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Biomedical subjects

K Gyr

Publications and source records attributed to K Gyr.

At least 37 records · Page 2Linked to original sources
PubMed1996

Effect of flumazenil on the electroencephalogram of patients with portosystemic encephalopathy. Results of a double blind, randomised, placebo-controlled multicentre trial.

The efficacy of the benzodiazepine antagonist flumazenil has been assessed clinically in a double blind, randomised, placebo-controlled multicentre study in patients with grade I-III portosystemic encephalopathy. In an ancillary study reported here the effect of flumazenil on the electroencephalogram (EEG) was analysed in 32 patients who had EEG grading according to protocol. Following the baseline observation period, patients were randomised to receive (at 1 min interval) 3 sequential bolus injections of flumazenil (0.4, 0.8 and 1 mg) or placebo followed by infusions of flumazenil (1 mg/h) or placebo for 3 h. Patients were monitored for 5 h after infusion. A positive response was defined as 1 point improvement in EEG grade. After independent analysis of the EEG gradings 5 out of 17 (29%) flumazenil treated patients showed an improvement in EEG grading (3 after bolus, 2 during follow-up) compared to 2 out of 15 (13%) placebo treated patients (1 after bolus, 1 during follow-up) (95% confidence interval of difference: -12% to + 50%). Of the 5 EEG responders after flumazenil, 3 also had an improvement in clinical PSE grading (none after bolus, 2 during infusion, 1 during follow-up), compared to neither of the 2 EEG responders after placebo. EEg responders did not differ from non-responders with respect to Child-Pugh score, basal EEG, PSE grade and positivity for benzodiazepines. In conclusion, treatment perspectives for flumazenil in portosystemic encephalopathy appear to be present for only a minority of patients; however, this study yields no support for a major role of benzodiazepine antagonists in the treatment of hepatic encephalopathy.

Adult↗
PubMed1996

N-acetyltransferase 2 polymorphism in patients infected with human immunodeficiency virus.

OBJECTIVES: To evaluate the prevalence of slow acetylation of hepatic N-acetyltransferase 2 (NAT2) in patients with different stages of human immunodeficiency virus (HIV) infection, to assess the relationship between acetylation capacity and the degree of immunosuppression, and to study the concordance between NAT2 phenotype and genotype. METHODS: This prospective study in a consecutive sample of HIV-infected patients was performed in the outpatient department of a university hospital that provides primary and tertiary care. The NAT2 genotype was assessed by polymerase chain reaction and restriction fragment length polymorphism, the NAT2 phenotype was determined by caffeine test (urinary metabolic ratio of the caffeine metabolites 5-acetylamino-6-formylamino-3-methyluracil and 1-methylxanthine). RESULTS: Fifty patients with Centers for Disease Control HIV infection stages A (10 patients), B (20 patients), and C (20 patients) were included in the study after each gave informed consent. According to genotyping and phenotyping, 32 (64%) patients were slow acetylators, with a concordance of the two methods of 96%. The overall distribution was similar to distributions reported in other white populations. The slow acetylator phenotype was found in seven, 16, and nine patients with stage A, B, and C, respectively. Eight of the 10 patients with previous adverse reactions to sulfonamides had slow acetylator phenotypes. Acetylation capacity was independent of CD4 cell counts. CONCLUSIONS: This study revealed an excellent agreement between genotypes and phenotypes of NAT2 in patients with HIV infection. There was no increase in prevalence of slow acetylation in patients with advanced stages of the disease. This apparent discrepancy to an earlier study may be the result of differences in co-medication of the patients studied and may point to the relevance of drug interactions in the treatment of patients with HIV infection.

Acetylation↗
PubMed1996

Helicobacter pylori infection in the young in Bangladesh: prevalence, socioeconomic and nutritional aspects.

