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PubMed1995

Octreotide-associated biliary tract dysfunction and gallstone formation: pathophysiology and management.

Octreotide exerts a wide range of biological actions, many of which have important clinical applications, notably in treatment of acromegaly, gastroenteropancreatic endocrine tumors, and secretory diarrhea. In most patients, octreotide is well tolerated. Side effects are primarily gastrointestinal and are usually transient. Short term (< or = 1 month) octreotide therapy appears to pose minimal risk of gallstone formation, but the risk may increase with longer treatment periods. Chronic octreotide administration may increase the incidence of small, cholesterol gallstones that are typically asymptomatic. The mechanism of octreotide-associated gallstone formation is not delineated but may involve inhibition of gallbladder emptying, hepatic bile secretion, and sphincter of Oddi motility, as well as modification of bile composition. Gallbladder stasis may sequentially lead to increased bile concentration, precipitation of cholesterol and calcium salts, retention of biliary precipitates, and maturation of gallstones. Octreotide-associated gallstones are usually asymptomatic and do not require surgical or medical therapy. Some physicians advocate periodic gallbladder ultrasound evaluations, but, in most cases, the results would not influence management of asymptomatic patients. Symptomatic gallstones may require surgery or nonsurgical treatments after an appropriate work-up. Gallstone prevention strategies (e.g., bile acid or nonsteroidal anti-inflammatory drug therapy) during long term octreotide therapy are under investigation. Currently, clinicians may want to consider noninvasive strategies to reduce gallstone incidence, such as timing octreotide injections in relation to meals or periodic cessation of octreotide treatment. Octreotide is a valuable therapeutic option in managing a variety of hypersecretory states associated with high morbidity and mortality (e.g., acromegaly, carcinoid syndrome, and VIP-secreting tumors), so the benefits of long term octreotide therapy (such as increased quality of life) outweigh the risk of asymptomatic gallstone formation in many patients.

Bile↗
PubMed1999

Rheumatologic manifestations of gastrointestinal disorders.

There are many different rheumatic symptoms of gastrointestinal (GI) disorders and a whole range of GI symptoms that occur in rheumatologic disorders. Spondyloarthropathies (SpA) are closely related to the GI tract. Bacterial DNA has been detected in peripheral but not the sacroiliac joints of patients, including enterobacteria; the significance of this finding is not clear yet because antibiotic therapy seems not to be effective. The synovial lymphocyte proliferation of reactive arthritis (ReA) patients to the 60-kD heat-shock protein of Yersinia plays a major role in the immune response. Anti-Klebsiella antibodies are associated with gut lesions in SpA; their significance for the pathogenesis of SpA remains uncertain. ReA patients seem to have an impaired TH1-cytokine response, which might contribute to disease persistence. HLA B27-positive subjects seem to have a low tumor necrosis factor-alpha secretor status, possibly leading to diminished immune responses against certain microbes. In patients with Whipple's disease, Tropheryma whippelii can be cultured from gut biopsy specimens when interleukin-4 is added. The gene for hemochromatosis has been identified. Hepatitis C virus DNA can be found in many patients with cryoglobulinemia. Treatment with interferon-alpha might help in some patients. Effective treatment for primary biliary cirrhosis with ursodeoxycholic acid is not helpful for rheumatic symptoms. The severity of esophageal dysfunction in systemic sclerosis does not correlate with symptoms. GI symptoms do, although not frequently, occur in vasculitides.

Bacterial Infections↗
PubMed2001

[Clinical evaluation of effects and improvement in quality of life from palliative therapy of combination chemotherapy with Furtulon and consecutive low-dose cisplatin in cases of unresectable advanced gastrointestinal carcinoma].

Combination chemotherapy of Furtulon/low-dose cisplatin (CDDP) was administered to 13 patients with unresectable advanced gastrointestinal carcinoma (including 4 cases of gastric cancer, 6 of colorectal cancer, 1 of pancreatic cancer, 1 of hepatic cancer, and 1 of esophageal cancer). All patients were unresectable due to poor performance status (PS > 3) or metastasis. They were treated with Furtulon 1,200 mg/day orally on days 1-10 followed by 4 drug-free days, every 2 weeks, and CDDP 3.5 mg/m2/day, on days 1-5 by i.v. followed by 2 drug-free days every 4 weeks repeatedly. An average of 2-3 cycles were used. Six out of 13 patients had a partial response, 5 had no change, and 2 had progressive disease. The response rate was 46% and median survival time was 320 days. After chemotherapy, there was an increase in appetite and body weight in 11 patients (85%), and the patients maintained a good performance status and quality of life. Moreover no renal dysfunction occurred after treatment with CDDP. There was no high-grade toxicity over grade 2, only slight nausea, vomiting and diarrhea. From the present study, combination chemotherapy of Furtulon/low-dose CDDP seems to be effective for patients with advanced gastrointestinal cancer, and to have improved their quality of life (QOL).

