Nitric oxide and the migrating motor complex.
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Gastrointestinal Motility↗
Biomedical subjects
G Lindberg
Publications and source records attributed to G Lindberg.
[Intestinal transplantation. The first Swedish transplantation of the small intestine in an adult patient with pseudoobstruction].
Recent advances, first and foremost the development of new immunosuppressive agents, have markedly improved the outcome of intestinal transplantation, which is a treatment option for patients with serious intestinal diseases who have become dependent on total parenteral nutrition. The first small bowel transplantation in Sweden was performed at Huddinge Hospital in 1997, in the adult patient with intestinal pseudo-obstruction. The article reports the course of this patient and an update of international progress in intestinal transplantation.
Abdominal Pain↗
[Feared risk factors in connection with calcium antagonists are not to be dismissed].
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Apoptosis↗
Use of calcium channel blockers and risk of suicide: ecological findings confirmed in population based cohort study.
OBJECTIVE: To investigate possible associations between use of cardiovascular drugs and suicide. DESIGN: Cross sectional ecological study based on rates of use of eight cardiovascular drug groups by outpatients. A population based cohort study including users of drugs to control hypertension. SUBJECTS: The ecological study included 152 of Sweden's 284 municipalities. The cohort study included all inhabitants of one Swedish municipality who during 1988 or 1989 had purchased cardiovascular agents from pharmacies within the municipality. Six hundred and seventeen subjects (18.2%) were classified as users of calcium channel blockers and 2780 (81.8%) as non-users. MAIN OUTCOME MEASURES: Partial correlations (least squares method) between rates of use of cardiovascular drugs and age standardised mortality from suicide in Swedish municipalities. Hazard ratios for risk of suicide with adjustments for difference in age and sex in users of calcium channel blockers compared with users of other hypertensive drugs. RESULTS: Among the Swedish municipalities the use of each cardiovascular drug group except angiotensin converting enzyme inhibitors correlated significantly and positively with suicide rates. After adjustment for the use of other cardiovascular drug groups, as a substitute for the prevalence of cardiovascular morbidity, only the correlation with calcium channel blockers remained significant (r = 0.29, P < 0.001). In the cohort study, five users and four non-users of calcium channel blockers committed suicide during the follow up until the end of 1994. The absolute risk associated with use of calcium channel blockers was 1.1 suicides per 1000 person years. The relative risk, adjusted for differences in age and sex, among users versus non-users was 5.4 (95% confidence interval 1.4 to 20.5). CONCLUSIONS: Use of calcium channel blockers may increase the risk of suicide.
Calcium Channel Blockers↗
Cholesterol-lowering drugs and antidepressants--a study of prescription symmetry.
The subject of this study was to investigate the relationship between prescription of cholesterol-lowering drugs and depression. We used prescription of antidepressants as a proxy for depression and analysed the prescription order for cholesterol-lowering and antidepressant drugs. The ratio of persons with antidepressants prescribed second and first translates directly into a rate ratio (RR) associating cholesterol-lowering drugs use with antidepressants. The crude RRs were then adjusted for trends in sales of the drugs over the study period. All residents of Funen, Denmark, who started the two therapies during the period 1 April 1991 through 31 December 1995 were included in the study cohort. Of 184 individuals included in the analysis, 105 started antidepressant first and 79 second, giving a crude RR of 0.75. However, the sales of cholesterol-lowering drugs increased more than the sales of antidepressants. Accordingly, the adjusted RR was higher than the crude, 0.90 (95% confidence interval 0.68 to 1.22). Among three tested cholesterol-lowering drug classes, only simvastatin showed an adjusted RR above unity (1.59, 95% confidence interval 1.08 to 2.45). The hypothesis that the use of cholesterol-lowering drugs has an adverse effect on mood is not supported by the present study. Confounding by indication might explain the apparent association between use of simvastatin and antidepressants.
Journal Article↗
Biofeedback training in patients with fecal incontinence.
PURPOSE: This study was undertaken to assess the functional results of biofeedback training in patients with fecal incontinence in relation to clinical presentation and anorectal manometry results. METHODS: Twenty-six consecutive patients with fecal incontinence were treated with biofeedback training using anorectal manometry pressure for visual feedback. Ten patients had passive incontinence only, six patients had urge incontinence, and ten patients had combined passive and urge incontinence. RESULTS: Patients with urge incontinence had a lower maximum voluntary contraction pressure (92+/-12 mmHg) and a lower maximum tolerable volume (78+/-13 ml) than patients with passive incontinence (140+/-43 mmHg and 166+/-73 ml). Twenty-two patients completed the treatment, five patients (23 percent) showed excellent improvement, nine patients (41 percent) had good results, and eight (36 percent) patients showed no improvement. At follow-up on average of 21 months after therapy, 41 percent of our patients reported continued improvement. The maximum tolerable volume was higher in those with excellent (140.4+/-6.8 ml) or good (156.3+/-6.64 ml) results of therapy than it was in those with poor results (88.5+/-2.5 ml). Greater asymmetry of the anal sphincter also correlated to poor results. CONCLUSION: Biofeedback therapy improved continence immediately after training and at follow-up after 21 months, but the initial results were better. The urge fecal incontinence seems to be related to function of the external anal sphincter and to the maximum tolerable volume. Low maximum tolerable volume and anal sphincter asymmetry were associated with a poor outcome of therapy.
