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Biomedical subjects

G Stacher

Publications and source records attributed to G Stacher.

At least 73 records · Page 4Linked to original sources
PubMed1988

[Secondary achalasia caused by diffuse infiltrating cardial cancer].

Malignant tumors, especially gastric adenocarcinomas infiltrating into the submucosa of the esophagus, can result in a clinical syndrome termed secondary or pseudo-achalasia that mimicks idiopathic primary achalasia. History, symptoms, radiology, esophago-gastroscopy with biopsy, and esophageal manometry do not discriminate secondary from primary achalasia at initial evaluation. The difficulty in establishing the diagnosis is demonstrated on the case of a 57-year old man presenting with dysphagia, vomiting, and weight loss. Fluoroscopically, the esophagus was moderately dilated and bird-beaked. The patient underwent two gastroesophagoscopies, in the second of which the endoscope could not be passed through the esophagogastric junction. Esophageal manometry revealed an only partial relaxation of the lower esophageal sphincter upon swallowing and nonpropulsive, repetitive contractions in the esophageal body, compatible with the diagnosis "vigorous achalasia". After two mechanic dilatations, a myotomy of the sphincter seemed indicated. At operation, a cardiac carcinoma infiltrating submucosally into the esophagus was found. The recognition of secondary achalasia is difficult, and signs such as older age, brief duration of symptoms, marked weight loss and the presence of vigorous achalasia, relatively rare in primary achalasia, are unspecific. Hence, in all instances in which secondary achalasia cannot be ruled out, it seems advisable to perform an explorative laparotomy with eventual sphinctermyotomy as primary therapeutic intervention instead of a mechanic dilatation, which potentially further obscures the underlying disease. To enable the recognition of undetected secondary achalasia, all patients with achalasia should be followed up thoroughly.

Adenocarcinoma↗
PubMed1987

Effects of oral cisapride on interdigestive jejunal motor activity, psychomotor function, and side-effect profile in healthy man.

Intravenous cisapride was shown to induce a phase-2-like pattern of human interdigestive jejunal motor activity containing an increased number of propagated contractions. This study investigated the effects of oral cisapride in 12 fasting healthy males. Jejunal pressures were recorded by a pneumohydraulic system and five catheter orifices positioned 10-30 cm aborad the ligament of Treitz. Single oral doses of 5 and 10 mg cisapride, administered 5 min after an activity front under random double-blind conditions, induced a phase-2-like jejunal motor pattern with a significantly higher number and amplitude of contractions and significantly more aborally propagated waves than placebo (P less than 0.001), while the number of subjects with activity fronts decreased with increasing dose. Five and 10 mg cisapride administered tid for three days affected psychomotor function, subjective feelings, and side-effect frequency, apart from increases in systolic blood pressure and heart rate, no more than placebo. It is concluded that in fasting man, oral cisapride induces a highly propagative phase-2-like jejunal motor pattern causing only minor side effects.

Administration, Oral↗
PubMed1987

Intravenous cisapride accelerates delayed gastric emptying and increases antral contraction amplitude in patients with primary anorexia nervosa.

Delayed gastric emptying is common in primary anorexia nervosa. We investigated in 12 patients whether gastric emptying could be accelerated by the prokinetic drug cisapride. Patients were studied on two occasions 1 wk apart and received, under random double-blind conditions, 8 mg of cisapride and placebo intravenously. Gastric emptying of an isotopically labeled semisolid meal and antral motor activity were measured using a dual-headed gamma-camera for 50 min. Emptying was significantly slower (half-emptying time, 50-191 min; median, 121 min) than in 24 healthy volunteers (half-emptying times, 21-119 min; median, 47 min). Cisapride accelerated emptying significantly (p less than 0.001; half-emptying time after cisapride, 22-80 min; median, 42 min). Antral contraction amplitude increased and contraction frequency decreased significantly (p less than 0.001), whereas the propagation velocity of contractions remained unchanged. We concluded that intravenous cisapride accelerates gastric emptying and increases antral contraction amplitude in patients with anorexia nervosa. Whether or not these effects can prove beneficial in diminishing the patients' symptoms and in helping them to gain weight can only be answered from studies involving long-term treatment with cisapride.

Adolescent↗
PubMed1987

Effects of graded oral doses of a new 5-hydroxytryptamine/noradrenaline uptake inhibitor (Ro 15-8081) in comparison with 60 mg codeine and placebo on experimentally induced pain and side effect profile in healthy men.

