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Biomedical subjects

E Ros

Publications and source records attributed to E Ros.

At least 91 records · Page 5Linked to original sources
PubMed1989

[Excessive intake of fats and cholesterol in hypercholesterolemic individuals. Effects of dietary intervention on plasma lipids and lipoprotein cholesterol].

Preliminary evidences suggest that both the frequency of ischemic heart disease and the plasma cholesterol levels are increasing in the Spanish population, whose dietary habits are becoming progressively "westernized". In the present work we used the food frequency method to evaluate the dietary habits of 30 hypercholesterolemic subjects. These and another 65 free-living individuals of both sexes, ages 18-77 yrs, with plasma cholesterol 301 +/- 41 mg/dl or 7.80 +/- 1.06 mmol/l (means +/- SD) were submitted to a hypolipidemic diet similar to the mediterranean diet in order to assess effects on plasma lipids and lipoprotein cholesterol. The usual diet contained (% kcal/day): total fat 37, saturated fat (S) 12, monoinsaturated fat 16 and poliinsaturated fat (P) 6, with P/S = 0.5 and a daily cholesterol intake of 506 mg. During dietary intervention, respective changes were: -7%, -5%, -1%, +2%, +0.6, and -304 mg. After a 3 - month dietary period, significant (p less than 0.001) decreases occurred in total plasma cholesterol (-40 mg/dl or -1.04 mmol/l, -14%), LDL-cholesterol (-35 mg/dl or -0.91 mmol/l, -16%) and triglycerides (-5 mg/dl or -0.28 mmol/l, -14%), while HDL-cholesterol and body weight did not change. Similar effects were obtained when diet was continued for 1 yr in a subgroup of 40 individuals. The responses of plasma cholesterol to dietary change had a normal distribution, with 17% hyporresponses and 15% hyperresponses. A marked decrease (-36%) of plasma triglycerides was observed in 12 subjects with IIb hyperlipidemia. The total cholesterol/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol ratios improved in both men and women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Radiological diagnosis of inorganic lead poisoning.

A 43-year-old woman had abdominal pain and anemia due to inorganic lead poisoning. Plain abdominal x-ray films showed metallic densities within the lumen of the large bowel. The patient admitted that she used to chew the sheets of metallic lead enclosing wine bottle necks regularly. We report the case because of both the unusual radiographic findings and the exceptional source of lead intoxication.

Adult↗
PubMed1989

Efficacy of sucralfate in refractory reflux esophagitis. Results of a pilot study.

Patients with severe reflux esophagitis unresponsive to standard medical therapy constitute a vexing clinical problem. We evaluated 8 patients with long-standing gastroesophageal reflux disease complicated by peptic stricture (n = 6), Barrett's esophagus (n = 5), bleeding esophageal ulcer (n = 2), and/or failure or prior antireflux surgery (n = 4), and 4 patients with rapidly advancing esophagitis following surgical resection of the cardia. After an 8-week course of full-dose H2-receptor antagonists, domperidone and antacids, marginal clinical improvement and unchanged or worsened endoscopic appearance of esophagitis was observed in all patients. Thereafter, in an attempt to enhance esophageal mucosal resistance, sucralfate alone (4.0 g/d) was given for 8 weeks. Both symptoms and endoscopic appearance improved in all patients after sucralfate, and the need for dilatation of strictures was lessened. On follow-up, complete healing of esophagitis was demonstrated by endoscopy in 6 patients after 4 to 6 months of uninterrupted sucralfate therapy. The results of this pilot study indicate that (cyto)protection with sucralfate has an important therapeutic potential in reflux esophagitis. They also suggest that impaired esophageal epithelial resistance is an important pathophysiological factor in persistence of esophageal inflammation in esophagitis refractory to conventional treatment.

Aged↗
PubMed1988

Utility of inpatient 24-hour intraesophageal pH monitoring in diagnosis of gastroesophageal reflux.