Adult↗
Antroduodenal manometry findings in patients with slow-transit constipation.
BACKGROUND: The results of subtotal colectomy for slow-transit constipation are unpredictable. Abdominal pain, distension, and bloating often persist after operation. To ascertain whether patients with slow-transit constipation may have a generalized intestinal motor disorder, we studied the antroduodenal motor activity in 20 consecutive patients with slow-transit constipation. METHODS: All patients underwent symptom registration, whole-gut transit time, anorectal manometry, electromyography of the anal sphincter, the balloon expulsion test, and defecography to characterize their constipation. The motor activity of the the gastric antrum and the proximal small bowel was monitored for 5 h, using a pneumohydraulic water-perfused manometry system with six channels. RESULTS: Twelve patients (60%) had abnormal patterns of motor activity: abnormal propagation or configuration of phase III in 9 of 12 patients, bursts of non-propagated phasic activity in 8 of 12 patients, and sustained periods of intense phasic activity in 3 of 12 patients. One patient had generalized hypomotility with low-amplitude contractions. In addition, an abundance of so-called discrete clustered contractions was found in 6 of 20 patients. CONCLUSION: A significant proportion of patients with slow-transit constipation have manometric findings that indicate a generalized motor disorder of the gut. The clinical significance of this finding is still unclear.
Adolescent↗
Constipation assessed on the basis of colorectal physiology.
BACKGROUND: Constipation is a collective term for symptoms of different aetiologies and pathophysiologies. Our aim was to determine the prevalence of colorectal pathophysiology findings in a prospective series of patients with chronic constipation. METHODS: A total of 155 consecutive patients with chronic constipation underwent anorectal manometry, electromyography (EMG), the balloon expulsion test, colonic transit-time study, and defecography. RESULTS: All investigations were completed by 134 patients (112 females) with a median age 52 (range, 17-79) years. Patients were categorized on the basis of transit time and pelvic-floor function as belonging to 1 of 4 groups: slow-transit constipation (STC) (delayed transit time but normal pelvic-floor function, n = 28), pelvic-floor dysfunction (PFD) (pelvic-floor dysfunction and normal transit time, n = 32), combined slow transit and pelvic-floor dysfunction (STC + PFD) (n = 27), and normal-transit constipation (NTC) (normal transit time and normal pelvic-floor function, n = 47). There was no difference between diagnostic groups in anal sphincter pressures. However, rectal sensitivity to balloon distension was lower (P < 0.05) in patients with delayed transit. Paradoxical puborectalis contraction (PPC) was found on EMG in 42 patients (31%). The prevalence of PPC was higher (P < 0.001) in patients with pelvic-floor dysfunction. Inability to evacuate the rectal balloon was reported by 37% of patients with pelvic-floor dysfunction and 12% of patients with normal pelvic-floor function (P < 0.001). Rectocele was the only anatomic abnormality at defecography which was associated with poor rectal emptying. CONCLUSIONS: About two-thirds of our patients with constipation had objective evidence of delayed transit or pelvic-floor dysfunction. No single test could reliably identify any of the pathophysiologic subgroups of constipation.
Adult↗
Symptom criteria do not distinguish between functional and organic dyspepsia.
DESIGN: Retrospective study. SETTING: Teaching hospital, Sweden. OBJECTIVE: To find out if various diagnostic criteria could distinguish organic from non-organic causes of dyspepsia. SUBJECTS: 635 patients previously interviewed by computer questionnaire. INTERVENTIONS: Upper gastrointestinal endoscopy, laboratory tests, clinical examination. MAIN OUTCOME MEASURE: Differentiation between organic and functional dyspepsia. RESULTS: 106 patients had functional dyspepsia. Of these 83 had ulcer-like dyspepsia, 76 motility-like dyspepsia, and 50 reflux-like dyspepsia. Eight patients had unspecified dyspepsia. CONCLUSIONS: There was a considerable overlap between different subgroups, and the criteria did not differentiate between organic and non-organic causes of dyspepsia though the symptom criteria in most cases showed an independent value in discriminating between different subgroups. The clinical usefulness of the criteria remains to be shown.
