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At least 1,045 records · Page 58Linked to original sources
PubMed1999

Intestinal flora translocation and overgrowth in upper gastrointestinal tract induced by hepatic failure.

AIM:To explore the relationship between endoinfection caused by intestinal flora translocation and multiple organ dysfunction in hepatic failure.METHODS:By using the quantitative bacteria culture, bacteria colony was counted in GI tract, bile duct and mesenteric lymphonodus in rat hepatic failure model.RESULTS:Intestinal flora migrated up to the upper GI tract and overgrew in stomach and jejunum in rats with hepatic failure.The number of bacteria colonies in the specimens of stomach, jejunum and ileum were 4.7X10(4)/mL, 2.1X10(5)/mL, 5.5X10(6)/mL in experiment group and 4.6X10(2)/mL, 6.1X10(1)/mL, 2.4X10(3)/mL in control group respectively (P < 0.05 ). Bacteria in bile duct and mesenteric lymphonodus of hepatic failure rats were also cultured. Extensive damages of gastrointestinal mucosa caused by bacterial overgrowth were observed.CONCLUSION:Intestinal flora translocation and overgrowth in stomach and jejunum formed an endoinfectious source and caused obvious pathological injury of gastrointestinal mucosa, which play a very important role in developing abdominal distension, toxic intestinal expansion, alimentary tract haemorrhage and endotoxemia in patients with hepatic failure.

Journal Article↗
PubMed2001

Neurotoxicity of mercury sulfide in the vestibular ocular reflex system of guinea pigs.

A traditional Chinese mineral medicine, cinnabar, naturally occurring mercuric sulfide (HgS), is still occasionally prescribed, but the neurotoxic effects of HgS have not been elucidated. In this paper, an animal model of the purified HgS intoxication was established in guinea pigs in order to study neurotoxicity and pathophysiology of the vestibular ocular reflex system (VOR). Guinea pigs were dosed with HgS by gastric gavage (0.01, 0.1 and 1.0 g/kg per day) for 7 consecutive days. By means of caloric testing coupled with the electronystagmographic (ENG) recording in guinea pigs, we have found that HgS at a dose of 0.1 g/kg induced reversible caloric hypofunction pattern and at a higher dose of 1.0 g/kg induced irreversible hypofunction of caloric test. Monitoring the mercury contents of various tissues (blood, kidney, liver and cerebellum) by continuous flow and cold vapor atomic absorption spectrometry (AAS) revealed that a certain amount of HgS could be absorbed from the gastrointestinal tract and was detectable in these tissues. In addition to the induced dysfunction of VOR system, HgS also caused disturbance of motor performance in guinea pigs. In enzyme assay, Na+/K+-ATPase activity of cerebellum was also significantly inhibited by HgS. Morphological studies showed partial cell loss only in the cerebellar Purkinje cell layer, but not in the granule cell layer, nor in the vestibular labyrinth. All of these findings suggest that cerebellar Purkinje cells are the sensitive target site responsible for HgS-inducing dysfunctions of both VOR system and the motor performance in guinea pigs. Thus, it is concluded that caloric test coupled with ENG recording in VOR system is certainly a sensitive biomarker for monitoring the neurotoxicity of HgS.

Analysis of Variance↗
PubMed2003

[Haematemesis and dysphagia in a 20-year-old woman with congenital spine malformation and situs inversus partialis].

A 20-year-old woman with a four-week history of dysphagia, weight loss of four kilograms and unspecific abdominal pain was admitted because of sudden haematemesis. The physical examination showed a patient with a prominent kyphoskoliosis. The patient reported of having a situs inversus abdominalis and a tethered cord syndrome. Bladder function disorders were present since childhood. Upper endoscopy demonstrated a 4 cm large, exophytically growing necrotic tumour of the oesophagus. The CT scan showed a space occupying tumour of the oesophagus and metastases in a size of 1.5 cm in both lungs. Further imaging revealed a UICC-Stadium IVB (T2NxMIb ). Histology of the tumour biopsies showed a poor differentiated squamous cell carcinoma. Staging after the 6 th dose cisplatin (100 mg/m2/die) and 5-fluorouracil (5 x 1000 mg/m2/die) showed a mild reduction of the tumour and the metastases. The patient died ten months later of multiorgan failure after severe progress of tumour and metastatic growth. The manifestation of squamous cell carcinoma of the oesophagus is unusual in people at the age of twenty. Genetic and chromosomal analysis of the patient gave no evidence for a hereditary disorder. Drug history revealed that the patient had been treated with the alpha-receptor blocking drug phenoxybenzamine over at least 12 years for bladder dysfunction. Animal experiments of rats with exposition of phenoxybenzamine over 24 months produced gastrointestinal malignomas. By the German admission board phenoxybenzamine is only recommended for short term therapy. It seems to be likely that even in humans phenoxybenzamine acts as a mutagenic substance and should be carefully used in long-term treatment.

