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Results for “gastrointestinal dysfunction”

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PubMed1980

Toxicologic evaluation of streptozotocin (NSC 85998) in mice, dogs and monkeys.

Single intravenous doses of CDF1 mice, and single and five daily intravenous treatment schedules in beagle dogs and rhesus monkeys were used to evaluate the toxicity of Streptozotocin (SZN). The major target organs in the three species were liver, kidney, lymphoid tissue and pancreatic islet beta cells. Moderate bone marrow depression and gastrointestinal toxicity were observed in the large animal species after lethal doses. Monkeys were less sensitive than the dog to the hepatotoxic effects of SZN and clinical signs of liver dysfunction were more severe in dogs after multiple doses. Microscopic lesions in the renal proximal convoluted tubules were present in the three species; these lesions appeared to be irreversible for dogs. The toxic effect on the endocrine pancreas was manifest by hyperglycemia, glucosuria, islet atrophy and beta cell degranulation. Multiple dose regimens were less toxic than single doses in dogs and monkeys in terms of the total dose received.

Animals↗

PubMed1993

Massive oral ingestion of elemental mercury.

A 42 year old male, while repairing a sphygmomanometer, intentionally ingested an estimated 3 kg (220 mL) of metallic mercury. During admission, only tremor, irritability, forgetfulness and fatigue were noted. There were no obvious gastrointestinal or hepatic complications. Blood and urine mercury levels were significantly elevated. Most of the metallic mercury was cleared from the gut within 10 days. A few months later, hepatic dysfunction with jaundice developed. Serial investigations did not suggest a viral etiology or alcoholism. Liver function tests and blood and urine mercury levels returned to normal over the next 10 months. The observation suggests that massive and prolonged retention of metallic mercury may facilitate the conversion of metallic, elemental mercury to divalent mercury and its subsequent absorption with development of hepatic dysfunction.

Administration, Oral↗

PubMed1999

An autopsy report of graft-versus-host disease (GVHD) following blood transfusion.

A case of graft-versus-host disease (GVHD) associated with blood transfusion in a 71-year-old man is reported. The patient received transfusions (irradiation red cells M.A.P 14 units, fresh frozen plasma 11 units) and developed features of GVHD including fever, a skin rash, diarrhea, liver dysfunction, hypoplastic bone marrow, and pancytopenia. He died on day 32 posttransfusion. Pathologically, lymphocyte infiltration of skin and liver lesions, degeneration of small bile ducts, crypt cell necrosis in the gastrointestinal tract, and bone marrow hypoplasia were observed. Immunohistochemically, infiltrating lymphocytes were CD8+ T type, the result suggesting that they role a part in posttransfusion GVHD.

Aged↗

PubMed2000

Undernutrition and function: another piece in the jigsaw [commet].

The stomach, small intestine and pancreas share in the progressive bodily dysfunction associated with undernutrition and weight loss. All these changes are reversed by nutritional support whether given enterally or parenterally, emphasizing that parenteral and enteral nutrition are the treatment of gastrointestinal failure as dialysis is of renal failure or ventilation is of respiratory failure. The observations described by Winter and colleagues have important implications for our understanding of the relationship between nutrition and physiology. They also have important implications for the care of patients with gastrointestinal disease.

Cachexia↗

PubMed2005

[Surgical treatment of metastatic spinal tumors by anterial approach].

OBJECTIVE: To investigate the efficacy of surgical treatment of the patients with metastatic spinal tumors by anterial decompression and stabilization. METHODS: From December 1997 to December 2003, 93 patients (40 women and 53 men) with metastatic spinal tumors were treated in our department. The locations of the tumor included, thoracic vertebra (53 cases), lumbar vertebra (33 cases), and cervical region (7 cases). The original tumors included lung cancer (21 cases), renal cancer (13 cases), prostate cancer (8 cases), hepatic cancer (5 cases), breast cancer (13 cases), thyroid cancer (5 cases), gastrointestinal tumor (3 cases), and multiple myeloma (8 cases). However, no primary tumor was found in the rest of 17 cases. Among 54 of 93 patients who presented with neurological dysfunction, 16 patients completely paralyzed and others incompletely paralyzed. The follow-up time ranged from 10 to 72 months. RESULTS: Pain was relieved in 87 of 93 patients (93.5%) and neurological function was improved in 47 of the 54 patients. Among 16 completely paralyzed patients, 7 patients experienced a neurological function improvement (from Frankel grade A or B to C or D after decompression). The average amount of blood transfused was 3000 ml. No severe complications were seen in our series. The one-year survival rate was 85% (79 cases). CONCLUSIONS: The integrity of the spinal column structure and neurological function should be considered firstly in the treatment of spinal metastasis. Thorough resection of metastatic tumor and stable internal fixation by anterior approach should be performed when single or two vertebra are involved. In order to alleviate paralysis, promote spinal stability, and improve the quality of life, urgent decompression should be performed on patient with spinal metastasis.