Adult↗
PubMed2005

Bioadhesive dosage forms for esophageal drug delivery.

The esophagus as a site for drug delivery has been much overlooked in comparison to the remainder of the gastrointestinal tract. The low permeability and transient nature of the esophagus means that it is unsuitable for delivery of drugs for systemic action. However, esophageal disorders including fungal infection, cancers, motility dysfunction, and damage due to gastric reflux may be treated using locally acting agents that offer benefits of reduced dosage and decreased side effects. Bioadhesive dosage forms that adhere to the esophageal mucosa and prolong contact have been investigated to improve the efficacy of locally acting agents. The rationale for local esophageal drug delivery and its limitations, the factors that determine adhesion to this organ, and the experimental models used in esophageal drug delivery research are reviewed.

Adhesives↗
PubMed2005

Prokinetic activity of an aqueous extract from dried immature fruit of Poncirus trifoliata (L.) Raf.

Aqueous extracts from dried immature fruit of Poncirus trifoliata Raf. (Rutaceae) (PF-W) are used as a traditional Korean folk medicine for the treatment of digestive dysfunction. In the present study, PF-W exhibited no significant toxicity even at a dose of 5 g/kg when orally administered to mice. The effect of PF-W on gastrointestinal (GI) motor function was investigated by examining its effect on the serum concentration of orally administered ranitidine, a putative indicator of GI motility, in human subjects. The area under the serum concentration-time curve and the peak serum concentration of ranitidine following an oral administration (300 mg/individual) were decreased by one half as the result of a predose (10 g/individual) of PF-W, except for the time to reach peak serum concentration and the serum half-life at the terminal phase of ranitidine. In rat studies, PF-W had no effect on the apparent permeability of ranitidine across the jejunum or the gastric emptying rate (GER) of phenol red. However, the transit time for charcoal in the intestine was significantly increased by the PF-W pretreatment. The above results are consistent with the hypothesis that PF-W has a unique prokinetic activity, which accelerates the transit of intestinal contents, but has no effect on the GER.

Animals↗
PubMed1984

Acquired immune deficiency syndrome: postmortem findings.

The autopsies of 13 male homosexuals with acquired immune deficiency syndrome (AIDS) were reviewed. All patients had laboratory evidence of cellular immune dysfunction. The most common diagnoses made were disseminated cytomegalovirus infection in 12 patients and Kaposi's sarcoma in 10. All patients infected with cytomegalovirus had pulmonary compromise. The adrenal glands and gastrointestinal tract also were involved often by cytomegalovirus. Cytomegalovirus infection of organs uncommonly affected such as heart, meninges, cerebrum, and peripheral nerves was documented in two patients. Skin most frequently was involved by Kaposi's sarcoma, followed by gastrointestinal tract and lymph nodes. Two patients had visceral and/or nodal Kaposi's sarcoma with no skin compromise. Other important diagnoses were Pneumocystis carinii pneumonia, cryptosporidiosis, fungal infections, toxoplasmosis, and brain lymphoma. The cause of death was due to one or more infections in most patients. Kaposi's sarcoma did not contribute substantially to the cause of death, except in one patient with massive multifocal and multiorgan involvement.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Intravenous methotrexate for primary central nervous system non-Hodgkin's lymphoma in AIDS.

OBJECTIVE: To evaluate high-dose intravenous methotrexate in primary central nervous system (CNS) lymphoma in HIV-infected patients. DESIGN: An uncontrolled pilot trial. SETTING: An infectious diseases department in Paris, France. PATIENTS: All consecutive AIDS patients with primary CNS lymphoma attending the same unit from August 1994 to March 1996. INTERVENTIONS: Methotrexate was intravenously administered at a dose of 3 g/m2 every 14 days with leucovorin rescue. A maximum of six cycles was planned. Steroids were given to all patients and haematological growth factors were administered as required. MAIN OUTCOME MEASURES: Rate of response, time to response and survival. RESULTS: Fifteen patients (10 with histological documentation) were recruited. The median time since clinical onset was 27 days (range, 7-69 days), median Karnofsky score was 51 (range, 30-70), and mean CD4+ cell count was 30 +/- 19 x 10(6)/l (range, 7-69 x 10(6)/l). Complete responses, defined as clinical improvement and disappearance of contrast-enhancing brain abnormalities on computed tomography or magnetic resonance imaging, were obtained in seven out of 15 patients (three out of 10 patients with histological diagnosis and four out of five patients without histological confirmation). The Karnofsky score of these seven patients improved to 80 +/- 10 (range, 70-100). The mean time taken to respond was 62 +/- 20 days (range, 45-90 days). One patient relapsed at 6 months. Six patients failed to respond, and two died of severe sepsis on days 15 and 45. The median survival time was 290 days (range, 11-570 days): 73 days (range, 11-570 days) in the 10 patients with histological diagnosis, and 347 days (range, 286-409 days) in the five patients without histological confirmation. Side-effects occurred in 10 patients, with gastrointestinal disorders in five, mucositis and skin rash in two, and fever in three patients; however, these events were mild and did not require cycle postponement or dose changes. No cognitive dysfunction occurred. CONCLUSION: Methotrexate appears to be an attractive alternative to radiation therapy for primary CNS lymphoma and is associated with a far greater improvement in quality of life relative to historical series of radiation therapy.

