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Biomedical subjects

K Gyr

Publications and source records attributed to K Gyr.

At least 73 records · Page 4Linked to original sources
PubMed1992

Non-immunological defence mechanisms of the gut.

Non-immunological defence mechanisms represent an important line of intestinal defence in addition to humoral and cellular immunity. This review summarises the evidence for the role of the non-immunological defence system. Protective factors that have been amply documented are gastric juice, intestinal motility, and intestinal flora. Components of pancreatic juice, lysozyme, and epithelial cell turnover may also be involved. Special attention is given to gastric acid, infection with Helicobacter pylori, and hypochlorhydria and their association with infectious diarrhoea. Epidemic hypochlorhydria is discussed since this increases sensitivity to intestinal infections in third world countries.

Achlorhydria↗
PubMed1992

Antimicrobial therapy of bacterial diarrhea in adult residents of Mexico--lack of an effect.

Two clinical trials in adults in Mexico are reported. In the first trial, long-term residents of Mexico with acute fecal leukocyte-positive diarrhea were randomized to receive trimethoprim/sulfamethoxazole (TMP/SMX), clioquinol or a placebo. Neither antimicrobial shortened the illness for all cases or for those with shigellosis or enterotoxigenic Escherichia coli diarrhea. In a second study, US and Mexican students received enoxacin, TMP/SMX or a placebo on a blind random basis. While the placebo-treated subjects with bacterial diarrhea tended to be more ill after treatment than other groups, no statistical differences were seen in treatment groups. These studies cast doubts on the value of antimicrobial drugs for 'invasive' and other forms of bacterial diarrhea in adults living in endemic areas and indicate the importance of a placebo control group when conducting clinical trials in these populations.

Adult↗
PubMed1992

Diagnosis of bacterial overgrowth after culturing proximal small-bowel aspirate obtained during routine upper gastrointestinal endoscopy.

The purpose of this study was to evaluate the method of obtaining aspirated fluid for culture from the small intestine through a fiberoptic gastrointestinal endoscope for diagnosing small-bowel overgrowth. The study population consisted of 10 healthy volunteers and 26 patients with various gastrointestinal problems referred for routine endoscopic examination. The material to be cultured was obtained under direct visualization approximately 25 to 30 cm distal to the pylorus or from the afferent loop (in Billroth-II patients) with a sterilized sheathed wash pipe passed through the suction channel of the endoscope. Cultures were considered positive for bacterial overgrowth if total counts of organisms were 10(5)/ml or more. All healthy volunteers and 16 of 21 unoperated patients had sterile or insignificant growth, whereas all 5 patients who had Billroth-II operations had positive overgrowth. The endoscopic method for collection of proximal gastrointestinal fluid for culture is simple and can be performed during routine endoscopy.

Adult↗
PubMed1992

Perfusion studies in cholera: methods and procedures.

This paper reviews the characteristics of perfusion techniques in the study of intestinal functions by specifically examining the methods and procedures of perfusion in patients with diarrhoea due to infection with V. cholerae 01. Because of abundant jejunal secretion of water and electrolytes in cholera, perfusion studies require special approaches with regard to patient preparation, use of tubing material, selection of markers, and rate of perfusion. A discussion on specific problems involved in marker perfusion techniques in cholera and on the interpretation of the results is followed by practical recommendations.

Cholera↗
PubMed1991

Human gastrin-releasing peptide: biological potency in humans.

Gastrin-releasing peptide (GRP) was infused in graded doses (1-27 pmol/kg per h) to healthy human volunteers to study the effects on gastric, pancreatic and gallbladder functions as well as on gastrin, CCK and PP release. The results were compared to equimolar doses of synthetic bombesin. GRP significantly (P less than 0.05) stimulated gastric and pancreatic secretory responses, gallbladder contraction and gastro-enteropancreatic hormone release in a dose-dependent manner. GRP was found to be equipotent to bombesin with respect to gastric acid secretion, pancreatic enzyme output, gallbladder contraction and plasma hormone release. We conclude (a) that human GRP has similar biologic effects as synthetic bombesin; (b) as GRP is localized exclusively in nerve tissue and has potent effects on different organs, it is a likely candidate for peptidergic control of human gastric, pancreatic and gallbladder functions.

Adult↗
PubMed1991

[Combined oral and endoscopic mepacrine therapy in therapy-resistant symptomatic giardiasis].

A case of extremely refractory infection with Giardia lamblia is described. A 28-year-old male patient with a 7-year history of mushy diarrhea and epigastric pain was repeatedly treated orally and intravenously, without success, with metronidazole, tinidazole, ornidazole, and mepacrine. The rate of success for these drugs is generally more than 90%. Only therapy with mepacrine orally in combination with intraduodenal administration, was successful. Therapeutic failure of 5-nitroimidazole derivatives is described in relation to immune deficiency syndromes and IgA deficit. None of these defects were found in this case.

