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Biomedical subjects

J C Mangla

Publications and source records attributed to J C Mangla.

At least 19 recordsLinked to original sources
PubMed1989

Effect of duodenal ulcerogens cysteamine, mepirizole, and MPTP on duodenal myoelectric activity in rats.

Increased gastric acid secretion, enhanced acid delivery to the duodenum, and reduced alkaline secretion in the proximal duodenum are relatively well-established pathophysiologic abnormalities in duodenal ulcer. Impaired duodenal motility, however, may also contribute to duodenal ulceration by altering the distribution of acid and alkaline secretions along the upper digestive tract. We tested the hypothesis that the duodenal ulcerogens cysteamine, MPTP, and mepirizole modify duodenal motility in the rat and that motility changes might be a common and early alteration in experimental duodenal ulceration. All three duodenal ulcerogens rapidly produced extensive changes in duodenal myoelectric activity and reduced the frequency of myoelectric slow waves. Cysteamine induced marked hypermotility for at least 6 hr; MPTP rapidly decreased motility and fragmented the myoelectric migrating pattern. Mepirizole induced biphasic changes: an early hypermotility phase of about 30 min was followed by profound hypomotility. These results indicate that marked alterations of duodenal motility are common during experimental duodenal ulceration. In light of the differential effect of the ulcerogens on duodenal motility, it remains to be determined how these changes influence acid neutralization in the proximal duodenum. Nevertheless, our results suggest that all three duodenal ulcerogens, which are different in structure, alter duodenal motility.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗
PubMed1985

Nodular duodenitis in chronic maintenance hemodialysis patients.

A retrospective study of 138 cases of chronic hemodialysis between 1977 and 1982 were reviewed for endoscopic, radiographic, and histologic characteristics of duodenitis. Forty patients underwent upper gastrointestinal barium x-rays; 13 were found to have multiple duodenal bulb nodules and three of these patients had very prominent duodenal bulb folds. There were 42 patients on whom upper panendoscopy was performed, and multiple duodenal nodules were seen in 15 patients and thickened folds in three patients. There were five patients in whom nodules were seen only on endoscopy. The size of the nodules varied between 3 and 8 mm in diameter and mucosal folds between 4 and 8 mm. Duodenal mucosal hyperplasia with chronic inflammatory cell infiltrate was found on biopsy of the nodules in 12 cases, while three cases with nodules revealed blunted villous structure with chronic inflammatory cells.

Adult↗
PubMed1982

Tricyclic antidepressants in the treatment of peptic ulcer disease.

Doxepin hydrochloride was given to 12 patients with duodenal ulcer and one patient with an anastomotic ulcer. The dose of doxepin hydrochloride was 100 mg at bedtime, except in patients receiving hemodialysis, where only 50 mg at bedtime was given. Eight patients, including the four receiving hemodialysis, has not responded to treatment after eight weeks of cimetidine and/or antacid therapy. All patients (except one where a minor erosion was left in the duodenum) responded, and healing of the ulcer was demonstrated by endoscopy after four to six weeks of treatment. In two patients the ulcer recurred in four to eight weeks after discontinuation of doxepin therapy; however, ulcers healed after four weeks when therapy was reintroduced. Five previously untreated patients with duodenal ulcer were also given the same treatment. Four healed six weeks after starting doxepin therapy. In one patient the dose of doxepin hydrochloride had to be raised to 150 mg for complete healing.

Adult↗
PubMed1981

Malignant tumors associated with carcinoid tumors of the gastrointestinal tract.

Twenty-three associated malignant neoplasms mostly adenocarcinomas were recognized in 96 patients with gastrointestinal carcinoid tumors, between 1968 and 1977 at the University of Rochester Medical Center. Associated malignancies were present in 17 patients, affected various organs and led to an early death even though the carcinoid tumors generally remained localized. There was a 36% incidence of a second malignant neoplasm in patients with ileal carcinoid, but no second tumor in patients with carcinoid of the rectum. The presence of a carcinoid tumor should alert the physician to search for a second neoplasm.

Adenocarcinoma↗
PubMed1981

Spontaneous bacterial peritonitis presenting as a perforated viscus.

A young man with severe nephrotic syndrome and symptoms suggestive of peptic ulcer disease treated with steroids developed symptoms and signs of peritonitis and pneumoperitoneum. Laparotomy and ascitis fluid culture revealed B. fragilis peritonitis without any perforation, suggesting a diagnosis of spontaneous primary peritonitis.

Adult↗
PubMed1981

A second look at cimetidine.

Two-well conducted double blind studies have shown that cimetidine is not better than placebo in healing of duodenal ulcers at the end of the 6 weeks. I was surprised when the F.D.A. released the use of cimetidine on August 17, 1977, even when they knew the results of a large multicentered American study. However, considering the results of many European studies, one has to be fair in saying that cimetidine is useful for duodenal ulcers if used according to F.D.A. guidelines. The problem of cimetidine therapy starts when it is used for almost any gastrointestinal condition in a knee jerk fashion. Cimetidine is not any better than antacids. It gained rapid acceptance in the treatment of ulcer disease only because of its ease of administration and lack of side effects, like diarrhea. My purpose of writing this article is to highlight that cimetidine is not a cure-all and is over utilized. It has been estimated that approximately 11 million patients were treated with cimetidine between November 1976 to February 1979. The number has reached a staggering level now. I will be heartbroken if some serious side effect comes into light after 15-20 years of its use. I am sure everyone is familiar with the INH story. INH toxicity is just becoming known after more than 20 years of clinical use. One should also not forget the uterine cancer in daughters of mothers on DES. The purpose of this article is just to underline the need for a proper indication in the use of cimetidine.

