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Biomedical subjects

B Fleshler

Publications and source records attributed to B Fleshler.

At least 19 recordsLinked to original sources
PubMed1993

Interaction between patient and test administrator may influence the results of edrophonium provocative testing in patients with noncardiac chest pain.

Edrophonium is a widely used provocative agent in the evaluation of noncardiac chest pain, with reported positivity rates of 30-55%. The influence of a subjective response and psychological factors on test results have not been examined previously. A retrospective analysis was performed to compare positivity rates for three physicians in the same laboratory. This was followed by a prospective study of 62 patients with noncardiac chest pain randomized to two groups. Group 1 patients were told that intravenous medication was given to observe changes in the tracing. Group 2 patients were told that the injection was to elicit their usual pain. During the 2-yr retrospective review, 260 patients were tested. The positivity rate varied from 31.1% with physician A to 20.2% with physician B and 7.5% for physician C (p = 0.001 for A vs. C, and p = 0.04 for B vs. C). In the prospective study, chest pain was elicited in nine of 62 patients (14.5%). Two of the 29 patients in group 1 (6.9%) and seven of 33 patients in group 2 (21.2%) contributed to this result. Contraction amplitude and duration increased similarly in all groups. These data suggest that edrophonium testing may be influenced by coaching, that manometric changes are similar in positive and negative tests, and that the prevalence of positive tests is lower than previously reported.

Adult↗
PubMed1992

Deceptive liver histology delays diagnosis of cardiac ascites.

Cardiac ascites is a rare condition. Diagnosis is aided by liver histology, which characteristically shows diffuse hepatic congestion affecting the centrilobular region. In our case of refractory ascites due to constrictive pericarditis, diagnosis was delayed because centribular hepatic congestion was absent histologically. Contrary to numerous published reports, diffuse hepatic congestion is not uniformly present in cardiac ascites. Constrictive pericarditis is curable and should be considered in all cases of unexplained ascites, regardless of atypical hepatic histology.

Adult↗
PubMed1986

Abnormal lower esophageal sphincter pressure responses in patients with orange juice-induced heartburn.

The mechanism of orange juice-induced heartburn is unclear. One previous uncontrolled study showed only a transient fall in lower esophageal sphincter pressure (LESP) after orange juice and suggested that orange juice-induced heartburn was caused by a direct effect on the esophageal mucosa. We studied the effect of orange juice on LESP by comparing symptomatic patients with asymptomatic controls. LESP was measured for 10 min before and 60 min after the ingestion of 250 ml of orange juice in eight patients with orange juice-induced heartburn and in seven asymptomatic controls. Before orange juice ingestion, LESPs were similar in the symptomatic and asymptomatic groups, 18.3 and 17.8 mm Hg, respectively (not significant). In the control group, LESP increased by at least 5 mm Hg at 20 min after orange juice ingestion and remained elevated for the duration of the observation. In the symptomatic group there was no significant change in LESP despite the onset of heartburn. This was significantly different from the control group (p less than 0.01). We conclude that LESP response to orange juice is different in those who develop heartburn from those who do not. This abnormal response may make these patients more prone to reflux, but the numerical change in LESP is small and the LESP remains within the normal range. We believe that gastroesophageal reflux is unlikely to be the mechanism of orange juice-induced heartburn.

Adult↗
PubMed1985

Return of peristalsis in achalasia after pneumatic dilatation.

Distally progressive contraction waves were demonstrated in seven of 34 (20%) patients with achalasia, successfully treated with pneumatic dilatation. There was no correlation between the appearance of such waves and clinical status, the decrease in lower esophageal sphincter resting pressure, or in the radiographically measured diameter of their esophagus. Return of these waves cannot be adequately explained by the "common cavity phenomenon."

Dilatation↗
PubMed1981

An aggressive approach to the medical management of peptic ulcer disease.