Breast Neoplasms↗

PubMed1984

Intolerance to administered lipids in tumor-bearing animals.

Cancer cachexia is a poorly understood phenomenon that contributes to patient intolerance of operations, radiation, and chemotherapy. Reversal of this dysmetabolic state has been attempted by administration of carbohydrates, proteins, and lipids, with little demonstrated clinical benefit. Identification of elevated serum triglycerides (TG) in two tumor-bearing (TB) animal models and recently reported in humans with cancer may be a part of this dysfunctional state. Because lipids makeup energy repletion in patients receiving TPN, the question of how exogenous lipids affect these TB animals needed to be resolved. Intralipid administered by intravenous or gastrointestinal routes raised serum levels in TB animals to greater than 600 mg/dl, even when their baseline TG levels were comparable to nontumor-bearing control animals. The addition of glucose concomitantly with Intralipid failed to prevent TG levels from rising abruptly. Increased lipolytic activity in TB sera was demonstrated and that was not due solely to hypoglycemia or hypoinsulinemia. Administration of lipids to TB animals results in excessively high serum TG levels that appear to be due, in part, to the demonstrated lipolytic activity in TB animal sera.

Animals↗

PubMed1980

Absence of nafcillin-associated nephritis. A prospective analysis of 210 patients.

In a prospective study of 210 consecutively seen patients receiving nafcillin, no patient's therapy was discontinued because of clinically manifested or suspected nephritis. Administration of nafcillin was discontinued because of an adverse reaction in only two patients, one with a rash and one with neutropenia. In seven of the ten patients in whom renal dysfunction developed during treatment, renal function improved while the patients continued to receive nafcillin. In the remaining three patients, renal failure was attributed to other factors including rhabdomyolysis and myoglobinuria, gastrointestinal hemorrhage and hypotension, and what appeared to be aminoglycoside toxicity. No renal biopsy studies were done because none were clinically indicated. Although the results of this study do not rule out the possibility that nafcillin may induce nephritis, if it does occur it appears in such a mild form-manifested solely as urinary sediment abnormalities-or so infrequently that it was not detected in this group of patients. In four patients, leukopenia could not be explained on any basis other than nafcillin administration.

Adolescent↗

PubMed1994

[Radioisotope study of esophageal transit].

Diagnostics relating to esophageal motility disorders has come into the focus of attention in recent years. A review is made of the possibilities of application of radioisotope esophageal transit measurement. The methods employed and the models of data recording and processing in this field are listed. The value of this procedure in different esophageal disorders is discussed in detail. Two characteristic cases are reported to illustrate the method. It is concluded that measurement of the radionuclide esophageal transit is a noninvasive, simple and safe technique for the screening of esophageal motility dysfunction.

Esophageal Motility Disorders↗

PubMed1991

Bacterial translocation induces procoagulant activity in tissue macrophages. A potential mechanism for end-organ dysfunction.

The ability of bacterial translocation to induce cell-associated procoagulant activity was examined in a rodent model. Intestinal decontamination with streptomycin sulfate and bacitracin followed by oral feeding with a streptomycin-resistant strain of Escherichia coli produced monoassociation of the gastrointestinal tract with this microorganism. Using this model, the rate of bacterial translocation at day 3 increased from 6% (1 of 17) to 90% (28 of 31). Cell-associated procoagulant activity was measured in the mononuclear cell population of mesenteric lymph nodes as well as portal and systemic blood and also in hepatic nonparenchymal cells. In monoassociated animals, the procoagulant activity of mesenteric lymph node mononuclear cells was significantly greater than in control animals at day 3 (210% +/- 28% vs 100% +/- 6%) but not at days 1 or 6. Procoagulant activity of hepatic nonparenchymal cells was elevated in monoassociated animals at days 3 and 6 compared with control animals. Both control and monoassociated animals remained well throughout the experiment. The histologic features of the gastrointestinal tract, mesenteric nodes, and liver did not differ between groups. These studies provide evidence that bacterial translocation, in the absence of external stimuli, is able to induce cell activation at sites remote from the gastrointestinal tract and may therefore contribute to the pathogenesis of multiple organ failure.

