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At least 1,675 records · Page 93Linked to original sources
PubMed2006

Proton pump inhibitors reduce gallbladder function.

BACKGROUND: In the authors' previous study of gallbladder function before and after fundoplication, 58% of the patients demonstrated preoperative gallbladder motor dysfunction, and 86% of those retested after operation and cessation of proton pump inhibitors (PPIs) normalized. Because no study has directly assessed the impact of antisecretory agents on gallbladder function, this study measured gallbladder ejection fraction (GBEF) in healthy volunteers before and after initiation of PPIs. METHODS: A total of 19 subjects completed the study, which included baseline determination of GBEF by cholecystokinin-stimulated hepatobiliary acid scan, 30 days of antisecretory therapy with omeprazole (40 mg daily), and repeat GBEF on day 30. Subjects were surveyed regarding compliance and symptoms. RESULTS: For 15 of 19 subjects, PPI therapy was associated with reduced gallbladder motility. Evolution of symptoms consistent with a biliary etiology was reported by 26.7% of these subjects. CONCLUSIONS: Short-term PPI therapy reduces gallbladder motility in healthy volunteers. Chronic PPI therapy may pose a risk for long-term gallbladder dysfunction and biliary complications.

Adult↗
PubMed1996

Autonomic neuropathy, I. Clinical features, investigation, pathophysiology, and treatment.

Autonomic dysfunction is a common complication of peripheral neuropathies. It is often of little clinical importance, but some conditions may cause profound disturbance of autonomic function, including postural hypotension, impotence and impairment of heart rate and bladder and bowel control. Autonomic function can be evaluated by a number of investigations, some of which can be performed in a neurophysiology laboratory. Diseases that primarily affect small nerve fibres or cause acute demyelination of small myelinated fibres are most likely to cause autonomic dysfunction. Management includes treating the underlying cause and symptomatic therapy.

Autonomic Nervous System Diseases↗
PubMed2001

Function of the eustachian tube after weekly exposure to pepsin/hydrochloric acid.

OBJECTIVE: To determine the effects of repeated pepsin/hydrochloric acid (HCl) exposure on the eustachian tube (ET). STUDY DESIGN AND SETTING: ET function was studied in 22 rats. Group I (control) rats received transtympanic phosphate buffered saline solution; groups II (0.5 mg/ml) and III (2.0 mg/ml) received transtympanic pepsin/HCl. Test solutions were applied on day 0 with ET function evaluated on days 1, 2, 3, and 7 after exposure. Each 7-day period represents 1 cycle; all groups underwent 4 cycles. ET function was evaluated using passive opening and closing pressure, and active clearance of positive and negative pressure tests. RESULTS: Rats exposed to pepsin/HCl had elevated passive opening pressures and a decreased ability to clear positive and negative pressure. A temporal relationship exists. CONCLUSION: The results suggest middle ear exposure to pepsin/HCl leads to ET dysfunction in rats, and that this dysfunction is enhanced with repeated exposures. SIGNIFICANCE: Gastroesophageal reflux may induce ET dysfunction.

Animals↗
PubMed1989

Placebo-controlled trial of terlipressin (glypressin) in the management of acute variceal bleeding.

In a double-blind trial 60% of acute variceal bleeding episodes were controlled with terlipressin (glypressin) compared with 37% in patients given placebo (NS). Rebleeding was more common in the placebo group so that at 5 days bleeding remained under control in 54% of patients treated with terlipressin compared with only 19% after placebo therapy (p less than 0.025). Blood transfusion requirements were similar in the two groups. Terlipressin appeared to be the most effective in those patients with severe hepatic dysfunction.

Acute Disease↗
PubMed1980

Normal patterns of human upper small bowel motor activity recorded by prolonged radiotelemetry.

In order to characterise human interdigestive cyclical motor activity, and its interruption by food, jejunal pressure changes in healthy volunteers were recorded continuously for 24 hours, using an ingested pressure-sensitive radiotelemetry capsule tethered at the duodenojejunal flexure. In 20 studies, the subjects fasted throughout; in another 20 studies they received a single standard meal. Using this technique, fasting motor complexes were easily detected. There was considerable variation in interdigestive cycle duration and in the interruption caused by food. The data were not normally distributed. The study indicates that any descriptions of 'atypical' jejunal motility patterns must take into account the wide variations seen in health, before they can be regarded as representing dysfunction or disease.

Adult↗
PubMed1992

[Primary prevention of varicose bleeding: current status].

