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Biomedical subjects

L Wallin

Publications and source records attributed to L Wallin.

At least 73 records · Page 4Linked to original sources
PubMed1982

Spontaneous peristaltic activity in the oesophagus after imitated acid gastro-oesophageal reflux. A study in normal subjects.

Prolonged measurements of pH and peristalsis in the oesophagus do not enable quantitation of the reflux material. Eight healthy subjects underwent 12-h continuous pH and pressure recording in the oesophagus and, subsequently, recording of pH and spontaneous peristaltic activity after instillation of 0.1 N HCl. Volumes of 2.5, 5, 10, and 15 ml were instilled in the lower end of the oesophagus in randomized order. No relationship between volume and peristaltic activity could be demonstrated. A direct relationship between the change in pH after instillation and the peristaltic activity was demonstrated (r = 0.8052; p less than 0.001). The clearing efficiency was 0.3 pH units per peristaltic contraction. A similar relationship could be found between the change of pH during a spontaneous reflux episode and the following peristaltic activity (r = 0.5993; p less than 0.002). The clearing efficiency was 0.37 pH units per peristaltic contraction. It is concluded that low pH is the determining factor for eliciting oesophageal peristalsis.

Adult↗
PubMed1982

Failures after surgical treatment of patients with hiatus hernia and reflux symptoms. A pathophysiological study.

Patients treated surgically for hiatus hernia and reflux symptoms may still have reflux symptoms at follow-up examination, even though relapse of the hernia cannot be demonstrated on X ray. In an attempt to explain the causes of surgical failures, a group of 13 patients with persisting reflux symptoms after a modified Belsey MK IV repair for sliding hiatus hernia and reflux symptoms underwent intraluminal oesophageal manometry, acid clearing test, and 12-h continuous pH recording in the lower part of the oesophagus. None of the patients had radiological relapse of the hernia. The results of these tests, pre- and post-operatively, were compared with the results obtained in a group of successfully treated patients and with normal subjects. No differences of clinical importance could be demonstrated between the two patient groups with regard to the preoperative test results. Postoperatively, the 'failures' had low sphincter pressure, prolonged acid clearing, and pathological acid reflux. The tests seem of little value in the prediction of symptomatic failures, but do to some extent explain the symptoms of surgical 'failures'.

Adolescent↗
PubMed1982

Impairment of renal function in patients on long-term lithium treatment.

A survey of the renal function in 278 patients on long-term lithium treatment maintained on plasma lithium concentration of 0.7-1.2 mmoles/l was conducted. The extent of renal damage were studied with urinary concentration tests, beta-2-microglobulin excretion and measurement of glomerular filtration rate. The mean treatment time was 6.5 years and the longest treatment time was 15 years. Forty-nine per cent of the patients could not concentrate their urine to above 800 mOsm/kg of water, which did not correlate with the presence of polyuria. The urine concentration capacity decreased as a function of time in the lithium treated group, and it was also influenced by the type of tablet administration (readily soluble or sustained release), but not by combination with other drugs, such as neuroleptics. Beta-2-microglobulin excretion was not increased. A reduced glomerular filtration rate was found in 17% and the filtration rate in the whole group of patients was clustered around the lower limit of normal. The filtration rate decreased as a function of the duration of treatment. It was found that the concentrating capacity and the filtration rate decreased in parallel and that there was no selective impairment of the concentrating capacity. We conclude that severe impairment of renal function is uncommon in well controlled patients. Urinary concentration tests are shown to be the most suitable test for detection of kidney damage in long-term lithium treatment.

Adult↗
PubMed1981

Renal function and biopsy findings in patients on long-term lithium treatment.