The aims of the present study were to evaluate the accuracy of 24-hr intraesophageal pH monitoring in the diagnosis of gastroesophageal reflux in the hospital setting and to establish whether there were any differences in terms of reflux events between patients with and without endoscopic esophagitis. Fifteen control subjects and 47 patients with proven gastroesophageal reflux disease were studied. A composite score of reflux events (number of reflux episodes; total, upright, and supine reflux time; number of refluxes lasting more than 5 min; and duration of the longest reflux) provided the best discrimination between controls and patients (94% sensitivity and 100% specificity). Patients with esophagitis showed concurrently a longer total reflux time and supine reflux time, and more prolonged reflux episodes than those without esophagitis. On the other hand the severity of esophagitis was directly related to the duration of both total and supine reflux. The results indicate that inpatient 24-hr pH-metry is very accurate in the diagnosis of gastroesophageal reflux. They also suggest that prolonged esophageal exposure to acid, particularly at night, and slow esophageal acid clearing are factors that determine the appearance and/or perpetuation of esophagitis in patients with reflux.

Adult↗
PubMed1988

Intraesophageal pH monitoring after breakfast + lunch in gastroesophageal reflux.

To evaluate intraesophageal pH monitoring during two consecutive 3-h postprandial periods (breakfast + lunch) in the diagnosis of pathological gastroesophageal reflux, we studied 40 patients with documented gastroesophageal reflux and 15 healthy controls. Reflux events were analyzed in the two separate postprandial periods, their sum (double postprandial pHmetry), and a standard 24-h period. Data from all pH-recording periods were compared and correlation coefficients were obtained between postprandial and 24-h reflux events. While pH recordings from the two separate postprandial periods provided good separation between patients and controls, double postprandial pHmetry was most accurate in the diagnosis of gastroesophageal reflux. In the latter procedure, mean percent reflux time was 2.5 +/- 1.8% in controls and 19.4% +/- 10.3% in patients (p less than 0.001), with a specificity of 100% and a sensitivity of 97%. A high degree of correlation existed for all reflux events between postprandial and 24-h pHmetries. We believe that double postprandial intraesophageal pH monitoring accurately distinguishes between normal persons and patients with pathological reflux. The technique considerably shortens the examination time in relation to 24-h pH monitoring and may prove the esophageal test of choice for objective evidence of gastroesophageal reflux.

Adult↗
PubMed1988

Lipomatosis of the pancreas: an unusual cause of massive steatorrhea.

Fat replacement of the exocrine pancreas is a rare cause of exocrine pancreatic failure. We report two adult patients (a 25-year-old woman and a 63-year-old man) with weight loss and massive steatorrhea in whom abdominal computed tomograms were diagnostic of pancreatic lipomatosis. In both patients, oral pancreatic enzyme replacement in association with cimetidine led to a marked reduction of steatorrhea and weight gain. Pancreatic lipomatosis should be suspected in cases of severe exocrine pancreatic insufficiency in the absence of abdominal pain and diabetes. Computed tomogram scanning should lead to an increasing detection rate of this unusual condition.

Adult↗
PubMed1987

Postcholecystectomy symptoms. A prospective study of gall stone patients before and two years after surgery.

The results of cholecystectomy in terms of symptomatic improvement were prospectively evaluated in 124 unselected gall stone patients interviewed before and two years after elective surgery. Indications for cholecystectomy were biliary pain (n = 65), previous complications of gall stone disease (n = 52), and flatulent dyspepsia (n = 7). At two years 93 patients could be re-evaluated, of whom only 49 (53%) were completely symptom free. Postcholecystectomy symptoms occurring in the remaining 44 patients were mainly flatulent dyspepsia (which had relapsed in 22 of 46 patients who suffered it preoperatively), dull abdominal pain or diarrhoea. Incisional hernia was present in five patients and one had recurrence of pain because of retained common bile duct stones. Symptomatic cures after cholecystectomy decreased with the duration of the preoperative history. The results reconfirm that cholecystectomy eradicates specific symptoms and complications of gall stone disease, but they also show that nearly one half of operated patients are dissatisfied with the procedure because of mild but distressing 'postcholecystectomy' symptoms. These are probably caused by previously undiagnosed functional gut disease associated with, but unrelated to, gall stones. A systemic approach to multisymptomatic patients with gall stones is recommended.

