[Irritable bowel syndrome. Not to be examined too frequently!].
Explore the source record for details and available documents.
Colonic Diseases, Functional↗
Biomedical subjects
J Hotz
Publications and source records attributed to J Hotz.
Treatment of functional dyspepsia with a fixed peppermint oil and caraway oil combination preparation as compared to cisapride. A multicenter, reference-controlled double-blind equivalence study.
The therapeutic equivalence of a fixed combination preparation consisting of peppermint oil and caraway oil (PCC, Enteroplant) and the prokinetic agent cisapride (CIS, CAS 81098-60-4) was investigated in a four-week randomized controlled double-blind study with planned adaptive interim analysis. The study comprised 120 outpatients with functional dyspepsia. The efficacy was evaluated in 118 patients. Of these, 60 patients received the enteric-coated combination preparation (2 x 1 capsule containing 90 mg peppermint oil +50 mg caraway oil per day) and 58 patients received the reference preparation cisapride (3 x 10 mg/day). The mean reduction of the pain score (primary variable) recorded on a visual analog scale (VAS) during the four-week treatment was 4.62 points with the peppermint oil/caraway oil preparation. This score was comparable with the mean reduction under cisapride (4.60 points) (p = 0.021; test for equivalence). Equivalence was also found in the secondary variable "frequency of pain" with a reduction by 4.65 points under PCC and by 4.16 points under cisapride carried out on an exploratory basis (p = 0.0034). Comparable results were attained with both treatments in the Dyspeptic Discomfort Score which included the other dyspeptic symptoms as well as intestinal and extraintestinal autonomic symptoms, in the prognosis as appraised by the physician and in the CGI scales (Clinical Global Impressions). Corresponding results were also found in Helicobacter pylori-positive patients and patients with initially intense epigastric pain in the two treatment groups. The combination preparation consisting of peppermint oil and caraway, oil appears to be comparable with cisapride and provides an effective means for treatment of functional dyspepsia. Both medications were tolerated well (adverse events were reported in 12 patients of the PCC group and in 14 patients of the CIS group).
Cisapride↗
[Consensus report: irritable bowel syndrome--definition, differential diagnosis, pathophysiology and therapeutic possibilities. Consensus of the German Society of Digestive and Metabolic Diseases].
Explore the source record for details and available documents.
Colon↗
Nonmalignant hyperthermia on induction of anesthesia in a pediatric patient undergoing bidirectional Glenn procedure.
We report a case of severe hyperthermia in a 6-month-old boy with a single ventricle, dextrocardia, asplenia, and transposition of the great arteries, during induction of anesthesia on three separate occasions. To our knowledge, this is the first case reported of repeated intraoperative hyperthermia not related to malignant hyperthermia, infection, neuroendocrine tumor, or iatrogenic causes (e.g., anticholinergic blockade or warming devices). The severe hyperthermia may be secondary to the medications given before and during induction and/or the stress of the induction. Among the induction medications given during the three episodes, fentanyl is the most likely contributing drug. Human data indicate that opioids increase the sweating threshold and decrease the vasoconstriction and shivering thresholds. The medications could cause a widening in the thermoregulation interthreshold and the stress could induce nonshivering thermogenesis.
Adjuvants, Anesthesia↗
[Reflux disease of the gastrointestinal tract. Acute therapy and long-term care in daily practice. 2. Therapeutic procedure--diagnosis--therapy-diagram].
Explore the source record for details and available documents.
Amoxicillin↗
[Esophageal reflux. Acute therapy and long-term management in routine general practice. 1: The disease picture, diagnosis and pathogenesis].
Explore the source record for details and available documents.
Diagnosis, Differential↗
Prolonged regional nerve blockade. Injectable biodegradable bupivacaine/polyester microspheres.