Studies indicate that endoscopy provides the best index for accurate diagnosis of peptic ulcer and for evaluating results of therapy. The use of cimetidine or frequent administration of a potent liquid antacid ensures initial healing of duodenal ulcers in 75% to 90% of patients. A similar, but not so clearly statistically significant, trend toward healing exists when cimetidine is used in gastric ulcers. Cimetidine also is useful in postsurgical ulcers, in the Zollinger-Ellison syndrome, and as prophylaxis (up to one year) in patients with healed duodenal ulcers. Although the long-term effects of healing ulcers and preventing relapses remain to be defined, an aggressive approach toward healing and the management of the healed state seems advisable. The frequent use of endoscopy as a diagnostic tool plus vigorous application of proved medical therapy is advocated.

Acute Disease↗
PubMed1978

Cimetidine and placebo in the treatment of benign gastric ulcer: a multicenter double blind study.

A randomized, prospective, multicenter trial of the effects of cimetidine on benign gastric ulcer was conducted in 60 outpatients. Endoscopic assessment was used as the criterion for healing. Although none of the differences was statistically significant, mean healing rates were higher and mean decreases in ulcer size were greater with cimetidine than they were with placebo. Twenty-four per cent of the ulcers healed completely in 2 weeks when cimetidine was administered, compared with a placebo healing rate of 14 percent. At 6 weeks in the incidence of healing increased to 60 percent in the cimetidine group and 41 percent in the placebo group. The mean percentage of decrease in ulcer size was greater at both 2 and 6 weeks in the cimetidine group than it was in the placebo group. In both, the cimetidine and placebo groups, relatively liberal intake of a potent antacids in treatment of gastric ulcers has not been defined definitively. Thus, a possible beneficial effect of cimetidine may have been obscured. For more clear discimination between the effects of cimetidine and placebo in healing of gastric ulcer, studies utilizing either no antacid or antacids of low neutralizing capacity will be needed.

Antacids↗
PubMed1977

Effects of parenteral secretin--cholecystokinin and of duodenal acid perfusion on gastric secretion in duodenal ulcer patients.

The effect of parenteral secretin-cholecystokinin and duodenal acid perfusion on broth-stimulated gastric acid secretion was studied in 11 duodenal ulcer patients. Statistically significant inhibition occurred in both experimental conditions. The effect of secretin-cholecystokinin was more marked than the effect of duodenal acid perfusion. A poorly responsive subgroup of patients appeared to be responsible for the diminished inhibitory effect of duodenal acid perfusion. In this poorly responsive group there was a diminished duodenal volume response as well as diminished duodenal acid clearing. We conclude that there may exist a diminished release of gastrointestinal hormones such as secretin and cholecystokinin in certain duodenal ulcer patients.

Adult↗
PubMed1970

Sodium dependency of L-alanine absorption in canine Thiry-Vella loops.

The effect of sodium on the absorption of L-alanine in vivo was tested by measuring the absorption of L-alanine from Thiry-Vella loops in dogs. Solutions containing L-alanine (10 or 50 mM) sodium at concentrations of 0, 74, or 145 m-equiv/1 and mannitol, as needed to maintain isotonicity were instilled into the loops for 10 minutes. Similar studies were done with L-alanine 50 mM and either 0 or 145 m-equiv/1 of sodium for five minutes. Under all conditions absorption of alanine was significantly less from the solution initially free of sodium. Although these differences were statistically significant, the physiological significance was not great since the actual differences in amounts of L-alanine absorbed were small. Insorption of sodium was low from the fluid which initially had no sodium, but exsorption proceeded rapidly and was unaffected by the luminal sodium concentration. This resulted in a rapid rise of intraluminal sodium concentration when no sodium was initially present. This persistent exsorption of sodium was, therefore, adequate to provide sodium in the lumen to activate the sodium-dependent carrier, postulated on the basis of studies in vitro. These data in vivo are consistent with the view that sodium at the intraluminal surface is important in accelerating amino acid transport, but indicate that in the absence of added intraluminal sodium the gut mucosa itself, under normal circumstances, provides the sodium needed for L-alanine absorption.

Alanine↗