Abdomen↗
PubMed1986

Upper gastrointestinal bleeding caused by gastroduodenal vascular malformations. Incidence, diagnosis, and treatment.

Within a two-year period, 12 patients with upper gastrointestinal bleeding due to gastroduodenal vascular malformations were admitted to a specialized intensive care unit. They represented 2.1% of all admissions for upper gastrointestinal bleeding, and 3.7% of those with severe hemorrhage (greater than or equal to 2 units of blood transfused). Early endoscopy was nondiagnostic during the first bleeding episode in all nine patients with nonhereditary vascular malformations; the diagnosis was eventually made after relapsing hemorrhage by repeat endoscopy in five patients, angiography in two, and histology in another two. These nine patients accounted for 23.6% of all cases of upper gastrointestinal bleeding considered to be of unknown origin after initial work-up. The remaining three patients had Rendu-Osler-Weber disease, and the first endoscopy was diagnostic in all of them. Emergency treatment was required for 11 patients; surgery was undertaken in seven, and transendoscopic therapy (electrocoagulation or endoscopic clipping) in four. There was a 25% mortality rate. No further bleeding has occurred in eight patients after a mean follow-up period of two years. Gastroduodenal vascular malformations are a more frequent cause of upper gastrointestinal bleeding than heretofore recognized, especially in patients whose hemorrhage is deemed to be of unknown origin after an initial work-up. Endoscopy, which may need to be repeated, is the most rewarding diagnostic procedure. Awareness of their possible existence facilitates endoscopic recognition. When available, transendoscopic therapy is a good choice to stop active bleeding from such lesions.

Adolescent↗
PubMed1986

Reversibility of exocrine pancreatic failure in chronic pancreatitis.

In patients with chronic pancreatitis, the development of exocrine pancreatic failure is generally thought to be an irreversible process. We found evidence to the contrary in a prospective study of 70 patients who were evaluated by endoscopic retrograde cholangiopancreatography and sequential measurements of stool fat, percent urinary PABA excretion, and serum trypsin during a follow-up time period of 1-4 yr. Initial p-aminobenzoic acid (PABA) testing showed exocrine failure in 51 patients, 35 of whom had low serum trypsin levels while 14 (27%) disclosed unexpectedly high trypsin concentrations. Ductal morphology was similar in patients with low and high trypsin values. In 8 of the latter cases, steatorrhea improved and pancreatic function tests became normal after pancreaticojejunostomy in 4 patients, alcohol abstinence in 3 patients, and spontaneous resolution of a pseudocyst in 1 patient. Pancreatic cancer was present in a further 3 patients. Of the 37 patients with low PABA and low trypsin at the outset, there was no improvement of exocrine function in 17 of 18 who were surgically treated. Conservative treatment had a similar effect in another 6 patients who were available for follow-up in this group. The mean duration of symptomatic disease was shorter (p less than 0.001) in patients with low PABA and high trypsin levels (1.4 +/- 1.2 yr) than in those with low PABA and low trypsin levels (4.5 +/- 1.3 yr). The results show that up to 20% of patients with chronic pancreatitis have exocrine pancreatic failure, which is apparently due to early ductal obstruction of a gland with preserved function; this situation can be suspected when low urinary PABA excretion and high serum trypsin levels are simultaneously found; and (c) exocrine failure may be reversible in these patients by using a pancreatic drainage procedure or alcohol abstinence. Such a peculiar pattern of pancreatic function tests may also suggest pancreatic cancer.

4-Aminobenzoic Acid↗
PubMed1986

Utility of biliary microscopy for the prediction of the chemical composition of gallstones and the outcome of dissolution therapy with ursodeoxycholic acid.