Nine patients on long-term lithium treatment (3 to 13 years) had abnormal renal function with a decreased GFR and/or a decreased maximal urinary concentration capacity. Four patients had received lithium as the only drug, whereas five patients had had concomitant treatment with neuroleptics. No patient had a history of nephrourological diseases. Abnormal renal morphology was present in the biopsy samples from all patients. Cortical fibrosis was found in a variable degree. Dilated tubules and microcysts in which the epithelial lining was clearly abnormal were found in majority of samples. Electron micrographically, two types of abnormal epithelial cells were observed, one with small elongated mitochondria with dense matrix and the other with large spherical and less dense mitochondria. In distal tubules, mitochondrial swelling, accumulation of cytosegrosomes, and nuclear pyknosis dominated the picture. These findings indicate a tubulointerstitial nephropathy and support the hypothesis that long-term lithium treatment may cause renal damage in susceptible patients.

Adult↗
PubMed1981

Tryptophan malabsorption in dementia. Improvement in certain cases after tryptophan therapy as indicated by mental behaviour and blood analysis.

Twenty-four senile dementia patients in the age range 65-85 years were subjected to a new sensitive tryptophan loading test: Dopa-Tryptophan loading ("Dop-Try loading") in order to determine whether Try malabsorption occurs in senile dementia and if so how frequent this is. For comparison the same loading test was performed on 23 subjects in the same age grouping but with normal metal function. The differences in Try absorption were statistically analyzed and this revealed that absorption was less effective in the senile dementia group. Four patients with Try malabsorption were treated with 3 G 1-Try + 50 Mg dl-5-hydroxytryptophan (5-HTP) per day orally for 20-30 days and four patients with normal absorption were treated in the same way. The Dop-Try loading test was repeated after this treatment. Two patients showed improved absorption and coincident mental improvement, while one showed decreased absorption and mental deterioration. One died during the course of the treatment. None of the four patients with normal absorption showed mental improvement after the treatment. This pilot study suggests that increase in Try absorption following the Try treatment is a necessary condition for improvement in the mental state. The study is being continued with larger numbers of patients.

5-Hydroxytryptophan↗
PubMed1981

Fourier-analysis of peristaltic pressure variations in the oesophagus during a 12-hour investigation. A study in normal subjects.

Long-term measurements have been made of peristaltic pressure variations 8 and 23 cm proximally to the gastro-oesophageal sphincter. The investigation was performed using perfused catheter systems and results of the 12-h measuring period were recorded on tape recorder. The peristaltic pressure variations were frequency analysed using a Fast Fourier Transform analyser. Nineteen normal subjects took part in the study. One subject was tested seven times. The investigation showed that the significant information regarding the pressure variations can be registered by recording systems with an upper frequency limit of at least 2 Hz. The pressure variations were built up more rapidly proximally in the organ than distally. Repeated investigations on a single subject showed that the intravariation lies within the intervariation in the subjects tested.

Adult↗
PubMed1981

The effect of parietal cell vagotomy on gastrooesophageal function in duodenal ulcer patients.

By means of a previously described method, the gastro-oesophageal region of duodenal ulcer patients was examined before and 3 months after parietal cell vagotomy. Postoperatively the patients had fewer symptoms of gastro-oesophageal reflux. The intragastric acid secretion was significantly reduced. In spite of this the oesophagus function tests used to evaluate the gastro-oesophageal region--basal gastro-oesophageal sphincter pressure, acid perfusion test, acid clearing test, and intensity of acid gastro-oesophageal reflux measured by automatic integration of the pH variations as a function of time in arbitrarily chosen pH intervals during 12 h together with peristaltic activity in the oesophagus--were unchanged. The total number of reflux episodes was unaltered, but a significant change took place postoperatively in the distribution of the reflux episodes, in the direction of reflux episodes of higher pH. A comparison preoperatively during cimetidine treatment and postoperatively showed an increase in gastro-oesophageal sphincter pressure and a reduced intensity of acid gastro-oesophageal reflux during cimetidine treatment. It is concluded that parietal cell vagotomy does not affect the gastro-oesophageal sphincter pressure, oesophageal peristaltic activity, or frequency of acid gastro-oesophageal reflux. The reduction in intragastric acid secretion causes reflux episodes of higher pH, and this in connection with healing of the ulcer explains the improvement in the symptoms of the patients.

