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Biomedical subjects

A J DiMarino

Publications and source records attributed to A J DiMarino.

At least 19 recordsLinked to original sources
PubMed2005

Manometric evaluation of achalasia in the elderly.

BACKGROUND: The effect of ageing on oesophageal motility in patients with achalasia is not well described. Oesophageal contraction amplitude is decreased in otherwise healthy elderly subjects. AIM: To evaluate whether ageing influences the motor function of the oesophagus in achalasia. METHODS: Initial manometry studies of patients with achalasia were reviewed and findings (lower oesophageal sphincter basal and residual pressures and oesophageal body contraction amplitudes) were compared between two groups of patients, those 65 years of age or older (49 patients) and those younger than 65 years (68 patients). The older group was further divided into those > or =70 years and those <70 years. RESULTS: Patients 65 years and older had significantly higher lower oesophageal sphincter basal pressures compared with younger patients (65.6 +/- 4.9 vs. 52.3 +/- 2.7, P = 0.02). At an age cut-off of 70 years, older patients had significantly higher basal (70.7 +/- 1.6 vs. 53.0 +/- 2.4, P = 0.02) and residual (19.7 +/- 1.6 vs. 15.9 +/- 0.7, P = 0.03) lower oesophageal sphincter pressures compared with younger patients. Amplitude of oesophageal contractions was not different between the groups. Across all age groups, there was no linear correlation between age and basal or residual lower oesophageal sphincter pressures (r = 0.28 and 0.12, respectively). CONCLUSIONS: Older patients with achalasia have higher lower oesophageal sphincter pressures, however there is no linear correlation between age and lower oesophageal sphincter pressures. Unlike healthy subjects, advanced age is not associated with a decrease in oesophageal contraction amplitude in patients with achalasia.

Adult↗
PubMed2001

Crohn's disease of the esophagus: Three cases and a literature review.

Three cases of esophageal Crohn's disease (CD) are described, each with dysphagia and/or odynophagia caused by esophageal ulceration. All three patients had associated ileocolitis. One patient followed for a prolonged period responded to treatment with sulfasalazine and prednisone. A computer search back to 1967 produced 72 additional cases of esophageal CD. Among these 75 patients (total), who were, on average, 34 years old, esophageal disease was the presenting disease symptom in 41 patients (55%). The diagnosis was difficult in 13 patients, in whom no distal bowel disease was detected at the time of initial esophageal presentation. The most common presentation was dysphagia associated with aphthous or deeper ulcerations (52 patients). In 11 of these patients, oral aphthous ulcerations were also present. Esophageal stenosis or fistulas to surrounding structures were present in 27 patients and led to surgery in 17 patients. Most of the unfavourable outcomes were in this group of 27 patients with esophageal complications, including five deaths. Fourteen additional patients required surgery for CD of other areas. Responses of uncomplicated ulcerative disease of the esophagus tended to be favourable if the medical regimen included prednisone. Clinical patterns of esophageal CD were divided into three categories: ulcerative, stenosing and asymptomatic (acute disease in children).

Adrenal Cortex Hormones↗
PubMed2000

Diarrhea as a side effect of mesalamine treatment for inflammatory bowel disease.

Tablets of coated 5-aminosalicylate (5-ASA) called mesalazines are among the most widely prescribed preparations for the treatment of colitis, including ulcerative, Crohn's disease (CD), collagenous and lymphocytic colitis, and-to a lesser extent-CD of the small bowel. Mesalamines have, to a large extent, replaced the parent drug sulfasalazine because they produce fewer side effects. Although mesalamines have been known from earlier studies to produce occasional diarrhea, the true incidence of this effect is not known and is not always recognized. We are presenting the cases of five patients in whom oral mesalamines produced severe and persistent diarrhea-made worse by increasing doses of the drug-and intensified the colitis in two. Recognition of the problem is by symptom analysis after careful history taking. Changing the therapeutic regimen or discontinuing the medication is usually required to reverse this potentially debilitating and occasionally life-threatening side effect.

Adult↗
PubMed2000

End expiration is more accurate than mid respiration in measuring lower esophageal sphincter pressure.

