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Biomedical subjects

D O Castell

Publications and source records attributed to D O Castell.

At least 361 records · Page 20Linked to original sources
PubMed1979

High amplitude, peristaltic esophageal contractions associated with chest pain and/or dysphagia.

Esophageal manometric tracings obtained using low-compliance pneumohydraulic infusion systems were reviewed from patients with symptoms of chest pain and/or dysphagia. Using this sytem, we report on 7 symptomatic patients with markedly increased esophageal peristaltic amplitude. Maximal peristaltic amplitude for these 7 patients (225-430 mmHg) was greater than for normals (75-175 mmHg). Mean peristaltic amplitude for the 7 was 170 mmHg, which was greater than for normals (81 +/- 30 mmHg, mean +/- 2 SD). This finding is believed to reflect the sensitivity of currently available manometric systems. It may be possible with these techniques to define more clearly the bulk of presumed esophageal dysfunction, which is at present poorly characterized. The relationship of clinical symptoms to abnormal esophageal motility is often less than optimal and may result from an inability to define "normal" or from inadequacies of currently available techniques. Our observations of a subset of symptomatic patients having peristaltic contractions with amplitudes exceeding the normal range seem to characterize one form of esophageal motility defect. This abnormality was seen more frequently than diffuse esophageal spasm in our laboratory.

Adult↗
PubMed1978

Gastric retention in peptic ulcer disease. A reappraisal.

The saline load test is a popular method to demonstrate gastric retention. This technique, however, does not permit evaluation of volumes contributed by gastric secretion. We have studied 11 normal subjects and 7 patients with pyloric outlet obstruction using a dyedilution technique. We measured simultaneously rates of water secretion, fractional emptying rates, total intragastric volumes, and the fractions of gastric volume contributed by gastric secretion both during fasting and following a 250-ml water load. Total intragastric volume was significantly increased in patients with outlet obstruction compared to normal subjects both during fasting and following the water load (P less than 0.01). This increase resulted from significantly increased water secretion (P less than 0.01) combined with significantly decreased gastric emptying (P less than 0.01). Thus, gastric retention produced in patients with outlet obstruction by delayed emptying appears to be magnified by gastric hypersecretion of water. These data in no way invalidate the use of the saline load test in the diagnosis of gastric retention states, but help define the role of gastric secretion in the residual volumes measured following the load.

Adult↗
PubMed1978

Histaminergic pharmacology of primate lower esophageal sphincter.

We have studied the lower esophageal sphincter (LES) response to exogenous histamine and to H1- and H2-blocking agents in the awake baboon. Increasing intravenous bolus doses of histamine produce an increase in LES pressure with a maximum response at a dose of 12 microgram/kg. H1-receptor blockade with chlorpheniramine over a wide dose range did not alter basal LES pressure but did abolish the response of the LES to exogenous histamine. H2-receptor blockade with cimetidine at doses markedly inhibiting gastric acid secretion (2 mg/kg.h) did not alter basal LES pressure or the response of the LES to exogenous histamine. In addition, cimetidine did not alter the response of the LES to pentagastrin and bethanechol. Although histamine and histamine receptors are important in gastric secretion, they appear to have no identifiable role in the maintenance of basal LES smooth muscle tone in the baboon. These results demonstrate the presence of a stimulatory H1 receptor on baboon LES smooth muscle, but provide no evidence for the presence of an H2-inhibitory receptor. As opposed to the parietal cell, the LES response to pentagastrin and bethanechol does not require a H2 receptor.

Animals↗
PubMed1978

Food sensitivity in reflux esophagitis.

We examined 66 patients with pain of possible esophageal origin for sensitivity to intraesophageal infusions of coffee, orange juice, spicy tomato drink, or HCl of varying concentrations as an addendum to their acid infusion (Bernstein) tests. Compared to Berstein-negative subjects, acid-sensitive patients were sensitive to infusion of coffee (P less than 0.01), orange juice (P less than 0.001), and tomato drink (P less than 0.001). Patients were largely insensitive to HCl solutions with a titratable acidity of 1 mEq per liter or less, less than the least acidic food solution tested. However, Berstein-positive patients were still highly sensitive to infusions of coffee, orange juice, and tomato drink adjusted to pH 7 (P less than 0.001). Patients were unable to differentiate symptoms caused by acid or food infusions, and solutions did not differ in the duration of infusion needed either to cause symptoms or to relieve them by saline. We conclude that the pain of esophagitis is nonspecific and can be precipitated by variety of seemingly unrelated substances.

Adult↗
PubMed1978

Cimetidine in the treatment of symptomatic gastroesophageal reflux: a double blind controlled trial.

The effectiveness of cimetidine for symptomatic relief in patients with chronic gastroesophageal reflux was studied in a multicenter, double blind clinical trial. Patients were entered into the study for a total of 8 weeks, receiving either cimetidine, 300 mg four times daily, or identical placebo tablets. Throughout the trial, frequent assessments were made of symptom severity and frequency, combined with careful measurement of antacid use. Esophagoscopy, esophageal acid sensitivity, and lower esophageal pressures were performed before and at the completion of the treatment period. Significant (P less than 0.05) decreases in symptom frequency and severity were noted throughout the study in the cimetidine-treated patients, as compared with the placebo group. This subjective improvement was corroborated by a concomitant decrease in antacid use, which was significantly (P less than 0.05) reduced in the cimetidine-treated group. In addition, significant improvement in esophageal acid sensitivity resulted from cimetidine therapy. No objective improvement in esophageal endoscopic appearance or sphincter pressures was noted. The results of this double blind trial indicate that cimetidine is more effective than the placebo for the relief of symptoms of gastroesophageal reflux.

Adult↗
PubMed1978

Muscle function and structure of the esophagus of the baboon (Papio anubis).

A baboon (Papio anubis) was used as a model for the study of the physiology of the esophagus. This model closely resembles the human being phylogenetically and physiologically. Base-line lower esophageal sphincter pressure and peristaltic amplitude are similar to that of man. In addition, the anatomic transition from striated to smooth muscle is identical to that of the human esophagus. The sphincter-depressing effect of ketamine anesthesia was demonstrated.

Anesthesia↗