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Biomedical subjects

D O Castell

Publications and source records attributed to D O Castell.

At least 379 records · Page 21Linked to original sources
PubMed1977

Pressure profile of esophageal peristalsis in normal humans as measured by direct intraesophageal transducers.

The pressure profile of esophageal peristalsis was studied in healthy young adult males using an intraesophageal transducer assembly. The amplitude of peristaltic contractions following wet swallows was determined at intervals along the esophagus from the lower esophageal sphincter (LES) to the upper esophageal sphincter (UES). The amplitude profile revealed a trough of significantly decreased (P less than 0.05) amplitude at 17.5-20.0 cm above the LES. The change in pressure per unit time (dp/dt) produced a profile also with a significant decrease (P less than 0.01) in the upper esophagus, having good correlation (r = 0.91, P less than 0.001) with the amplitude profile. Mean velocity of the peristaltic wave in the upper esophagus varied from 2.92 +/- 0.19 (+/- SEM) to 3.29 +/- 0.36 cm/sec. In the distal esophagus, mean velocity increased significantly (P less than 0.01) to 4.98 +/- 0.38 cm/sec at 7.5 cm above the LES, and then fell significantly (P less than 0.05) to 2.15 +/- 0.27 cm/sec at 2.5 cm above the LES. This report establishes amplitude and velocity profiles in the human esophagus. The profile of the first derivative of the primary peristaltic wave (dp/dt) is also described, and its possible importance discussed.

Adult↗
PubMed1977

Abdominal examination: role of percussion and auscultation.

Clinicians should not minimize or overlook the importance of percussion of the liver and the spleen and of auscultation over the liver as routine parts of abdominal examination. Splenic percussion can be used to detect splenomegaly even before the spleen becomes palpable. The span of liver dullness on percussion can be compared with established normal standards to detect hepatomegaly or alterations caused by cirrhosis. A systolic bruit, a friction rub, or a venous hum detected by auscultation over the liver is an important sign of liver disease.

Abdomen↗
PubMed1977

Lower esophageal sphincter response to oral administration of cimetidine in normal subjects.

Anithistamines that specifically block the gastric and secretory action of histamine have recently been developed. One of these H2-receptor blockers, metiamide, has been found to increase lower esophageal sphincter (LES) pressure in the opossum. Because of reported agranulocytosis with metiamide, another H2-receptor blocking agent, cimetidine, was developed. To determine its effect on LES pressure, 8 normal volunteers received placebo or oral doses of cimetidine (50, 100, 200, and 400 mg) in a random, blinded manner. Indicative of adequate absorption, significant serum levels were achieved with all doses of cimetidine (50 mg = 0.17 mug per ml; 100 mg = 0.33 mug per ml; 200 mg = 0.76 mug per ml; and 400 mg = 1.61 mug per ml). Although these serum levels have been found to produce marked inhibition of gastric acid secretion, no discernible effect was found on LES pressure when compared to placebo. Thus cimetidine does not increase LES pressure. It does not decrease sphincter pressure either and is therefore not contraindicated in patients with reflux esophagitis.

Administration, Oral↗
PubMed1977

Esophageal function in diabetes mellitus and its relation to peripheral neuropathy.

Esophageal function was determined in 50 unselected patients with diabetes mellitus (DM). Fourteen age-matched healthy subjects served as controls. The presence of peripheral neuropathy (PN) was determined by a neurological examination and by nerve conduction studies. An intraluminal transducer assembly placed in the distal esophagus measured pressure in the lower esophageal sphincter and body of the esophagus. Esophageal function was studied both before and after edrophonium chloride, 80 microgram per kg intravenously. There was no significant difference in peristaltic amplitude between the controls and diabetics. There was also no difference in amplitude when DM was divided into presence or absence of PN. However, there was a significant decrease in velocity of peristalsis in DM with PN when compared to DM without PN and to controls. Resting lower esophageal sphincter pressure in DM was similar to controls, with no difference with or without PN. Twenty-eight patients (56%) with DM had abnormal motility, characterized by frequent spontaneous contractions, and decreased prevalence of peristalsis. Abnormal motility in DM was associated with PN and was characterized by a dysfunction of esophageal innervation with intact smooth muscle function.

Adult↗
PubMed1977

Diabetic peripheral neuropathy: a correlation of nerve conduction studies and clinical findings.