BACKGROUND/AIMS: Two ways popularly used to measure lower esophageal sphincter pressure are the mid-respiratory and end-expiratory methods. The aim of this study was to compare the suitability of these methods in the manometric assessment of patients with endoscopically documented esophagitis. METHODS: Manometry was performed on 22 consecutive patients to determine whether medical therapy or surgery was the more appropriate treatment strategy. Lower esophageal sphincter pressure was measured during a slow station pull-through. End-expiratory lower esophageal sphincter pressure was assessed by measuring the highest trough which coincided with end expiration. Mid-respiratory lower esophageal sphincter pressure was assessed by bracketing the highest pressure over >/=3 respiratory cycles and measuring the mid point. RESULTS: Mid-respiratory lower esophageal sphincter pressure (25.6 mm Hg) was higher (p < 0.0001) than end-expiratory lower esophageal sphincter pressure (15.7 mm Hg). Nine (41%) end-expiratory lower esophageal sphincter pressures were abnormally low (i.e., <10 mm Hg), whereas three (14%) mid-respiratory lower esophageal sphincter pressures were abnormally low (i.e., <14 mm Hg; p = 0.042). CONCLUSIONS Mid-respiratory lower esophageal sphincter pressure measurement includes respiratory artifact and does not accurately measure lower esophageal sphincter pressure. End-expiratory sphincter pressure better identifies potential surgical candidates.

Adult↗
PubMed2000

American Society for Gastrointestinal Endoscopy-Society of Gastroenterology Nurses and Associates Endoscope Reprocessing Guidelines.

Adequate endoscope reprocessing is one of the most essential functions in any endoscopy setting. Standards and guidelines for reprocessing endoscopes have been established by the Society of Gastroenterology Nurses and Associates (SGNA) and the American Society for Gastrointestinal Endoscopy (ASGE). These standards pertain to any setting in which gastrointestinal endoscopy is performed. Endoscope reprocessing that meets the established standard of practice helps to ensure a patient-ready instrument for all patients, reduces the risk of disease transmission to practitioners and staff, and helps to prolong the life of the endoscope.

Endoscopes, Gastrointestinal↗
PubMed2000

Noncompliance with FDA and society guidelines for endoscopic reprocessing: implications for patient care.

Flexible endoscopic instruments are very valuable in the diagnosis and treatment of patients with gastrointestinal diseases. Current guidelines for reprocessing these instruments between patient use are appropriate. Rigid adherence to these guidelines, however, will be necessary to reassure governmental authorities, other medical authorities, and the public that the risk of infection from these procedures is minimal.

Disinfection↗
PubMed1999

Serologic hepatitis B immunity in vaccinated health care workers.

BACKGROUND: Hepatitis B vaccination is recommended for health care workers but has a nonresponse rate of 5% to 32% and an unknown duration of immunity. There is no standardized postvaccination protocol to confirm, monitor, and maintain immunity. OBJECTIVE: To assess the hepatitis B serologic immune status in health care workers who were previously vaccinated. METHODS: A convenience survey and an objective laboratory study, which included testing for hepatitis B surface antigen, core antibody, and qualitative and quantitative surface antibody (anti-HBs), were performed. The data collected included vaccination date, number of doses of vaccine, whether and when titers had previously been checked, titer results, sex of patient, job description, and age at the time of our study and at vaccination. RESULTS: Group A (n = 109, 71%) had detectable anti-HBs titers, and group B (n = 45, 29%) had no detectable anti-HBs titers. Group A was vaccinated 4.80 +/- 0.30 (mean +/- SEM) years prior to our testing, received 2.91 +/- 0.04 (mean +/- SEM) vaccinations, and had a mean +/- SEM titer of 112.91 +/- 5.18 mIU/mL. There was no statistical significance in time since vaccination, number of doses of vaccine, sex, job description, age at the time of our serologic testing, or age at the time of vaccination between groups A and B. Six of 6 subjects given booster doses of vaccine in group B developed anti-HBs. Only 62 subjects (40%) in the entire study population had anti-HBs status previously determined, with 48 (77%) reporting immunity to hepatitis B virus. CONCLUSIONS: Twenty-nine percent of the health care workers who were vaccinated against hepatitis B showed no serologic evidence of hepatitis B immunity. It is unclear whether these subjects are nonresponders, lost immunity, or retained anamnestic potential. Booster vaccination response in 6 of 6 subjects suggests immunity. We recommend (1) postvaccination testing within 1 to 2 months to document immunity, (2) periodic anti-HBs monitoring, and (3) booster vaccination to maintain protective titer levels.