1. Surgical shunts should be abandoned for prevention of the first bleeding because of an increased mortality rate, despite a marked reduction in frequency of bleeding. 2. Sclerotherapy is not recommended for clinical practice in preventing the first bleeding. The meta-analysis of numerous randomized clinical trials shows a small effect on bleeding risk and mortality rate. But these effects are remarkably heterogenous in various studies and are compensated by the complications of sclerotherapy. 3. Prophylactic treatment with beta-blockers has similar results as sclerotherapy documented by meta-analysis of several studies. In contrast to sclerotherapy both risk and side effects are minimal. More controlled clinical trials are needed to define subgroups of patients with higher benefit of the prophylaxis. In individual high-risk patients (size of varices, liver dysfunction, red-colour-signs) beta-blocker prophylaxis may have possible benefit.

Adrenergic beta-Antagonists↗
PubMed1992

[Intestinal transit studied with radiopaque markers in patients with multiple sclerosis].

The patients affected with multiple sclerosis (MS) often complain of constipation. This symptom is little tolerated by the patient; its etiology is still unknown. MS patients often have their movements impaired by disease progress, so that they have to sit down for a long time, or else they exhibit severe problems walking or moving. MS patients also present low intraabdominal pressure during voluntary contraction of abdominal wall muscles. In these patients, the authors suggest to study intestinal transit time by means of radiopaque markers. To this purpose, the radiological follow-up contributes to the setting of colorectal MS dysfunctions by daily controls of the progress of per os radiopaque markers, focusing on colonic transit time and temporary deposit areas. The results show high incidence of anorectal constipation. Thus, the examination can be considered a useful tool in the study of MS dysfunctions and an effective alternative to anorectal manometry.

Colon↗
PubMed1989

[Pancreatic exocrine secretion and plasma gut hormones response after intraduodenal infusion of elemental diet in patients with chronic pancreatitis].

We studied the responses of pancreatic polypeptide (PP) and cholecystokinin (CCK) using specific RIAs, and simultaneously exocrine pancreatic secretion and gall bladder contraction were checked by using triple lumen tube to intraduodenal ingestion of 100 Kcal/hr semi-digested liquid meal: Clinimeal (Eisai, Tokyo) or Elemental Diet: ED (Morishita, Osaka) in 10 patients with chronic pancreatitis (CP). Intraduodenal infusion of Clinimeal did not result in a significant physiological rise of CCK and PP from the basal values. Pancreatic secretions (volume and bicarbonate output) were slightly increased paralleled to the gall bladder contraction in chronic pancreatitis. On the other hand, intraduodenal ED can significantly stimulate the release of CCK from the small intestine and PP from the pancreas with the near range of physiological concentration. This level of CCK can evoke a significant increase in pancreatic secretion and gall bladder contraction. These results suggest that in CP the physiological regulation was disturbed and pancreatic secretion was not observed after ordinary meal ingestion. Infusion of ED which contained similar components of digestive product partially improved the responses of gut hormones and pancreatic secretion. Therefore, impaired gut hormone release in CP primarily is due to the inappropriate stimuli because of pancreatic exocrine dysfunction, and not other factors(s).

Cholecystokinin↗
PubMed1984

Tuberculosis of the large bowel. Report of two cases.

Two patients with primary tuberculosis of the ileocecal region and transverse colon were thought to be Crohn's disease or carcinoma of the colon. No pathognomonic symptoms or roentgenographic findings were present, and the diagnosis was made on the basis of histopathological features including the presence of alcohol/acid fast bacilli. In one case human tubercle bacilli were cultured. The involved bowel segments were resected and the patients received antituberculous chemotherapy postoperatively. Although tuberculosis of the colon is very rare it should however be considered in cases of vague bowel dysfunction.

Adult↗
PubMed1988

Gastrointestinal and colonic segmental transit time evaluated by a single abdominal x-ray in healthy subjects and constipated patients.

Gastrointestinal transit time (GITT) and segmental colonic transit times were studied in 56 healthy subjects by repeated daily ingestion of 10 radiopaque markers followed by abdominal x-ray. A seven-day procedure including marker intake for 6 days and a single radiograph on day 7 was found to be a simple method to differentiate between rapid, normal and prolonged transit. Addition of 20 distinguishable markers on day 6 helped to describe transit profiles. Healthy women had longer GITT than men (median 2.4 and 1.9 days, respectively) measured as mean 50% excretion time for the ingested doses of markers. For comparisons with patients percentiles for transit were calculated. In constipated patients the 7-day method demonstrated prolonged GITT as well as transit dysfunction in separate colonic segments. The method seems convenient for clinical use in diagnostic as well as therapeutic studies of colonic transit.