To learn whether microcrystalline solids in bile could predict gallstone composition, the findings determined by polarizing microscopy of gallbladder bile were related to stone type at cholecystectomy in 53 patients. Cholesterol crystals were present in 36 of 39 cholesterol stone bile and absent in 12 of 14 bile from non-cholesterol stones. Fifteen cholesterol stones (eight radiopaque) contained calcium carbonate, and characteristic vaterite microspheroliths were observed in 53% of their bile. In another study, crystals in basal duodenal bile were related to the outcome of gallstone dissolution treatment with ursodeoxycholic acid, 10 mg/kg X day. In 39 patients treated for 1 yr, efficacy (complete gallstone dissolution) was 41% overall and 52% in patients with stones less than or equal to 10 mm in diameter. In connection with the findings of biliary microscopy, efficacy was 93% in 14 patients with cholesterol crystals in bile, and 27% in 11 patients with microspheroliths in bile. Cholecystectomies in 9 patients with dissolution failure revealed 4 cases of non-cholesterol stones and 5 cases (including 3 with on-therapy calcification) of calcium carbonate-rich cholesterol stones with a surface/interior mineral ratio greater than 3. The results confirm that cholesterol crystals in bile are a sensitive measure of cholesterol gallstones. They also show that vaterite microspheroliths in bile indicate the presence of calcium carbonate in gallstones. Both findings suggest that biliary crystals reflect gallstone composition, and it is demonstrated that this information is useful in predicting the success or failure of cholelitholysis with ursodeoxycholic acid. Finally, the data show that radiologically undetectable stone calcification reduces the probability of dissolution, and that the calcified structures appearing in some stones during treatment are composed of calcium carbonate.

Bile↗
PubMed1985

Chronic hepatitis: a possible etiology of fatty liver.

In a survey of the etiology of hepatic steatosis, none of the known causes of fatty liver was identified in 12 of 137 patients with severe fatty changes (more than 50% of hepatic cells containing fat vacuoles) diagnosed over a 4-year period. The retrospective analysis of the clinical records of these patients disclosed the absence of symptoms, liver biopsy being performed because of persistent hypertransaminasemia, which had been discovered fortuitously in 10 cases and after acute hepatitis in two. None had HBsAg in serum. In addition to fatty changes, lobular necrosis was found in 11 cases and chronic inflammation of portal tracts in eight. Patients remained asymptomatic and had raised transaminases during a follow-up ranging from 1 to 3 years. The clinical, biochemical and follow-up features of these patients closely resemble those of patients with chronic hepatitis in Mediterranean countries. Thus it can be suggested that in some cases fatty liver may be a prominent feature of chronic hepatitis.

Adolescent↗
PubMed1984

Comparison of fasting, nasogastric suction and cimetidine in the treatment of acute pancreatitis.

88 unselected patients with acute pancreatitis entered a randomized clinical trial comparing the therapeutic efficacy of fasting alone, nasogastric suction and fasting plus cimetidine. The disease was mild to moderate in all but 3 cases, and cholelithiasis was the main etiological factor. The number of treatment failures and complications, and the clinical outcome were similar in the three groups. However, when compared to fasting alone, nasogastric suction was shown to delay the resumption of bowel activity a mean of 11 h (p less than 0.05), prolong the duration of pain a mean of 20 h (p less than 0.01), increase analgesic needs (pentazocine lactate) a mean of 64 mg (p less than 0.05), and lengthen hospital stay a mean of 2 days (p = NS). In conclusion, cimetidine has no beneficial effects in acute pancreatitis. It is suggested that fasting alone be initially used as the simpler, safer and more economical therapy. Nasogastric suction should be reserved for patients presenting with intestinal ileus, a situation that occurred in 1 out of every 8 cases in the present series.

Acute Disease↗
PubMed1984

Fat digestion and exocrine pancreatic function in primary biliary cirrhosis.