Adult↗
PubMed1999

GI endoscopic reprocessing practices in the United States.

BACKGROUND: Patient infection from contaminated gastrointestinal (GI) endoscopes can generally be attributed to failure to follow appropriate reprocessing guidelines. Recently, the Food and Drug Administration recommended a 45-minute exposure of GI endoscopes to 2.4% glutaraldehyde solutions heated to 25 degrees C. Simultaneously, the American Society for Gastrointestinal Endoscopy (ASGE), the American Gastroenterological Association, and the Society of Gastroenterology Nurses and Associates endorsed a reprocessing guideline that emphasized manual precleaning and recommended a 20-minute exposure to a 2.4% glutaraldehyde solution at room temperature. Since then, little information has become available regarding actual reprocessing practices in the United States. METHODS: A previously developed questionnaire regarding endoscopic disinfection practices was mailed to randomly selected members of the ASGE. RESULTS: The survey was sent to 730 members and 294 responded (40.3%). Appropriate manual cleaning (suctioning detergent through the accessory channel and brushing the channel and valves) is performed by 90.7% of respondents; 69.9% then use automated reprocessors for disinfection or sterilization. Glutaraldehyde is the most widely used chemical disinfectant; 85.3% use glutaraldehyde as one of their primary disinfectants. The most commonly used disinfection time with 2.4% glutaraldehyde is 20 minutes (83.9%) followed by 45 minutes (11.4%). Only 23.8% of users of 2.4% glutaraldehyde heat their solution; 59.6% of centers test disinfectant concentration daily or more frequently; 74.0% sterilize nondisposable forceps before use; 29.2% of centers re-use disposable endoscopic accessories (which are more frequently disinfected rather than sterilized). Twelve respondents reported cases of endoscopic cross infection. CONCLUSIONS: A significant minority of endoscopy centers still do not completely conform to recent ASGE, American Gastroenterological Association, and the Society of Gastroenterology Nurses and Associates guidelines on disinfection, and they may not be appropriately disinfecting GI endoscopes. Rigid adherence to recommended guidelines is strongly encouraged to ensure patient safety.

Data Collection↗
PubMed1998

Manometric measurement of anal canal resting tone: comparison of a rectosphincteric balloon probe with a water-perfused catheter assembly.

The purpose of this study was to compare the manometric measurements of a rectosphincteric balloon probe with a water-perfused catheter assembly on anal canal resting tone. Ten normal subjects (9 males, 1 female; mean age: 32 years; range 27-46 years) underwent station pull-through (0.5 cm/3 sec) beginning in the rectum with a water-perfused catheter assembly and a rectosphincteric balloon probe. Both the probe and the catheter were 5 mm in diameter. Three catheter side ports were perfused at 1 ml/min, and the rectal balloon was inflated with 5 ml of air. Measurements were taken on the same day in a counterbalanced manner. Data were analyzed on a computerized system. Mean (+/-SEM) values with the balloon were 82.3 (+/-8.9) mm Hg and 97.1 (+/-9.3) mm Hg with the catheter. These values were not significantly different (P=0.22). A significant order effect (P=0.04) was found where the first measure (101.3+/-10.2 mm Hg) was higher than the second measure (78.1+/-6.6 mm Hg), which was controlled for in the experimental design. A rectosphincteric balloon probe can accurately measure the resting tone of the anal canal compared to a water-perfused catheter assembly. Caution should be used when measuring anal canal resting tone early in an anorectal manometry assessment.

