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Biomedical subjects

D Y Graham

Publications and source records attributed to D Y Graham.

At least 487 records · Page 27Linked to original sources
PubMed1987

Gastroduodenal mucosa and dyspeptic symptoms in arthritic patients during chronic nonsteroidal anti-inflammatory drug use.

Gastroduodenal intolerance is one of the major factors limiting the use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAID) in patients with arthritic conditions. We evaluated the endoscopic appearance of the gastroduodenal mucosa in 65 patients (63 men and two women) taking regular daily doses of NSAIDs over a long period for osteoarthritis or rheumatoid arthritis. Eight different drugs (indomethacin, ibuprofen, naproxen, sulindac, piroxicam, aspirin, salsalate, and tolmetin) had been taken continuously for at least 6 wk. Seven patients took two different NSAIDs. No other drug known to damage the mucosa was used. Twenty-one patients (32%) had an endoscopically completely normal stomach and duodenum, and 44 (68%) had evidence of injury (mucosal hemorrhage 44.6%, erosions 53.8%, both mucosal hemorrhage and erosions 34%). Ten patients had ulcers detected (seven gastric, two pyloric channel, one duodenal bulb) for a point prevalence of 15.4%. Ulcers were found in patients taking naproxen, indomethacin, tolmetin, sulindac, and ibuprofen, either alone, or in combination with aspirin. Dyspeptic symptoms were present in 19% of those with completely normal endoscopy and in only 9% of those with abnormal endoscopic findings. Only three of the 10 patients with ulcer had dyspeptic symptoms. There was no significant difference between drugs in tendency to cause gastroduodenal injury. We confirm that fairly severe gastroduodenal injury occurs in asymptomatic patients with rheumatoid and osteoarthritis, and that symptoms do not predict the presence of damage.

Adult↗
PubMed1987

Campylobacter pyloridis gastritis: the past, the present, and speculations about the future.

Campylobacter pyloridis infection of the stomach has been associated with gastric ulcer, duodenal ulcer, nonulcer dyspepsia, and gastritis. The etiological role of C. pyloridis in most of those conditions remains unclear. We reviewed what is known about C. pyloridis infections in man. Considerable clinical data on C. pyloridis infections was available in older literature concerning gastritis and gastric urease. C. pyloridis causes a form of type B gastritis. In some individuals the acute infection is associated with abdominal pain and transient hypochlorhydria. C. pyloridis infection is difficult to eradicate with current therapies. The mechanisms by which C. pyloridis infection may lead to development of peptic ulcers, nonulcer dyspepsia, or atrophic gastritis are discussed. Recent technological advances, such as the 13C-urea breath test, provide rapid noninvasive methods of identifying active C. pyloridis infection. These methods will permit the rapid execution of definitive investigations of the epidemiology, transmission patterns, and possible reservoirs of C. pyloridis infection and will delineate the spectrum of C. pyloridis-associated disorders.

Achlorhydria↗
PubMed1987

Cardiac tamponade as a result of endoscopic sclerotherapy: report of a case.

Sclerotherapy was used in the treatment of a patient with actively bleeding esophageal varices. Chest pain and a pericardial friction rub became evident on the day after sclerotherapy and resolved without therapy. Six months later the patient manifested cardiac tamponade which required pericardiectomy. The events of this case suggest that chronic pericarditis with cardiac tamponade was a direct complication of sclerotherapy. This report extends the range of reported complications and emphasizes the importance of follow-up of patients in whom transient pericardial friction rub develops after sclerotherapy.

Adult↗
PubMed1987

Improved palliation of a respiratory-esophageal fistula with a cuffed esophageal prosthesis.

We report a case in which a traditional prosthesis failed to seal a malignant respiratory-esophageal fistula. Removal of the prosthesis and replacement with a new type with an inflatable cuff provided palliation, and allowed the patient to leave the hospital. The cuffed prosthesis provides a custom fit which should seal fistulous tracts of any shape or size, without causing tissue necrosis.

Carcinoma, Squamous Cell↗
PubMed1986

Antigenic characterization and ELISA detection of adult diarrhea rotaviruses.

