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Biomedical subjects

G F Longstreth

Publications and source records attributed to G F Longstreth.

At least 55 records · Page 3Linked to original sources
PubMed1985

Night blindness after jejunoileal bypass surgery.

A 53-year-old woman developed night blindness 9 years after jejunoileal bypass surgery. Abnormal rod function was confirmed by dark-adapted electroretinography, and vitamin A deficiency was confirmed by low serum levels of vitamin A and carotene. Administration of oral vitamin A supplementation resulted in complete resolution of the patient's symptom and return of the electroretinogram to normal. Based on this case and the four previously reported cases, we suggest that jejunoileal bypass patients be routinely questioned about decreased night vision. Patients with this complaint should undergo thorough ophthalmic evaluation. Dark-adapted electroretinography or dark adaptation testing should be done to establish the presence of abnormal rod function, and serum levels of vitamin A or carotene should be obtained to identify the cause. It is important to identify vitamin A-deficient patients because of their potential to develop permanent impairment of night vision.

Administration, Oral↗
PubMed1983

Healing of benign gastric ulcer with low-dose antacid or cimetidine. A double-blind, randomized, placebo-controlled trial.

We conducted a 12-week, double-blind, randomized, placebo-controlled trial to determine whether cimetidine (300 mg with meals and at bedtime) or a convenient, liquid aluminum-magnesium antacid regimen (15 ml one hour after meals and at bedtime) would expedite healing or relief of symptoms in patients with benign gastric ulcer. Of the 101 patients who completed the trial according to protocol, 32 received the antacid, 36 cimetidine, and 33 placebo. At 4, 8, and 12 weeks after entry, ulcers had healed in a larger percentage of patients treated with cimetidine than of those treated with placebo: 53, 86, and 89 per cent of the cimetidine group versus 26, 58, and 70 per cent of the placebo group (P = 0.02, 0.01, 0.05), respectively. Healing at the three intervals had occurred in 38, 70, and 84 per cent, respectively, of the antacid-treated patients. Neither cimetidine nor antacid was more effective than placebo in relieving symptoms. The presence or absence of symptoms during the fourth and eighth treatment weeks was a poor predictor of the presence of absence of an ulcer crater. We conclude that cimetidine significantly hastens the healing of benign gastric ulcer.

Adult↗
PubMed1983

Folate status in patients receiving maintenance doses of sulfasalazine.

Hematologic studies, including serum and RBC folate assays, were done on 45 outpatients with chronic colitis who either took sulfasalazine (n = 27) or did not use it (n = 18). Overall, sulfasalazine users and nonusers had similar mean hemoglobin, hematocrit, serum folate, and RBC folate levels. However, within the drug users, RBC folate was inversely correlated with drug dose; serum folate was not. Patients taking 2 g or more of sulfasalazine daily had lower mean RBC folate levels (221.2 +/- 27.3 ng/mL) than patients either taking less (371.7 +/- 35.0 ng/mL) or nonusers (330.3 +/- 30.3 ng/mL). Mean corpuscular volume was also related to drug dose but not to RBC folate. Although maintenance sulfasalazine use rarely causes clinically significant folate deficiency, subclinical tissue depletion occurs as a dose-related effect.

Colitis↗
PubMed1982

Evolution of symptomatic diffuse esophageal spasm to achalasia.

Two patients manifested an esophageal disorder which began as typical symptomatic diffuse esophageal spasm and evolved to achalasia. The evolution was evident by roentgenographic criteria in both cases and by manometric findings in one. The features displayed support the contention that these two forms of dysmotility are etiologically related.

Adolescent↗
PubMed1981

Tyropanoate cholecystography early in the course of acute pancreatitis.

Oral cholecystography (OCG) has traditionally been delayed until several weeks after hospitalization for pancreatitis because of the putative frequent poor visualization during the acute episode. Recently, OCG with iopanoic acid was reported successful in most patients with acute pancreatitis soon after resumption of a solid diet. We evaluated OCG with sodium tyropanoate, a pharmacokinetically different contrast material, in 30 hospitalized patients with pancreatitis before resumption of solid food. It accurately evaluated the gallbladder in 24 cases (80%). Abnormal liver function tests, including mild hyperbilirubinemia, did not interfere with the examination. Consequently, 1) tyropanoate OCG adequately opacifies the gallbladder in most patients with acute pancreatitis who are fasting or taking liquids only; 2) allows gallbladder evaluation earlier than with iopanoic acid OCG; 3) is less affected by hepatic dysfunction; and 4) provides an alternative to ultrasonography.

Acute Disease↗
PubMed1981

Psyllium therapy in the irritable bowel syndrome. A double-blind trial.

