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Biomedical subjects

M Fried

Publications and source records attributed to M Fried.

At least 217 records · Page 12Linked to original sources
PubMed1995

New Approach in Surgical Treatment of Morbid Obesity: Laparoscopic Gastric Banding.

BACKGROUND: gastric banding has been performed for morbid obesity, with the last nine patients having a laparoscopic approach. MATERIALS: forty-five patients who had undergone primary operations for morbid obesity between 1986 and 1993 were selected for retrospective analysis. All patients had undergone gastric banding. Average pre-operative BMI was 50.9 (kg m(2)) and average pre-operative weight was 135.1 kg. RESULTS: the 3 year mean post-operative BMI reached 28.7 and the 3 year mean post-operative weight loss was 55.7 kg. Blood pressure significantly decreased from the mean 151/ 96 mmHg to l32/90 mmHg at 1-year follow-up. There were no significant changes noted in the levels of RBC, electrolytes and transaminase. There were post-operative wound-healing complications in 18.1% of the patients, wound discharge in 8.8% and incisional hernia in 8.8% of the patients. In 1993 we commenced laparoscopic gastric banding which enabled us to shorten the hospital stay and decrease post-operative complications. CONCLUSION: we are achieving the same good weight-loss results with the laparoscopic technique as after 'open' laparotomy gastric banding.

Journal Article↗
PubMed1995

Cerulein-induced changes in plasma amino acid concentrations are not a valid test for pancreatic insufficiency.

OBJECTIVES: There is controversy about the cholecystokinin (CCK)-induced decrease of plasma amino acids for the diagnosis of pancreatic insufficiency in that it is unclear whether the conflicting results are due to different degrees of stimulation by CCK. We have therefore evaluated the amino acid consumption test by examining the dose-response relation among increasing doses of cerulein and plasma amino acids compared with the release of pancreatic polypeptide in six healthy volunteers and six patients with severe pancreatic insufficiency proven by a pathological para-aminobenzoic acid test. METHODS: Stepwise increasing doses of cerulein (10-80 pmol/kg/h) were given i.v., each for 60 min with a secretin background (1 CU/kg/h). In the volunteer group, an additional experiment with infusion of placebo (saline 0.9%) was performed. RESULTS: CCK-induced amino acid changes were small in volunteers (maximum decrease: 8.4 +/- 0.9%; mean +/- SEM), tended to be more pronounced in patients (maximum decrease: 13.8 +/- 2.8%; NS), and did not permit a distinction among volunteers and patients. There was no dose-response relationship between CCK and plasma amino acids in either group. In contrast, pancreatic polypeptide levels increased markedly and dose-dependently in volunteers and patients and tended to be lower in patients with pancreatic insufficiency. CONCLUSIONS: The decrease of plasma amino acid levels in response to cerulein does not reflect pancreatic function and does not permit the diagnosis of pancreatic insufficiency.

Adult↗
PubMed1995

[Prospective randomized comparison of the effects of pefloxacin and clindamycin with cefoxitin after hepatobiliary and pancreatic operations].

The authors present their experience from a prospective randomized study of therapeutic effects of a combination of pefloxacine (Abaktal) and klindamycin with cefoxitine in patients after hepatobiliary and pancreatic surgery. The therapeutic results in both investigated groups were evaluated in more than 95% patients as excellent, without statistically significant differences. The authors provided evidence of a comparable effectiveness of a combination of pefloxacine with klindamycin and the effectiveness of cefoxitine in patients after the above mentioned types of surgery, while treatment was cheaper when a combination of pefloxacine and klindamycin was used and moreover there was the possibility of oral administration of these preparations, as soon as the patients' condition made it possible.

Anti-Bacterial Agents↗
PubMed1994

YY1 is involved in the regulation of the bi-directional promoter of the Surf-1 and Surf-2 genes.