Administration, Oral↗
PubMed1991

[Gastritis associated with Gastrospirillum hominis--a zoonosis?].

We found spiral bacteria (non-Helicobacter pylori, SB) in gastric biopsies of 5 patients corresponding to an incidence of 0.3%. The bacteria were found on the surface of the gastric mucosa and in part tightly packed within the crypts. Contrary to Helicobacter pylori, most of them had no direct contact to the surface and crypt epithelium. They are distinctly coiled, 3.6-5.5 microns in length and on average 0.5 microns thick. Ultrastructural studies revealed sheathed flagella at each pole. In one case the bacteria displayed periplasmic fibrils in pairs as also described in cultures of SB from cats' stomachs. In all 5 cases there was histological evidence of inflammation of the gastric mucosa, i.e. one acute diffuse gastritis, one case of granulomatous and three of slight to medium grade chronic gastritis. Biopsies of 2 patients showed a positive urease reaction in the CLO test. Morphologically very similar SB occur as commensals in the stomachs of various animals, in particular dogs and cats. We investigated the stomachs of four dogs and four cats and found all to be infested with SB. The bacteria were found not only on the surface of the mucosa and in crypts, but within the glands of the corpus and antrum and often also within parietal (oxyntic) cells. Yet despite bacterial colonization there was no evidence of gastritis in dogs. However, all of the cats' stomachs showed slight to medium grade chronic gastritis. Cultivation of SB has not been successful so far, with the exception of cats' stomachs. Since the germs have been defined only morphologically, the question as to how close the relationship is among SB of various origins must for the time being remain unanswered. Furthermore, species-specific pathogenicity and the possibility of contagion from animal to man has not yet been clarified.

Adult↗
PubMed1991

Flumazenil in the treatment of portal systemic encephalopathy--an overview.

Hepatic encephalopathy is a complex neuropsychiatric syndrome associated with acute, subacute and chronic liver failure, involving increased neural inhibition by activation of the GABA/benzodiazepine inhibitory neurotransmitter system. Improvement by GABA and benzodiazepine receptor antagonists as well as by chloride ionophore blockers has been shown in animal experiments. Recent reports indicate that flumazenil may improve hepatic encephalopathy in man. To date 46 episodes of HE in 41 patients have been treated with flumazenil with a short term success rate of 72%. Most of the patients were screened for exogenous benzodiazepines and found negative. These interesting observations should now be investigated in a randomised double-blind controlled study in patients with HE to evaluate the efficiency of this therapy.

Animals↗
PubMed1991

Pharmacokinetics and pharmacodynamics of a new transdermal delivery system for bopindolol.

1. In two separate studies, each with 12 healthy male volunteers, the pharmacokinetic and dynamic properties of a transdermal delivery system for bopindolol were evaluated. 2. In study I it was shown that bopindolol absorption from a 14 mg patch occurred over the whole 7-day application period. No signs of a significant skin depot were found. 3. In study II, a linear pharmacokinetic behaviour but a non-linear kinetic/dynamic relationship was established for the patches over a dose range from 7 to 21 mg. Comparable peak effects of reduction in exercise-induced tachycardia were observed after different patch doses and an i.v. injection. However, the effect was significantly prolonged with the patches compared with the injection and was maintained over 7 days. 4. The patches showed a good local and systemic tolerability in both studies over a dosing interval of up to 7 days.

Administration, Cutaneous↗
PubMed1991

[Collagen colitis--a clinical entity of relevance].

Collagenous colitis is a clinical and pathological entity characterized by chronic watery diarrhea and deposition of collagen beneath the surface epithelium of the large intestine. By colonoscopy and barium enema the colon appears normal. The laboratory tests give usually normal results. 75% of the patients are middle-aged women with a mean age around 50 years. The etiology of the disease is still unknown. An association with various autoimmune diseases has been suggested, but was never proven. Up to now, it is not clear whether the collagenous colitis is a distinct entity or only an epi-phenomenon of another disease which leads to thickening of the collagen layer. Collagenous colitis is diagnosed if all other diseases with chronic watery diarrhea are excluded. A specific treatment is not known. Symptomatic treatment with bulk and antidiarrheal drugs improves the symptoms of most of the patients.

Colitis↗
PubMed1990

[Intramural hematoma of the duodenum as complication in anticoagulant therapy. Diagnosis and therapy].

We report the history of a 68-year-old man who has been hospitalized for an aortic valve endocarditis. The patient was under full anticoagulation therapy because of an artificial aortic valve (Omnicarbon 23 mm). During hospitalization the patient developed a subacute abdomen accompanied by upper gastrointestinal tract hemorrhage. At endoscopy and radiology an intramural hematoma of the duodenum was found. The typical findings of intramural hematoma such as abdominal X-ray, ultrasound, CT scan, selective small bowel transit and endoscopy are presented and the history as well as therapeutic modalities discussed.

4-Hydroxycoumarins↗
PubMed1990

[ERCP in bile duct dilatation with jaundice due to spontaneous hydatid cyst rupture. Diagnosis, differential diagnosis, therapy and result].