Recently, severe epidemics of diarrhea among both adults and children in China have been associated with an agent called adult diarrhea rotavirus (ADRV). We have studied ADRV from two areas of China (Jinzhou and Guangxi) and compared them with prototype group A, B, and C rotaviruses. The viral genomes were compared by electrophoresis of the RNA genome segments in polyacrylamide gels, and the antigenic relatedness of these viruses was examined by immune electron microscopic studies using virus preparations of either double- or single-capsid particles. Hyperimmune antisera (guinea pig and rabbit) to one strain of ADRV reacted with high titers with other strains of ADRV and with single-shelled capsids of a porcine group B rotavirus. The antisera to ADRV did not react with either group A or group C rotaviruses. Antisera to either bovine or porcine group B rotaviruses reacted with ADRV but not with the group A or group C viruses. Antisera to group A or group C virus reacted only with their respective homologous virus. These results and those of immunofluorescence studies place the human ADRV rotaviruses from China among the group B rotaviruses. We also report the development of an ELISA to detect ADRV; this ELISA should be useful for defining the epidemiology of these recently described rotaviruses.

Adult↗
PubMed1986

Cimetidine hepatitis.

A 62-year-old man developed asymptomatic anicteric hepatitis during cimetidine therapy for duodenal ulcer disease. Liver biopsy revealed zonal (centrolobular) necrosis, bile stasis, and mononuclear cell infiltration. Electron microscopy featured mitochondrial hyperplasia, giant mitochondria, and liver cell bile inclusions. The diagnosis of cimetidine-related hepatitis was confirmed by re-exposure to cimetidine, which prompted a rapid rise in serum transaminases while under observation in the hospital. Cimetidine hepatitis is rarely reported, and routine monitoring of the patient's liver tests during therapy does not seem cost-effective as a general practice.

Chemical and Drug Induced Liver Injury↗
PubMed1986

Mycobacterial aetiology of Crohn's disease: serologic study using common mycobacterial antigens and a species-specific glycolipid antigen from Mycobacterium paratuberculosis.

Crohn's disease is a granulomatous form of enteritis superficially similar to Johne's disease (paratuberculosis) of ruminants. Recently, a Mycobacterium sp closely related to Mycobacterium paratuberculosis was cultured from tissues of patients with Crohn's disease suggesting that M paratuberculosis may be the aetiologic agent in some cases. In addition, greater seroreactivity to M paratuberculosis has been reported in patients with Crohn's disease. In the present study, we have evaluated the serum antibody response to disrupted M paratuberculosis using ELISA and serum specimens from 33 people with Crohn's disease, 21 with ulcerative colitis, and 12 non-inflammatory bowel disease controls. We failed to find a consistent IgG, IgM, or IgA antibody response to Mycobacterium paratuberculosis. The results indicate that, as in bovine paratuberculosis, serum seroreactivity is not a reliable tool for examining the relationship between human intestinal disease and mycobacteria.

Antibody Formation↗
PubMed1986

Aspirin and the stomach.

Aspirin often causes acute gastric mucosal damage that can be seen endoscopically or assessed indirectly (for example, by measuring increased gastrointestinal blood loss). The occurrence of most adverse effects is apparently related to the dose administered. This dose-response effect, evident in both endoscopic and microbleeding studies done after acute or short-term aspirin administration, is also associated with the risk of developing chronic gastric ulcer. The occurrence of gastric adaptation, or lessening injury with continued treatment, obscures the interpretation of results from studies of acute administration. Moreover, evidence of dose-response effects has frequently been ignored when lists of complications and side effects are compiled. The absence of symptoms does not correlate with acute or chronic mucosal damage and appears to have no predictive value. Endoscopic studies linking the extent and degree of acute mucosal injury to various nonsteroidal anti-inflammatory drugs have little or no value in predicting the frequency or severity of chronic gastric ulcer or gastrointestinal bleeding.

Acute Disease↗
PubMed1985

Rotavirus antigens.

The rotaviruses are important medical and veterinary pathogens that cause acute diarrheal disease in children and in the young of most mammalian and avian species. The successful development of a rotavirus vaccine should significantly reduce worldwide infant morbidity and mortality and economic losses and increase food-production. Recent successes in the cultivation and characterization of rotavirus strains from humans and animals have led to a better understanding of the major antigens of these viruses and the genes encoding these antigens. The products of three independent genes (1) the neutralization antigen (the outer capsid glycoprotein); (2) the subgroup antigen (the major inner capsid protein); and (3) the hemagglutinin (the outer capsid protease-sensitive protein) are the major viral antigens. The properties and structure of these antigens are discussed. Further knowledge should facilitate the synthesis and development of novel antigen or subunit vaccines.