Animals↗

PubMed1998

Revving the motor of multiple organ dysfunction syndrome. Gut dysfunction in ARDS and multiorgan failure.

Despite its initial description as primarily a pulmonary disorder, the acute respiratory distress syndrome (ARDS) has been recognized as one component of a systemic disorder associated with microvascular permeability and widespread organ involvement that often afflicts the gastrointestinal tract. Although a healthy gut is an important defense for the body, its unique vascular anatomy and its predisposition toward ischemia and mucosal hypoxia put the gastrointestinal tract at high risk of injury during the course of the systemic inflammatory response syndrome. Once the mucosa is damaged and host defenses break down translocation of bacteria and bacterial toxins is likely to contribute to the inflammation associated with sepsis and ARDS. Gastric tonometry offers a potentially useful mechanism to monitor regional perfusion and oxidative metabolism in the splanchnic vascular bed. Many studies have shown that tonometry can assist the clinician on prognostic assessment of patients. Several studies also have demonstrated improved patient outcome when therapies aimed to protect the GI tract are aggressively pursued with tonometric guidance.

Carbon Dioxide↗

PubMed1998

Gastrointestinal complications of chronic granulomatous disease: case report and literature review.

Chronic granulomatous disease (CGD), an inherited disorder of phagocytic leukocyte function, is characterized by recurrent infections with catalase-positive organisms. Gastrointestinal (GI) tract involvement, present in the majority of affected individuals, may be present initially and recurrently, mimics other entities such as inflammatory bowel disease, and causes substantive morbidity and mortality. Disorders of motility, ulceration, obstruction, and infection (e.g., abscesses) occur from the mouth to the anus and stereotypically manifest with vomiting, diarrhea, abdominal pain, weight loss, and fever. Careful physical examination, in concert with appropriate diagnostic studies, is necessary to delineate intraabdominal pathologic processes. Abdominal radiographs, ultrasonography, computerized tomography, and endoscopy are useful ancillary diagnostic procedures. Drainage of accessible abscesses, antimicrobial therapy based on organisms cultured from blood and tissue, and interferon gamma may lead to suppression or eradication of infections and resolution of symptoms. Corticosteroids are useful for gastric outlet obstruction and sulfasalazine and cyclosporine for large bowel disease. Gallbladder dysfunction may be ameliorated, as in our patient, with administration of cholestyramine.

Child, Preschool↗

PubMed1997

Ruptured visceral artery aneurysms.

Visceral artery aneurysms are uncommon lesions that are rarely identified in the absence of symptoms. Between February 1972 and April 1992, nine patients (5 men and 4 women) with rupture of visceral artery aneurysms were treated. The average age was 62 years old (range 39 to 86 years old). The arteries involved were the splenic (4), the common hepatic (2), the left hepatic (1), the celiac (1), and the superior mesenteric (SMA) (1). No ruptured renal artery aneurysm was identified. Six patients presented with abdominal distension, pain, and hemodynamic instability. Three patients had recurrent gastrointestinal bleeding with erosion into the duodenum, the common bile duct or the pancreatic duct. All three had unnecessary gastrointestinal operations despite preoperative (2 patients) or intraoperative (1 patient) identification of a visceral artery aneurysm. One patient with an SMA aneurysm had ligation and bypass. Three patients with splenic artery aneurysms had splenectomy. The remaining five patients had either ligation or resection without arterial reconstruction. No end-organ dysfunction was identified. There was one death (11%) due to the SMA aneurysm. Pathological findings in four patients were cystic medial necrosis, diffuse deficiency of the internal elastic lamina, fibromuscular dysplasia, and atherosclerosis, respectively. The remainder were thought to be due to atherosclerosis on gross examination. Rupture of visceral artery aneurysms occurs infrequently and can be treated by simple ligation in most cases. Recognition that rupture of splanchnic arterial aneurysms into adjacent viscera can cause recurrent gastrointestinal bleeding may prevent both substantial delays in diagnosis and inappropriate therapy.