Adult↗
PubMed1996

A method to produce sedation in critically ill patients.

OBJECTIVE: To evaluate a protocol based on continuous infusion of a benzodiazepine and morphine to produce apnea/decreased respiratory effort as an adjunct to complex mechanical ventilation in patients with respiratory failure. DESIGN: Observational report of consecutive patients. SETTING: University medical intensive care unit. PATIENTS: Seventeen consecutive patients with acute respiratory failure requiring high levels of sedation and/or paralysis to facilitate mechanical ventilation were studied. INTERVENTIONS: Patients were started on a continuous infusion of a benzodiazepine and morphine soon after mechanical ventilation was instituted. The dosages of the benzodiazepine and morphine were increased to the end point of diminished respiratory effort or apnea depending on the clinical status of the patient and ventilatory mode. This regimen was supplemented with single doses of neuromuscular blocking agents (NMBAs) only as the dosages of benzodiazepine/narcotic were being titrated. The benzodiazepine/narcotic agents were then gradually reduced as the patient's condition improved, often using an oral route of administration. MEASUREMENTS AND RESULTS: The benzodiazepine/morphine combination produced apnea and diminished respiratory effort in patients requiring sedation from 2 to 50 days, including those with hemodynamic instability, hepatic dysfunction, renal dysfunction, and sepsis. The combination allowed the use of NMBAs to be minimized. There was no evidence of worsened hemodynamic instability as a result of the administration of these agents. The gastrointestinal tract could be used for nutrition in 8 of the 17 patients. CONCLUSIONS: Continuous infusion of a benzodiazepine and morphine controlled the respiratory rate in patients with severe respiratory failure requiring complex mechanical ventilatory support.

APACHE↗
PubMed2001

Conditions associated with canine hypothyroidism.

Careful review of the literature regarding clinical signs caused by hypothyroidism in dogs has shown that some assumptions regarding the relation of hypothyroidism to other conditions are based on anecdotal evidence. Cutaneous manifestations are present in most hypothyroid dogs, but the specific abnormalities and breed variations remain to be clearly defined. Decreased metabolic rate manifested by obesity and lethargy is also common. Neurologic manifestations, although uncommon, clearly occur in hypothyroid dogs. Cardiac abnormalities seem to be common, but their clinical significance is questionable. The only consistent hematologic abnormality that occurs in hypothyroid dogs is anemia; evidence for acquired von Willebrand's disease or other bleeding disorders is negligible. Reproductive dysfunction secondary to hypothyroidism is unlikely to occur in male dogs, and there is no evidence to support abnormalities in female dogs. The relation of megaesophagus, laryngeal paralysis, ocular abnormalities, and gastrointestinal disorders with hypothyroidism remains to be established. Future research into canine hypothyroidism may serve to convert dogma into a more clear understanding of the manifestations and pathophysiologic findings of this common endocrinopathy.

Anemia↗
PubMed2003

Oral symptoms associated with fibromyalgia syndrome.