Intestinal bile salt deficiency marginally impairs fat absorption in cholestatic patients. The finding of massive steatorrhea in some patients with primary biliary cirrhosis led us to systematically study and compare fat digestion in control subjects (n = 4) and patients with biliary cirrhosis with (n = 11) and without (n = 3) steatorrhea. The jejunum was anatomically and functionally intact in all subjects, as demonstrated by normal gastrointestinal radiology and xylose absorption, respectively. The intestinal contents were recovered during digestion of a fat meal. Lipolysis, pH, and trypsin activity were measured in whole intestinal contents, whereas bile salts, total lipid, and fatty acid were determined in both total and aqueous phases. The results obtained in controls and patients without steatorrhea were similar. Percentage of lipolysis and intraluminal pH were normal in controls and in both patient groups. The intestinal contents of the patients with steatorrhea had a significantly lesser capacity to solubilize both total lipid and fatty acid in relation to abnormally low aqueous bile salt concentrations. No bile salt deconjugation and only minimal bile salt precipitation were found, thus low aqueous bile salts were strictly related to bile secretory failure. Steatorrhea was always present when aqueous bile salt levels were below 3.0 mM. Intestinal trypsin activity was subnormal in patients with steatorrhea; decreased trypsin activity was related (r = 0.82, p less than 0.001) to reduced intestinal bile salt levels. One patient was found to have severe exocrine pancreatic failure. Administration of medium chain triglycerides was uniformly effective in improving nutrition in patients with steatorrhea, but the course of the disease was unaffected. These results indicate that overt pancreatic failure is uncommon in primary biliary cirrhosis, and that fat maldigestion and steatorrhea, regardless of what degree, are due mainly to low intestinal bile salt levels secondary to bile secretory failure. Finally, subnormal pancreatic function in this disease appears to be related to the bile secretory failure, suggesting either that the lack of bile or bile salts in the intestine depresses pancreatic exocrine function or that both biliary and pancreatic secretions decrease in parallel as part of a widespread secretory failure syndrome.

Adult↗
PubMed1983

Effects of B-HT 920 and B-HT 933 on dopamine and noradrenaline autoreceptors in the rat brain.

B-HT 920 at low doses inhibited the accumulation of DOPA following treatment with reserpine and a DOPA decarboxylase inhibitor in the dopamine-, but not in the noradrenaline-predominant regions of the rat brain. B-HT 933 selectively inhibited this DOPA accumulation in the noradrenaline-predominant regions. These effects of B-HT 920 and B-HT 933 were completely antagonized by haloperidol and yohimbine, respectively. The rat motor activity was reduced by B-HT 920 and it was restored following apomorphine. B-HT 933 decreased the motor activity by a yohimbine-sensitive mechanism. The results indicate that B-HT 920 can selectively and potently stimulate the dopamine autoreceptors whereas B-HT 933 can selectively stimulate the noradrenaline autoreceptors.

Animals↗
PubMed1980

[Clinical and experimental studies on pulsatile and continuous flow during extracorporeal circulation (author's transl)].

In 20 patients who underwent open-heart surgery, the plasma concentrations of glucose, insulin, glucagon, growth hormone, free hemoglobin, and cholinesterase were measured before, during and after pulsatile and continuous perfusion. Pulsatile flow was achieved by modification of a roller pump to effect rapid acceleration and slowing. The driving motor was interfaced with a control module to enable ECG-triggered perfusion. In addition to the clinical studies, investigations were performed in 9 dogs to assess the effects of pulsatile and continuous perfusion on liver and pancreas flow during total bypass. During pulsatile perfusion there was a significant increase in insulin which, however, was clearly diminished in relation to glucose levels. The response of the beta-cells was markedly more compromised after continuous than pulsatile perfusion. The secondary postoperative increase in insulin can be accounted for by intravenous administration of glucose and, particularly, after pulsatile perfusion, indicates an almost completely normal response of pancreatic beta-cells. As opposed to the effects of continuous perfusion, the low glucose, glucagon, and growth hormone levels, the insulin increase during and after pulsatile perfusion as well as normal cholinesterase values observed in association with pulsatile perfusion appear to be the result of improved pancreatic and hepatic function. This contention is supported by the experimental finding of significantly increased pancreas and liver perfusion during pulsatile perfusion.

Animals↗