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Biomedical subjects

F L Iber

Publications and source records attributed to F L Iber.

At least 37 records · Page 2Linked to original sources
PubMed1987

Gallbladder volume and emptying in insulin-requiring male diabetics.

Gallbladder function was evaluated in 27 healthy male volunteers and 47 male insulin-requiring diabetics from a diabetic clinic. Three groups of patients were studied: 18 patients without neuropathy or retinopathy (A); 17 patients with evidence of peripheral neuropathy (B); and 12 patients with evidence of peripheral and autonomic neuropathy (C). Eleven patients complained of gastrointestinal symptoms (three in group B, eight in group C). Thirty minutes after a standard breakfast, fasting gallbladder volumes and gallbladder emptying rates were measured using a real-time mechanical sector ultrasound scanner. Fasting gallbladder volume in diabetic patients was similar to controls (24.9 +/- 2.7 N; 28.9 +/- 3.9 A; 23.7 +/- 2.2 B; 16.7 +/- 3.4 C ml mean +/- SEM). Postprandial gallbladder emptying was not significantly different in any groups (47.4 +/- 5.1% N; 43.2 +/- 7.7% A; 50.7 +/- 7.7% B; 46.8 +/- 11.1% C). Seven diabetics and two controls had poor gallbladder emptying. One screened patient had cholecystectomy, three patients had stones, and two had sludge with a thickened gallbladder wall for a total of 12.5% gallbladder disease. These data suggest that gallbladder dysfunction in male insulin-requiring diabetics is rare.

Adult↗
PubMed1987

Esophageal manometry and radionuclide emptying in chronic alcoholics.

Eighteen asymptomatic alcoholics, half with neuropathy, were studied within 3 days of drinking to evaluate the frequency, nature, and underlying causes of esophageal dysmotility. Ten were restudied after a month of sobriety. The mean lower esophageal sphincter pressure and esophageal contraction amplitude in alcoholics were significantly higher than controls. Radionuclide esophageal emptying was slower than controls. Abnormal motility studies included 9 patients with nutcracker esophagus and 5 patients with nonspecific motor disorder. After 1 mo of abstinence, 5 of 6 patients with nutcracker esophagus and one with nonspecific motor disorder became normal. Lower esophageal sphincter pressure and esophageal contraction amplitude also returned to normal. These abnormal findings were independent of neuropathy. One patient who had normal manometry and emptying had esophagitis. We demonstrated that esophageal dysfunction is common in alcoholics, even in the absence of esophagitis and neuropathy, suggesting that these do not play a major role in esophageal dysmotility. Nutcracker esophagus is a reversible and common manometric finding in asymptomatic alcoholics.

Adult↗
PubMed1987

Gastrointestinal involvement in insulin-requiring diabetes mellitus.

Gastrointestinal (GI) dysfunction in diabetes mellitus has never been evaluated systematically in all parts of the digestive system in a group of diabetics. Therefore, we have evaluated the frequency, extent, and clinical significance of GI complications in 75 consecutive, male, insulin-requiring diabetics (46 with neuropathy). Nineteen percent of the 75 patients and 30% of those with neuropathy had one or more GI symptoms. Esophageal, gastric, gallbladder, and small intestinal functions were studied in 30 patients using radionuclide esophageal and gastric emptying, postprandial gallbladder emptying, and intestinal transit of lactulose. We divided them into three groups: (1) 10 without neuropathy, (2) 10 with peripheral neuropathy, and (3) 10 with autonomic and peripheral neuropathy. Twenty-five patients (83%) had abnormalities of at least one GI organ, and 57% had abnormalities of two. Nineteen of the 25 patients (76%) with GI involvement and 8 of 9 (89%) symptomatic diabetics had delayed esophageal emptying. Symptomatic diabetics had more diabetic retinopathy, neuropathy, and autonomic dysfunction than asymptomatic diabetics and also had more widespread and more severe gastrointestinal involvement than asymptomatic diabetics. Therefore, our results indicate that in diabetics, (1) gastrointestinal motor abnormalities are common even though they are usually asymptomatic and (2) gastrointestinal dysfunction, especially in symptomatic diabetics, is often widespread and usually includes the esophagus.

Diabetes Mellitus, Type 1↗
PubMed1987

Liver toxicity encountered in the Veterans Administration trial of disulfiram in alcoholics.

Alcoholic subjects (453) were randomly assigned to disulfiram or placebo therapy and followed for up to 12 months for drinking. Drinking status was determined from interviews of the subject and a household contact each 2 months and from the analysis of eight blood samples or 39 urines submitted at intervals during the year. Liver status was monitored each 2 months by obtaining serum alkaline phosphatase, bilirubin, and AST. Sensitive criteria were arbitrarily selected to identify about 1/5 of the patients with episodic elevations of liver tests. There was no relationship of liver test elevations to disulfiram treatment. However, the elevated AST related significantly to drinking status (p = 0.004) as did elevated bilirubin (p = 0.044), but not elevated alkaline phosphatase (p = 0.146). Two hundred one patients had liver test elevations at least one time and were continued on drug, four were dropped. One hundred seventy-nine of these patients were drinking, 22 were abstinent, and four were indeterminant. It is concluded that patients on disulfiram with minor liver test abnormalities are usually drinking.