Adrenergic alpha-Antagonists↗
PubMed1997

A comparison of low molecular weight heparin and low dose unfractionated heparin prophylaxis in subacute myelopathy.

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are common life threatening complications of acute myelopathy. Prophylaxis with low dose unfractionated heparin (LDUH) has been the standard of care. Studies suggest that low molecular weight heparin (LMWH) has superior efficacy, but advantages may be offset by higher expense. Since LMWH (enoxaparin sodium) became available, standard practice at our institution has been to treat all inpatients with myelopathy with LMWH. To examine the impact of this practice, all inpatients diagnosed with myelopathy and treated with LMWH were sequentially matched by diagnosis and compared in a retrospective review with inpatients treated with LDUH. In each group, 11 patients had traumatic injury, four had transverse myelitis, four had neoplasms and five had spinal stenosis. Characteristics of the LMWH/LDUH groups were: mean age--48.5/50.4; spinal level--cervical 13/7, thoracic 9/12, lumbar 2/5; American Spinal Injury Association impairment scale-A, 8/9; B, 2/2; C, 8/5; D, 6/8. There were five DVTs and two PEs in five patients taking LDUH; there were no cases of DVT or of PE in the LMWH group (p = 0.04, two-tailed chi-square test). Isolated DVTs occurred in two patients with traumatic injuries and in one patient with transverse myelitis; PE + DVT occurred in one patient with a primary and one patient with a metastatic tumor. All developed within 3.5 months of the onset of spinal dysfunction. One patient with a traumatic injury on ibuprofen and dexamethasone had a gastrointestinal hemorrhage while receiving LMWH. The cost of administration of LMWH was $24,499 compared with $5,700 for LDUH. The LDUH group spent a total of 57 days in an acute care facility, costing $57,000.00 and patients treated with LMWH spent nine days, costing $9,000.00. We conclude that treatment with LMWH was associated with a significant decrease in incidence of DVT/PE and an overall decline in health care costs of approximately $30,000 or approximately $1,250 per patient.

Acute Disease↗
PubMed2000

New insights into neural injury, repair, and adaptation in visceral afferents and the enteric nervous system.

In this brief review, we focus on some of the proposed mechanisms of injury in peripheral visceral afferents (sensory) pathways and the enteric nervous system, including the interstitial cells of Cajal. Injury involving afferent neurons is discussed because of the relevance of these neurons to the pathophysiology of pain syndromes. The effect of various noxious stimuli on sensory and enteric neural function is examined. Finally, we discuss recent data on the role of autoimmune antibodies in neuronal injury in systemic diseases, such as diabetes mellitus and the Lambert-Eaton myasthenic syndrome. Neither central nervous system manifestations of peripheral nerve injury nor functional bowel disorders are addressed in this review. An improved understanding of the pathophysiology of peripheral neuronal dysfunction will probably result in new treatment strategies for a broad range of gastrointestinal disorders, including constipation, pseudo-obstruction, ileus, and inflammatory bowel disorders.

Journal Article↗
PubMed2001

The gastrointestinal tract in critical illness.

The gut has often been suggested to be one of the essential factors in the pathogenesis of many nosocomial infections and possibly multi-organ failure. In the light of several recent studies, the importance of normal gut bacterial flora and the role of the gastrointestinal tract in human immune function are now better understood. It now seems clear that stimulation of gut-associated lymphoid tissue through enteral feeding is the key to the preservation of mucosal-derived immunity; however, the role of this native gastrointestinal immune function in the subsequent development of sepsis and multi-organ dysfunction syndrome remains the subject of ongoing study.