A randomized, double-blind trial of a psyllium preparation was initiated in 77 patients with painful irritable bowel syndrome. Sixty-patients finished and submitted symptom data for 8 weeks while taking placebo (n = 34) or psyllium (n = 26). Increase in normal stools and decrease in pain severity (p less than 0.05) occurred equally in both groups. Subjective improvement was reported by 24 of 34 patients on placebo and 20 or 26 on psyllium (p greater than 0.05). Five symptom variables were significantly correlated (p less than 0.05) with patient's subjective global assessment (R = 0.64). Discriminant analysis of Minnesota Multiphasic Personality Inventory variables yielded overall rates of correct prediction of 66.1% for whether patients got "much better" and 77.9% for whether they voluntarily dropped from the study. A major placebo effect occurs in patients with painful irritable bowel syndrome and is probably responsible for the efficacy of psyllium. Personality factors influence the magnitude of therapeutic response and whether patients discontinue treatment within 8 weeks.

Clinical Trials as Topic↗
PubMed1980

Dysfunctions of the stomach with gastric ulceration.

Factors implicated in the pathogenesis of gastric ulcer were studied simultaneously in seven patients with strictly defined type 1 gastric ulcer (single benign ulcer above the incisura of the stomach) and in six healthy controls. After ingestion of an ordinary solid-liquid meal, patients with gastric ulcer demonstrated gastric hyposecretion of acid, pepsin, and water; delayed gastric emptying of solids with normal emptying of liquids; and increased intragastric concentrations of bile acids. These functional abnormalities appear to be interrelated. Metoclopramide, administered orally in a double-blind fashion, ameliorated the defect in the emptying of solids and the high concentrations of bile acid in the gastric contents. The ability of this drug to break this interdependent cycle suggests the need for further clinical investigation.

Achlorhydria↗
PubMed1980

Determinants of the intravenous diazepam dose required for gastroscopy.

Factors influencing the intravenous dose of diazepam required by 100 consecutive outpatients being prepared for peroral endoscopy were evaluated. Eleven patients reported a history of using 2 or more doses of benzodiazepine a week and required 0.48 +/- 0.1 mg/kg of diazepam compared with 0.30 +/- 0.02 mg/kg (P < 0.01) needed by 89 patients who reported less frequent or no use. The log (dose/kg) was negatively correlated with age (r = 0.51, P < 0.01), and the log dose was positively correlated with weight to a lesser degree (r = 0. 31, P < 0.01). In the larger group of patients who reported less than twice-weekly or no benzodiazepine use, no effect of alcohol use on dose was found. The dose was unrelated to sex. The findings emphasize the importance of individualizing intravenous doses of diazepam.

Age Factors↗
PubMed1980

Nurse-supervised education of patients with symptomatic gastroesophageal reflux.

Patient educational programs supervised by non-physicians are becoming popular, but comparison of their effect on outcome with that of physician teaching is limited. We developed a nurse-supervised class for patients with symptomatic gastroesophageal reflux (GER). Primary physicians referred patients to the program. The patient's initial knowledge and the program's excellent cognitive effect were unrelated to demographic and symptom data. One hundred twelve consecutive patients were alternately given appointments either with the class or with a gastroenterologist. Although failed appointments and inappropriate referrals excluded some patients, the remainder of the two groups were similar with regard to demographic and symptom data and their return rate of follow-up questionnaires. They reported equivalent symptomatic improvement and therapeutic compliance after 2 weeks and 2 months. The program's success prompts us to continue this form of patient education.

Gastroesophageal Reflux↗
PubMed1977

Abdominal pain caused by diabetic radiculopathy.

In diabetes mellitus, pain and weakness in a lower extremity can result from lumbosacral radiculopathy. However, abdominal pain caused by a similar type of thoracic nerve root disease is not generally recognized. Four diabetic patients with abdominal pain were studied. In none of the patients was the actual cause--radiculopathy--suspected until after extensive negative diagnostic investigation, which frequently included invasive procedures. Their clinical features were suggestive of malignant disease. Electromyographic examination revealed the correct diagnosis, and all four of the patients had a spontaneous and complete recovery.

Abdomen↗
PubMed1977

Postprandial gastric, pancreatic, and biliary response to histamine H2-receptor antagonists active duodenal ulcer.

Histamine H2-receptor antagonists are potentially useful agents in duodenal ulcer and knowledge of their effect on postprandial digestive events will contribute to their clinical application. We studied the effect of 200- and 300-mg doses of cimetidine, an H2-receptor antagonist, taken with an ordinary meal, on gastric, pancreatic, and biliary function. Both doses significantly reduced acid output and its delivery into the duodenum. Gastric secretory volume and pepsin output were less affected. Acid inhibition was related to blood drug levels and was less than that previously found at night in nocturnal fasting studies. As the stomach emptied the food, the gastric pH rose. The fractional gastric emptying rate, pancreatic enzyme, and bile acid outputs were unaltered. Cimetidine taken orally with meals at these doses is a potent gastric antisecretory agent without affecting other postprandial gastric, pancreatic, or biliary functions.

Adult↗