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Biomedical subjects

M E Stark

Publications and source records attributed to M E Stark.

At least 19 recordsLinked to original sources
PubMed2000

Manometry of the upper esophageal sphincter and pharynx is not useful in unselected patients referred for esophageal testing.

OBJECTIVE: We sought to determine whether routinely performing upper esophageal sphincter/pharyngeal (UES/P) manometry in patients referred for esophageal testing alters clinical practice. METHODS: Clinical history along with radiography and manometry studies were reviewed in 470 patients referred for manometry. A total of 435 (92.6%) were found to have adequate evaluation of the UES/P and were included in the study. RESULTS: Of 435 studies, 80 (17.7%) had one or more UES/P abnormalities. Indications for these 80 studies were dysphagia in 30 cases (37.5%), chest pain in 26 (32.5%), both in four (5.0%), and other in 20 (25%). There were 85 manometric abnormalities in the 80 studies: hypertensive UES in 16 cases (18.8%), incomplete UES relaxation in 38 (44.7%), hypertensive pharynx in seven (8.2%), hypotensive pharynx in 15 (17.6%), and abnormal coordination in nine (10.6%). A total of 41 patients had a barium study, which was normal in 11 cases (26%), confirmed the problem in 16 (40%), and suggested another problem in 14 (34%). In 17 patients (21%), there was clinical suspicion for an oropharyngeal disorder before manometry, whereas in 58 cases it was an unexpected finding. Of the 58 patients with an unexpected finding, therapy based on this finding was offered in six (three esophageal dilations, two dietary changes, and one swallowing therapy). If patients with concomitant esophageal body disorders are excluded, in only three patients an unexpected UES finding led to change in management. CONCLUSIONS: An unexpected UES/P finding resulted in a change in therapy in only six of the manometries. Barium esophagogram was diagnostic of the oropharyngeal abnormality in nearly two-thirds of the patients in whom it was clinically suspected. These data, along with limited therapeutic options, suggest limited usefulness for routine UES/P manometry.

Barium↗
PubMed1999

Challenging problems presenting as constipation.

Patients who seek medical care for constipation present challenges which may involve communication problems, difficulties in diagnosis, lack of optimal therapy, uncorrectable underlying disorders, or psychiatric issues which complicated management. This review describes some of these challenges, and presents management approaches that may increase the likelihood of satisfactory treatment outcomes. Situations which are reviewed include the diagnostic evaluation of the new patient with constipation; syndromes of uncertain pathophysiology including irritable bowel syndrome, slow transit constipation, and pelvic floor dysfunction; constipation associated with neurologic disorders including spinal cord injury, Parkinson's disease, and multiple sclerosis; and psychiatric issues which complicate the management of constipation, including recognition of associated psychiatric diseases, unusual attitudes toward bowel function, eating disorders, and referral for psychiatric care.

Constipation↗
PubMed1997

A restricted 'spotlight' of attention in visual object recognition.

We describe a patient (NJ), with a progressive visual disturbance, who showed an impairment in identifying larger visually-presented objects relative to their smaller counterparts. NJ showed this size effect for line drawings of objects, words and single letters. When presented with large letters comprised of smaller letters and asked to give speeded identification responses to either the large or small letters, NJ was grossly impaired at identifying the large letter. Additionally, when presented with a context meant to bias responding to either the large or small letter, NJ showed faster and more accurate responding in the small direction, but not in the large direction. We interpret these results as indicative of an impaired 'spotlight' of attention, which is deployed across the visual array, and is necessary for providing the selective visual attention responsible for the integration of visual features.

Aged↗
PubMed1996

Breast cancer evaluation and follow-up: a survey of The Ohio Chapter of The American College of Surgeons.