BACKGROUND: The gastric acid barrier, an important host defence against small bowel infection, may be compromised by infection with Helicobacter pylori. In developing countries, H. pylori infection occurs early in life and prevalence of hypochlorhydria is high particularly in the malnourished, which may predispose a child to repeated gastrointestinal infection and diarrhoea. Diarrhoea being a leading cause of childhood mortality and morbidity in developing countries, we investigated the prevalence of H. pylori infection in children in a poor Bangladeshi community and explored its association with socioeconomic and nutritional status. METHODS: The study was conducted in a poor periurban community among 469 children aged 1-99 months. Parents were interviewed using a questionnaire. To detect active infection with H. pylori a 13C-urea breath test was performed and weight was recorded on a beam balance with a sensitivity of 20 g. RESULTS: In all, 61% of 36 infants aged 1-3 months were positive for H. pylori; this rate dropped steadily with increasing age and was 33% in 10-15 month old children and then rose to 84% in 6-9 year olds. Overall H. pylori infection had no association with nutritional state of the child, or family income but the infection rate was 2.5 times higher in children of mothers with no schooling. CONCLUSIONS: The H. pylori infection rate is very high in early infancy in a poor periurban community of Bangladesh. The reason for a drop in the infection rate in late infancy is unclear but could be due to initial clearance of the infection by the body's defence mechanisms but with possible alteration of the gastric mucosa which sustains infection. Maternal education may be protective and may operate through some unidentified proximate behavioural determinants. The rate of H. pylori infection in infants and young children may predispose them to repeated gastrointestinal infection and diarrhoea.

Age Factors↗
PubMed1996

Bacterial overgrowth during treatment with omeprazole compared with cimetidine: a prospective randomised double blind study.

BACKGROUND: Gastric and duodenal bacterial overgrowth frequently occurs in conditions where diminished acid secretion is present. Omeprazole inhibits acid secretion more effectively than cimetidine and might therefore more frequently cause bacterial overgrowth. AIM: This controlled prospective study compared the incidence of gastric and duodenal bacterial overgrowth in patients treated with omeprazole or cimetidine. METHODS: 47 outpatients with peptic disease were randomly assigned to a four week treatment regimen with omeprazole 20 mg or cimetidine 800 mg daily. Gastric and duodenal juice were obtained during upper gastrointestinal endoscopy and plated for anaerobic and aerobic organisms. RESULTS: Bacterial overgrowth (> or = 10(5) cfu/ml) was present in 53% of the patients receiving omeprazole and in 17% receiving cimetidine (p < 0.05). The mean (SEM) number of gastric and duodenal bacterial counts was 6.0 (0.2) and 5.0 (0.2) respectively in the omeprazole group and 4.0 (0.2) and 4.0 (0.1) in the cimetidine group (p < 0.001 and < 0.01; respectively). Faecal type bacteria were found in 30% of the patients with bacterial overgrowth. Basal gastric pH was higher in patients treated with omeprazole compared with cimetidine (4.2 (0.5) versus 2.0 (0.2); p < 0.001) and in patients with bacterial overgrowth compared with those without bacterial overgrowth (5.1 (0.6) versus 2.0 (0.1); p < 0.0001). The nitrate, nitrite, and nitrosamine values in gastric juice did not increase after treatment with either cimetidine or omeprazole. Serum concentrations of vitamin B12, beta carotene, and albumin were similar before and after treatment with both drugs. CONCLUSIONS: These results show that the incidence of gastric and duodenal bacterial overgrowth is considerably higher in patients treated with omeprazole compared with cimetidine. This can be explained by more pronounced inhibition of gastric acid secretion. No patient developed signs of malabsorption or an increase of N-nitroso compounds. The clinical significance of these findings needs to be assessed in studies with long-term treatment with omeprazole, in particular in patients belonging to high risk groups such as HIV infected and intensive care units patients.

Adult↗
PubMed1996

Evaluation of the efficacy and safety of flumazenil in the treatment of portal systemic encephalopathy: a double blind, randomised, placebo controlled multicentre study.