The Surfeit locus is an unusual cluster of at least 6 housekeeping genes whose organisation is conserved between birds and mammals. We have previously shown that the divergently transcribed Surf-1 and Surf-2 genes are separated by a bi-directional, TATA-less promoter. In mouse, the Surf-1/Surf-2 promoter contains three important factor binding sites: Su1, Su2, and Su3. These sites are conserved between the mouse and human Surf-1/Surf-2 promoters, bind nuclear factors in vitro, and are required for accurate and efficient expression of Surf-1 and Surf-2 in vivo. Using gel retardation assays, methylation interference experiments, and specific antibodies we demonstrate that the Su1 binding factor is the initiator protein YY1. Over-expression of YY1 results in a major stimulation of transcription in the Surf-1 direction and a minor stimulation of transcription in the Surf-2 direction.

Amino Acid Sequence↗
PubMed1994

[Effect of the menstrual cycle on the reproducibility of anorectal manometry].

The influence of the menstrual cycle on the reproducibility of anorectal manometry was investigated in 6 healthy volunteers (median age 29 years) without hormonal treatment, who were studied during the follicular and the luteal phases and during the menstruation phase. The intra- and interindividual variations were compared by calculating KENDALL's concordance coefficient. The following results were obtained (mean +/- SD): sphincter length (41 +/- 4 mm), anal pressure at rest (79 +/- 6 cm H2O) and during voluntary contraction (167 +/- 23 cm H2O), threshold volume for the anorectal reflex (12 +/- 3 ml), duration after 20 ml (24 +/- 7 seconds), after 40 ml (47 +/- 3 seconds) and variation of the rectoanal inhibitory reflex after 40 ml (25 +/- 9 cm H2O), threshold volume of rectal sensation (16 +/- 5 ml), volume of constant perception after 30 seconds (101 +/- 27 ml), maximum tolerable volume (212 +/- 18 ml) and rectal pressure during maximum tolerable volume (23 +/- 6 cm H2O). For all of the above parameters, the intra-individual variations were not higher than the inter-individual variations. We therefore conclude that the menstrual cycle does not influence the reproducibility of anorectal manometry in the healthy woman.

Adult↗
PubMed1994

[Functional dyspepsia. Old wine in new bottles?].

Functional dyspepsia covers various symptoms associated by the physician with the upper gastrointestinal tract without an identifiable organic cause. The existence of dyspepsia subgroups according to different symptom complexes, e.g. so-called "ulcer-like dyspepsia", has not been proved. Gastro-esophageal reflux disease is a distinguishable independent entity. Little is known about the pathogenesis of this common syndrome. Disturbances of gastric motility, especially postprandial antral hypomotility, are found in 50% of these patients but offer no explanation of the dyspeptic symptoms. Neither abnormal gastric acid secretion nor abnormal acid sensitivity has been proved in these patients. Furthermore, no relation between the symptoms and a Helicobacter pylori infection or a functional disturbance of the biliary tract has been established. In some cases fatty foods can provoke dyspeptic symptoms. Unfavorable psychosocial factors can influence the decision to consult a physician for dyspepsia. Recently, a lowered threshold of perception of stomach and small intestine distension in dyspepsia has been demonstrated. This disturbance of perception offers a new basis for further understanding and for possible treatment. Prokinetic agents can be of help in the treatment of functional dyspepsia. H2-receptor antagonists are most effective in patients presenting symptoms of gastro-esophageal reflux disease. Empiric therapeutic trials in this disease entity, which shows a high placebo response rate (between 30% and 60%), are not of proven value.

Dyspepsia↗
PubMed1994

Gd-DOTA as a gastrointestinal contrast agent for gastric emptying measurements with MRI.

