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Biomedical subjects

K Gyr

Publications and source records attributed to K Gyr.

At least 91 records · Page 5Linked to original sources
PubMed1990

[Diarrhea in returning travellers (etiology, diagnosis and therapy)].

International tourism is constantly expanding and traveller's diarrhea has become a common disease. Although traveller's diarrhea may already have ceased after return, more and more general practitioners are confronted with patients complaining of GUT-symptoms associated with the journey. To manage these patients the precise knowledge of the etiology of traveller's diarrhea and the forms leading to chronic diarrhea is mandatory. This review deals with the etiology of diarrhea after returning home from tropical/subtropical areas and gives special emphasis on adequate diagnosis and treatment. It also points to the importance of parasites as cause of chronic traveller's diarrhea. Parasitic disease needs more often antibiotic treatment than infectious diarrhea due to bacterial agents. We summarize the etiology, the diagnostic and therapeutic approach.

Algorithms↗
PubMed1989

[Stress ulcer disease and its prevention].

The incidence and prophylaxis of stress ulcer disease are analyzed. Acute gastroduodenal stress lesions are frequently encountered in critically ill patients, yet the incidence of stress ulcer bleeding has decreased. It is still difficult to describe the risk in an individual patient in spite of the fact that patient groups prone to development of stress ulcer disease have been well defined (e.g. patients on mechanical ventilation). Prophylaxis with antacids, H2-receptor antagonist, pirenzepine and sucralfate seems to be equally effective and capable of reducing the incidence of stress ulcer bleeding. Its efficacy does not really correlate with the capability of a drug to keep gastric pH above 4. The higher the incidence of stress ulcer bleeding under placebo, the better the efficacy of prophylactic treatment. There is evidence that blockers of gastric acid secretion may be associated with an increased incidence of nosocomial pneumonia, but more data are needed in this regard.

Antacids↗
PubMed1989

Role of gastric colonization in nosocomial infections and endotoxemia: a prospective study in neurosurgical patients on mechanical ventilation.

The role of gastric microbial colonization in nosocomial infections and endotoxemia was investigated prospectively in 40 neurosurgical patients requiring mechanical ventilation for greater than 48 h. Each was studied up to 7 d. Swabs from the nose and oropharynx were cultured at admission, and aspirates from the stomach and trachea were cultured daily until enteral alimentation was started. Patients were evaluated every second day for endotoxemia and coagulation activation. Of 153 gastric aspirates, 66.7% contained microorganisms at a mean quantity of 10(7) cfu/ml. Nosocomial pneumonia occurred in 15 patients, septicemia in 5, and meningitis in 1. The stomach was the evident source of infection in only 1 patient with pneumonia. Of 140 plasma samples, 12 (8.6%) from 10 patients showed detectable endotoxin levels, but there was no association between endotoxemia or coagulation activation and the presence of microorganisms in the stomach. The stomach was not an important source for nosocomial infections or endotoxemia, even in patients with high gastric pH.

Adult↗
PubMed1989

Liver disease in rural Tanzania--a diagnostic approach.

In a prospective study on the aetiology of liver disease and its diagnostic approach in a District hospital in rural Tanzania, 48 consecutive patients with evidence of liver disorders were investigated by physical examination, biochemical tests, laparoscopy and histology. Liver cirrhosis (posthepatic, alcoholic) was found in 31%; non cirrhotic alcoholic liver disease in 15%; viral, bacterial and protozoal liver disorders in 33%, and neoplastic liver changes in 21% of all patients. Clinical impression alone coincided with the final diagnosis in 40% of all cases. This figure was increased to 46%, when haematological and biochemical results were included, and to 71%, when laparoscopy (without histology) was used in addition. Laparoscopy was particularly decisive in the diagnosis and further management of cirrhosis, liver abscess and neoplastic liver disorders. The additional information obtained from histology led to the final diagnosis. Histology was specially useful for the diagnosis of alcoholic liver disease, tropical splenomegaly syndrome and non specific reactive hepatitis. The usefulness of laparoscopy as a diagnostic tool in a district hospital is discussed.

Adolescent↗
PubMed1988

[Acute bacterial sacroiliitis caused by Salmonella cholerae-suis].

A 17-year-old schoolboy was admitted to hospital because of one-sided pelvic pain of uncertain aetiology and fever gradually rising over several days. Bacteriological analysis of blood cultures, skeletal scintigraphy and computed tomography revealed sacroiliitis caused by Salmonella cholerae-suis. Specific antibiotic treatment quickly stopped all symptoms and cured the infection. Radiologically there remained sclerosis of the sacro-iliac joint.