Adult↗
PubMed1980

Gastro-oesophageal function in duodenal ulcer patients.

An investigation of the gastro-oesophageal region was made in 39 patients with uncomplicated duodenal ulcer (DU). The results were compared with the results from a group of normal volunteers. The DU patients had a lower gastro-oesophageal sphincter pressure (p less than 0.05) and a reduced acid-clearing ability (p less than 0.05). Furthermore, an increased acid gastro-oesophageal reflux (p less than 0.05) and a greater number of reflux episodes lasting longer than usual (p less than 0.05) were demonstrated. There was a positive correlation between low gastro-oesophageal sphincter pressure and acid gastro-oesophageal reflux within the pH intervals 0--3 and 0--4. The peristaltic activity was measured by the number of pressure amplitudes registered in the upper and lower part of the oesophagus; an increase (p less than 0.05) in pressure amplitudes in the lower part was found in the DU patients. When time relationship was used to distinguish between propagating, simultaneous, and reversed peristaltic activity, an increase in reversed peristaltic activity (p less than 0.001) was demonstrated in DU patients. The conclusion is that DU patients have an increased acid gastro-oesophageal reflux, probably as a result of an incompetence in the gastro-oesophageal sphincter barrier, and a reduced acid-clearing ability. The peristaltic activity is increased during the reflux episodes, although this investigation does not determine whether this is due to an increased reflux volume or an insufficient peristaltic activity.

Duodenal Ulcer↗
PubMed1980

Acid gastro-oesophageal reflux pattern in duodenal ulcer patients related to dyspeptic symptoms.

Thirty-nine patients with uncomplicated duodenal ulcer were divided into two groups, one with pathological acid gastro-oesophageal reflux and one with non-pathological acid gastro-oesophageal reflux, on the basis of the results of a 12-h pH recording in the lower part of the oesophagus. The duodenal ulcer patients with pathological acid gastro-oesophageal reflux had a longer history of the disease (p less than 0.05), but there was little correlation between the symptoms of heartburn and regurgitation and acid gastro-oesophageal reflux. The gastro-oesophageal sphincter pressure was lower (p less than 0.05) in the patients with pathological acid gastro-oesophageal reflux. Acid clearing was prolonged in both duodenal ulcer groups (p less than 0.05) compared with asymptomatic volunteers. At low pH, a reflux episode lasted longer in both duodenal ulcer groups than in asymptomatic volunteers. Clearing of a reflux episode with low pH needed longer duration and/or increased peristaltic activity than a reflux episode with higher pH in both duodenal ulcer groups. In conclusion, acid gastro-oesophageal reflux is not the only important factor in releasing the symptoms of heartburn and regurgitation. All the duodenal ulcer patiets in this investigation had changes in the peristaltic activity in the oesophageal body. Pathological acid gastro-oesophageal reflux is found in duodenal ulcer patients with a low gastro-oesophageal sphincter pressure and a long history of the disease.

Adult↗
PubMed1980

The influence of cimetidine on the acid gastro-oesophageal reflux in duodenal ulcer patients.

Using a method described earlier, an investigation of the gastro-oesophageal region was made on duodenal ulcer patients before and during cimetidine treatment. During cimetidine treatment there was a small increase in the gastro-oesophageal sphincter pressure (p less than 0.05), although the pressure still was lower than in normal individuals (p less than 0.05). The acid perfusion test and the acid-clearing test were unchanged. The intensity of the acid gastro-oesophageal reflux at pH less than or equal to 4 was reduced p less than 0.05) but still greater than in normal individuals (p less than 0.05). A tendency to an increase of the intragastric pH postprandially (0.05 less than p less than 0.01) was found during treatment, whereas the intragastric pH fasting 12 h after the intake of the last tablet was unchanged. There was no change in the number of amplitudes registered at the proximal and distal pressure catheters (p greater than 0.1), whereas the reversed peristaltic activity still was increased compared with normal individuals (p less than 0.00u). Before treatment a reflux episode at pH less than or equal to 3 needed longer time and greater peristaltic activity to be cleared than was the case during treatment. Nineteen of 20 patients improved their symptoms during treatment. Cimetidine increased the gastro-oesophageal sphincter pressure in duodenal ulcer patients, which may be due to either the reduced intragastric acid secretion or to a direct influence on the gastro-oesophageal region. The reduction in the acid gastro-oesophageal reflux is partly due to an increased gastro-oesophageal sphincter pressure and partly due to a reduced output of acid reflux material. Low pH and the volume of the reflux material in the distal part of the oesophagus are important in regulating the peristaltic activity in duodenal ulcer patients.