BACKGROUND: Portal systemic encephalopathy (PSE) is a complex neuropsychiatric syndrome associated with hepatic failure. Small scale studies have shown the benzodiazepine receptor antagonist flumazenil to be effective in ameliorating PSE. AIMS: To determine the efficacy of flumazenil in patients with non-comatous mild to moderate PSE (stages I to III) due to severe chronic liver disease. PATIENTS: 49 male and female adults without symptoms of severe bleeding and sepsis and who screened negative for benzodiazepine in both blood and urine, were included in the study. METHODS: Patients were randomised to receive either three sequential bolus injections of flumazenil (0.4, 0.8, and 1 mg) or placebo at one minute intervals, followed by intravenous infusions of either flumazenil (1 mg/h) or placebo for three hours. Clinical PSE grading and vital signs were assessed hourly during baseline and post-treatment periods and half hourly during treatment. The main outcome measures were improvement in group average PSE score and reduction of two points in individual PSE score (clinically relevant improvement). RESULTS: The mean average improvement in the PSE score in the subjects treated with flumazenil was not statistically significantly different from placebo. However, for patients showing clinically relevant improvement, the difference between flumazenil and placebo was statistically significant (seven of 28 v none of 21; p = 0.015). Flumazenil was well tolerated. CONCLUSIONS: A subgroup of patients with PSE resulting from chronic liver disease may benefit from the administration of flumazenil.

Chronic Disease↗
PubMed1996

Concomitant active Crohn's disease and the acquired immunodeficiency syndrome.

Symptomatic human immunodeficiency virus (HIV) infection is accompanied by depressed CD4+ T-lymphocyte counts. These cells seem to play a role in the inflammatory processes in Crohn's disease. It has even been speculated that depression of CD4+ T-lymphocytes in HIV infection may cure Crohn's disease. Here we describe a 41-year-old drug-addicted man with a 9-year history of Crohn's disease. HIV infection was diagnosed 8 years ago. At present he has stage-C3 HIV infection. He was admitted because of weight loss and chronic diarrhea with rectal blood and mucus discharge. Crohn's disease was confirmed endoscopically and histologically. Infectious diarrhea known to mimic Crohn's disease in patients with acquired immunodeficiency syndrome (AIDS) was excluded. In summary, we describe a patient with AIDS (CD4 count, 84/microliter) and active Crohn's disease, showing that both illnesses can occur simultaneously.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Prevalence of Helicobacter pylori infection in infants and family contacts in a poor Bangladesh community.

Although H. pylori is well established as an etiological agent of type B gastritis and a predisposing factor for peptic ulcer, knowledge about its transmission is unclear. In this study we examined the prevalence of H. pylori infection in the family members of index infants infected with this organism as indicated by positive [13C]-urea breath test (UBT). We performed UBT among family members of 15 predominantly breastfed infants, eight with and seven without H. pylori infection. Infection rates were 82% and 91% in family contacts of the infected and noninfected infants respectively, the average infection rate being 85%, which is rated to be high. There was no difference in infection rates among the parents of the infected and noninfected infants. Fifty percent and 70% families belonging to infected and noninfected infants, respectively, were found to have all members infected with H. pylori. No evidence of sex predilection of infection was found. We conclude that in communities with high prevalence of H. pylori infection, there is almost an equal infection rate among the family contacts of infected and noninfected infants, suggesting that environmental factors may be more important than intrafamilial transmission.

Adult↗
PubMed1995

HIV-enteropathy and bile acid malabsorption: response to cholestyramine.

Chronic diarrhea and weight loss are common in patients with AIDS. We report on an AIDS patient with chronic diarrhea, steatorrhea, and marked weight loss. A 75SeHCAT test demonstrated that the diarrhea was mainly due to bile acid malabsorption. Therapy with cholestyramine dramatically reduced bowel movements and led to significant reversal of weight loss.

AIDS-Related Opportunistic Infections↗
PubMed1995

Plasma secretin determination as a test of gastric acid secretion: effect of a marker perfusion technique on validation.

OBJECTIVE: To examine whether plasma secretin levels can be used as a diagnostic measure of gastric acid output. METHODS: A marker perfusion technique was used to quantify gastric acid output. Blood samples were drawn for secretin radioimmunoassay at specified intervals before and after pentagastrin stimulation in six healthy volunteers and six patients suspected of having abnormal gastric acid secretion. RESULTS: Linear relationships were found between integrated secretin response and maximal acid output as well as between peak acid output and acid output at 2 h (P < 0.01). Similar correlations were also observed with secretin levels 52, 60 and 68 min after pentagastrin stimulation. Discrimination between low, average and high gastric acid secretors was possible at 52 and 60 min after stimulation. Plasma secretin did not increase after pentagastrin stimulation in the 12 subjects when acid was continually aspirated, nor did correction for gastric acid loss improve the correlation or discrimination. CONCLUSION: One or two measurements of plasma secretin about 1 h after pentagastrin administration may provide a useful quantitative estimate of gastric secretory capacity for epidemiological or clinical purposes.