Alcoholism↗
PubMed1987

Evaluation of an oral solution to accelerate alcoholism detoxification.

Twenty-five newly admitted patients were randomly assigned to supplemental treatment with an oral fructose mineral drink or a placebo solution. Nine pints were given in a double-blinded study during the first 3 days. Observations of tremor, chlordiazepoxide requirements, patients perceptions, and observer perceptions of common withdrawal symptoms and signs and the serum levels of Zn, Mg, and potassium were made initially and after the treatment. Although the patients improved over the 4 days of observations by many of the criteria, there were no differences between those receiving active solution and placebo.

Administration, Oral↗
PubMed1987

Radionuclide esophageal emptying and manometric studies in diabetes mellitus.

Esophageal function was prospectively studied in 50 consecutive insulin-requiring diabetes mellitus patients. The patients were stratified in three groups: A) 18 without peripheral neuropathy (PN); B) 20 with PN but no autonomic neuropathy; C) 12 with PN and autonomic neuropathy. Twelve patients (four B, eight C) had gastrointestinal symptoms including six with dysphagia. Radionuclide esophageal emptying was abnormal in 55, 70, and 83% of patients in groups A, B, and C, respectively. Eleven of the 12 (92%) symptomatic and 23 of the 38 (60%) asymptomatic diabetes mellitus patients had abnormal emptying. Five of six patients with dysphagia had abnormal emptying. Esophageal manometry was also performed in 15 patients. Twelve patients had abnormal manometry. These included nutcracker esophagus in two, achalasia in one, and increased percentage of multipeaked and simultaneous contractions in nine. There were no significant correlations between radionuclide esophageal emptying, manometric changes and symptoms. Gastrointestinal symptoms were more common in the presence of autonomic neuropathy. Delayed esophageal emptying was more profound in the presence of PN, but abnormal esophageal emptying was present in patients with neuropathy as commonly as patients without. Furthermore, the presence of diabetic retinopathy, duration or control of diabetics, and fasting blood sugar did not influence the frequency of abnormal esophageal emptying. Our data indicate that esophageal dysfunction is common in male diabetics even in the absence of clinical PN and retinopathy, suggesting that diabetic gastroenteropathy can occur in the absence of significant diabetic complications. Commonly observed abnormal esophageal manometry in diabetics is not necessarily accompanied by significant functional disturbances or symptoms.

Autonomic Nervous System Diseases↗
PubMed1987

Gastric emptying in patients with insulin-requiring diabetes mellitus.

Gastric emptying of technetium labeled liquid and solid meals were studied in a group of long-standing, insulin-requiring male diabetics to evaluate the relationship of gastroparesis to symptoms, diabetic control, and diabetic complications. Control subjects and three groups of diabetics were studied: A) no neuropathy; B) peripheral neuropathy; and C) peripheral and autonomic neuropathy. Nine diabetics had gastrointestinal symptoms. Gastric t1/2 liquid emptying was similar in all groups and in controls, but liquid gastric emptying in the first 15 min was significantly more rapid in the diabetics than controls. Solid emptying was prolonged in group C patients. There was a significant correlation between t1/2 solid emptying and the severity of neuropathy. The eight patients with slow solid emptying had more neuropathy and gastrointestinal symptoms than the remaining 22 patients. The type and duration of diabetes, diabetic control, and frequency of retinopathy are independent of gastroparesis. These data indicate that delayed emptying of solids is common (27%) in patients with clinically detectable neuropathy and may often be asymptomatic. Visceral autonomic neuropathy seems the most important underlying factor in diabetic gastroparesis.

Adult↗
PubMed1986

Disulfiram treatment of alcoholism. A Veterans Administration cooperative study.

We conducted a controlled, blinded, multicenter study of disulfiram treatment of alcoholism in 605 men randomly assigned to 250 mg of disulfiram (202 men); 1 mg of disulfiram (204 men), a control for the threat of the disulfiram-ethanol reaction; or no disulfiram (199 men), a control for the counseling that all received. Bimonthly treatment assessments were done for one year. Relative/friend interviews and blood and urine ethanol analyses were used to corroborate patients' reports. There were no significant differences among the groups in total abstinence, time to first drink, employment, or social stability. Among the patients who drank and had a complete set of assessment interviews, those in the 250-mg disulfiram group reported significantly fewer drinking days (49.0 +/- 8.4) than those in the 1-mg (75.4 +/- 11.9) or the no-disulfiram (86.5 +/- 13.6) groups. There was a significant relationship between adherence to drug regimen and complete abstinence in all groups. We conclude that disulfiram may help reduce drinking frequency after relapse, but does not enhance counseling in aiding alcoholic patients to sustain continuous abstinence or delay the resumption of drinking.