1. Ro 15-8081 (Hoffmann-La Roche, Basle, Switzerland) is a novel mixed 5-HT/noradrenaline uptake inhibitor producing potent antinociceptive effects in animal pain models. 2. In healthy man, two models with electrically and thermally induced pain, respectively, have been shown to reliably discriminate between the effects of opioid as well as of antipyretic analgesics and placebo. 3. This study investigated the effects of single oral doses of 10, 25, and 50 mg Ro 15-8081 in comparison with 60 mg codeine and placebo on threshold and tolerance to electrically induced pain and on threshold to thermally induced pain. Furthermore, the effects on psychomotor function, self-rated subjective feelings, and side effect profile were studied. 4. Twenty healthy males participated each in five experiments in which they received, in random double-blind fashion, each of the treatments. Every experiment comprised two series of measurements before and twelve after drug administration, carried out at 30 min intervals. 5. Ro 15-8081 produced marked elevations of threshold and tolerance to electrically and of threshold to thermally induced pain. The effects of all doses of Ro 15-8081 were significantly superior to those of placebo. Threshold and tolerance to electrically induced pain were not affected differently by the three doses of Ro 15-8081, whereas the threshold to thermally induced pain was elevated significantly more by 50 mg than by 10 and 25 mg Ro 15-8081. 6. Codeine 60 mg had a more rapid onset of action and greater maximal effects than Ro 15-8081.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Differential diagnosis of psychosomatic deglutition disorders].

Symptoms of dysphagia and chronic vomiting often are categorized as being elicited by psychogenic factors, when no explanation can be found by fluoroscopic and endoscopic means. Psychogenic factors were also thought to be of aetiological significance in 58 patients referred under the diagnoses "psychogenic", "psychosomatic", and "functional" swallowing disorder, "psychogenic vomiting", "conversion neurosis", "anorexia nervosa", "psychosomatic disturbances in pregnancy", "cancer phobia", "cardiac phobia (DaCosta syndrome)", and "depressive disorder" to the Psychophysiology Unit, University of Vienna, for further evaluation. However, manometric, pH-metric, and endoscopic investigations showed that all of these patients suffered in fact from organic disorders: 36 from achalasia, 5 from vigorous achalasia, 5 from diffuse oesophageal spasms, 6 from lower oesophageal contraction abnormalities, one from pharyngo-oesophageal dyscoordination, one from a gastric ulcer ad cardiam, and 4 from gastro-oesophageal refluxes of whom one also had a hypertonic upper oesophageal sphincter. These findings, together with the fact that all concepts relating swallowing disorders to psychogenic factors have remained purely speculative, show that it is not justifiable to label dysphagic symptoms, for which no organic aetiology can be detected, as "psychogenic" or "psychosomatic". Patients with such symptoms should be studied by means of oesophageal manometry and/or pH-metry to reveal the nature of their disorder and to enable adequate therapy.

Adult↗
PubMed1986

Effects of cisapride on jejunal motor activity in fasting healthy humans.

The effects of cisapride on jejunal interdigestive motor activity were studied in 12 healthy men participating in three experiments each. Five minutes after an activity front (phase III) they received, in random double-blind fashion, 10 mg of cisapride, 4 mg of cisapride, or saline placebo by intravenous injection. Motor activity was recorded for 4 h. A pneumohydraulic perfusion system and five catheters with orifices positioned 10-30 cm beyond the ligament of Treitz were used. Cisapride increased phase II-type activity (p less than 0.001) and reduced the number of activity fronts dose-dependently. Compared with phase II after placebo, the activity prevailing after cisapride was characterized by a significantly higher number and amplitude of contractions as well as by a significantly greater area under the pressure curve. Moreover, a significantly higher proportion of contractions was propagated aborally. Self-rated abdominal grumbling increased dose-dependently. Except for mild sedative effects, no side effects occurred. We conclude that cisapride induces a prolonged and highly propagative phase II-like jejunal motor activity in fasting humans.

Adult↗
PubMed1986

Effects of cholecystokinin and caerulein on human eating behavior and pain sensation: a review.