Adult↗
Calcium pyrophosphate deposition disease of the temporal bone.
Massive calcium pyrophosphate crystal deposition is a rare disorder that may affect the temporomandibular joint and temporal bone. The diagnosis is difficult, and misdiagnosis as malignancy, particularly chondrosarcoma, is frequent. This can lead to unnecessarily aggressive management. The clinical, radiographic, and pathologic features of this entity are reviewed, and treatment options are discussed.
Aged↗
Prolonged and profound acid inhibition is crucial in Helicobacter pylori treatment with a proton pump inhibitor combined with amoxicillin.
BACKGROUND: The aim was to investigate whether intragastric pH, meal-stimulated gastrin release, or demographic factors predict the outcome of Helicobacter pylori treatment. METHODS: Thirty-six patients with H. pylori infection were investigated with 24-h intragastric pH registration and meal-stimulated gastrin release before and during treatment with 20 mg omeprazole twice daily and 750 mg amoxicillin twice daily for 14 days. The influence of age, sex, smoking, ethnic origin, pH, and gastrin on treatment outcome were analysed with logistic regression. RESULTS: Eradication of H. pylori was achieved in 18 of 34 (53%) patients. The univariate analysis showed that age, ethnic origin, more than 84.2% of the time with pH above 4, and continuous periods longer than 156 min with intragastric pH above 6 were significantly associated with successful treatment of H. pylori. In the multivariate analysis only the two pH variables were found to be independent factors for predicting treatment outcome. CONCLUSION: The outcome of H. pylori treatment with omeprazole and amoxicillin may depend on several factors, such as age, ethnic origin, and a pronounced acid suppression. However, the only factor of independent importance in this study was prolonged and profound acid inhibition.
Adult↗
Selective serotonin reuptake inhibitors in anorexia nervosa.
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Anorexia Nervosa↗
[The 1997 public health report. Improved public health. Social differences remain].
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Europe↗
Biofeedback retraining in patients with functional constipation and paradoxical puborectalis contraction: comparison of anal manometry and sphincter electromyography for feedback.
PURPOSE: This study was undertaken to assess the effect of biofeedback therapy in patients with constipation and paradoxical puborectalis contraction and to compare two different feedback modes. METHODS: Twenty-six patients were randomly allocated to either of two feedback modes: anal pressure using a manometry probe or anal sphincter electromyography (EMG) using surface electrodes. RESULTS: Six patients were unable to complete their training; ten patients were retrained using anal manometry and ten patients using EMG. The paradoxical puborectalis contraction disappeared after retraining with manometry feedback in eight of ten patients and with EMG feedback in ten of ten patients. A significant improvement in both bowel function and abdominal symptoms was found after training and a continued improvement at follow-up six months later. Six patients in the manometry group and nine in the EMG group experienced an overall improvement in symptoms. The two feedback methods did not differ in terms of efficacy. CONCLUSIONS: Our results suggest that biofeedback, using either manometry or EMG, is effective in improving symptoms and anorectal function caused by paradoxical puborectalis contraction.
Adult↗
Erythroid response to treatment with G-CSF plus erythropoietin for the anaemia of patients with myelodysplastic syndromes: proposal for a predictive model.
Previous studies have shown that approximately 40% of patients with myelodysplastic syndrome (MDS) and anaemia respond to treatment with human recombinant granulocyte-CSF (G-CSF) plus erythropoietin (epo). The present study was designed to investigate pre-treatment variables for their ability to predict erythroid responses to this treatment. 98 patients with MDS (30 RA, 31 RARS, 32 RAEB, five RAEB-t) were treated with a combination of G-CSF (0.3-3.0 microg/kg/d, s.c.) and epo (60-300 U/kg/d, s.c.) for at least 10 weeks. Minimum criteria for erythroid response was a 100% reduction of red blood cell (RBC) transfusion need or an increase in haemoglobin level of > or = 1.5 g/dl. 35 patients (36%) showed responses to treatment. Medium duration of response was 11-24 months. In multivariate analysis, serum erythropoietin levels and initial RBC-transfusion need retained high statistical significance (P < 0.01). Using pre-treatment serum epo levels as a ternary variable (< 100, 100-500 or > 500 U/l) and RBC transfusion need as a binary variable (< 2 or > or = 2 units per month), the analysis provided a predictive score for erythroid response. This score divided patients into three groups: one group with a high probability of erythroid responses (74%), one intermediate group (23%) and one group with poor responses to treatment (7%). This predictive scoring system could be used in decisions regarding use of these cytokines for treating the anaemia of MDS, both for defining patients who should not be given the treatment and for selecting patients for inclusion in prospective trials.