OBJECTIVE: Studies have described oral problems associated with fibromyalgia syndrome (FM), including sicca, oral ulcerations, and orofacial pain. We evaluated the prevalence and profile of various oral symptoms in a population of patients diagnosed with FM. METHODS: Subjects diagnosed with FM by American College of Rheumatology criteria (n = 67; all women, mean age +/- SEM 47.6 +/- 2.3 yrs) were enrolled in the study after meeting strict exclusion criteria (i.e., oral mucosal conditions, Sjögren's syndrome, anemia, inflammatory bowel syndrome or other gastrointestinal disturbances, and other disorders that may manifest oral symptoms). Subjective oral evaluations were carried out for each subject, including oral pain (Melzack scale) for glossodynia, throbbing, aching, etc.; temporomandibular joint dysfunction (TMD); xerostomia (including intake of fluids, functional problems, etc.); dysphagia; dysgeusia; and information about frequent oral ulcerations or lesions. Psychological tests included Beck Depression Scale (BDS) and Spielberger Anxiety Scale (SAS) were administered. RESULTS: The results indicated a significant prevalence in some subjects' oral symptoms, compared to age and sex matched control data (mean +/- SEM) for xerostomia 70.9% vs 5.7% (p < 0.001); glossodynia 32.8% vs 1.1% (p < 0.001); TMD 67.6% vs 20% (p < 0.01); dysphagia 37.3% vs 0.4% (p < 0.001); dysgeusia 34.2% vs 1.0% (p < 0.001). Other findings were not significantly different from controls: oral ulcerations/lesions 5.1% vs 4.4% (NS); BDS 34% vs 30% (NS); SAS 21% vs 19% (NS). The average visual analog scale (100 mm) for burning pain was 53.0 +/- 5.6 (p < 0.001). Anxiety and depression scores were no different in the FM subjects compared to controls with chronic pain conditions. CONCLUSION: These data indicate that patients with FM have significantly increased prevalence of xerostomia, glossodynia, dysphagia, dysgeusia, and TMD compared to controls, with no significant difference in clinical oral lesions or psychological status.

Dysgeusia↗
PubMed1995

[A comparative study of tazobactam/piperacillin and piperacillin in chronic respiratory tract infections].

The efficacy, safety and usefulness were evaluated for a combined antibiotic tazobactam/piperacillin (TAZ/PIPC) consisting of a new beta-lactamase inhibitor, tazobactam (TAZ), and a broad spectrum penicillin antibiotic, piperacillin (PIPC), in chronic respiratory tract infections with PIPC as the control in a multi-institutional comparative study. The drugs used were a preparation containing 0.5 g of TAZ and 2.0 g of PIPC per vial (TAZ/PIPC group) and a preparation containing 2.0 g of (PIPC group). The drugs were intravenously injected one vial at a time twice a day for 14 days as a rule. The following results were obtained: 1. Clinical effect There was no significant difference between TAZ/PIPC (86% or 76/88) and PIPC (81% or 69/85). 2. Bacteriological effect There was no significant difference between TAZ/PIPC (93% or 42/45) and PIPC (88% or 36/41) in terms of bacterial eradication rates. In 34 patients with beta-lactamase-producing pyogenic bacteria, there was no significant difference between TAZ/PIPC (77% or 10/13) and PIPC (88% or 15/17). 3. Degrees of improvement in clinical symptoms, signs and laboratory findings The TAZ/PIPC group was likely to show reductions in fever and the amount of sputum soon after administration. 4. Side effects Incidences of side effects were 7% (7/96) in the TAZ/PIPC group and 3% (3/89) in the PIPC group, showing no significant difference between the two groups. The main symptoms were allergic reaction and gastrointestinal symptoms. 5. Abnormal clinical laboratory test values The incidence was 17% (15/89) in the TAZ/PIPC group and 21% (18/87) in the PIPC group. The main symptoms were eosinophilia and hepatic dysfunction, and most of these symptoms were mild. 6. Usefulness The usefulness rates in the TAZ/PIPC group were 80% (71/89) and 78% (66/85) in the PIPC group, showing no significant difference. Thus, TAZ/PIPC exhibited excellent clinical effects and presented no troubles with safety. When comprehensively evaluated, TAZ/PIPC appears to be a very useful drug for the treatment of chronic respiratory tract infections.

Adult↗
PubMed1994

The role of septic complications in aortic aneurysm surgery.

Out of 229 patients operated due to abdominal aortic aneurysms, 51 (22.3%) had prolonged (> 120 hours) postoperative intensive care stay. The mortality rate in this group was 27% representing 46% of the total mortality. Twenty-five of these 51 patients had postoperative septic complications, meaning positive blood cultures. Clinically wound infections (11), acalculous cholecystitis (9), urinary tract infections (9), septicemia (6), and diffuse peritonitis or abdominal abscess were found (4). Reoperations, time for ventilatory support, incidence of renal failure and dialysis, gastrointestinal complications and mortality were all frequent in patients with septic postoperative complications as compared to those with non-septic complications, the latter mainly of cardiovascular origin. Signs of organ dysfunction should raise a suspicion of a septic complication and prompt insertion of diagnostic procedures and therapeutic interventions are necessary in order to minimize morbidity and mortality.

Abdominal Abscess↗
PubMed1999

Quality of life in arthritis patients using nonsteroidal anti-inflammatory drugs.