Current MR meal markers may interfere with gastric motility and secretion restricting the use of MRI in the measurement of gastric physiology. We therefore evaluated Gd-DOTA as a liquid phase marker, in vitro by determining dissociation, and adherence to the solids, and in vivo by simultaneous MRI (0.35 T scanner, multiple T1-weighted sections of the upper abdomen) and double indicator (perfusion marker PEG 4000, meal marker 99mTc-DTPA) measurements of emptying and secretion, following ingestion of 500 ml 10% glucose. In vitro Gd-DOTA was stable at a pH > 2 with < 2% dissociation at 24 h during incubation with HCl. Dissociation during incubation with HCl was linearly dependent on H+ concentration (0.77 < pH < 2.02). Less Gd-DOTA was absorbed onto the solid phase than 99mTc-DTPA (25% cf 36%). In vivo Gd-DOTA marked gastric contents provided strong positive contrast. Similar emptying curves were observed with both MRI and double-indicator techniques (r = 0.987, P < 0.001). Gd-DOTA has the potential to be a useful liquid phase contrast agent in MR studies on gastric function.

Adult↗
PubMed1994

Association of Crohn's disease and Cogan's syndrome.

We describe the case of a young woman with Cogan's syndrome and associated Crohn's disease. Systemic disease was manifested by oligoarthritis and valvular involvement. Crohn's disease has previously been described in two cases of Cogan's syndrome. We suggest therefore that Crohn's disease is pathogenetically related to Cogan's syndrome. For both, systemic involvement is characteristic, and immune-mediated mechanisms and vasculitis are thought to play a major pathogenetic role. Furthermore, both respond to treatment with corticosteroids.

Adult↗
PubMed1994

Relation between gastric emptying of albumin-dextrose meals and cholecystokinin release in man.

The effect of intragastric dextrose on albumin-stimulated cholecystokinin (CCK) release was studied in five healthy subjects and was related to gastric emptying and pancreatobiliary secretions. When combined with low concentrations of dextrose (4 g/100 ml), a 500-ml solution of albumin (7 g/100 ml) was rapidly emptied from the stomach into the duodenum (T1/2: 35 min). This rapid gastric emptying resulted in an only transient stimulation of pancreatobiliary secretion and an integrated CCK release of 278 +/- 45 pM x 180 min. When the concentration of dextrose in the albumin solution was increased from 4 g/100 ml to 21 g/100 ml, gastric emptying rate was distinctly slower (T1/2: 78 min; P < 0.01) and pancreatobiliary secretions became sustained (P < 0.01). CCK release was markedly higher (900 +/- 421 pM x 180 min; P < 0.05) after ingestion of the solution containing a high dextrose concentration. Intraduodenal infusion of 21 g/100 ml dextrose (3.1 ml/min) failed to significantly stimulate plasma CCK levels (119 +/- 38 pM x 120 min). We suggest that the higher CCK release in response to intragastrically administered albumin solution containing high concentrations of dextrose may have been induced by augmented peptic digestion of albumin due to delayed gastric emptying and by increased enteral digestion of albumin due to increased pancreatobiliary outputs.

Adult↗
PubMed1994

Gastric motility measurement by MRI.

The motor mechanisms associated with gastric emptying of nutrient liquids are unclear. Gastric emptying and motility were determined in seven healthy volunteers using an MRI technique following ingestion of 500 ml of (1) 10% and (2) 25% dextrose labeled with 1 mM Gd-DOTA. Emptying was determined with transaxial scans and motility during fast coronal scans 1.2 sec apart. Emptying was slower after ingestion of 25% dextrose. Following both meals, proximal gastric diameter remained relatively constant, while antral contractile frequency and depth varied markedly. These variations were greater after 10% dextrose. These studies suggest that antral motility changes contribute to slowing of gastric emptying by nutrient meals.

Animals↗
PubMed1994

Measurement of gastric emptying and gastric motility by magnetic resonance imaging (MRI).

Hitherto it has been impossible to measure noninvasively gastric emptying and motility from multiple regions of the stomach in humans. We describe the development of a novel methodology to achieve this using magnetic resonance imaging (MRI). Initial validation studies performed in five healthy volunteers demonstrated similar gastric emptying curves and secretion rates after ingestion of 10% dextrose labeled with [Gd]DOTA, assessed by MRI ([Gd]DOTA as meal marker) and a simultaneous double-indicator technique. Comparison between MRI and scintigraphy in five patients also gave similar results. Application of newer MRI technology allowing a series of coronal scans 1.2 sec apart permitted quantification of wall motion in the proximal and distal stomach in seven healthy volunteers. These results indicate that MRI provides new insights into the mechanisms responsible for both normal and disordered emptying.