Acute Disease↗
PubMed1988

To extract or not to extract in secretin radioimmunoassay?

The importance of an ethanol extraction procedure in the radioimmunoassay of plasma secretin was investigated. The extraction step led to a higher assay sensitivity of 0.35 fmol/ml, compared to 5.93 fmol/ml using unextracted samples. The rise of plasma secretin after infusion of a low dose of secretin (1 pmol.kg-1.h-1) in 10 healthy humans was only detected after sample extraction. Higher doses (3 and 9 pmol.kg-1.h-1) resulted in increments of plasma IRS (immunoreactive secretin), which could be recorded both with and without sample extraction. After a steak meal 7 of 10 subjects showed a significant increase of plasma secretin assaying extracted plasma samples. The secretin release occurred in spikes. The mean increase of plasma IRS in this group was 0.6 fmol/ml, the mean maximal secretin release above basal was 2.3 fmol/ml. Without sample extraction, plasma secretin was not significantly changed. We conclude that plasma samples should be extracted in order to detect physiological postprandial secretin release.

Animals↗
PubMed1988

Calcitonin gene-related peptides I and II and calcitonin: distinct effects on gastric acid secretion in humans.

The human calcitonin gene-related peptides I and II (CGRP I and CGRP II) are two neuropeptides that have been recognized throughout the gastrointestinal system including the stomach. The present study was undertaken to compare in healthy volunteers the effects of intravenous infusions of CGRP I and CGRP II (79 pmol/kg.h) on pentagastrin-stimulated acid secretion to those of calcitonin (88 pmol/kg.h). Calcitonin gene-related peptide I did not inhibit basal or pentagastrin-stimulated acid secretion. However, CGRP II and calcitonin inhibited pentagastrin-stimulated acid responses by 20% and 28%, respectively (p less than 0.05 and p less than 0.01), whereas basal acid output was only reduced with calcitonin (p less than 0.05). These effects were recognized with low doses of pentagastrin, and absent with high doses suggesting competitive inhibition. Furthermore, step-doses of CGRP I and CGRP II (79-320 pmol/kg.h) were given intravenously on continuous pentagastrin stimulation and compared with calcitonin (88-352 pmol/kg.h). Calcitonin gene-related peptide II and calcitonin induced a dose-dependent decrease of acid output, whereas CGRP I was ineffective. The inhibitory effects of CGRP II and calcitonin are not due to increased gastric alkaline secretion or to somatostatin release, as neither peptide stimulated gastric bicarbonate secretion or induced an increase in circulating somatostatin. In conclusion, CGRP II, unlike CGRP I, inhibits gastric acid secretion in humans. Inhibitory effects of CGRP II and of calcitonin were comparable. The results imply that CGRP I and II, at the level of the stomach, have distinct biological properties in humans.

Adult↗
PubMed1988

Effect of calcitonin and calcitonin gene-related peptide on pancreatic functions in man.

Calcitonin gene-related peptide (CGRP) has recently been identified in central and peripheral nerve fibres, including those of blood vessels supplying the exocrine pancreas, and in pancreatic islet cells. Moreover, receptors have been characterised in the same tissue. The present study examined the effects of human CGRP and of calcitonin on exocrine pancreatic secretion and on islet cell function in nine healthy volunteers. CGRP (300 ng/kg/h) caused, respectively, a 25% and 31% inhibition of caerulein stimulated trypsin and amylase output which was similar to that seen with calcitonin (300 ng/kg/h). Arginine stimulated insulin and glucagon release was unaffected by either CGRP, or calcitonin. Calcitonin gene-related peptide caused cutaneous flushing, but did not affect the pulse rate or arterial blood pressure in the doses tested. Calcitonin gene-related peptide inhibits exocrine pancreatic secretion in vivo in man, but does not affect islet cell hormone release.

Adult↗
PubMed1988

Release of secretin along the canine small intestine.

The profile of secretin release along the entire canine small intestine was examined in this study. Four equal loops of the small gut, from the duodenal bulb to the ileocoecal valve, were isolated. In eight anesthetized dogs the four segments were perfused for 40 min each in random order with an acidified (pH 2.5) emulsion of 20 mM oleic acid. In four dogs control experiments were performed using 0.15 M saline. Secretin release in portal venous blood was measured by a sensitive radioimmunoassay. Although secretin was mainly released in the first quarter of the small intestine (310 pM X 40 min), large amounts of secretin, 33% of the total secretin release, were liberated in the second quarter of the small intestine (164 pM X 40 min). Minute amounts of secretin (23 pM X 40 min) were released in the third quarter, whereas perfusion of the last quarter of the small gut failed to release secretin. We conclude that the major portion of secretin is releasable in the first quarter of the small gut. High amounts of secretin can be liberated in the second quarter of intestine, an area that is probably never exposed to pH below 4.5 (the known threshold for secretin release by acid), but is still exposed to fatty acids (other releasers of secretin).

