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Biomedical subjects

M Bortolotti

Publications and source records attributed to M Bortolotti.

At least 55 records · Page 3Linked to original sources
PubMed1989

Laryngospasm and reflex central apnoea caused by aspiration of refluxed gastric content in adults.

Two patients with attacks of choking caused by aspiration of gastric contents in the laryngotracheal tube are presented. One had such severe attacks of respiratory arrest, that tracheostomy was done. The common symptoms of gastro-oesophageal reflux such as pirosis, acid regurgitation, or retrosternal burning were absent in both patients and upper gut radiological and endoscopic examinations were negative. Histology of the oesophageal mucosa showed a deep chronic eosophagitis, and the 24-hour pH-monitoring of the upper oesophagus showed frequent gastro-oesophageal refluxes. Manometry showed hypotonic lower oesophageal sphincter with marked alterations of peristalsis. In the patient with tracheostomy a 24 pH monitoring of the hypolaryngeal zone showed decreased pH at the time of choking attacks. In the other patient further investigations showed that amyotrophic lateral sclerosis was the cause of the oesophageal motility disorder. An intense antireflux treatment abolished the respiratory attacks in both patients.

Airway Obstruction↗
PubMed1989

Interdigestive gastroduodenal motility in patients with active and inactive duodenal ulcer disease.

The interdigestive gastroduodenal motility was studied by means of a manometric probe in 6 patients with active duodenal ulcer and acid hypersecretion, in 6 patients with ulcer disease in remission (inactive) and normosecretion and in 8 healthy subjects with normosecretion. After a basal recording period sufficient to record at least two activity fronts of the migrating motor complex (MMC), an intraluminal infusion of isotonic NaHCO3 was carried out for 180 min in patients with active duodenal ulcer, whereas in patients with ulcer in remission an HCl solution was infused for 180 min. Patients with active duodenal ulcer showed a basal motility with a longer than normal MMC cycle and a shorter than normal activity front, while patients with ulcer in remission showed a cyclic motor activity not significantly different from that of normal subjects. The NaHCO3 infusion in patients with active ulcer restored a near-normal motility, whereas the HCl infusion in patients with ulcer in remission induced a motility similar to that of patients with active ulcer. These data indicate that the increase in gastric acid secretion is responsible for the decrease in frequency and duration of MMC activity fronts, which have the function of cyclically clearing the gastroduodenal lumen. Consequently, acid and bacteria may remain a longer than normal time in contact with the gastroduodenal mucosa, which, in this manner, may be greatly exposed to the risk of peptic lesions.

Adult↗
PubMed1989

Interdigestive gastroduodenal motility in duodenal ulcer: role of gastric acid hypersecretion.

The interdigestive gastroduodenal motility was studied by means of a multilumen manometric probe in eight patients with active duodenal ulcer (group DU1) and in seven patients with hypersecretory gastroduodenitis (group GD). Both groups were selected on the basis of the presence of gastric acid hypersecretion. A group of five patients with non-active duodenal ulcer (group DU2) and a group of eight healthy subjects (group C) also were examined. Both of the latter groups were selected on the basis of the presence of normal gastric secretion. After a basal recording period of 200-300 min, in hypersecretory groups DU1 and GD, ranitidine was administered to decrease acid secretion; in normosecretory groups C and D2, impromidine was infused at two scalar doses to increase acid secretion. The basal recording showed in groups DU1 and GD a longer than normal time interval between consecutive activity fronts (AF) of the migrating motor complex (MMC cycle) and a shorter than normal percent of time occupied by AFs. In normal subjects and in DU2, the administration of the lowest dose of impromidine induced a motor pattern similar to that of the basal period of groups DU and GD, whereas the highest dose disrupted the MMC pattern that was replaced by an irregular motor activity. The results of this study indicate that duodenal ulcer with acid hypersecretion shows a marked inhibition of the MMC cycle that is not due to the ulcer itself, but to the increased acid secretion. In fact, the same motor pattern is observed in other hypersecretory states, both spontaneous and drug-induced, whereas DU with normal secretion showed a near normal motility. In active duodenal ulcer, the decreased incidence and duration of activity fronts may play a role in the pathogenesis of peptide ulcer, as it may impair the cyclic duodenal acid clearing, allowing a longer than normal contact of HCl with the duodenal mucosa.