BACKGROUND: Biodegradable microspheres are a useful method of drug delivery because they are both injectable and biodegradable, eliminating the need for surgical implantation or removal. Previous work has characterized implantable preparations of local anesthetics in polymer pellets for prolonged regional anesthesia. In this article, the authors characterize injectable suspensions of bupivacaine-polymer microspheres and examine whether they can produce prolonged blockade of the sciatic nerve in rats. METHODS: Microspheres were prepared using polylactic-co-glycolic acid polymers loaded with 75% w/w bupivacaine by a solvent evaporation method. Bupivacaine release from microspheres was determined in vitro by ultraviolet spectroscopy and scintillation counting. Sensory and motor blockade of the rat sciatic nerve were assessed in vivo after injection of microsphere suspensions. RESULTS: Depending on the type of microspheres, the dose, and the additive used, mean duration of sciatic nerve block ranged from 10 h to 5.5 days. Incorporation of 0.05% w/w dexamethasone into the microspheres resulted in significant prolongation of block (up to 13-fold), and only preparations that contained dexamethasone produced blocks lasting beyond 1 day. Bupivacaine was released in a controlled manner in vitro. Dexamethasone does not substantially slow bupivacaine release from microspheres in vitro. CONCLUSIONS: Prolonged percutaneous blockade of peripheral nerves is feasible. The recovery from blockade is complete, and plasma bupivacaine levels are far below the range associated with systemic toxicity. The mechanisms underlying the dexamethasone block-prolonging effect are under investigation.
Anesthetics, Local↗
Glucocorticoids prolong rat sciatic nerve blockade in vivo from bupivacaine microspheres.
BACKGROUND: Previous work showed that incorporation of dexamethasone (0.05 weight/weight percentage) into bupivacaine microspheres prolonged blockade by eight to 13 times compared with that produced by bupivacaine microspheres alone. The determinants of dexamethasone's block-prolonging effect were examined and reported here. METHODS: Polylactic-co-glycolic acid polymer microspheres (65/35) with 75 weight/weight percentage bupivacaine were prepared. Microspheres were injected adjacent to the rat sciatic nerve, and sensory and motor blockade were assessed. A procedure was developed to test drugs for block-prolonging ability in vivo by placing test drugs in the injection fluid along with a suspension of bupivacaine microspheres. RESULTS: Dexamethasone alone in suspension did not produce blockade, nor did it prolong blockade induced by aqueous bupivacaine. Bupivacaine microspheres (150 mg drug/kg rat weight) produced blockade for 6 to 10 h. Dexamethasone in the suspending solution of microspheres prolonged block by up to five times. Glucocorticoids prolonged block in proportion to glucocorticoid/antiinflammatory potency. The corticosteroid antagonist cortexolone inhibited dexamethasone's blockade-prolonging action. Durations of blockade with or without dexamethasone were unaltered by hydroxyurea-induced neutrophil depletion. Microspheres were extracted from rats at time points ranging from 7 h to 7 days, and residual microsphere dry weight and bupivacaine content were similar in groups of rats injected with either bupivacaine microspheres or bupivacaine microspheres containing dexamethasone, respectively. CONCLUSIONS: Glucocorticoids prolong blockade from bupivacaine microspheres. The mechanism appears unrelated to the kinetics of bupivacaine release in vivo.
Anesthetics, Local↗
Pantoprazole is superior to ranitidine in the treatment of acute gastric ulcer.
BACKGROUND: Pantoprazole is a newly developed gastric H+/K(+)-adenosine triphosphatase inhibitor with a potent and long-acting inhibitory effect on gastric acid secretion. METHODS: In a double-blind multicenter study with 28 centers in Germany, pantoprazole (40 mg before breakfast) was compared with ranitidine (300 mg at bedtime) with regard to healing rates, time until healing, symptom relief, and tolerability. A total of 248 outpatients with benign gastric ulcer were included. RESULTS: The healing rates after 2, 4, and 8 weeks were 37%, 87%, and 97%, respectively, in the pantoprazole and 19%, 58%, and 80% in the ranitidine group. The differences between the two groups were significant at 2 weeks (p < 0.01), 4 weeks (p < 0.001), and 8 weeks (p < 0.001; Cochran/Mantel-Haenszel method). Ulcer healing proceeded significantly faster with pantoprazole (p < 0.001; Uleman's U-test). Both treatments were well tolerated. CONCLUSIONS: Pantoprazole appears to be superior to ranitidine in gastric ulcer healing.