The electrophysiologic and clinical characteristics of diabetes were studied in 56 patients having diabetes of adult onset. Historical data including age, duration of diabetes, treatment type, family history and clinical symptoms were noted. Nerve conduction studies of the median, ulnar, peroneal, tibial and sural nerves were performed, and the H reflex was determined. Clinical sensory function of vibration, light touch, and two-point discrimination, muscle stretch reflexes in all four extremities and skin temperatures in the lower extremities were recorded. The data indicated a close correlation of clinical and electrophysiologic findings. The data supported the concept that diabetic peripheral neuropathy is progressive. It was concluded that diabetic peripheral neuropathy was present if two of the following three determinations were abnormal: median motor or sensory latency, ulnar sensory latency and sural latency.

Adult↗
PubMed1976

Symptomatic gastroesophageal reflux: incidence and precipitating factors.

The incidence and precipitating factors associated with symptomatic gastroesophageal reflux were evaluated by a questionnaire in 446 hospitalized and 558 nonhospitalized subjects. Of 385 control subjects 7% experienced heartburn daily, 14% noted heartburn weekly, and 15% experienced it once a month, giving a total of 36% of subjects having heartburn at least monthly. Daily heartburn occurred at a significantly greater (P less than 0.05) rate for 246 medical inpatients (14%) and for 121 patients seen in outpatient gastroenterological clinic (15%). Pregnant women seen in uncomplicated obstetrical clinic had symptoms of significantly greater (P less than 0.01) incidence: daily (25%) and at least once monthly (52%). Age, sex, or hospitalization did not significantly affect incidence. Fried foods, "spicy" foods, and alcohol were the most common precipitating factors.

Adult↗
PubMed1976

Lower esophageal sphincter pressures and serum gastrin levels after cholinergic stimulation.

To define the role of gastrin, if any, in the response of the lower esophageal sphincter (LES) to bethanechol, serum gastrin determinations and LES pressure measurements were made in controls, patients with vagotomy and antrectomy (V&A), and patients with vagotomy and pyloroplasty (V&P). Despite significant differences in mean basal serum gastrin levels no differences were found in mean resting LES pressures among these groups. In controls significant increases in LES pressure occurred after subcutaneous bethanechol, but serum gastrin levels did not change from basal values. Subcutaneous injections of bethanechol produced significantly greater increases in LES pressures in V&P patients than in V&A patients. Serum gastrin levels did not change in either group; however, background serum gastrin concentrations were significantly greater for V&P patients than V&A patients throughout the study. Intravenous infusion of human gastrin I heptadecapeptide in controls significantly increased sphincter responses to bethanechol. Thus, these studies provide evidence to suggest that the LES response to bethanechol is affected by background serum gastrin levels.

Adult↗
PubMed1976

Effects of cholinergic stimulation on human esophageal peristalsis.

The effects of cholinergic stimulation on esophageal peristalsis were studied in normal subjects. An intraesophageal transducer assembly was used to measure the dynamics of esophageal peristalsis before and after edrophonium chloride, 80 mug/kg intravenously. Following endrophonium, there was a marked increase in amplitude of esophageal persistalsis associated with a significant reduction in velocity of esophageal peristalsis and a significant increase in width and time of appearance of the contraction wave following a swallow. Graded doses of endrophonium all resulted in significant increases in peristaltic amplitude with the maximal response occurring at doses of 80 and 160 mug/kg. Similar results were obtained with a more direct-acting cholinergic agent, bethanechol, 80 mug/kg subcutaneously. The relevance of these results as an indication of the importance of cholinergic innervation in regulating esophageal motility are discussed.

Adult↗
PubMed1976

Isoenzyme composition of human plasma monoamine oxidase in normal subjects and in fibrotic liver disease.

Hydroxyapatite column chromatography elution profile reveals characteristic differences between monoamine oxidase (MAO) isolated from normal human plasma and from patients with hemochromatosis having hepatic fibrosis. In normal plasma, the alpha form constitutes about 84% of the enzyme, with the remainder in the beta and gamma forms. By contrast, in hemochromatosis there is less alpha form (less than 40%), an additional alpha1 form (about 20%) which was eluted immediately after alpha form, increased beta form (more than 25%), and no significant difference in gamma form. When calculated on the basis of total amount per liter, hemochromatosis is characterized by elevation of beta form (3- to 10-fold) and the presence of alpha1. These results also appear to indicate that the multiple forms separated by hydroxyapatite column chromatography represent true multiplicity of human plasma MAO in vivo.