Aged↗
Serum sialic acid and its correlates in community samples from Akita, Japan and Minneapolis, USA.
OBJECTIVE: The concentration of serum total sialic acid (S-TSA) is one recently investigated risk marker for cardiovascular mortality and atherosclerosis. Since the mortality from coronary heart disease is higher in the United States than in Japan, one could expect the S-TSA to be higher among Caucasian US citizens than among Japanese citizens, a hypothesis that is tested in this study. DESIGN: Cross-sectional study of population-based samples of Japanese and US Caucasian men and women. SETTING: The rural community Akita, Japan, and the suburbs of Minneapolis, Minnesota. SUBJECTS: These were 75 consecutive men and women from Akita and Minneapolis respectively aged 47-69 years in 1990. People who had smoked cigarettes during the past 5 years; who had a history of diabetes mellitus, liver disease, coronary heart disease, or stroke; or who were taking anticoagulants were excluded. OUTCOME MEASURES: Serum total sialic acid levels in male and female Japanese and US Caucasian subjects with adjustment for age, systolic blood pressure, fibrinogen, triglycerides and in women also for menopausal status. Race and sex-specific correlations with serum total sialic acid for selected cardiovascular risk markers. RESULTS: The entire sialic acid distributions were shifted to the right in Caucasian men and women compared to Japanese men and women. The mean +/- standard deviation concentrations of S-TSA were 54.1 +/- 5.3 mg/dl in Japanese men and 58.7 +/- 5.6 mg/dl in Caucasian men (P < 0.001). In women, the concentrations were 54.8 +/- 5.1 and 63.1 +/- 6.0 mg/dl respectively (P < 0.001). S-TSA level correlated significantly and positively with fibrinogen levels in Caucasian and Japanese men and women and with triglyceride levels in Caucasian and Japanese men and in Caucasian women but not in Japanese women. After adjustment for age, systolic blood pressure, fibrinogen, triglycerides and menopausal status, the sialic acid levels were 2.2 (P = 0.009) and 6.2 (P < 0.001) mg/dl higher in Caucasian compared to Japanese men and women respectively. CONCLUSIONS: Higher S-TSA levels in Caucasians living in Minneapolis compared to Japanese living in Akita, Japan is in concordance with the higher cardiovascular mortality in the US. Differences in S-TSA levels may reflect international differences in the prevalence of atherosclerosis.
Aged↗
The association between serum sialic acid and asymptomatic carotid atherosclerosis is not related to antibodies to herpes type viruses or Chlamydia pneumoniae. The Atherosclerosis Risk in Communities (ARIC) Study Investigators.
BACKGROUND: Total serum sialic acid is a recently investigated marker for cardiovascular mortality and carotid atherosclerosis. This study tested the hypothesis that past infection by Herpes simplex type 1 or type 2 viruses or Cytomegalovirus or Chlamydia pneumoniae accounts for the association between serum total sialic acid and atherosclerosis. METHODS: Population-based samples of men and women living in four US communities were used in a cross-sectional study. Cases and matched controls were defined by B-mode ultrasound measurements of carotid and popliteal arterial wall thickness. In all, there were 267 case control pairs with information about antibody titres to viruses and 256 pairs with information about antibody titres to Chlamydia pneumoniae. RESULTS: Serum total sialic acid (S-TSA) level was significantly higher in cases with carotid atherosclerosis compared to their controls. The odds ratio for carotid atherosclerosis associated with sialic acid level above 75th percentile was 1.73 (95% confidence interval [CI]: 1.02-2.95) in the sample with information about antibodies to viruses and 1.70 (95% CI: 1.00-2.93) in the sample with information about antibodies to C. pneumoniae. Adjustment for titres of antibodies to viruses and C. pneumoniae had no impact on the relation between sialic acid and carotid atherosclerosis. CONCLUSIONS: From these results, it seems unlikely that previous infection by any of these micro-organisms accounts for the relation between S-TSA level and carotid atherosclerosis.
Aged↗
Ectopic prostatic tissue in the uterine cervix.
This is the first reported case of ectopic prostatic tissue in the uterine cervix, diagnosed in a 38-year-old woman. A cluster of benign prostatic glands with cribriform and papillary patterns and focal squamous metaplasia occupied the superficial endocervical stroma. The glands were immunoreactive for prostatic specific antigen and prostatic specific acid phosphatase. This lesion, which could be confused with microglandular hyperplasia, mesonephric rests, or adenocarcinoma in situ may represent an embryonic rest.
Acid Phosphatase↗