Adult↗
PubMed1989

Esophageal electromyography in scleroderma patients with functional dysphagia.

Simultaneous recordings of myoelectric and manometric activities of the esophagus were made in two groups of patients with scleroderma. Group A consisted of patients who suffered from functional dysphagia that had appeared recently, and who had a normal size esophagus when examined radiographically. Patients in group B had complained of functional dysphagia for several years and showed a dilated hypotonic esophagus on x-ray. A control group of five normal subjects was also examined in the same manner. The study was carried out by means of a peroral probe with two pairs of suction-needle electrodes and two manometric side-hole catheters positioned at the same levels as the electrodes. Standard manometric examination of the esophagus was carried out in all patients. Normal subjects after each deglutition showed a propagated burst of spikes in correspondence with the ascending phase of the peristaltic wave, whereas, in the period between deglutitions, rare spikes and no pressure waves were recorded. Group A patients were characterized by the frequent appearance during the interdeglutitive period of spontaneous rhythmic sequences or bursts of spikes associated with pressure waves. In these patients, repetitive nonpropagated spike bursts with a higher than normal amplitude and duration were observed after deglutitions in association with high-amplitude nonpropagated repetitive pressure waves similar to those observed in diffuse esophageal spasm (DES). Five of the seven group B patients showed spike bursts and pressure waves with both amplitude and duration markedly lower than normal. The remaining two patients from group B presented no spike bursts or pressure waves at all. Standard manometry demonstrated findings equivalent to those obtained via electromyography (EMG) in all patients of group B and in only two patients of group A. In conclusion, the functional dysphagia of patients with scleroderma can be attributed to two different motor disorders. The first one is characterized by disorganized myoelectric hyperactivity and may have a manometric appearance similar to that of diffuse spasm. The second one is characterized by a marked decrease in myoelectric activity and corresponds to the classic manometric finding of scleroderma involvement of the esophagus. Both these myoelectric patterns seem to be related to subsequent stages of esophageal scleroderma involvement.

Adult↗
PubMed1988

Computer aided positioning of manometric probe in the upper digestive tract.

A method not needing fluoroscopic control for positioning a manometric probe in the gastroduodenal tract is described. It is based on hydrostatic pressure variations occurring at each recording port of a multichannel perfused probe after changes in patient's position. The data are fed into a computer and the schematic representation of the probe showing its position and direction appear on the CRT screen. The results were visually and mathematically compared with those obtained with fluoroscopy and showed good correspondence between the two techniques in identification of the position of the probe.

Duodenum↗
PubMed1988

Interdigestive gastroduodenal motor activity in subjects with increased gastric acid secretion.

The interdigestive gastroduodenal motor activity was studied in 7 patients with active duodenal ulcer and increased gastric acid secretion, in 7 patients with hypersecretory gastroduodenitis and in 7 subjects with normal acid secretion, in whom the increase in acid secretion was obtained by means of the intravenous administration of an H2 agonist, Impromidine. The gastroduodenal motor activity was recorded manometrically for about 200-300 min in basal conditions to obtain at least two subsequent activity fronts of the migrating motor complex (MMC cycle). Only in subjects with normal acid secretion was Impromidine administered at a dose of 2 micrograms/kg/h for 150 min followed by a dose of 10 micrograms/kg/h for another period of 150 min, to obtain, respectively, a submaximal and a maximal secretory response. Patients with spontaneous acid hypersecretion, with or without peptic ulcer, showed a longer than normal MMC cycle with a shorter than normal percent of time occupied by phase III. This motor activity was similar to that recorded in normal subjects during the increase in acid secretion induced by the lowest dose of Impromidine, whereas during the highest dose the gastroduodenal MMC was disrupted and replaced by an irregular motor activity.