Gastric Acid↗
PubMed1994

Influence of method of reporting study results on decision of physicians to prescribe drugs to lower cholesterol concentration.

OBJECTIVE: To determine whether the reporting of study results by using reductions in relative or absolute risk and the number needed to treat affects the views of physicians about the effectiveness of drugs to lower lipid concentrations and decisions about treatment. DESIGN: Random allocation of two questionnaires presenting the results of three end points of the Helsinki heart study as results from separate trials by using reduction in either relative or absolute risk. In both questionnaires one end point was also presented by showing person years of treatment needed to prevent one myocardial infarction. The effectiveness of lipid lowering drugs was assessed for all end points on an 11 point scale. For each study result the likelihood to treat hypercholesterolaemia of 7.5 mmol/l in a healthy man had to be indicated on a seven point scale. SUBJECTS: Random sample of 802 internists and general practitioners representative of providers of primary care in Switzerland. RESULTS: The response rate was 69.6% (558). For the prevention of fatal and non-fatal myocardial infarction the mean ratings of effectiveness of lipid lowering drugs were 0.45 (95% confidence interval 0.21 to 0.69) and 1.39 (1.09 to 1.68) scale points lower when the reduction of absolute risk or number needed to treat were reported instead of the relative risk reduction (both P < 0.001). Physicians receiving trial results for identical end points in form of absolute reduction of risk or number needed to treat were less inclined to treat hypercholesterolaemia (both P < 0.001). CONCLUSIONS: Physicians' views of the effectiveness of lipid lowering drugs and the decision to prescribe such drugs is affected by the predominant use of reduction of relative risk in trial reports and advertisements.

Adult↗
PubMed1994

[Compliance of asylum seekers with an expanded border health screening program in the Basel-Stadt canton 1992-1993].

In 1992, the Swiss Public Health Office introduced an expanded tuberculosis screening program for refugees. In addition to routine chest X-rays, it includes tuberculosis skin testing and prophylactic treatment with isoniazid of skin test positive individuals. In addition, a vaccine program has been established which, besides routine hepatitis B vaccination of anti-HBc negative individuals, includes vaccination of all refugees against tetanus, diphtheria, polio, measles, mumps and rubella. The two-year experience of this expanded program is reported from Canton Basel-Stadt, Switzerland. During the two-year period (1992 to 1993), 289 adults and 53 children were screened. In 3.1% (n = 9) of 289 refugees who were examined by X-ray, smear positive tuberculosis was found. These 9 cases contributed 12% of all tuberculosis cases identified in Canton Basel-Stadt during the observation period. In 4.4% of all refugees prophylactic treatment with isoniazid was initiated, but 7 of the 15 cases (46.6%) did not complete the prophylaxis. In contrast, compliance with the vaccine program was better and complete vaccination was achieved in 90% of all refugees. The prevalence of anti-HBc antibodies was 28.7% and highest among refugees from Turkey (48.6%) and Africa (34.2%). X-ray screening for tuberculosis in high risk populations such as refugees is effective. However, compliance with 6 months' prophylactic treatment with isoniazid for skin test positives was only moderate.

Adolescent↗
PubMed1994

[Etiology, diagnosis and course of infectious diarrhea in the Liestal canton hospital (5-year retrospective study)].