Since the mid-1970s, evidence has accumulated that cholecystokinin (CCK) has a role as a neuromodulator or neurotransmitter in the central nervous system as well as in the periphery. CCK has been shown to have a variety of effects on gastrointestinal functions and is one of the main candidates for a role as a peripheral negative feedback signal to stop feeding behavior. CCK produces satiety not only in animals but also in man: it reduces appetite and activation arising from the preparation of a meal and inhibits intake of liquid and solid food in both lean and obese subjects. The closely related peptide caerulein has similar effects. The site of action of peripherally administered CCK seems to be on an abdominal organ innervated by gastric vagal branches and relayed to the brain by afferent vagal fibres, since selective gastric vagotomy blocks the satiety effect, but pharmacological antagonism of vagal motor effects or lesions of the ventromedial hypothalamus do not. CCK also may have a role in the regulation of pain perception. In mice, CCK and caerulein were shown to produce a decrement in response to noxious stimulation after peripheral and central administration. In man, caerulein was demonstrated to relieve pain originating from biliary and renal colic as well as from cancer and ischemia. A series of studies in healthy man revealed that caerulein also alleviates experimentally induced cutaneous pain. Data from animal studies suggest that CCK-like peptides not only are able to produce analgesic effects on their own, but also are involved in the modulation of opioid systems mediating analgesia. Further study of these effects of CCK should elucidate the regulatory connections between the life-sustaining functions of feeding and pain sensation.

Analgesics↗
PubMed1986

Experimental pain induced by electrical and thermal stimulation of the skin in healthy man: sensitivity to 75 and 150 mg diclofenac sodium in comparison with 60 mg codeine and placebo.

Models with experimentally induced pain in healthy man might be useful for the screening for analgesic effects of new drugs. Experimental pain models have been shown to discriminate reliably between the effects of opioid analgesics and placebo but their sensitivity to nonsteroidal anti-inflammatory agents is disputed. This study investigated whether it would be possible by using electrically and thermally induced cutaneous pain to discriminate reliably the effects of single oral doses of 75 and 150 mg diclofenac sodium on the one hand and 60 mg codeine on the other from those of placebo. Forty-eight healthy subjects participated each in four experiments in which they received, in random double-blind fashion, each of the treatments. Every experiment comprised eight series of measurements, two before and six after drug administration, carried out at 30 min intervals. Diclofenac sodium produced significant dose-related increases of threshold and tolerance to electrically and threshold to thermally induced pain. Codeine 60 mg was significantly superior to placebo in all pain measures. Its analgesic effects were stronger than those of diclofenac 75 mg but weaker than those of diclofenac 150 mg. Neither 150 mg nor 75 mg diclofenac caused more side effects than placebo, whereas codeine 60 mg elicited a high frequency of side effects. No severe adverse effects occurred after any one treatment. The results suggest that both electrically and thermally induced cutaneous pain are well suited to evaluate analgesic effects not only of opioids but also of nonsteroidal anti-inflammatory drugs.

Acoustic Stimulation↗
PubMed1986

Oesophageal and gastric motility disorders in patients categorised as having primary anorexia nervosa.

UNLABELLED: Gastrointestinal motor function in patients with primary anorexia nervosa has rarely been investigated. We studied oesophageal motor activity in 30 consecutive patients meeting standard diagnostic criteria for primary anorexia nervosa (Feighner et al; DSM III). Seven were found to suffer from achalasia instead of primary anorexia nervosa, one from diffuse oesophageal spasm and one from severe gastro-oesophageal reflux and upper oesophageal sphincter hypertonicity, while partly non-propulsive and repetitive high amplitude, long duration contractions prevailed in the lower oesophagus of another six. In four patients with oesophageal dysmotility not responding to therapy and in 12 of 15 patients with normal oesophageal manometry, gastric emptying of a semisolid meal was studied. Emptying was normal in only three but markedly delayed in 13 cases (half emptying times 97-330 min, median: 147 min, as compared with 21-119 min, median: 47 min, in 24 healthy controls). In eight patients, the effects of domperidone 10 mg iv and placebo were compared under random double blind conditions. Half emptying times were shortened significantly (p less than 0.01) by domperidone. CONCLUSIONS: symptoms of disordered upper gastrointestinal motor activity may be mistaken as indicating primary anorexia nervosa; clinical evaluation of patients with presumed primary anorexia nervosa should rule out the possibility that disordered oesophageal motor activity underlies the symptoms; delayed gastric emptying is a frequent feature in primary anorexia nervosa and might be returned to normal with domperidone.

Adolescent↗
PubMed1986

[Methods for measuring the motor activity of the esophagus and gastroesophageal reflux].