Adult↗
PubMed2000

Phase II evaluation of a high-dose mitoxantrone based induction regimen in untreated adults with acute myeloid leukemia.

To evaluate a regimen including high-dose mitoxantrone in previously untreated adults with AML, 45 patients aged 21-59 (median 41) were given cytarabine, 3 g/m2 days 1-5, mitoxantrone, 80 mg/m2 day 2 and etoposide, 150 mg/m2 days 1,3,5. Post-remission therapy consisted of 5 cycles combining the same agents at reduced doses. Complete remission was seen in 36 patients. The observed 3-year survival is 28%. Cytogenetic pattern and CD34 expression correlated with response and survival. Significant toxicity included myelosuppression, mucositis, diarrhea and hyperbilirubinemia. Ventricular ejection fraction was generally reduced, with clinical cardiac dysfunction in only 2 patients. This high-dose mitoxantrone combination can be administered to young adults with AML with tolerable toxicity and results comparable to those of other dose-intensive regimens.

Actuarial Analysis↗
PubMed2004

Donepezil and vitamin E for preventing cognitive dysfunction in small cell lung cancer patients: preliminary results and suggestions for future study designs.

BACKGROUND: Up to 90% of small cell lung cancer (SCLC) patients suffer cognitive dysfunction. Since donepezil and vitamin E have been somewhat successful in treating other dementias, this study tested the hypothesis that these agents can prevent cognitive decline in SCLC patients. Because accrual was poor, this trial also offered opportunities for suggesting other study designs for future clinical trials on cognitive dysfunction in this group of patients. METHODS: This double blind, placebo controlled trial tested oral donepezil 5 mg/day (with dose escalation to 10 mg after 1 month) and oral vitamin E 1,000 IU/day in SCLC patients after completion of all cancer therapy, including prophylactic cranial irradiation (PCI). Cognition, adverse events, and quality of life were assessed throughout the study period. RESULTS: Only nine of 104 patients enrolled over 15 months (four donepezil and vitamin E-treated versus five placebo-exposed), and thus no definitive conclusions could be drawn. Nonetheless, the only patient who manifested a precipitous decline in cognition was taking donepezil and vitamin E. There was also a slight trend of increased gastrointestinal side effects among donepezil and vitamin E-treated patients. There were no notable differences in cognitive stability, adverse events, or quality of life between treatment arms. CONCLUSION: These preliminary findings do not provide enthusiasm for testing donepezil and vitamin E in the manner undertaken here for preventing cognitive dysfunction in SCLC patients. Eligibility criteria and timing of trial intervention are discussed as potential impediments to successful trial completion.

Aged↗
PubMedDate not supplied

Cystic fibrosis--an Indian perspective on recent advances in diagnosis and management.

Cystic fibrosis (CF) is a common inherited disorder in caucasians. The estimated incidence of CF in Asians varies from 1:10,000 to 1:12,000. Indian data is restricted to few case reports. The gene for CF is located on the long arm of chromosome 7 at position 7q13. There are more than 300 identified mutations in CF. The basic defect in CF is a mutational change in the gene for chloride conductance channel. Failure of chloride conductance by epithelial cells leads to dehydration of secretions that are too viscid and difficult to clear. The disease is characterized by abnormal secretions in the respiratory, gastrointestinal and reproductive tract and sweat glands. The common clinical manifestations include meconium ileus in neonatal period, recurrent lower respiratory tract infections (pseudomonas pneumonia, bronchiectasis), steatorrhoea, azoospermia, and in late stages hepatobiliary and endocrine pancreatic dysfunctions. The diagnosis of disease is established by clinical criteria and sweat chloride concentration more than 60 mEq/L. Facilities for DNA diagnosis of common CF mutations are now available in India. The treatment of CF includes early diagnosis, daily clearance of respiratory passages, appropriate antibiotic therapy, aerosolised recombinant human DNase and antibiotics, and nutritional supplementation. The latter include changes in diet composition, pancreatic enzyme supplementation and vitamins and trace mineral supplementation. Gene therapy for the pulmonary manifestations is being tried in a number of centres abroad. Other considerations include heart lung transplantation and ameloride inhalation therapy.

Adolescent↗
PubMed2004

Gastrointestinal complications of mitochondrial disease.