Between 1987 and 1991 219 patients (1.3% of all hospitalized patients) with acute infectious diarrhea were investigated retrospectively. 52% of the patients were hospitalized and 48% were outpatients. In 55% the inducing diarrhea microorganism could be identified. The most frequently detected pathogens were endemic Salmonella sp. and Campylobacter jejuni (65%). Imported diarrheas (Shigella sp. and parasites) were rare, as only 15% of the patients had a history of travel. All Clostridium difficile infections were associated with antibiotic treatment. The stool examinations for bacteria were positive in 92/160 patients (57%). Stool examinations for occult blood or fecal leukocytes were highly useful in detecting the infectious agent. In 70% of the patients with positive occult blood test or 81% of the patients with fecal leukocytes, an infectious agent in the stool was found. All patients recovered with few complications. 31% of the patients were treated by antibiotics because of septic disease or pathogenic parasites.

Adolescent↗
PubMed1994

[Percutaneous endoscopic gastrostomy in long-term nutrition].

Percutaneous endoscopic gastrostomy is the preferred method for administration of long-term enteral tube feeding. Data on long-term follow-ups are rare. We report the long-term outcome and the complication rates after percutaneous endoscopic gastrostomy in 165 patients (mean age 70 years). The most common indications were neurologically-related swallowing disorders. The data were collected prospectively. Percutaneous endoscopic gastrostomy in patients was technically successful in 164 patients (99%), with a mean implantation time of 12 minutes. The procedure-related morbidity was 1.2%. The mean length of percutaneous endoscopic gastrostomy feeding was 26 weeks (1-98) for the Charrière 9-tube and 29 weeks (1-158) for Charrière 15-tubes. There were 12% tube-related and 15% feeding-related late complications, the main ones being local skin infections (7.3%) and gastric perforations (1.2%). The procedure-related mortality was 0.6%. We conclude that endoscopically assisted percutaneous gastrostomy is the procedure of choice for long-term enteral nutrition in patients requiring tube-feeding.

Adult↗
PubMed1994

Circulating somatostatin-28 is not a physiologic regulator of gastric acid production in man.

Studies were designed to establish the acid inhibitory potency and plasma kinetics of somatostatin-28 (S-28) in humans and to determine whether the amount of S-28 released into the circulation after a meal is sufficient to regulate gastric acid secretion. A liquid meal induced a significant increase of S-28 (P < 0.01) whereas S-14 levels did not change. Postprandial S-28 concentrations were then mimicked by exogenous infusions and tested on basal and pentagastrin-stimulated gastric acid secretion. Expressed in terms of circulating plasma concentrations measured by specific radioimmunoassays, S-14 was 10 times more potent than S-28 in inhibiting gastric acid production. The plasma half-life of S-28 (1.86 min) was longer than that of S-14 (1.00 min) due to a slower plasma clearance rate. S-28 did neither affect basal and stimulated gastric acid secretion nor postprandial intragastric acidity. These studies suggest that postprandial plasma concentrations of S-28 are unlikely to regulate gastric acid secretion in man. They also show that S-28 is several times less potent than S-14 with respect to inhibition of gastric acid output.

Adult↗
PubMed1994

Cholecystokinin is a physiological regulator of gastric acid secretion in man.

CCK8 is a poor stimulant of gastric acid secretion in vivo, but is equipotent to gastrin-17 (G17) in in vitro systems. To further evaluate the role of cholecystokinin (CCK) in regulating acid output in humans, dose-response curves were constructed to CCK8 or G17 (6.4-800 pmol kg-1 per h) with and without a specific CCK-A receptor antagonist (loxiglumide). During loxiglumide infusion, G17-stimulated acid output was unchanged, whereas CCK8-stimulated secretion increased significantly. Gastric somatostatin-14 release increased fivefold with CCK8 alone, but was blocked with loxiglumide administration. These data suggest that CCK8 directly stimulates acid secretion by binding to a CCK-B/gastrin receptor on parietal cells, but at the same time inhibits acid responses by stimulating gastric somatostatin release to a CCK-A receptor-mediated pathway. To test which action of CCK is relevant under physiological circumstances, the effect of loxiglumide on fasting and post-prandial acidity was measured through continuous pH-metry. After eating, gastrin levels increased fourfold compared to controls with concomitant increases in acid secretion. These results suggest that post cibum, CCK is an inhibitor of acid secretion by regulating gastrin through local somatostatin; they support the hypothesis that CCK acts as an enterogastrone.

Adult↗