Adult↗
PubMed1998

Risk to the health care worker of HIV infection and how to minimize It.

Occupational transmission of HIV fortunately is uncommon. The risk of acquiring HIV depends on the mode of exposure, the body fluid involved, and the source patient. Percutaneous injuries carry the greatest risk (approximately 0.3%), and blood is by far the most important source of HIV to which the health care worker is exposed. Universal precautions should be applied to all patients in order to decrease the risk of occupational transmission of HIV. Furthermore, a system must be designed to provide adequate assessment, counselling, and follow-up for exposed health care personnel. Postexposure prophylaxis must be tailored to the specific exposure for each health care worker.

Disinfection↗
PubMed1996

Manometric diagnosis of diffuse esophageal spasm.

There are no requirements concerning the amplitude of simultaneous contractions among the present criteria for the manometric diagnosis of diffuse esophageal spasm. The purpose of this investigation was to determine whether the current criteria effectively identify an appropriately homogenous patient population. Sixty consecutive motility tracings that met the criteria for diffuse esophageal spasm were evaluated. A bimodal distribution of the highest simultaneous esophageal contraction for each patient was observed. One group's (N = 29) highest simultaneous esophageal contractile amplitude was < or = 74 mm Hg, the other's (N = 31) highest simultaneous esophageal contractile amplitude was > or = 100 mm Hg. Group 1 had significantly decreased lower esophageal sphincter pressure, lower peristaltic amplitude, more aperistalsis, fewer simultaneous contractions, and fewer complaints of chest pain. These comparisons suggest that consideration be given to the amplitude of simultaneous esophageal contractions in the manometric diagnosis of diffuse esophageal spasm.

Adult↗
PubMed1996

Mechanisms of gastroesophageal acid reflux and esophageal acid clearance in heartburn patients.

OBJECTIVES: Gastroesophageal reflux can occur because of low resting pressure, transient relaxation, or normal relaxation of the lower esophageal sphincter. Mechanisms for delayed esophageal clearance include impaired peristalsis, infrequent swallowing, and impaired sphincter relaxation. The purpose of this study was to examine esophageal function in patients with gastroesophageal reflux and to determine esophageal acid clearance. METHODS: Esophageal contractile pressure, duration, velocity, pH, sphincter pressure, and deglutition were monitored in 12 heartburn patients 1 h before and 3 h postprandially twice. RESULTS: Eighty-seven episodes of gastroesophageal reflux occurred during normal sphincter relaxation, and 72 episodes occurred during transient sphincter relaxation; however, the frequency with normal sphincter relaxations was quite low (1%) compared with transient sphincter relaxations (33%). Mean and median esophageal acid exposure was not different during normal sphincter relaxation (71 and 80 s) compared with during transient sphincter relaxation (71 and 81 s). There were 284 instances of primary peristalsis, with 157 resulting in esophageal acid clearance, compared with simultaneous contractions (6 of 66), secondary peristalsis (1 of 7), and tertiary contractions (0 of 45). Contractile pressures were higher and durations were longer with acid clearance, but velocities were not different. CONCLUSIONS: Frequency of gastroesophageal reflux is the same during normal and transient sphincter relaxation in heartburn patients. Primary peristalsis is necessary to accomplish acid clearance. Secondary peristalsis is rare and ineffective.

Adult↗
PubMed1995

Use of a tantalum-178 generator and a multiwire gamma camera to study the effect of the Mueller maneuver on left ventricular performance: comparison to hemodynamics and single photon emission computed tomography perfusion patterns.