Animals↗
PubMed1988

Human secretin. Biologic effects and plasma kinetics in humans.

The action of synthetic human secretin, which differs in two amino acid residues from porcine secretin, was compared with synthetic porcine secretin in 6 healthy volunteers. Pancreatic secretion was assessed by a marker perfusion technique and plasma secretin concentrations were assessed by a specific radioimmunoassay. Increasing doses of either human or porcine secretin produced increasing bicarbonate output (p less than 0.01), whereas trypsin and lipase were not stimulated over basal. The highest doses of secretin induced a significant increase in pancreatic amylase secretion. The two secretin preparations were found to be equipotent with respect to pancreatic secretion and plasma kinetics. Significant increases of plasma secretin were observed after a steak meal in 15 volunteers (p less than 0.001). When human secretin was infused at postprandial concentrations, significant increases in pancreatic bicarbonate output were observed (p less than 0.05). We conclude (a) that the substitution of two amino acids in human secretin does not affect biologic activity and plasma metabolism of the compound; (b) secretin does not stimulate pancreatic enzyme secretion at physiologic concentrations; and (c) the stimulatory effects of secretin on pancreatic amylase remain to be elucidated. The study suggests that human secretin is a true hormone.

Adult↗
PubMed1988

Treatment of hepatic encephalopathy (HE) with the benzodiazepine antagonist flumazenil: a pilot study.

In experimental animal studies the benzodiazepine antagonist (BZA) flumazenil reversed galactosamine-induced fulminant liver failure. Based on this observation, we treated three patients (two male, one female), mean age 41 yrs (34-52 yrs) with five episodes (ep) of hepatic encephalopathy (HE) with i.v. BZA over 24 h. The efficacy of BZA in reversing HE was evaluated. On admission all patients had elevated plasma ammonia levels. The patients were in coma stage II (n = 3 ep) and stage III (n = 2 ep); the modified Glasgow score was less than 10 (n = 1 ep), 10-15 (n = 2 ep), 15-20 (n = 2 ep). No evidence for benzodiazepine, barbiturate or opiate intake was found in the urine. Two patients with HE episode stage II showed an immediate recovery within 1 h, which continued without any therapy other than BZA. After 24 h BZA was given orally, 30 mg q.i.d. One patient with an HE episode stage II showed no effect over 12 h. After this time he progressed to HE stage III; BA therapy was stopped. After discontinuation of BZA the Glasgow score rapidly deteriorated. Twenty-eight hours later BZA was given again with i.v. mannitol (20%) and oral lactulose and Fordtran solution. The patient then recovered within the next day. Another patient with a HE episode stage III showed a short lasting improvement after BA bolus injection. Then impairment of the Glasgow score was noted again. Lactulose and Fordtran solution was added orally and mannitol (20%) was given i.v. The patient recovered within 24 h to HE stage II and after 72 h to normal. BZA seems to improve hepatic encephalopathy, especially at an early stage (II). It appears less effective in stage III, most of all when there is evidence of brain oedema. No specific side-effects were observed during BZA therapy.

Adult↗
PubMed1987

[Histoplasma duboisii osteitis as an imported disease].

A case of imported Histoplasma duboisii osteitis in a visitor from Africa to Switzerland is described. The diagnosis was by histology confirmed by culture. Infection of other organs was ruled out. Amphotericin B therapy and its side effects are discussed.

Adult↗
PubMed1987

Biological effects of a proglumide derivative as cholecystokinin antagonist in conscious dogs.

In conscious dogs we studied the effects of a new cholecystokinin (CCK) antagonist (coded CR 1505) on CCK8-stimulated exocrine pancreatic secretion and release of pancreatic polypeptide (PP). Graded doses of CCK8 (25-400 ng kg-1h-1) were infused i.v. Experiments were repeated against a background infusion of CR 1505 at different doses (0.1, 1 and 10 mg kg-1h-1). The lowest dose of CR 1505 had no biological effects. However, at the upper two doses the compound significantly inhibited the CCK8-stimulated PP release. Furthermore, a significant inhibition of exocrine pancreatic protein secretion was observed with 10 mg kg-1h-1 of CR 1505 (P less than 0.05). The results suggest that CR 1505 could be a useful tool in defining the physiological role of CCK in vivo.

Animals↗