Adult↗
PubMed1987

Influence of gastric acid secretion on interdigestive gastric motor activity and serum motilin in the elderly.

The purpose of this study is to investigate the influence of gastric secretion on the interdigestive gastric motor activity and related serum motilin variations in elderly subjects. The study was carried out on two groups of elderly subjects: one with achlorhydria or marked hypochlorhydria due to chronic atrophic gastritis and the other with normal acid secretion. A group of nonelderly subjects with normal acid secretion was also examined as control. Gastric motility was studied manometrically and serum motilin was measured by radioimmunoassay on blood samples taken every 15 min during the entire motor recording period of 200-300 min. Both groups of elderly subjects showed (1) alterations in interdigestive gastric motility and (2) serum motilin which was steadily high without the normal cyclic fluctuations. These studies suggest that the alterations in gastric motor activity and serum motilin in aged subjects are not related to the acid secretory capacity of the stomach. Other factors, such as alterations in the neurohormonal control system of gut motility, should be considered in the genesis of these age-related disorders.

Achlorhydria↗
PubMed1986

Interdigestive gastroduodenal motility and serum motilin levels in patients with idiopathic delay in gastric emptying.

The interdigestive gastroduodenal motor activity and serum motilin levels were studied in 22 dyspeptic patients with markedly delayed gastric emptying not due to diseases known to impair gastroduodenal motility and in 7 control subjects with normal gastric emptying. Motor activity was recorded using a manometric probe positioned in the gastric antrum and in the proximal duodenum, and blood samples for radioimmunoassay of motilin were taken every 15 min during the recording period. The control subjects showed gastroduodenal activity fronts of the migrating motor complex associated with motilin peaks. Almost all patients with delayed gastric emptying showed no activity fronts in the stomach, and only half of them showed activity fronts starting in the duodenum. In these patients a significant reduction in the number of motilin peaks and in the integrated motilin output during the identified peaks was also observed. The results of this study indicate that most dyspeptic patients with idiopathic delay in gastric emptying may also have an alteration in interdigestive gastroduodenal motility, mainly characterized by a lack of gastric activity fronts, associated with an impaired motilin release.

Adolescent↗
PubMed1985

99mTc-HIDA dynamic scintigraphy for the diagnosis of gastroesophageal reflux of bile.

In 5 patients with partial gastric resection and esophagitis, in whom esophageal pH metry was unable to demonstrate significant gastroesophageal reflux (GER), we administered i.v. 5 mCi (185 MBq) of 99mTc-HIDA, the patient lying under a computer-assisted LFOV gamma camera. When gallbladder image was evident, caerulein was administered i.v. at a physiologic dose in order to induce gallbladder contraction, and in the subsequent 45 min the patient was asked to perform a standard series of manoeuvres that increase the intraabdominal pressure (Valsalva, etc.) and favour GER. Scintigraphic images and time/activity curves obtained from areas of interest corresponding to gastric remnant and distal esophagus showed that at least one of these manoeuvres in each case was followed by the appearance of the radiocompound in the distal esophagus, indicating a 99mTc-HIDA-tagged bile GER. Consequently, we believe that HIDA-GER dynamic scintigraphy may be more useful than esophageal pH metry in demonstrating the biliary origin of an esophagitis.

Bile Reflux↗
PubMed1985

Measurement of gastric emptying time by real-time ultrasonography.