Preoperative evaluation and postoperative follow-up of breast cancer patients vary considerably. Recent literature suggests that routine surveillance studies for breast cancer patients can be reduced without compromising the outcome. The Ohio State Chapter of The American College of Surgeons Committee on Cancer sponsored a survey of its general surgeon fellows to determine their practice philosophies regarding these issues. The questions centered around breast cancer screening, evaluation and treatment, and follow-up. The fellows were also questioned as to their opinions regarding practice parameters and whether the State Chapter should take a role in this area. Of the 764 surveys sent out, 34.2% were appropriate for evaluation. For breast cancer screening, 96.1% believe yearly mammography is important. Newly diagnosed breast cancer patients are generally evaluated with history and physical exam, chest X-ray, complete blood cell count, and liver function tests. Bone scans are used by 38.6% of surgeons. Most patients with positive lymph nodes see a medical oncologist. About half of primary breast cancer treatment (44.7%) is by breast preservation. Essentially all surgeons follow their patients after treatment for breast cancer surveillance. Essentially all surgeons feel that physical exam and mammograms are important for post-treatment follow-up. Complete blood cell count, liver function studies, and chest X-rays are used less commonly but still by more than half of the surgeons. 44.4% of the surgeons have found difficulty with third-party payers covering the costs of surveillance studies. 87.7% of surgeons surveyed felt the State Chapter should become involved in establishing clinical guidelines or practice parameters.

Attitude of Health Personnel↗
PubMed1993

Nitric oxide mediates inhibitory nerve input in human and canine jejunum.

BACKGROUND: Nitric oxide (NO) may be an inhibitory neurotransmitter in the intestinal muscle. The present study examined its role in human and canine jejunum. METHODS: Mechanical and intracellular electrical activity were recorded simultaneously from the circular muscle layer. RESULTS: In the human jejunum, nerve stimulation inhibited mechanical activity and evoked an inhibitory junction potential that consisted of an initial fast hyperpolarization followed by a late sustained hyperpolarization. NO inhibited mechanical activity and evoked a dose-dependent hyperpolarization that mimicked the late hyperpolarization. In the canine jejunum, nerve stimulation inhibited mechanical activity and evoked an inhibitory junction potential that consisted of only a fast hyperpolarization. NG-Monomethyl-L-arginine and NG-nitro-L-arginine attenuated nerve-mediated inhibition of mechanical activity in both species. However, the effect of the synthase inhibitors on inhibitory junction potentials differed in the two species. In canine jejunum, both inhibitors reduced the amplitude of the initial fast hyperpolarization. In human jejunum, both inhibitors reduced only the late sustained hyperpolarization. CONCLUSIONS: NO mediates neural inhibition in circular muscle of both human and canine jejunum through different mechanisms.

Animals↗
PubMed1993

Maintenance of symptomatic remission in patients with Crohn's disease.

Crohn's disease is a chronic inflammatory intestinal disorder characterized in most patients by repeated episodes of diminished and exacerbated symptoms. Recent controlled trials demonstrated that oral preparations of 5-aminosalicylic acid decrease recurrence rates by approximately 40% when administered long-term to patients with quiescent Crohn's disease. Orally administered corticosteroids, sulfasalazine, metronidazole, azathioprine, and cyclosporine have not proved of benefit in the prevention of recurrences of Crohn's disease. Nonetheless, corticosteroids, metronidazole, and azathioprine can control chronically active disease. Methotrexate may have some benefit in the treatment of active Crohn's disease, but its role in maintenance of remission has not been investigated. Elimination diets seem to prolong periods of symptomatic remission. Further studies are needed to define subgroups of patients who are most likely to benefit from preventive therapy.

Adrenal Cortex Hormones↗
PubMed1992

Protein-losing enteropathy with collagenous colitis.