2-Pyridinylmethylsulfinylbenzimidazoles↗
[Treatment of acute peptic gastroduodenal ulcer: omeprazole is superior to ranitidine especially in the early phase of ulcer healing. A prospective controlled randomized serial endoscopy study].
UNLABELLED: Omeprazole (OM) has been shown to be superior to H2-Blockers in terms of complete healing rates of gastric (GU) and duodenal ulcers (DU). We investigated in more detail the kinetics of ulcer healing under OM (20 mg mane) compared with ranitidine (RAN 300 mg nocte) in GU (n = 28) and DU (n = 27) by multiple series endoscopy. After endoscopic diagnosis (day 0) patients were allocated to either OM or RAN in a random order. Endoscopic controls were undertaken at day (d) 3, 7, 14, 21, 28, 42 up to complete ulcer healing. The seize of ulcer areas was assessed by independent endocopists estimating the longest and shortest diameter D acc. to the formula A = pi x D1 x D2:4. RESULTS: In GU and DU cumulating healing rates were sign, higher under OM. In GU and DU, the most striking differences in the absolute and percentual reduction of ulcer seize in favour of OM vs RAN were observed mainly during the first week. At d3 under OM the reduction in DU-area was 43% and at d7 75% compared to a distinctly lower rate under RAN with the corresponding figures of 9% and 61% resp. In GU the mean reduction in area was for IM at d3 41%, at d7 82% in contrast to RAN at d3 of 34% and d7 of 49%. The faster healing during the first week was accompanied by sign more rapid reduction in day-and-night-painscore during OM vs RAN.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Improving the effect of orthograde colonic lavage with golytely solution by adding dimethicone].
The effectiveness of an additional application of Simethicone during an orthograde lavage with Golytely solution in preparation for colonoscopy was tested in a prospective, randomized, placebo-controlled double blind study on 152 patients 78 Simethicone, 74 placebo). The colon regions were separated into rectosigmoid, descending colon, transverse colon and ascending colon and interpreted according to the criteria formation of foam and contamination with feces. By the endoscopic examination of the colon we found a statistically significant improvement in visibility in the patients treated with Simethicone in contrast to placebo both in the individual scores, separated according to each of the colon regions, and in the total scores (p < 0.01). Furthermore, the time needed for the colonoscopy could be significantly shortened in the Simethicone group (p < 0.05). Adverse effects were not observed. We conclude that the additional application of Simethicone during the orthograde colon lavage with Golytely solution results in an improvement in the preparation for the colonoscopy as well as visibility of the colon mucosa.
Adolescent↗
[Effectiveness of plantago seed husks in comparison with wheat brain on stool frequency and manifestations of irritable colon syndrome with constipation].
BACKGROUND AND AIM: The importance of dietary fibres in treatment of irritable bowel syndrome increased during the last years. Yet the results of clinical studies on the different dietary fibres are not consistent. Therefore we decided to perform a controlled trial with a well defined group of patients to compare the effectiveness of wheat bran to psyllium seeds. PATIENTS AND METHODS: Thirty patients each with irritable bowel syndrome group II to III were treated in an open, not controlled study design either with 3 times 3.25 g psyllium seeds or 3 times 7 g wheat bran daily. All patients entering the study had not been treated for at least 3 weeks before. The study comprised two treatment phases of two weeks each, separated by two weeks without any treatment, thus leading to a study duration of 6 weeks altogether. Parameters for evaluation were stool frequency and consistency and the symptoms pain and abdominal distention, measured by a score (1 to 4). RESULTS: In both treatments groups stool frequency and consistency improved apparently compared to the starting point or the two weeks treatment free time in between. The improvement of stool frequency was statistically significant (p < 0.0001) for both substances. Furthermore the effect of psyllium seeds exceeded that of wheat bran statistically significant in week 1, 2, 3, 5 and 6 (p < 0.005). Other symptoms such as abdominal pain improved too by therapy, psyllium seeds again tending to show better results. A significant difference between both substances could be observed on the symptom abdominal distension. Whereas abdominal distension decreased under treatment with psyllium seeds it increased with wheat brain. This lead to discontinuation of the study in 5 cases, 3 of which could be changed successfully to psyllium seeds. The difference between psyllium seeds and wheat bran concerning the occurrence of abdominal distension was statistically significant (p < 0.01). CONCLUSION: The results of this study demonstrate the effectiveness of psyllium seeds and wheat bran on stool frequency and consistency of patients with irritable bowel syndrome. Psyllium seeds showed to be superior to wheat brain with respect to stool frequency and abdominal distension so that it should be preferred in treatment of irritable bowel syndrome and constipation.