Animals↗
PubMed1985

Famotidine, a new H2-receptor antagonist. Effect on parietal, nonparietal, and pepsin secretion in man.

We studied pentagastrin-stimulated acid and pepsin secretion with three doses (5, 10, and 20 mg) of a new H2-receptor antagonist (famotidine) administered orally to normal male volunteers. A dose response was identified: 2 hr after oral dosing, 5 mg famotidine suppressed stimulated acid secretion to 60% of control and was comparable to 300 mg cimetidine (55% suppression). Higher doses of famotidine yielded significantly more suppression of acid secretion (10 mg yielding 70% and 20 mg, 90%). Pentagastrin-stimulated acid secretion remained decreased (50% of control) 12 hr after oral dosing with 20 mg famotidine. The reduction in pepsin output paralleled the reduction in acid secretion and was primarily due to a reduction in the volume of secretion and not to a change in pepsin concentration. We calculated the components of gastric secretion (acid from parietal cells) and bicarbonate secretion (from nonparietal cells) and found that the primary effect of the H2-receptor antagonists was a dramatic reduction in parietal cell output without a significant decrease in nonparietal secretion. Famotidine proved to be a potent inhibitor of both the parietal component of gastric acid and pepsin output. Famotidine was significantly more potent than cimetidine; 5 mg of famotidine was comparable to 300 mg of cimetidine.

Adult↗
PubMed1985

Effects of aspirin and an aspirin-acetaminophen combination on the gastric mucosa in normal subjects. A double-blind endoscopic study.

Coadministration or preadministration of acetaminophen with aspirin affords partial protection against aspirin-induced gastric mucosal injury in animals. Recently, it was reported that preadministration of acetaminophen in humans yielded similar protection. That study used pylorus occlusion, intravenous atropine, and exogenous acid, and thus may not have mimicked the usual clinical situation. We studied a clinical regimen, in 7 normal volunteers. We coadministered acetaminophen (1.95 or 2.6 g/day) and aspirin (in a 1:1 ratio) and used gastroscopy to evaluate if there was gastric mucosal protection. Aspirin alone was used as a positive control. We found the expected significant increase in mucosal damage associated with increasing aspirin dose (p less than 0.05) comparing the lowest and highest aspirin doses (1.95 g vs. 3.9 g) after 7 days of continuous therapy. There was no difference in the degree of mucosal injury when receiving the same dose of aspirin (p = 0.38) whether or not acetaminophen was administered in a dose equal to that of aspirin. Thus, in a more normal clinical situation, we were unable to confirm the findings from the pylorus-occluded model, i.e., we failed to identify either a beneficial effect, or a trend, for protection from gross mucosal damage by the coadministration of acetaminophen and aspirin in equal dosages.

Acetaminophen↗
PubMed1985

Balloon dilatation of benign and malignant esophageal strictures. Blind retrograde balloon dilatation.

Balloon esophageal dilatation offers many theoretical advantages (safety, speed, and patient comfort) over dilatation with mercury-filled bougies or with the Eder-Puestow system. The authors used balloon dilators in 22 patients with dysphagia secondary to benign or malignant strictures. Dilatation was performed with fluoroscopic guidance, blindly, or by a combination of these techniques. For "blind" stricture dilatation, an Eder-Puestow spring-tipped guide wire is placed into the stomach using a fiberoptic endoscope. The distance from the incisor teeth to the stricture is measured, and the balloon shaft is marked to indicate when the middle of the balloon is within the stricture. Dilatation is then performed using the antegrade or, the preferred, retrograde technique. Finally, the dilated stricture is calibrated by pulling an inflated balloon through the previously strictured area without difficulty. An attempt was made to achieve an esophageal diameter of 15 mm at the initial dilatation episode, and patient discomfort was used as a guide as to the final diameter. The balloon dilatation technique was highly successful, and a stricture diameter of 15 mm (45-47 French) was achieved at the initial dilatation in most instances. Malignant strictures were easily dilated. Balloon dilatation is convenient, effective, quick, and potentially safer than the previous Eder-Puestow or mercury-filled bougie techniques.

Dilatation↗