Adult↗
PubMed1980

Acid-sensitive oesophagus.

The aim of the present study was to investigate whether any differences could be demonstrated between patients with reflux symptoms and an acid-sensitive oesophagus (group I) (positive acid perfusion test) and a matched control group of patients with reflux symptoms and an acid-insensitive oesophagus (group II) (negative acid perfusion test) with respect to other oesophageal function tests (manometry, acid clearing and acid reflux (12-h continuous pH recording)). The two groups consisted of 47 and 46 patients, respectively. No differences were demonstrated between the two groups with respect to gastro-oesophageal sphincter pressure, acid-clearing ability, and acid reflux (irrespective of the criterion used for reflux). From the study it may be concluded that not only hydrochloric acid but other components of the reflux material may be responsible for producing symptoms of gastro-oesophageal reflux.

Adult↗
PubMed1980

Intraluminal oesophageal manometry. Influence of pressure probe diameter.

The influence of the pressure-probe diameter on the values of gastro-oesophageal sphincter pressure, pharyngo-oesophageal sphincter pressure, and peak peristaltic pressure in the oesophageal body was investigated in eight healthy subjects. A low-compliance perfused pressure-measuring unit was used for the recordings. Three different probes were made with external diameters of 1.5 mm, 3.5 mm, and 4.5 mm. Sphincter pressures were measured in the resting state, and peristaltic pressures were measured during wet swallows. The pressure in the sphincter regions was found to depend on the diameter of the probe, whereas the peak peristaltic pressure amplitudes were independent of the probes used. The need for standardization of manometry equipment is emphasized.

Adult↗
PubMed1979

The influence of cimetidine on basal gastro-oesophageal sphincter pressure, intargastric pH, and serum gastrin concentration in normal subjects.

A pressure and pH-sensitive probe has been constructed for simultaneous measurement of gastro-oesophageal sphincter pressure and intragastric pH. The coefficient of variation for measurements of the gastro-oesophageal sphincter was 0.24, and for the intragastric pH, 0.09. After peroral ingestion of 400 mg of cimetidine or placebo, simultaneous measurements of gastro-oesophageal sphincter pressure and intragastric pH were made at fixed time intervals, and at the same time blood samples were taken for determination of serum gastrin and serum cimetidine concentrations. No demonstrable difference was found in the time-course of the gastro-oesophageal sphincter pressure after ingestion of cimetidine or placebo. After ingestion of cimetidine a significant rise in intragastric pH (p less than 0.05) occurred after 40 min, and this increased pH was maintained for the remainder of the experimental period, corresponding to a serum cimetidine concentration of over 1.00 mg/l. Similarly, there was a significant rise (p less than 0.05) in serum gastrin concentration after 150 min. There was a significant direct correlation between corresponding measurements of intragastric pH and serum gastrin (p less than 0.001), between intragastric pH and serum cimetidine (p less than 0.001), and between serum gastrin and serum cimetidine (p less than 0.05). Ingestion of cimetidine results in an increase in the serum gastrin concentration in healthy subjects, presumably as a result of reduced secretion of acid in the stomach. Neither the endogenous increase in serum gastrin concentration nor the increase in intragastric pH causes alteration in the gastro-oesophageal sphincter pressure.

Adult↗