Actuarial Analysis↗
PubMed1986

Intestinal-transit and lactose intolerance in chronic alcoholics.

Intestinal transit time of lactulose and malabsorption of lactose were measured by hydrogen excretion in breath following ingestion of 20 g lactulose or 25 g lactose. Patients were 20 recently drinking, adequately nourished, chronic, male alcoholics. Many (65%) complained of diarrhea while drinking actively. Small bowel transit was significantly shorter in alcoholics with diarrhea (62 +/- 8.6 min) than in normal controls (93 +/- 10.4 min, p less than 0.05). It increased significantly after 8-10 days abstinence, to a value of 101.5 +/- 11 min, not significantly different from normal controls. Following lactulose 75% of alcoholics developed diarrhea after 1-2 days compared with only 15% after 8-10 days of abstinence; 40% had diarrhea after lactose in the initial study, whereas no subjects had diarrhea from the same dose after a period of sobriety. These data suggest that drinking alcoholics have an increased sensitivity to osmotic loads, which is associated with diarrhea, shortened transit time, and lactose intolerance. Abnormalities disappeared 8-10 days following cessation of drinking and normal diet.

Adult↗
PubMed1986

Gastric emptying of solid meal in male chronic alcoholics.

Nausea and vomiting are common complaints in chronic alcoholics. Autonomic neuropathy and esophageal motor abnormalities are frequently observed in chronic alcoholics, but gastric emptying has not been studied in these patients. Gastric emptying of a solid meal was measured, using 99mTc-sulfur colloid cooked in a scrambled egg, in 10 male chronic alcoholics with upper gastrointestinal complaints of nausea and vomiting. All patients were adequately nourished, recently drinking, but just over withdrawal and free of clinical peripheral neuropathy. Gastric emptying in 10 alcoholics was similar to 5 normal controls (t 1/2 115 +/- 12 versus 107 +/- 8 min). These data suggest that upper gastrointestinal symptoms in chronic alcoholics are not related to gastric motor dysfunction.

Adult↗
PubMed1986

Vitamin K deficiency in chronic alcoholic males.

Twenty male alcoholic subjects were studied initially within 1 day after stopping alcohol and again after about 1 week. Vitamin and mineral measurements were made on blood and abnormal prothrombin molecules quantitated for vitamin K status. Nine of the 20 patients received menadiol after the initial blood sample. Twelve of the alcoholics had significant elevations of abnormal prothrombin. Of these 12, all five who received vitamin K reduced the abnormal prothrombin levels toward normal but no change was observed in the seven who did not receive vitamin K. All nine patients receiving vitamin K lowered the abnormal prothrombin level significantly whereas there was no change in those 11 who did not receive vitamin K. The prothrombin time by the one-stage technique was normal in all patients. These data suggest that the production of abnormal prothrombin is frequently present in alcoholics and this may represent a subclinical vitamin K deficiency.

Adult↗
PubMed1986

Intestinal transit in insulin-requiring diabetics.

Intestinal transit was assessed in 25 insulin-requiring male diabetics and 15 healthy controls by measuring the breath hydrogen appearance time after the ingestion of both the liquid and the solid meal containing nonabsorbable carbohydrate. Three groups of patients were studied: nine patients without peripheral or autonomic neuropathy or retinopathy; nine patients with peripheral neuropathy; and seven patients with peripheral and autonomic neuropathy. Eight patients complained of gastrointestinal symptoms, including three with watery diarrhea. Intestinal transit of the solid meal was more prolonged than the liquid meal in normal and diabetic subjects. There was no significant difference in intestinal transit between normal controls and any group of diabetics; however, one-third of the diabetics had abnormal intestinal transit of the liquid test meal (four rapid, four delayed); only one patient with diarrhea had rapid intestinal transit. These data suggest that abnormal intestinal transit is common in diabetics. Altered intestinal transit is not a prerequisite of diabetic diarrhea.

Adult↗
PubMed1984

Prevalence and natural history of distal common bile duct stenosis in alcoholic pancreatitis.

Distal common bile duct stenosis was observed in 16 (9%) of 170 alcoholic patients admitted to a Veterans Administration Medical Center in the last five years. The following clinical and biochemical features were significantly more common (P less than 0.05) among the 16 patients with common bile duct stenosis than in 154 without: jaundice, cholangitis, hyperbilirubinemia, alkaline phosphatasemia, pancreatic calcification, and malabsorption. Surgical decompression of biliary tree was necessitated in 13 of 16 cases due to obstructive jaundice in seven, cholangitis in four, portal fibrosis in one, and persistent abdominal pain in one. The mean (+/- SE) time interval between initial serum alkaline phosphatase elevation and surgical intervention was 308 +/- 108 days. Liver histology in eight cases was remarkable for portal fibrosis in seven and biliary cirrhosis in one. These data suggest that distal common bile duct stenosis is a progressive lesion which is quite prevalent in patients with advanced pancreatic disease of alcoholic etiology.

Alcoholism↗