We report the case of a 17 years old Turkish patient hospitalized for colics and jaundice. Ultrasound, computer tomography and ERC showed enlarged intra- and extrahepatic bile ducts. The further investigations documented the rupture of a hepatic hydatid cyst into the biliary tract with obstructive jaundice. Other causes of jaundice as cystic duct malformation, calculi, tumours could be ruled out by surgery and histology. Etiology, diagnosis and treatment of hydatid jaundice are discussed.

Adolescent↗
PubMed1990

[ERCP under ceftriaxone antibiotic cover in patients with obstructive jaundice].

The risk of cholangitis after ERCP has been reported to occur in up to 50% of patients with obstructive jaundice. Prophylactic antibiotics have therefore been advocated to reduce the risk. Here we report on the results of 46 patients with obstructive jaundice who were given 1 g of Ceftriaxone i.v. 30 to 60 min. prior to the procedure. Only one patient developed cholangitis with septicemia, which was treated conservatively. No side effects were observed in this group of patients. It is suggested that Ceftriaxone is an adequate prophylactic method to prevent cholangitis and septicemia in patients with obstructive jaundice.

Adult↗
PubMed1990

Effect of loxiglumide, a cholecystokinin antagonist, on pancreatic polypeptide release in humans.

The purpose of this study was to determine the role of cholecystokinin in the regulation of postprandial pancreatic polypeptide secretion in humans. The pancreatic polypeptide responses to modified sham feeding and gastric instillation of a test meal were first compared with the response to oral ingestion of the same meal. The experiments were repeated under cholinergic (atropine) and cholecystokinin (loxiglumide) blockade. Atropine completely abolished the pancreatic polypeptide response to sham feeding and caused significant reductions after gastric and oral food intake. Loxiglumide, on the other hand, significantly reduced pancreatic polypeptide release to oral food (51% inhibition) without affecting the response to sham feeding. In separate experiments using a duodenal perfusion system, the effects of atropine and loxiglumide on intestinal phase-stimulated pancreatic polypeptide release were examined, and both cholinergic and cholecystokinin blockade induced complete suppression. It was concluded (a) that cholecystokinin is involved in postprandial pancreatic polypeptide response, especially during the intestinal phase stimulation, and (b) that the cholinergic system is crucial and superimposed on cholecystokinin in stimulating pancreatic polypeptide release.

Adult↗
PubMed1990

Prospective endoscopic study of stress erosions and ulcers in critically ill neurosurgical patients: current incidence and effect of acid-reducing prophylaxis.

We studied prospectively 40 critically ill neurosurgical patients who required prolonged mechanical ventilation to determine the current incidence of stress-related gastroduodenal erosions and ulcers, and to assess endoscopically the efficacy of acid-reducing prophylactic treatment. Nineteen patients were randomized to receive ranitidine plus antacids if necessary to maintain gastric pH at greater than or equal to 4. The remaining 21 patients were given no drug prophylaxis. Gastric pH was significantly (p less than .001) higher in the treated group: 78% of pH readings were at greater than or equal to 4 as compared to 32% in the control group. However, after five study days, incidence and severity of stress lesions were similar in the two groups: nine patients in each group had more than five erosions, one treated patient had a gastric ulcer, and one control patient had duodenal ulcerations. No patient experienced clinically relevant upper GI bleeding. The lack of severe stress bleeding and the low ulcer rate contrast with results from earlier reports on similar patient populations. Furthermore, drug prophylaxis had no detectable benefit, as assessed endoscopically. These findings suggest that routine stress lesion prophylaxis may not be necessary in critically ill patients with comparable risk factors.

Adolescent↗
PubMed1990

Effects of a cholecystokinin receptor antagonist on intestinal phase of pancreatic and biliary responses in man.

The present study was designed (a) to characterize the activity of loxiglumide as a peripheral cholecystokinin (CCK) antagonist in healthy human subjects, and (b) to determine whether CCK is a physiologic regulator of the intestinal phase of meal-stimulated exocrine pancreatic and biliary secretions in man. Intravenous loxiglumide (22 mumol/kg per h) was highly potent in antagonizing CCK8-induced pancreatic enzyme and bile acid secretion as well as pancreatic polypeptide release. The potency and selectivity of loxiglumide as an antagonist of CCK provides the tool for evaluating the role of CCK as a physiological mediator of meal-induced pancreatic and biliary responses in humans. Infusion of a liquid test meal into the duodenum evoked an immediate response of pancreatic enzyme and bilirubin outputs, respectively. Intravenous loxiglumide significantly inhibited the meal-induced pancreatic amylase output by 63% (P less than 0.05), lipase output by 43% (P less than 0.05), and bilirubin output by 59% (P less than 0.05). These data suggest that CCK is a physiological mediator of the intestinal phase of meal-stimulated pancreatic and biliary responses.

Adult↗