal bacterial overgrowth. These derive from motility alterations, with stasis or delayed transit, and hypotrophy due to deficient nutrition that alters the intraluminal ecological medium. This alteration impairs the development of the normal saprophytic flora and facilitates the proliferation of anaerobic colonic germs, leading to intestinal bacterial overgrowth.

Colonic Diseases, Functional↗
PubMed1997

Septic syndrome and septic shock in the wounded treated at the Split Clinical Hospital Intensive Care Unit.

INTRODUCTION: A retrospective study on the occurrence of septic syndrome and septic shock, as well as multiorgan failure, in the wounded at the Split Clinical Hospital Intensive Care Unit (ICU). PATIENTS AND METHODS: From 1991 to 1995, 257 wounded persons were treated at the Split Clinical Hospital ICU. Criteria for septic syndrome included evident infection, body temperature > 38 degrees C or < 30.5 degrees C, leukocytosis or leukopenia, thrombocytopenia, as well as dysfunction of one organ. The criterion for septic shock was septic syndrome with hypotonia. RESULTS: Fifteen patients with septic syndrome and 9 patients with septic shock were admitted and treated at the ICU. Septic syndrome developed in 17 patients and septic shock in 16 patients at the ICU. Acute respiratory distress syndrome developed in 16, renal insufficiency in 26, gastrointestinal disorders in 6, hepatic disorders in 4, hematologic disorders in 13, and central nervous system dysfunction in 17 patients. Twenty-eight percent of patients died in septic syndrome, and 74% died in septic shock. CONCLUSION: Septic syndrome and septic shock were the most common causes of death in wounded persons treated at Split Clinical Hospital ICU. At the earliest phase the main cause of death was refractory hypotension, and at the later stage the main cause of death was multiorgan failure.

Adult↗
PubMed1999

Obesity: effects on the liver and gastrointestinal system.

Obesity, or the presence of a body mass index exceeding 30 kg/m, has assumed epidemic proportions in the United States. More than a cosmetic issue, obesity is associated with many comorbidities that contribute to multiple organ dysfunction, illness, and shortened life span. This review covers new and emerging information on the relationship of obesity to common and debilitating hepatic and gastrointestinal disorders, including nonalcoholic steatohepatitis, gastroesophageal reflux, gallstones, and increased risk of colon cancer. Understanding the role of obesity in these disorders should lead to new insights into the pathogenesis of common liver and gastrointestinal diseases and to new treatment strategies for the practicing gastroenterologist.

Journal Article↗
PubMed1999

Obesity: effects on the liver and gastrointestinal system.

Obesity, or the presence of a body mass index exceeding 30 kg/m2, has assumed epidemic proportions in the United States. More than a cosmetic issue, obesity is associated with many comorbidities that contribute to multiple organ dysfunction, illness, and shortened life span. This review covers new and emerging information on the relationship of obesity to common and debilitating hepatic and gastrointestinal disorders, including nonalcoholic steatohepatitis, gastroesophageal reflux, gallstones, and increased risk of colon cancer. Understanding the role of obesity in these disorders should lead to new insights into the pathogenesis of common liver and gastrointestinal diseases and to new treatment strategies for the practicing gastroenterologist.

Animals↗
PubMed2002

Dependence, dementia, cerebellar dysfunction, and myopathy in association with chronic isopropanol ingestion.

Little is known about the chronic sequelae of isopropanol ingestion. Acute effects of isopropanol ingestion include central nervous system depression, gastrointestinal irritation, impaired gluconeogenesis, delirium, hypotension, and coma. We present a case of a patient who preferentially consumed isopropyl alcohol for at least 17 years and developed sequelae of alcoholic neuromyopathy, recurrent rhabdomyolysis, cerebellar dysfunction, and dementia. Issues related to the patient's preferential consumption of isopropanol are discussed, along with descriptions of the neurobehavioral, neurophysiologic, and neuropathologic studies related to her chronic isopropanol ingestion. The epidemiology of nonbeverage alcohol is briefly reviewed, and clinicians are encouraged to inquire about nonbeverage-alcohol consumption in patients presenting with alcohol-related problems.

2-Propanol↗
PubMed1997

[Intra-digestive fermentation in intestinal malabsorption syndromes: relations with elevated serum activity of gamma-glutamyl-transpeptidase].

UNLABELLED: The aim of this prospective study was to examine the relationship between gastrointestinal ethanol production ("Mei-Tei-Sho" syndrome described in Japan) and biological liver dysfunction associated with intestinal malabsorption syndromes. METHODS: Sixty-five patients with malabsorption-diarrhea underwent 98 simultaneous measurements of plasma gamma-glutamyl-transpeptidase and of faecal ethanol concentrations; in 5 cases, ethanolemia and faecal ethanol concentrations were measured after a 250 g rice-meal; in 1, ethanol concentration was measured in a sample of caecal liquid in hours following local instillation of fructose (40 g). RESULTS: Faecal ethanol was detected at least once in 60/65 patients (74/98 measurements, maximum 3.50 g*L-1), more often (98.0%, P < 0.001) in 51 patients with gamma-glutamyl-transpeptidase above 38 IU/L. Eating rice increased the faecal ethanol concentration in 5 patients, 2 of whom had measurable ethanolemia (0.20 and 0.47 g*L-1). Ileo-caecal ethanol concentration following local fructose instillation was 11.8 g*L-1. CONCLUSION: Endogenous gastrointestinal ethanol production contributes to elevated gamma-glutamyl-transpeptidase activity observed during malabsorption syndromes.