Critical Illness↗
PubMed2001

The selective serotonin reuptake inhibitor sertraline: its profile and use in psychiatric disorders.

The naphthylamine derivative sertraline is a potent and selective inhibitor of serotonin reuptake into presynaptic terminals. Sertraline has a linear pharmacokinetic profile and a half-life of about 26 h. Its major metabolite, desmethylsertraline does not appear to inhibit serotonin reuptake. Sertraline mildly inhibits the CYP2D6 isoform of the cytochrome P450 system but has little effect on CYP1A2, CYP3A3/4, CYP2C9, or CYP2C19. It is, however, highly protein bound and may alter blood levels of other highly protein bound agents. Sertraline is a widely used serotonin reuptake inhibitor that has been shown to have both antidepressant and antianxiety effects. Many clinical trials have demonstrated its efficacy in depression compared with both placebo and other antidepressant drugs. Its efficacy has also been demonstrated in randomized, controlled trials of patients with obsessive-compulsive disorder, panic disorder, social phobia, and premenstrual dysphoric disorder. In short-term, open-label studies it has appeared efficacious and tolerable in children and adolescents and in the elderly, and data are positive for its use in pregnant or lactating women. Typical side effects include gastrointestinal and central nervous system effects as well as treatment-emergent sexual dysfunction; withdrawal reactions may be associated with abrupt discontinuation of the agent. The safety profile of sertraline in overdose is very favorable. Sertraline's efficacy for both mood and anxiety disorders, relatively weak effect on the cytochrome P450 system, and tolerability profile and safety in overdose are factors that contribute to make it a first-line agent for treatment in both primary and tertiary care settings.

Aging↗
PubMed1999

Multiple presentation of mitochondrial disorders.

The aim of this study was to assess the heterogeneous clinical presentations of children with mitochondrial disorders evaluated at a metabolic neurogenetic clinic. The charts of 36 children with highly suspected mitochondrial disorders were reviewed. Thirty one children were diagnosed as having a mitochondrial disorder, based on a suggestive clinical presentation and at least one of the accepted laboratory criteria; however, in five children with no laboratory criteria the diagnosis remained probable. All of the patients had nervous system involvement. Twenty seven patients also had dysfunction of other systems: sensory organs in 15 patients, cardiovascular system in five, gastrointestinal system in 20, urinary system in four, haematopoietic system in four, and endocrine system in nine. The clinical presentation was compatible with an established syndrome in only 15 children. Severe lactic acidosis or ragged red muscle fibres were encountered in very few patients. These results suggest that mitochondrial disorders should be evaluated in children presenting with a complex neurological picture or multisystem involvement.

Adolescent↗
PubMed2004

Infantile hyperinsulinism associated with enteropathy, deafness and renal tubulopathy: clinical manifestations of a syndrome caused by a contiguous gene deletion located on chromosome 11p.

We describe the clinical features of a new syndrome causing hyperinsulinism in infancy (HI), severe enteropathy, profound sensorineural deafness, and renal tubulopathy in three children born to two pairs of consanguineous parents. This combination of clinical features is explained by a 122-kb contiguous gene deletion on the short arm of chromosome 11. It deletes 22 of the 39 exons of the gene coding for the SUR1 component of the KATP channel on the pancreatic beta-cell thereby causing severe HI. It also deletes all but two of the 28 exons of the USH1C gene, which causes Usher syndrome and is important for the normal development and function of the ear and the eye, the gastrointestinal tract, and the kidney, thereby accounting for the symptoms of deafness, vestibular dysfunction and retinal dystrophy seen in type 1 Usher syndrome, diarrhoea, malabsorption, and tubulopathy. This contiguous gene deletion provides important insights into the normal development of several body organ systems.

Child, Preschool↗
PubMed2004

Paroxetine in panic disorder: clinical management and long-term follow-up.