The contractile activity of the oesophageal body and of the upper and lower oesophageal sphincter (LOS) can reliably be portrayed by means of low compliance recording systems, either pneumohydraulic or with strain gauge force transducers, and at least two pressure sensors. LOS resting pressure can be assessed by both station and rapid pull-through techniques, or by the sleeve method. States of disordered LOS function, such as achalasia, can be diagnosed dependably only by manometric means. Manometry is of high diagnostic yield for motor disorders of the oesophageal body as well, although generally accepted diagnostic criteria are still lacking. In patients with angina-like chest pain, provocation tests can prove that oesophageal contraction abnormalities cause the symptoms. Edrophonium has been shown to be the most effective and best tolerated provocative agent. Transport of swallowed material through the oesophagus can reliably be recorded by radionuclide transit studies. Such studies are valuable in identifying patients with absent or impaired peristalsis and in evaluating treatment effects, e. g., the effects of mechanic dilatation in achalasia. Gastrooesophageal reflux should be recorded not only qualitatively but also quantitatively, although a definition of what is pathological and what is not has not been generally agreed upon. Recording of oesophageal intraluminal pH over longer periods of time, preferably 24 h, may have the best diagnostic yield. The advent of computer-aided analysis techniques will replace the cumbersome handscoring of motor and pH tracings and, hopefully, contribute to a better understanding and classification of oesophageal pathophysiology.

Esophagitis, Peptic↗
PubMed1985

Satiety effects of cholecystokinin and ceruletide in lean and obese man.

Cholecystokinin (CCK) has been shown to produce satiety not only in a variety of animal species but in man as well. In healthy humans, CCK reduces appetite and activation arising from the preparation of a meal, inhibits intake of liquid food in both non-obese and obese subjects, and decreases the intake of solid food. The closely related caerulein produces a similar reduction of solid food consumption in lean and, as suggested by preliminary results, in obese man. There is good evidence that the satiety effect of CCK depends on its inhibition of gastric emptying and the consequent gastric distension. In healthy man, the same dose of caerulein found to reduce food intake also slows gastric emptying of a semisolid meal. This effect seems to be relayed into the brain by afferent vagal fibers as in animals; selective gastric vagotomy blocks the satiety effect while pharmacological antagonism of vagal motor effects or lesions in the ventro-medial hypothalamus do not. Ongoing studies suggest that gastric vagotomy also blocks the satiety effects of caerulein in man. A critical role for CCK in the control of human feeding behavior seems certain.

Ceruletide↗
PubMed1984

Effects of oral cyclotropium bromide, hyoscine N-butylbromide and placebo on gastric emptying and antral motor activity in healthy man.

Cyclotropium bromide, a new antimuscarinic agent, inhibits gastrointestinal motility in animals at lower doses than those required to inhibit gastric acid secretion and salivation. In man, cyclotropium bromide suppresses fasting and meal stimulated colonic motility. This study investigated the effects of single oral doses of 60 mg cyclotropium bromide, 60 mg hyoscine N-butylbromide and placebo on gastric emptying and on antral motor activity. Twenty four healthy men (mean age 25 years) participated in three experiments one week apart. The drugs were administered, in random double blind fashion, 30 minutes before the ingestion of a semisolid test meal labelled with 74 MBq (2 mCi) 99mTc sulphur colloid. A gamma camera coupled to a computer monitored gastric emptying together with amplitude, frequency, and propagation velocity of antral contractions. Cyclotropium bromide and, to a lesser degree, hyoscine N-butylbromide delayed gastric emptying and reduced contraction amplitude, but did not affect frequency and propagation velocity of antral contractions. Cyclotropium bromide was significantly more active than hyoscine N-butylbromide; the effects of hyoscine N-butylbromide differed significantly from placebo. Antral contractile activity was present all the time. After cyclotropium bromide, there was a significant correlation between antral contraction amplitude and gastric emptying. No adverse side effects occurred with any one treatment. In conclusion, cyclotropium bromide markedly inhibits gastric emptying and reduces antral contraction amplitude.

Adult↗
PubMed1984

Ceruletide increases dose dependently both jejunal motor activity and threshold and tolerance to experimentally induced pain in healthy man.

The effects of ceruletide on jejunal motility and experimentally induced pain were studied in 16 healthy men, who participated each in four experiments and received in random double blind fashion 5, 10, or 20 micrograms ceruletide intramuscularly or placebo. Jejunal pressures were recorded by three perfused catheters with orifices between 10 and 20 cm aboral of the ligament of Treitz. Ceruletide dose dependently diminished phase I and increased phase II type activity and tended to reduce the number, but not the duration, of activity fronts. The number and amplitude of contractions as well as the area under the curve increased significantly and dose dependently as did threshold and tolerance to electrically and threshold to thermally induced pain. Only mild sedative and other side effects occurred.

Adult↗