During the Mueller maneuver, there is a decrease in intrathoracic pressure and an increase in transmural left ventricular pressure. The changes in loading conditions cause transient left ventricular dysfunction. This study examined the effects of the Mueller maneuver on left ventricular performance using tantalum (Ta)-178 (half-life 9.3 min) and a multiwire gamma camera. First-pass radionuclide angiograms were obtained at baseline and during Mueller maneuver in 41 patients aged 58 +/- 10 years. In 34 patients, stress single photon emission computed tomography (SPECT) myocardial perfusion imaging with thallium-201 or sestamibi was also performed. Hemodynamic measurements during the Mueller maneuver (n = 10) showed a decrease in systemic pressure (139 +/- 25 mm Hg vs 123 +/- 24 mm Hg, p < 0.001) and pulmonary artery pressure (24 +/- 6 mm Hg vs 14 +/- 12 mm Hg, p = 0.01) and an increase in heart rate (67 +/- 10 bpm vs 75 +/- 14 beats/min, p = 0.001). Among the 34 patients who had perfusion imaging, the left ventricular ejection fraction remained unchanged or increased in 17 patients (group 1) (48% +/- 19% vs 49% +/- 21%, p not significant) and decreased (> or = 5%) in 17 patients (group 2) (55% +/- 13% vs 40% +/- 16%, p = 0.001). The stress SPECT images showed no or only fixed defects in 11 (65%) patients in group 1 and 3 (18%) patients in group 2 (p = 0.02), and reversible defects in 6 (35%) patients in group 1 and 14 (82%) patients in group 2 (p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Gastrointestinal blood loss with low dose (325 mg) plain and enteric-coated aspirin administration.

OBJECTIVES: The purpose of this study was to assess gastrointestinal blood loss with low dose (325 mg) plain and enteric-coated aspirin. METHODS: A total of 47 healthy volunteers participated in randomized, controlled acute and chronic trials. Seventeen participated in a repeated measures acute trial, and 30 participated in an independent sample chronic trial. Gastrointestinal blood loss was determined by obtaining 72-hour stool collections and quantitating Chromium-51 labeled erythrocytes. RESULTS: Acute phase trials: gastrointestinal blood loss during base line was 0.47 (+/- 0.11) mL/day, 0.96 (+/- 0.12) mL/day with enteric-coated aspirin (p < 0.0006), and 1.82 (+/- 0.35) mL/day with plain aspirin (p < 0.0001 vs. base line, p = 0.0476 vs. enteric-coated aspirin). Chronic phase trials: gastrointestinal blood loss was 1.12 (+/- 0.31) mL/day with enteric-coated aspirin (p = 0.0024 vs. control) and 2.60 (+/- 0.68) with plain aspirin (p < 0.0001 vs. control, p = 0.0364 vs. enteric-coated aspirin). CONCLUSIONS: During acute and chronic ingestion, plain aspirin at a dose of 325 mg/day significantly increased gastrointestinal blood loss when compared to control or enteric-coated aspirin values, although enteric-coated aspirin values were also significantly increased compared to control. Gastric adaptation does not decrease blood loss with low dose aspirin consumption.

Adaptation, Physiological↗
PubMed1994

Gastroesophageal reflux during gastrostomy feeding.

BACKGROUND/AIMS: Aspiration pneumonia is one of the most serious complications of gastrostomy tube feeding, with a reported incidence of 10%-20% in nursing home patients. The aims of this prospective study were to examine lower esophageal sphincter (LES) pressure before and after placement of gastrostomy tubes and to examine the effects of rapid intragastric bolus and slow, continuous feeding on LES pressure. METHODS: Ten subjects were enrolled in the study. Basal LES pressure was measured before and after placement of gastrostomy tubes. Thereafter, LES pressure was measured for 15 minutes during rapid intragastric infusion of 250 mL of an enteral feeding formula and 100 mL water and continuous infusion of the enteral feeding formula at 80 mL/h. Scintigrams evaluating gastroesophageal reflux were obtained during each method of feeding. RESULTS: Placement of gastrostomy tubes had no effect on basal LES pressure. Rapid intragastric bolus infusion led to a reduction in LES pressure to incompetent levels at 2.1 +/- 2.0 mm Hg (P < 0.001). Free gastroesophageal reflux to the sternal notch was shown by scintigraphy. Slow, continuous gastrostomy feedings did not alter LES pressure (P > 0.05) or show free gastroesophageal reflux by scintigraphy. CONCLUSIONS: Gastroesophageal reflux and aspiration in patients fed via the gastrostomy tube may be caused by LES relaxation secondary to gastric distention caused by distention of the stomach.

Aged↗