Adult↗
[Therapy of acute pancreatitis].
The management of acute pancreatitis (AP) is symptomatic and is adjusted to the clinical course of the disease, which is assessed by different clinical variables, laboratory findings as well as by contrast-medium-enhanced computed tomography. The therapy of AP consists of a general basic treatment (fluid substitution, antibiotics, etc.) and additional measures according to intensive-care principles. Antisecretory substances such as glucagon, calcitonin and somatostatin are ineffective; the value of peritoneal lavage and early ERCP with EPT as standard treatment is still under debate. Surgical treatment is only indicated if the clinical course worsens various of the supportive measures.
Acute Disease↗
[The effectiveness of ranitidine in non-ulcer dyspepsia (functional dyspepsia) in comparison with an antacid].
BACKGROUND: It is generally accepted that functional dyspepsia is caused by heterogeneous pathogenetic factors. From the clinical point of view acid-related symptoms as heartburn, acid regurgitation and epigastric pain (acid-type) can be separated from general dyspeptic symptoms as predominant fullness, nausea/vomiting (dysmotility-type). PATIENTS AND METHODS: In the present study, the influence of a four-week-treatment with ranitidine (twice 150/d, n = 346) in comparison with an antacid (40 mmol/d, n = 340) on the severity and course of symptoms in patients suffering from an acid-related functional dyspepsia was investigated. RESULTS: With ranitidine, acid-related as well as general dyspeptic symptoms disappeared in a significantly higher percentage after two and four weeks compared with antacid. Complete disappearance of symptoms was documented with ranitidine after two weeks in 37% and after four weeks in 66% compared with antacid in 13% and 30% respectively (p < 0.005). Patients with severe symptoms, history of ulcer and long-term dyspepsia and slight endoscopic changes in the upper gastrointestinal tract showed a significant faster and more distinct response. Both kinds of treatment were well tolerated. CONCLUSION: It is concluded that in acid-related functional dyspepsia ranitidine is superior to antacid in relieving symptoms. Therefore, a probative treatment with ranitidine up to four weeks is recommended as a practical therapeutic alternative in this syndrome.
Adolescent↗
Ranitidine in the treatment of non-ulcer dyspepsia. A placebo-controlled study in the Federal Republic of Germany.
The trial randomly assigned 652 patients with non-ulcer dyspepsia (NUD), defined as chronic or recurrent complaints of acid-related (heartburn, acid regurgitation, epigastric pain) and non-acid related (fullness/vomiting, nausea) symptoms and with no evidence of organic disease, to treatment for 4 weeks with 150 mg of ranitidine (Zantic, CAS 66357-59-3) twice a day, or placebo, according to a double-blind design. The presence and duration of all dyspeptic symptoms were recorded by interviews at the beginning and after 2 and 4 weeks of treatment as well as by diaries. The complete disappearance of all dyspeptic symptoms after 4 weeks in the placebo group was 36%; ranitidine treatment resulted in a significant improvement after 4 weeks (p < 0.05). The effect of ranitidine was slightly more pronounced in acid-related than in non-acid-related symptoms. We conclude that suppression of gastric acid secretion is of clinical value in NUD patients, especially in those suffering from epigastric pain, acid regurgitation and heartburn.