Chromatography, Ion Exchange↗
PubMed1976

Studies on the mechanism of esophagitis-induced lower esophageal sphincter hypotension in cats.

Perfusion of 0.1 n HC1 5 cm above the lower esophageal sphincter (LES) in cats for 30 min on 4 consecutive days produced biopsy-documented esophagitis and marked decreases in LES pressure. Using this model the effects of experimental esophagitis on the LES response to edrophonium, pentagastrin, and bethanechol were determined. The sphincter response to both edrophonium and pentagastrin after esophagitis was induced was significantly less than preperfusion responses. When the esophagitis had resolved, the pressure response to edrophonium and pentagastrin returned to preperfusion levels. In contrast, the sphincter response to bethanechol during esophagitis was not different from the preperfusion response and remained unchanged after resolution of the esophagitis. Lower esophageal smooth muscle taken from cats with active esophagitis appeared normal by both light and electron microscopy. These studies indicate that besides decreasing resting LES tone, esophageal inflammation causes functional impairment of a cholinergic mechanism regulating LES pressure. In contrast, the smooth muscle appears to be unaffected by inflammation despite the LES hypotension.

Animals↗
PubMed1976

Lower esophageal sphincter and gastric acid response to intravenous infusions of synthetic human gastrin I heptadecapeptide.

Human gastrin I heptadecapeptide was administered by constant intravenous infusion to 7 adult male volunteers without gastrointestinal disease, and serum gastrin concentrations and responses of the lower esophageal sphincter (LES) pressure and gastric acid output were measured and compared. Significant responses in LES pressure were found at gastrin infusion rates which produced submaximal gastric acid output. These LES pressure responses were quantitatively smaller than those occurring concomitantly with similar total immunoreactive gastrin levels evoked by administration of a protein meal in the same subjects. These observations suggest that, although increases in serum gastrin concentrations may contribute to increases in LES pressure seen under physiological conditions after feeding, the increase in LES pressure produced by feeding cannot be explained exclusively on the basis of endogenous gastrin release.

Adult↗
PubMed1975

Cholinergic stimulation of the lower esophageal sphincter in patients with vagotomy and antrectomy.

Recently cholinergic stimulation of the lower esophageal sphincter (LES) with bethanechol has been shown to be effective in the treatment of chronic gastroesophageal reflux. Since chronic reflux and esophagitis also occur in patients with vagotomy and antrectomy, we studied the effect of bethanechol on sphincter pressure in 10 patients who had had vagotomy and antrectomy. Both subcutaneous (0.08 mg/kg) and oral (25 mg) administration of bethanechol caused significant increases in LES pressure in these patients. In addition, both subcutaneous and oral administration of bethanechol elevated hypotensive sphincter pressures to normal levels. Orally administered bethanechol produced a sustained increase in LES pressure throughout a 90-min study period. These studies suggest that cholinergic stimulation of the LES with bethanechol may be of therapeutic benefit in vagotomized and antrectomized patients with gastroesophageal reflux.

Administration, Oral↗
PubMed1975

The adverse effect of chocolate on lower esophageal sphincter pressure.

Decreased lower esophageal sphincter (LES) pressure after ingestion of chocolate has been previously noted. We have further evaluated the effect of chocolate on the known ability of gastric alkalinization or bethanechol to increase LES tone. 9 normal subjects were studied using an infused open-tip recording system. Pressure was monitored for a 15-min basal period, and for 60 min after ingestion of 120 ml of chocolate syrup either alone or with the concurrent administration of commercial antacid, oral bethanechol, or subcutaneous bethanechol. After chocolate ingestion, mean basal LES pressure of 14.6 +/- 1.1 (+/-SEM) mm Hg decreased significantly (P less than 0.01) to 7.9 +/- 1.3 mm Hg. An identical LES response occurred when antacid was given with the chocolate dose. Oral bethanechol (25 mg) and chocolate together resulted in lesser decreases in LES pressure. Subcutaneous bethanechol (5 mg) and chocolate produced significant increases (P less than 0.05) in sphincter pressure, although of lesser magnitude than reported with bethanechol alone. These results indicate that the adverse effect of chocolate on the LES is not reversed by gastric alkalinization and suggest that bethanechol in sufficient dose may overcome chocolate-induced decreases in LES pressure.

Adult↗
PubMed1975

Letter: LES pressure.

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Esophagogastric Junction↗