Contrast Media↗
PubMed1994

Gastric emptying of liquid meals measured noninvasively in humans with [13C]acetate breath test.

The aim of the present study was to develop a breath test to measure liquid gastric emptying rates that would be without radiation exposure and applicable to field testing. Four different test meals were investigated: a glucose meal, an amino acid meal, a fat meal, and a mixed meal (Ensure). The test meals were labeled with two markers, [13C]acetate and PEG-4000 (polyethylene glycol 4000). Gastric emptying rates were measured simultaneously by both breath test and the double-indicator technique in eight healthy male subjects. The appearance of 13CO2 in the breath closely reflected gastric emptying of the four test meals as measured by the double-indicator technique. It is concluded that the [13C]acetate breath test is a reliable, noninvasive test to measure gastric emptying rates of liquid test meals.

Acetates↗
PubMed1994

Conscious sedation, clinically relevant complications and monitoring of endoscopy: results of a nationwide survey in Switzerland.

There is no conclusive evidence that electronic monitoring during gastrointestinal endoscopy reduces patient morbidity and mortality. The aim of this nationwide Swiss survey was to assess the impact of monitoring on the outcome for patients. We therefore evaluated the monitoring practice and the rate of sedation-related clinically relevant complications in a country with a low monitoring prevalence, and compared the results with those for a country in which monitoring is widely applied. A questionnaire pertaining to 1990 was mailed to all 173 Swiss gastroenterologists. The response rate was 71.1%. Data from 115,200 endoscopies performed by 123 gastroenterologists were analysed. Sixty percent of the procedures were performed under sedation. Patient's vital signs were rarely monitored clinically (< or = 25%). Electronic monitoring was virtually never performed: oximetry was used by 2.5% and an electrocardiogram by 0.8%. The overall sedation-related complication rate was 0.10%, and no deaths occurred. Thus, the morbidity and mortality related to conscious sedation in Switzerland is low, and not higher than it is in countries with a high monitoring level, such as the USA (0.06-0.54%). We conclude that clinically detectable and relevant complications attributable to conscious sedation are rare even when vital parameters are not monitored routinely. There is need for a prospective study to evaluate the effect of electronic monitoring on the complication rate for average-risk patients undergoing routine gastrointestinal endoscopy.

Colonoscopy↗
PubMed1994

The Surf-1 and Surf-2 genes and their essential bidirectional promoter elements are conserved between mouse and human.

The organization of the Surfeit locus and the juxtaposition of at least five of the Surfeit genes (Surf-1 to -5) are conserved between mouse and human (Williams et al., 1988; Yon et al., 1993). In the mouse, the heterogeneous transcription start sites of the divergent Surf-1 and Surf-2 genes are separated by a maximum of only 73 bp (Williams and Fried, 1986). This region contains a bidirectional promoter composed of three major factor binding sites required for the efficient expression of both the Surf-1 and Surf-2 genes (Lennard and Fried, 1991). Here we report the isolation and characterization of the human Surf-1 and Surf-2 genes and their intergenic region. Although the major Surf-1 and Surf-2 transcription start sites are separated by 97 bp in the human and there are multiple differences in the mouse and human sequence between and around the transcriptional start sites, there is high conservation of the sequence specifying the three major factor binding sites of the bidirectional promoter. The three factor binding sites (HSu1, 2, and 3) present within the human promoter bind nuclear factors, of which the binding of HSu1 and HSu2 are competed by oligonucleotides carrying the corresponding mouse factor binding sites. The HSu3 site binds factors that are similar but apparently not direct homologs of those that bind to the equivalent mouse sequences. Human Surf-1 and Surf-2 cDNAs have been cloned and sequenced. The putative human Surf-1 and Surf-2 proteins are 77% and 69% identical to the corresponding mouse proteins.

Amino Acid Sequence↗