The clinical presentation of mitochondrial disease can involve a number of organ systems which are seemingly unrelated. Gastrointestinal manifestations are often an early presentation of mitochondrial disorders. Dysphagia, feeding difficulties, gastroesophageal reflux, dysmotility with delayed gastric emptying, intestinal pseudo-obstruction, diarrhea and pancreatic exocrine insufficiency are amongst the major complications. Neuromuscular dysfunction affecting peristalsis is a common pathophysiologic mechanism causing many of these symptoms and treatment is primarily supportive.

Journal Article↗
PubMedDate not supplied

Use of mycophenolate mofetil in liver transplantation: a literature review.

Mycophenolate mofetil (MMF) is an immunosuppressive drug, exhibiting its effect through inhibition of proliferation of T and B lymphocytes. Standard primary immunosuppressive therapy after orthotopic liver transplantation (OLT) is based on a calcineurin-inhibitor (CNI): cyclosporine or tacrolimus. Renal failure with arterial hypertension, due to CNI side-effects, is a major cause of morbidity and mortality after OLT. Several studies have shown the efficacy of MMF to improve CNI-induced nephrotoxicity, blood pressure, and uric acid concentration in liver transplant patients with concomitant reduction or withdrawal of CNI. Predose plasma mycophenolic acid concentrations (MPA) are related to adverse events, drug dose, and clinical status. Blood level values outside the suggested MPA therapeutic range are associated with acute rejection episodes and side effects, which have been described in about half of the patients treated with MMF. Most authors have described gastrointestinal and hematological side-effects, whereas these appear usually dose related, responding quickly to reduction. MMF is potent and safe immunosuppressive agent, and replacement of CNI by MMF in liver transplant patients with renal dysfunction may improve not only kidney function but also other CNI-associated side-effects, such as hypertension and hyperuricemia, with a low risk of rejection.

B-Lymphocytes↗
PubMed2006

Parasitic infections in transplant recipients.

Parasitic infections are important complications of organ transplantation that are often overlooked in the differential diagnosis of post-transplantation pyrexial illness. Although their frequency is unknown, they seem to be much less prevalent than bacterial and viral infections. Only 5% of human pathogenic parasites have been reported to cause significant illness in transplant recipients. Infection can occur via transmission with the graft or blood transfusion, or be acquired de novo from the environment. Recrudescence of dormant infection can lead to active disease. Post-transplantation parasitic disorders tend to cluster into two clinical profiles. First, an acute systemic illness with anemia, constitutional manifestations and variable stigmata of organ involvement; acute graft dysfunction can lead to confusion and acute rejection. Protozoa including malarial Plasmodium, Leishmania, Trypanosoma and Toxoplasma are associated with this profile. The second typical manifestation encompasses a few localized syndromes, usually associated with the lower gastrointestinal tract, caused by either protozoa (Cryptosporidium and microsporidia) or nematodes (Strongyloides and Ascaris). Dissemination of localized infections can lead to life-threatening systemic manifestations. A high index of suspicion is essential, as diagnosis requires special sampling techniques and laboratory procedures. Definitive diagnosis is usually achieved by detecting the parasite in the patient's tissues or body fluids by histological examination or culture, or by polymerase chain reaction amplification of the parasite-specific antigen sequence. Antibody detection using serological techniques is also possible in a few parasitic infections. Certain lesions have characteristic radiological appearances, hence the value of imaging, particularly in the cerebral syndromes. Treatment is usually straightforward (broad spectrum or specific drugs), yet some species are drug resistant.

Animals↗
PubMed1995

[Disorders of autonomic regulation in Parkinson syndrome].

Ever since the first description of Parkinson's disease, it has not only been associated with the classical triad of akinesia, rigor and tremor but also with autonomic regulation disorders. However, the studies published on this subject show differing and partly contradictory results. A large number of studies demonstrate a distinct autonomic disorder. On the other hand there are authors who question an affliction of the autonomic nervous system and others who attribute the autonomic disorder to Parkinson specific medication. To make matters worse, the various pathogeneses of Parkinson's syndrome within the patients collectives have not been sufficiently differentiated and nomenclature of the multisystem degeneration was handled in different ways. Taking our examinations of the various autonomic functions and the underlying literature into critical consideration, we come to the conclusion that regulation disorders of the cardiovascular system, gastrointestinal and urinary tract, as well as sweat and thermoregulation are often seen in the idiopathic Parkinson's disease. In our opinion the idiopathic Parkinson's syndrome must be attributed to the multisystem degenerations. Autonomic dysfunction occurs in different intensities in the disease.

Antiparkinson Agents↗