Aged↗

PubMed1999

Sensory and autonomic neuropathy in patients with idiopathic slow-transit constipation.

BACKGROUND: Slow-transit constipation (STC) is a severe disorder of unknown aetiology, which may result from an autonomic or sensory neuropathy. This study aimed to investigate patients with STC for the presence of neural dysfunction, and relate the findings to other factors, including any familial associations. METHODS: Thirty-three patients with STC were studied using standard neurophysiological tests and a range of quantitative sensory and autonomic tests. The findings were compared with those of 20 matched control subjects and nine diabetic patients with gastrointestinal symptoms. RESULTS: Twenty of the 33 patients with STC gave a family history of constipation, including an affected identical twin and Hirschsprung's disease (n = 3). None had abnormalities on neurological examination or nerve conduction studies. Fifteen of the 33 patients had abnormalities on quantitative tests, including all six who required a colectomy. Eleven patients with STC had reduced axon-reflex sweating in the presence of normal sweat gland responses (P < 0.001, all patients with STC versus controls). Twelve patients with STC had small sensory fibre dysfunction, with significantly increased thermal thresholds (cool, P < 0.05; warm, P < 0.01); these included six of nine patients with STC and rectal hyposensation. There were similar findings on quantitative testing in diabetic patients. CONCLUSION: Quantitative tests in patients with STC provide evidence of a small fibre neuropathy. The high incidence of a positive family history, particularly a possible association with Hirschsprung's disease, suggests a genetic basis, which deserves further investigation.

Adolescent↗

PubMed1995

Manipulation of substrate utilization with somatostatin in patients with secondary multiple organ dysfunction syndrome.

OBJECTIVES: To determine whether glucose utilization and metabolic substrate (glucose and fat) oxidation could be manipulated in patients with secondary multiple organ dysfunction syndrome. DESIGN: Prospective study. SETTING: Intensive care units (ICU) of two university hospitals. PATIENTS: Eight adults free of hepatic disease and hemodynamically stable at the time of study, but with failed respiratory and gastrointestinal systems, who thus required mechanical ventilation and intravenous nutrition. INTERVENTIONS: Patients were infused with 20% dextrose through central venous cannulas at rates that increased and maintained (clamped) their plasma glucose concentration at 216 mg/dL (12 mmol/L) for 3 hrs. Somatostatin was infused continuously during the second and third hours of the clamp to reduce plasma concentrations of endogenous insulin and glucagon. Exogenous insulin was administered together with somatostatin during the third hour to restore basal insulin concentrations. Energy expenditure was measured by indirect calorimetry throughout the study and blood samples were withdrawn regularly for determination of metabolite and hormone concentrations. Main statistical comparisons were made between the baseline data (first hour of the study) and data collected during the second and third hours of the clamp. MEASUREMENTS AND MAIN RESULTS: Plasma glucagon concentrations were reduced by nearly 50% (p < .05) toward the end of the study, whereas no significant changes in plasma concentrations of cortisol or growth hormone occurred. Energy expenditure did not change significantly at any time during the clamp procedure. Glucose utilization (6.1 mg/kg/min [34 mumol/kg/min]) during the first hour of the hyperglycemic clamp, decreased by 53% (p < .05) with the infusion of somatostatin during the second hour of the clamp. However, once exogenous insulin was infused during the third hour, glucose utilization increased by 55% (p < .05) when compared with the baseline (hour 1) rate. Glucose oxidation was nearly doubled during the third hour of the study when compared with oxidation rates during the first and second hours. Fat oxidation decreased steadily during the 3-hr clamp. CONCLUSIONS: Glucagon has a significant inhibitory effect on glucose utilization during intravenous glucose infusion in the multiple organ dysfunction syndrome patient. Pharmacologic intervention with somatostatin and insulin (physiologic dose) can facilitate glucose utilization and oxidation in these patients. Further investigations are needed to determine whether long-term alteration of glucose and fat metabolism would be beneficial in the patient with secondary multiple organ dysfunction syndrome.