Adult↗
PubMed1990

The prevalence of symptoms in medical outpatients and the adequacy of therapy.

Common symptoms account for substantial patient disability and health services utilization. To determine the prevalence of 15 symptoms and the adequacy of therapy, 500 medical outpatients were surveyed. The 410 respondents indicated which symptoms were "major problems" and what therapy, if any, had been helpful. Each symptom was present in at least 10% of patients, with the most prevalent symptoms being fatigue (33%) and back pain (32%). Patients were clustered into three groups: (1) 140 were asymptomatic or monosymptomatic, (2) 135 reported 2 or 3 symptoms, and (3) 135 had 4 or more symptoms. The majority (77%) of these symptoms had been previously reported to a physician. Whereas 80% of patients with pain syndromes and gastrointestinal complaints had obtained some therapeutic benefit, only 39% of the individuals with fatigue, dyspnea, dizziness, insomnia, sexual dysfunction, depression, and anxiety reported any relief. Better therapy is needed for these common outpatient complaints.

Adult↗
PubMed1999

Oropharyngeal dysfunction and gastroesophageal dysmotility are present in girls and women with Rett syndrome.

BACKGROUND: Feeding impairment frequently complicates the course of children with neurologic disorders and places them at risk for malnutrition and growth failure. Although feeding abnormalities have been reported in female patients with Rett syndrome, the mechanisms that account for these findings have not been elucidated fully. This study was designed to characterize the clinical features of oropharyngeal and gastroesophageal dysfunction and their impact on the dietary intake and nutritional status of female subjects with Rett syndrome. METHODS: The clinical features of oropharyngeal and gastroesophageal dysfunction in 13 female patients with Rett syndrome, (age range, 3.7 to 25.7 years) were characterized by an oral feeding assessment, swallowing function study, and upper gastrointestinal series. Growth, nutritional status, and body composition were determined by stadiometry and anthropometry. Dietary intakes were determined from 3-day food records. RESULTS: Oropharyngeal dysfunction and gastroesophageal dysmotility were present in 100% and 69%, respectively, of the study patients with Rett syndrome. The scope and severity of these abnormalities were apparent only by videofluoroscopy. Abnormalities of oropharyngeal function included poor tongue mobility, reduced oropharyngeal clearance, and laryngeal penetration of liquids and solid food during swallowing. Esophageal dysmotility included absent primary or secondary waves, delayed emptying, atony, the presence of tertiary waves, spasm, and gastroesophageal reflux. Gastric dysmotility included diminished peristalsis or atony. Lower dietary energy intakes were associated with persistence of residue in the valleculae and pyriform sinuses and less body fat. CONCLUSION: The prevalence of oropharyngeal dysfunction and gastroesophageal dysmotility warrants early diagnostic evaluation and intervention strategies to improve the nutritional status of girls and women with RS.

Adolescent↗
PubMed2004

IBS: a syndrome or many diseases?

Patients with irritable bowel syndrome (IBS) are characterized by a broad spectrum of gastrointestinal (GI) symptoms. These IBS-symptoms and symptoms of other functional GI disorders frequently overlap. Moreover, at least in patients with severe disease manifestations there is a remarkable psychiatric comorbidity. There is a number of abnormalities of GI functions including sensory and motor dysfunction that are believed to play a role for the manifestation of symptoms in patients with these functional gastrointestinal disorders (FGID). Family studies provide strong evidence for a clustering of FGID in families. Furthermore, twin studies clearly demonstrate an increased concordance in monocygotic compared to dicygotic twins. This points towards the role of one or more hereditary factors. Considering sensory and motor function as well as the psychiatric comorbidity, polymorphisms of adrenergic, opioidergic or serotonergic receptors as well as G-protein beta3 (GNB3) subunit gene polymorphism and polymorphisms of 5-HT transporter genes are suitable mechanisms for these abnormalities. Hence acute GI infections with a mucosal inflammation appear to trigger a cascade of events that ultimately results in the manifestation of FGID, it is reasonable to assume that functionally relevant polymorphisms of genes with immunmodulating and/or neuromodulating features (OPRM1, IL-4, IL-4R, TNFalpha) play a role. It has emerged that a number of various factors may contribute to the manifestation of functional GI disorders. The currently symptom based labels for functional GI disorders may be helpful to categorize patients and target therapy. However, various underlying pathophysiologies may cause similar symptom patterns. Thus, it is reasonable to anticipate that IBS will be dissected accordingly and our disease concepts will accept the irritable bowel syndrome as the clinical manifestation of a number of different disorders.

Gastrointestinal Diseases↗