This paper describes an ultrasound method of assessing gastric emptying time based on measurements of the gastric antrum, which is visible in almost all subjects before and after meals. A total of 54 subjects were examined including 18 normal subjects and 36 subjects with idiopathic functional dyspepsia. The emptying time was determined in all subjects by measuring the changes in the cross-sectional area of the gastric antrum. In a subgroup of 34 subjects the volume of the whole antropyloric region was also considered. Measurements were taken by the same observer after fasting and at regular 30-min intervals after a standard 800-cal meal. Final emptying time (calculated in relation to the start of the meal) was considered to be the time at which the antral area or volume returned to basal value. Final emptying time (mean +/- SD) was 248 +/- 39 min in normal subjects and 359 +/- 64 min in patients with functional dyspepsia (p less than 0.001). A significantly higher degree of dilatation of the gastric antrum was found in dyspeptic patients than in control subjects. Barium x-ray of the stomach in 19 subjects always confirmed the ultrasound finding on the presence or absence of contents within the stomach. We conclude that this kind of ultrasound study of the antropyloric region allows accurate determination of total gastric emptying time.

Adolescent↗
PubMed1985

Effect of Billroth II operation on the intestinal interdigestive motor activity.

The interdigestive motor activity of the gastric remnant and the efferent jejunal loop was studied manometrically in 10 patients who underwent Billroth II operation for duodenal ulcer. Two groups, one of 9 normal subjects and the other of 7 duodenal ulcer patients, were used as controls. In the Billroth II group the interdigestive migrating motor complex (IMMC) showed a higher relative duration of phase II activity than the controls and a shorter mean time-interval than the controls between subsequent activity fronts, with abnormal jejunal propagation. These findings indicate that the distal two-thirds of the stomach are necessary for the inhibitory mechanism, which in normal conditions slow down the idiointestinal interdigestive motor activity to the level of that of the stomach, and suggest that some postgastrectomy syndromes, such as diarrhoea, may have their pathological basis in this hyperactive intestinal IMMC.

Duodenal Ulcer↗
PubMed1985

Endoscopic electromyography and manometry of the human sphincter of Oddi.

The myoelectric and manometric activities of the sphincter of Oddi were recorded in 8 patients using an original probe passed through the papilla of Vater during duodenoscopy. The sphincter of Oddi's myoelectric activity showed rhythmic bursts of action potentials which appeared in correspondence with the ascending phase of the phasic pressure waves. On the basis of these results, we believe that electromyography could in some cases replace manometry for studying sphincter of Oddi motility, since it avoids pressure perfusion of the bilio-pancreatic tract, with its concomitant risks, and provides sufficient information for motor studies.

Ampulla of Vater↗
PubMed1983

Endoscopic manometry in the diagnosis of the postcholecystectomy pain syndrome.

A manometric study of the distal biliary tract was carried out by means of a side-hole perfused catheter passed through the papilla Vateri during duodenoscopy in patients with postcholecystectomy biliary pain not due to stones or inflammation of the biliary tree. The sphincter of Oddi showed in these cases a significantly higher basal tone than in controls with superimposed phasic pressure waves of high amplitude. The basal pressure of the common bile duct was also higher than in controls. These manometric findings may help differentiate the functional papillary stenosis from other causes of the postcholecystectomy pain syndrome and may be useful in settling the question of performing sphincterotomy in these patients.

Ampulla of Vater↗
PubMed1982

Atrioventricular block induced by swallowing in a patient with diffuse esophageal spasm.

A patient had syncope induced by swallowing. Electrocardiographic monitoring during eating and esophageal balloon inflation demonstrated a second-degree atrioventricular block (Mobitz type II) with dizziness. Radiologic and manometric examinations of the esophagus showed diffuse esophageal spasm associated with hypertension of the upper esophageal sphincter (UES), gastroesophageal reflux, and a sliding hiatal hernia. Cineradiographic observations were made during ingestion of a meal mixed with barium; at the time of cardiac dysrhythmia, the proximal part of the esophagus containing the bolus assumed a balloonlike shape, while the distal part and the UES contracted. On the basis of these observations and review of all published cases, we propose the pathways of this esophagocardiac reflex and discuss up-to-date treatment.

Aged↗