Adult↗
[Diagnosis of factitious diarrhea (Munchausen syndrome) by colon biopsy].
The differential diagnosis of chronic diarrhea is broad. Most of the illnesses causing diarrhea can be diagnosed through a carefully taken medical history, stool examination, few complementary laboratory tests as well as an endoscopy and, if needed, a radiological examination. However, a few causes could still remain undiagnosed and special diagnostic techniques must then be implemented. The diagnosis of self-induced diarrhea by concealed laxative abuse is a special challenge and should be considered in every case of diarrhea where the cause remains unclear. This paper reports such a case where the diagnosis of the habitual laxative abuse with Bisacodyl was made with the help of the pathologist on the basis of stepwise taken colonic biopsies. The most important histological criteria are a champagne glass-like ectasia of the deep curved crypts, combined with increased goblet cell content and increased mucus production in the presence of an intact surface-epithelium.
Biopsy↗
[Epidemiology of antirheumatic drug-induced ulcer in comparison with peptic gastroduodenal ulcer. Five-year analysis of a hospital patient sample].
Within the framework of a five-year analysis of a hospital population (n = 503), the epidemiological and diagnostic data of patients with non-steroidal anti-inflammatory drugs-associated ulcers of the stomach and duodenum (AIU) were evaluated and compared with those of patients with peptic ulcers (PUC) in the stomach and duodenum with no history of NSAIDs use. With respect to age and sex, patients with AIU were significantly older, in particular in the case of gastric ulcer, and revealed a predominance of female sex as compared with those with PU. Episodes of ulcer disease showed no seasonal dependence, either in the AIU or in the PU group. The use of tobacco and alcohol was comparable in both groups. Nor was any difference found between city and rural populations in either group. Laboratory data revealed a higher rate of pathological deviations in the AIU as compared with the PU group, which, however, was unequivocally due to the larger percentage of elderly patients in the former. With respect to blood group distribution, no differences were observed between the groups. An analysis of ulcer site showed a small preponderance of gastric ulcer (59%) over duodenal ulcer (41%) in the AIU group, while the distribution in the case of the PU group was virtually identical (gastric ulcer 51%, duodenal ulcer 49%), with only small differences in site within the stomach and duodenal bulb resp. Analysis of the risk indicators for ulcer bleeding (AIU 66%, PU 50%) revealed the following pattern: in the case of AIU, patients aged over 65, and in the case of AIU and PU, overweight males, bled significantly more often than, respectively, younger patients and female or normal-weight patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Treatment of chronic diarrhea in Crohn disease. A pilot study of the clinical effect of tannin albuminate and ethacridine lactate].
METHOD: The present prospective controlled study investigated the effect of a combination of 500 mg of tannin albuminate and 50 mg ethacridine lactate (Tannacomp) on chronic diarrhea in stable-phase Crohn's disease. Of the 30 patients admitted to the study, Crohn's disease was confined to the small intestine in 5, involved both small and large bowel in 11 patients, and only the large intestine in 14 cases. TREATMENT: Basic treatment was continued throughout the study; in addition, three times 2 tablets of Tannacomp were administered for 5 days, followed by a 5-day period of no such treatment, and then a further 5 days with the same regimen. RESULTS: At the end of the treatment phases, there was a significant reduction in stool frequency from 5.5 +/- 0.6 (mean +/- SEM) to 4.0 +/- 0.8, and the summed score of the symptoms decreased from 6.3 +/- 0.6 to 5.3 +/- 0.6; in comparison with the initial situation or at the end of the five-day period of no additional treatment, the consistency of the stools also increased. The effect of Tannacomp showed a tendency to be more marked among patients with Crohn's disease limited to the large intestine, as compared with patients with small intestinal involvement. However, before Tannacomp can be recommended as treatment of chronic diarrhea in stable-phase Crohn's disease, further studies are needed.
Adult↗