Arthritis is a painful and disabling condition. To suppress the pain and the inflammatory process, patients are often chronic nonsteroidal anti-inflammatory drug (NSAID) users. Chronic use of NSAIDs may induce peptic ulcer, dyspeptic problems and heartburn. Therefore, these patients are often provided with treatment to relieve and/or protect against gastrointestinal problems. Rheumatic disorders also affect a range of health-related quality of life domains. In one study, patients with NSAID-associated gastroduodenal lesions complained about lack of energy, sleep disturbances, emotional distress and social isolation in addition to pain and mobility limitations. The degree of distress and dysfunction differed markedly from scores in an unselected population. Clinical trial data suggest that acid-suppressing therapy with omeprazole is superior to therapy with misoprostol and ranitidine in healing gastroduodenal lesions and preventing abdominal pain, heartburn and indigestion symptoms during continued NSAID treatment. Because arthritic patients are severely incapacitated by their condition regarding most aspects of health-related quality of life, it is important to offer a treatment that is effective in healing and preventing NSAID-induced ulcers and gastrointestinal symptoms during continued NSAID treatment without further compromising the patients' quality of life. Treatment with omeprazole once daily has been shown to be superior to that with ranitidine and misoprostol in this respect.

Aged↗
PubMed2006

Fatal case of amiodarone-induced acute respiratory distress syndrome in a patient with severe left ventricular dysfunction due to extensive anterior acute myocardial infarction.

We here report a case of 71-year-old man with acute extensive anterior myocardial infarction, who was complicated with ventricular tachycardia (VT) even after successful percutaneous coronary intervention. As intravenous administration of nifekalant terminated VT, we started oral administration of amiodarone (day 1). We gave 400 mg of amiodarone a day for the first week and 200 mg a day from the second week. The patient was stable with normoxia by day 20, in spite of pulmonary congestion-like infiltrates on chest X-ray. On day 21, he was complicated with acute respiratory distress syndrome. Immediate discontinuance of amiodarone and high-dose pulse glucocorticoid therapy with intubation slightly improved the infiltrations on chest X-ray. However, glucocorticoid therapy induced hyperglycemia with an increase in plasma osmolality, complicated with hypoalbuminemia, and gastrointestinal bleeding. Despite treatment with a large amount of saline, high-doses of catecholamines, and blood transfusion, the patient died on day 28. It is sometimes difficult to diagnose congestive heart failure or amiodarone-induced pulmonary infiltrates in patients with severe left ventricular dysfunction.

Aged↗
PubMed1991

Gastrointestinal symptoms in Parkinson's disease.

We have investigated the prevalence of gastrointestinal (GI) symptoms in 98 individuals with Parkinson's disease (PD) and in a control group of 50. Seventy-nine of those with PD were being treated with dopaminergic medications and 19 were untreated. Those symptoms occurring more frequently in PD patients than in controls included abnormal salivation, dysphagia, nausea, constipation, and defecatory dysfunction. Except for defecatory dysfunction, symptoms did not correlate with treatment but instead correlated with disease severity. This suggests that the GI symptoms of PD reflect direct involvement in the GI tract by the primary disease process.

Aged↗
PubMed2000

Evaluation of gastric motility by Fourier analysis of condensed images.

In this study Fourier analysis was applied to condensed images of gastric emptying with the aim of evaluating the amplitude and frequency of gastric contractions as well as gastric emptying in patients with various well-defined disorders. In 15 controls, 65 patients with progressive systemic sclerosis (PSS), 41 patients with diabetes mellitus type I (DM), 12 patients with pyloric stenosis and 9 patients who had undergone gastric surgery, gastric emptying was determined after ingestion of a semi-solid test meal. In addition, condensed images were generated to evaluate the amplitude and frequency of gastric contractions by means of Fourier analysis. In PSS and DM patients, gastric emptying and contraction amplitudes were significantly reduced (P<0.01). Patients with pyloric stenosis displayed regular peristalsis but significantly delayed emptying (P<0.01). Patients who had undergone gastric surgery showed normal or rapid gastric emptying associated with decreased amplitudes (P<0.01). The frequency of gastric contractions in the patient groups was not different from that in controls. This study showed Fourier analysis of condensed images to be a rapid and feasible approach for the evaluation of gastric contractions. Depending on the underlying disorder, gastric emptying and peristalsis showed both corresponding and discrepant findings. Data on gastric contractions provided additional information compared with results obtained by conventional emptying studies. Therefore, both parameters should be routinely assessed to further improve characterisation of gastric dysfunction by scintigraphy.

Adult↗