Animals↗
PubMed1981

Diagnosis of occult gastrointestinal lesions by stool guaiac testing in a geriatric hospital.

In a long-term care facility, the fecal guaiac test for occult blood was used as a screening method to detect gastrointestinal (GI) bleeding lesions. The study involved 450 chronically ill hospitalized patients whose average age was 70 years. Each underwent 6 fecal guaiac tests for three consecutive days while receiving a standardized meat-free, high-fiber diet. The 21 patients in whom the fecal hemoccult test yielded positive findings were further studied with x-ray upper GI series, barium enema, and fiberoptic examination of the upper and lower GI tract when necessary. In 4.7 percent of this population, the guaiac test gave positive results, which usually involved only 1 or 2 of the 6 guaiac slides. On further study it was found that 2 patients had large-bowel tumors, 5 had duodenal ulcers, 1 had gastric cancer, and 7 had diverticulosis. The incidence of colon cancer in this population was the same as that reported in other studies, but the incidence of duodenal ulcers was high. In 20 of the 21 patients with positive test findings, a lesion of the GI tract was found. The therapeutic implications of such screening are important. This study emphasizes the value of routine fecal hemoccult testing of whole institutional populations once or twice a year.

Adult↗
PubMed1981

Barrett's esophagus: an old entity rediscovered.

I have reviewed Barrett's esophagus in the light of recent advances. Barrett's esophagus is not as rare as general practitioners and gastroenterologists think. Present evidence suggests that the disorder is acquired as a complication of reflux esophagitis. The epithelium is prone to inflammation, ulceration, bleeding, stricture, and adenocarcinoma. The epithelium may contain chief and/or oxyntic cells; pepsinogens are demonstrable by agar gel electrophoresis in the mucosa and Barrett's epithelium secretes pepsin and acid, and also contains gastrin by radioimmunoassay. Pertechnetate scintigraphy in the screening of these patients may be helpful. In the treatment of these patients, anti-reflux operations stop the progressive ascent of the heterotopic epithelium, prevent inflammation, and stricture formation, and lead to healing of the mucosa. Cimetidine and bethanechol along with the conventional medical regimen for reflux esophagitis may also be helpful in healing the inflamed mucosa. Adenocarcinoma in Barrett's epithelium may have a better prognosis than gastric carcinoma which invade the esophagus or than esophageal carcinoma.

Adenocarcinoma↗
PubMed1980

Hepatic friction rub in uremia.

Hepatic friction rubs developed in two patients undergoing maintenance hemodialysis. Thorough evaluation, including autopsy in one patient, did not demonstrate any known cause for the rubs except that uremic pericarditis had complicated the course of both patients and one suffered from chronic hemolytic anemia. The clinical course suggests that hepatic friction rubs may be associated with either uremia or maintenance hemodialysis.

Adult↗
PubMed1980

Barrett's ulcer and treatment with cimetidine.

Of seven patients with Barrett's esophagus, two had acute upper gastrointestinal (GI) tract bleeding, two had slow chronic upper GI tract bleeding; and three had dysphagia and weight loss. At upper GI tract endoscopy, 1- to 2-cm ulcers were seen in all seven patients in the distal esophagus. Four of the seven patients also had stricture of varying severity in the distal esophagus. Serial esophageal mucosal biopsy specimens in all seven patients revealed specialized columnar epithelium distal to 28 cm from the incisor teeth. Five of the seven patients were treated with intensive antacid therapy for eight weeks; but the ulcers had not healed after this period of treatment as assessed endoscopically. These five patients and two more then started therapy with cimetidine, 1.2 g per day. Repeat endoscopy four weeks and eight weeks after institution of cimetidine therapy revealed complete healing of the esophageal ulcers in six of the seven patients. One patient needed 16 weeks of cimetidine therapy before his ulcer had healed completely. Cimetidine therapy was not effective in preventing restricture of the esophagus. Two patients underwent biopsy 18 months after successful treatment; gastric epithelium had not reverted to squamous epithelium.

Aged↗
PubMed1980

Campylobacter colitis presentin as inflammatory bowel disease with segmental colonic ulcerations.

Campylobacter fetus subspecies have recently been recognized as an important cause of diarrheal illness in humans. We report a case of culture positive C. fetus colitis with colonoscopic findings of segmental mucosal edema, loss of normal vascular pattern with ulceration, and patchy involvement of mucosa. These colonoscopic findings were similar to those seen in granulomatous colitis. However, these findings may be difficult to distinguish from a number of other colonic mucosal diseases such as antibiotic-associated colitis, amebiasis, shigellosis, salmonellosis, invasive E. coli colitis, and ischemic colitis. On histopathologic examination of the mucosa, acute and chronic colitis with crypt abscess formation, mucosal atrophy, and mucous depletion was found which suggested the diagnosis of chronic ulcerative colitis. Cryptitis and crypt abscess are not specific to chronic ulcerative colitis alone and can be seen in many nongranulomatous inflammations of the colonic mucosa. Therapy with erythromycin led to prompt clinical improvement, clearance of the pathogen, and normalization of the colon by repeat examination 11 days after the initiation of the therapy.

Campylobacter Infections↗