Collagenous colitis is a distinct cause of chronic watery diarrhea characterized by abnormal deposition of collagen in the subepithelial region of the colonic mucosa. Typically, laboratory tests of blood, urine, and stool are normal. A few patients have laboratory evidence of small bowel dysfunction and malabsorption, but excessive enteric protein loss is not a commonly recognized manifestation of collagenous colitis. We report a 62-yr-old woman who had collagenous colitis associated with a marked protein-losing enteropathy in the absence of obvious small intestinal disease or colonic ulceration. Biopsies of endoscopically normal-appearing colonic mucosa should be performed in patients with protein-losing enteropathy in whom no cause is apparent after initial evaluation.

Colitis↗
PubMed1991

Effect of nitric oxide on circular muscle of the canine small intestine.

1. Experiments were designed to determine in circular muscle of the canine jejunum whether exogenous nitric oxide (NO) mimics the non-adrenergic, non-cholinergic inhibitory junction potential (NANC IJP), and whether changes in the availability of endogenous NO affects IJP amplitude. 2. Mechanical and intracellular electrical activity were recorded simultaneously from circular muscle of the canine jejunum. Electrical field stimulation evoked NANC IJPs and inhibited spontaneous contractions. 3. Infusions of NO solutions evoked immediate dose-dependent and transient hyperpolarizations and transiently inhibited spontaneous contractions. NO-evoked hyperpolarizations were unaffected by atropine, propranolol, phentolamine and tetrodotoxin. 4. The maximum IJP amplitude and the maximum amplitude of NO-evoked hyperpolarization were similar. 5. NG-Mono-methyl-L-arginine (L-NMMA), which inhibits synthesis of NO from L-arginine, reduced IJP amplitudes but did not reduce the response to exogenous NO. L-Arginine, but not D-arginine, reversed the effect of L-NMMA on IJP amplitude. 6. Oxyhaemoglobin, which binds and inactivates NO, reduced IJP amplitude and abolished the response to exogenous NO. 7. Exogenous NO mimicked the effects of NANC inhibitory input. Reducing the availability of endogenous NO reduced NANC inhibitory input. 8. It was concluded that NO mediates NANC neural inhibition and may act as a NANC inhibitory neurotransmitter in the canine jejunum.

Animals↗
PubMed1987

Fatal acute tumor lysis syndrome with metastatic breast carcinoma.

A 53-year-old woman presented with an extensively metastatic and rapidly growing breast adenocarcinoma, markedly elevated lactate dehydrogenase, and mildly elevated blood urea nitrogen. She received 5-fluorouracil, doxorubicin, and cyclophosphamide. Eighteen hours after chemotherapy she was noted to have hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and acute renal failure. She experienced cardiac arrest and died 72 hours after receiving chemotherapy. A postmortem liver biopsy revealed adenocarcinoma undergoing necrosis. This case represented the acute tumor lysis syndrome that occurred after chemotherapy of breast carcinoma. Patients with metastatic breast carcinoma and similar presentations should be considered for prophylactic therapy with allopurinol and hydration before chemotherapy.

Adenocarcinoma↗
PubMed1987

The initial electrocardiogram during admission for myocardial infarction. Use as a predictor of clinical course and facility utilization.

The first electrocardiogram obtained on presentation for suspected myocardial infarction was examined for its usefulness in predicting clinical course and facility use. We studied 221 patients consecutively admitted to a nonuniversity hospital coronary care unit. High-risk patients were identified if the electrocardiographic diagnoses included myocardial infarction, ischemia, left ventricular hypertrophy, left bundle-branch block, or paced rhythm. These 63 patients (29% of total) had significantly greater incidences of serious events, need for procedures, and death than low-risk patients whose initial electrocardiograms did not carry the above diagnoses. Patients with a low-risk initial electrocardiogram may not require the facilities of a coronary care unit and perhaps could be safely observed in an intermediate care area. However, many hospitals do not have an intermediate care facility available, and in those that do, daily costs may not be markedly different than for treatment in a coronary care unit. Whether these low-risk patients could be safely treated in general medicine beds, where potential cost savings would be much greater, is unknown.

Coronary Care Units↗