Panic disorder is one of the most common anxiety disorders and has a lifetime prevalence of 3-5%. Panic attacks can begin at any age, but commonly have their onset in early adulthood between the ages of 20 and 40 years. Naturalistic data has shown that panic disorder has a chronic and relapsing course. Panic disorder is reported to be associated with an increased risk of suicidal behavior and comorbid psychiatric diagnoses such as depression and substance abuse. Currently, recommended treatment modalities for panic disorder include the use of antidepressant pharmacotherapy and/or cognitive behavioral therapy. Paroxetine is unique among the selective serotonin reuptake inhibitors since, in addition to its effect on the CNS serotonergic neurotransmission, it also has mild noradrenergic properties demonstrated to be effective in the treatment of anxiety disorders and depression. Paroxetine treatment has the potential to cause weight gain and sexual dysfunction, primarily anorgasmia and ejaculatory dysfunction for the long term. In the short-term, treatment causes nausea, gastrointestinal disturbances, irritability, headaches and eating and sleeping difficulties. Paroxetine is an example of an selective serotonin reuptake inhibitor agent, which has been well studied in the treatment of panic disorder and is efficacious and well-tolerated. Paroxetine pharmacotherapy has been recommended to be continued for 1 year as specified in the treatment guidelines set by the American Psychiatric Association in the treatment of panic disorder.

Clinical Trials as Topic↗
PubMed2006

Vacuolar hepatopathy in dogs: 336 cases (1993-2005).

OBJECTIVE: To determine disorders associated with vacuolar hepatopathy (VH), morphologic hepatic and clinicopathologic abnormalities, and affiliation with steroidogenic hormone excess in dogs. DESIGN: Retrospective case series. Animals-336 dogs with histologically confirmed moderate or severe VH. PROCEDURES: Information on signalment, results of diagnostic testing, definitive diagnoses, and exposure to glucocorticoids (ie, exogenous glucocorticoid administration or high endogenous concentrations of steroidogenic hormones) was obtained from medical records. Dogs were grouped by underlying disorder, glucocorticoid exposure, acinar zonal distribution of lesions, and histologic severity. RESULTS: 12 disease groups (neoplastic, acquired hepatobiliary, neurologic, immune-mediated, gastrointestinal tract, renal, infectious, cardiac disease, diabetes mellitus, portosystemic vascular anomaly, adrenal gland dysfunction, and miscellaneous disorders) were identified. There were 186 (55%) dogs with and 150 (45%) dogs without evidence of glucocorticoid exposure. Acinar zonal distribution of hepatic vacuolation and clinicopathologic values did not differ between dogs with and without evidence of glucocorticoid exposure. However, a 3-fold increased likelihood of severe VH was associated with steroidogenic hormone exposure. Of 226 dogs with high serum alkaline phosphatase activity, 102 (45%) had no evidence of glucocorticoid exposure. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that neoplasia and congenital or acquired hepatobiliary disease are common in dogs with VH and provide support for the suggestion that VH, high alkaline phosphatase activity, and illness-invoked physiologic stress may be associated. Histologic confirmation of VH should initiate a diagnostic search for a primary disease if glucocorticoid treatment and hyperadrenocorticism are ruled out.

Alkaline Phosphatase↗
PubMedDate not supplied

Digestive tract involvement with exudative enteropathy in Langerhans cell histiocytosis.

Protein-losing enteropathy was observed in two children with Langerhans' cell histiocytosis (LCH). One patient was an infant with congenital cutaneous lesions; the second child had sigmoid and lymph node infiltration. Electron microscopy and immunohistochemistry confirmed, in both, infiltration of duodenum, skin, and liver by LCH. Gastrointestinal involvement by LCH seldom produces prominent clinical manifestations but indicates widespread multisystem disease. Immunohistochemical and/or ultrastructural features allow definitive diagnosis from mucosal biopsy specimens. Review of the literature of gastrointestinal infiltration by LCH emphasizes its poor prognosis, especially when associated with organ dysfunction.

Female↗
PubMed1991

Taiwan National Poison Center survey of glyphosate--surfactant herbicide ingestions.