Aged↗

PubMedDate not supplied

Serum carcinoembryonic antigen in the differential diagnosis of pancreatic cancer: influence of tumour spread, liver impairment, and age.

In order to verify the role of CEA in the differential diagnosis of pancreatic cancer and to evaluate some influencing factors like age, tumor spread and liver dysfunction, this antigen was measured in the sera of 60 control subjects, 45 patients with pancreatic cancer, 37 with chronic pancreatitis, 67 with benign, and 28 with malignant extra-pancreatic diseases. CEA was found to be elevated in 23/45 pancreatic cancers, in 8/37 chronic pancreatitis, in 17/67 benign and in 9/28 malignant extra-pancreatic diseases. Significant correlations were documented between CEA and age in all the subjects; between CEA and immunoglobulins G in liver cirrhosis and between CEA and alkaline phosphatase in gastrointestinal extra-pancreatic malignancies. In pancreatic cancer higher CEA levels were detected in patients with metastases. We can conclude that CEA is of limited value in the differential diagnosis of pancreatic cancer; it does not seem to be able to detect early pancreatic tumors. Age and liver dysfunction may contribute towards elevating this marker in serum.

Adult↗

PubMed1990

Depression increases mortality and morbidity in acute life-threatening medical illness.

The presence of depression in consecutive admissions with life-threatening illness was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS). The 211 patients had one of four conditions, myocardial infarction (N = 100), subarachnoid haemorrhage (N = 41), pulmonary embolism (N = 40), and acute upper gastrointestinal haemorrhage (N = 30). Depression was measured using both the standard MADRS, and a modified version excluding somatic items which might be influenced by the underlying illness. The patients were also assessed for severity of illness and cognitive dysfunction. The results showed that immediately following a life-threatening illness approximately 34% of the patients were depressed, using the modified scale, but that the depressed group did not have a more severe physical illness. However, the depressed patients had a significantly poorer outcome over the 28 days following admission, with 47% of the depressed patients dying or having life-threatening complications, as opposed to 10% of the non-depressed group. This study demonstrates that the psychological state of an individual can affect their individual risk of mortality following physical illness.

Aged↗

PubMed2002

[Irritable bowel syndrome--a multifactorial disease in children and adults].

Irritable bowel syndrome is the most frequent gastrointestinal disorder in Norway. Though there has been huge research activity in the field, no proven single aetiology or effective treatment has emerged. Consensus-based clinical diagnostic criteria have not yet brought diagnostic clarity. Possibly, there are dysfunctions in the processing of sensory stimuli in the "brain-gut" axis that may cause visceral hypersensitivity and secondary motility changes. In some patients, a multifactorial explanation of the mechanisms is useful, including stressful life events or other psychological factors. Psychiatric co-morbidity is probably the most important maintaining factor. Irritable bowel syndrome may serve as a model for the study of the interaction between biological, psychological and social factors in functional disorders. A good therapeutic relationship between the physician and the patient is an important element in the treatment approach.

Adult↗

PubMed2000

[Gastrointestinal surgery and gastroenterology. VII. Proximal motility disorders in the digestive tract].

Dysphagia and chest pain are the two commonest symptoms of abnormalities of oesophageal motility. Dysphagia is to be distinguished into high or oropharyngeal and low or oesophageal dysphagia. Oropharyngeal dysphagia pertains to dysfunction of the pars cricopharyngea of the M. constrictor pharyngis inferior (M. cricopharyngeus), which is frequently associated with a Zenker diverticulum. Treatment consists of endoscopical or surgical myotomy and diverticulectomy. In achalasia there is incomplete relaxation of the lower esophageal sphincter with aperistalsis. The main treatment modalities are endoscopic pneumodilation and surgical myotomy of this sphincter. In dysphagia or non-cardiac chest pain spastic or hypocontractile abnormalities of the oesophageal motility can be involved, these are often difficult to treat. Disorders of gastric motility are mainly gastroparesis and functional dyspepsia. In diabetic gastroparesis, adequate monitoring of the blood sugar level is also necessary. New insights into the pathophysiology of functional dyspepsia concern abnormal visceral sensitivity and reduced adaptive relaxation of the stomach during intake of food.

Chest Pain↗