Between January, 1986 and September, 1988, the Taiwan National Poison Center recorded 97 telephone consultations (49 male, 48 female) on cases of ingestion of glyphosate-surfactant herbicide concentrate containing the isopropylamine salt of glyphosate (N-phosphonomethyl glycine, CAS 1071-83-6) and a non-ionic tallow amine surfactant. Eleven of the cases resulted in fatalities, all among those attempting suicide. The average amount ingested by survivors was 120 +/- 112 mL and by nonsurvivors was 263 +/- 100 mL (p less than or equal to 0.0001). The average age of survivors was 35 +/- 15 years compared to 54 +/- 11 years for fatalities (p less than or equal to 0.0002). Irritation of the oral mucous membrane and gastrointestinal tract was the most frequently reported effect. Other effects recorded were pulmonary dysfunction, oliguria, metabolic acidosis, hypotension, leukocytosis and fever. Fourteen patients received either atropine or pralidoxime plus atropine despite the fact that glyphosate does not inhibit acetylcholinesterase. Thirteen percent of patients received a urine test for paraquat or treatment customarily used for paraquat ingestion, possibly reflecting similar initial presentations following ingestion of these two herbicides. Laboratory differentiation is essential if any doubt exists about which herbicide was ingested. Patients ingesting large volumes of concentrated glyphosate-surfactant herbicide formulations require close observation and supportive treatment.

Accidents↗
PubMedDate not supplied

Bacterial cholecystitis with cardiac and pulmonary dissemination in a blue-naped mousebird (Urocolius macrourus).

A blue-naped mousebird (Urocolius macrourus) was diagnosed by gross necropsy and histopathology as having a chronic, fibrosing bacterial cholecystitis. Acute, severe, necrotizing pneumonia and myocarditis also were present with intralesional gram-negative bacteria. The bacteria within the lungs and heart were suspected to have spread from the biliary tract because of the pattern of distribution and similar gram-staining characteristics. Enterobacter sp. and Escherichia coli were cultured from the pulmonary lesions. Cloacal cultures in clinically normal blue-naped mousebirds and speckled mousebirds (Colius striatus) yielded both Enterobacter sp. and E. coli. We hypothesize a pathogenesis in this bird consisting of biliary stasis of unknown etiology and eventual infection of the biliary tract by the normal gram-negative gastrointestinal flora. Death was believed to be a result of cardiac and respiratory dysfunction secondary to the bacterial dissemination from the biliary tree and endotoxemia.

Animals↗
PubMed1993

Cardiovascular and thrombosis pathology associated with cocaine use.

After decades of focus on the effects of cocaine abuse on the central nervous system (CNS), the cardiovascular toxicity of cocaine is just beginning to be appreciated. The most common cardiovascular pathologies associated with cocaine use include: cardiomyopathy, left ventricular dysfunction, myocarditis, arrhythmia, hypertension, myocardial infarction, stroke, arterial thrombosis, deep vein thrombosis, and gastrointestinal, renal, and skeletal muscle ischemia. This article reviews the above pathologies with speculations on the mechanisms by which cocaine produces cardiovascular tissue damage.

Animals↗
PubMed2006

Bladder dysfunction in patients with cauda equina lesions.

AIMS: Data on lower urinary tract (LUT) function obtained in larger, systematically studied populations of patients with cauda equina lesions are limited. We report urinary function in 65 patients with chronic lesions. METHODS: A urinary function questionnaire was used, and neurological examination, quantitative electromyography (EMG) of the external anal sphincter (EAS) muscles, EMG assessment of the sacral reflex, and conventional urodynamic measurements were performed. RESULTS: Severe LUT dysfunction was found in 14%/15%, moderate in 27%/46%, and mild in 46%/39% men/women. Urinary symptoms interfered with daily life in 88%/92% and sexual life in 72%/67% of sexually active men/women. Symptoms of disturbed bladder emptying were the most common (95%/92% men/women), followed by urinary incontinence (56%/71%) and symptoms of overactive bladder (40%/56%). Perianal sensation was abnormal in 96%, EMG of the EAS muscle in 88%, and sacral reflex in 84% of patients. In 40%/17% men/women, a postvoid residual (>100 ml) was found. On filling cystometry overactive bladder was found in 21%/0%, reduced detrusor capacity in 9%/15%, and during voiding phase an acontractile detrusor or detrusor underactivity were found in 59%/85% men/women. Using multiple linear regression analysis, perianal sensory loss (P=0.0001) and female gender (P<0.02) had a significant positive effect on urinary incontinence score. CONCLUSIONS: Our study demonstrated significant LUT dysfunction, which disturbed the life of the majority of patients with chronic lesions of the cauda equina. Due to poor correlation between patients' symptoms and urodynamic findings cystometric surveillance is proposed in all patients with significant cauda equina lesions.

Adult↗