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Biomedical subjects

M H Mellow

Publications and source records attributed to M H Mellow.

At least 19 recordsLinked to original sources
PubMed1992

Manometry during food ingestion aids in the diagnosis of diffuse esophageal spasm.

It has been shown that food ingestion can provoke esophageal motor abnormalities in patients with otherwise normal manometry. Such motor abnormalities are usually nonspecific in character. We now report water swallow and food ingestion data on 12 patients with a history of dysphagia and/or chest pain who satisfied strict manometric diagnostic requirements for diffuse esophageal spasm. Three of these patients had normal water swallow manometry, yet, during food ingestion, showed manometric evidence of diffuse esophageal spasm. In the other nine patients, the occurrence of nonperistaltic contractions was greater, and there was a greater incidence of nonperistaltic contractions of 100 mm Hg or more after ingestion of food. We conclude that food ingestion increases the diagnostic yield of manometric testing for diffuse esophageal spasm and, not infrequently, magnifies an abnormality seen during standard water-swallow testing.

Adult↗
PubMed1990

The effect of raw onions on acid reflux and reflux symptoms.

Patients with gastroesophageal reflux often describe heartburn after "spicy meals." One ingredient common to most such meals is onion. We investigated the effects of onion on acid reflux and reflux symptoms in 16 normal subjects and 16 heartburn subjects. Subjects were studied with an esophageal pH probe for 2 h after the ingestion of a plain hamburger and a glass of ice water. The identical meal, with the addition of a slice of onion, was ingested on a counterbalanced day. Variables measured were number of reflux episodes, percentage of the time pH was less than four, heartburn episodes, and belches. Ingestion of onions did not increase any of the reflux variables measured in normals. However, onions significantly increased all measures in heartburn subjects, compared with the no-onion condition, and compared with normals under the onion condition. Onions can be a potent and long-lasting refluxogenic agent in heartburn patients.

Adult↗
PubMed1989

Endoscopic laser therapy in colorectal cancer.

Strong consideration should be given to the use of laser treatment as an alternative to surgery for palliation in patients with advanced metastatic rectal cancer. Based upon the lower cost and equivalent efficacy with surgery, laser treatment is cost-effective. In the light of this, laser treatment should be considered as an option to surgery in some patients with advanced disease. It is in these patients, however, where one must be cautious in recommending laser treatment indiscriminately. Advanced age alone should not be a sufficient reason for deciding against surgery. While it may be generally desirable to preserve the rectum, it is clear from our analysis that the presence of a rectum in no way assures satisfactory defecation. Thus, long circumferential lesions, especially those traversing the rectosigmoid angle, may be better treated with surgery even in the presence of metastatic disease, as long as the overall condition of the patient suggests reasonable survival, i.e. of more than 6 months. Any future advance in oncological therapy resulting in significant improvement in survival in patients with metastatic disease will also change the therapeutic approach to the primary tumor. Further studies are required to define which patients should be selected for endoscopic therapy. It is clear that laser treatment can eradicate totally a rectal cancer localized to the bowel wall at the time of initial treatment. Five of our patients have no evidence of residual or recurrent disease more than 12 months after laser treatment. Escourrou has reported a similar experience in a larger series.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1988

Water swallows versus food ingestion as manometric tests for esophageal dysfunction.

Data from 100 consecutive patients with chest pain or dysphagia, or both, who underwent esophageal testing with standard water swallows and upright food ingestion were retrospectively evaluated. In addition to having manometric patterns monitored, patients were asked to relate symptoms during testing. Of 77 patients with a history of dysphagia, significantly more had abnormal manometry during the test meal than with water swallows (79 vs. 43%, p less than 0.005). Additionally, dysphagia, although reported in only 8% of these patients during standard testing, occurred in 47% during the test meal (p less than 0.001). Of 60 patients with chest pain, symptoms were rarely reported (5%) with water or with food ingestion. We conclude that manometry with food ingestion should be used as a provocative test in anatomically normal patients with dysphagia.

Adult↗
PubMed1987

Esophageal zinc content in human squamous esophageal cancer.

Zinc and vitamin A are known to interact, and deficiencies have been associated with carcinogenesis in experimental animals and humans. Since we previously have demonstrated decreased plasma zinc and vitamin A levels in patients with esophageal cancer, we wished to examine endoscopically obtained epithelial tissue for vitamin A and zinc content. This was not feasible for vitamin A, but using newly developed techniques for zinc analysis of small tissue samples, we measured esophageal epithelial zinc as well as plasma zinc and plasma vitamin A in 21 patients with esophageal cancer, 17 patients with esophagitis, and 12 normals. Mean plasma zinc in the esophageal cancer group (56 +/- 3 micrograms/dl) (mean +/- SEM) was significantly less than in the esophagitis group (72 +/- 5 micrograms/dl) and the normals (78 +/- 5 micrograms/dl). Mean plasma vitamin A in the esophageal cancer group (32 +/- 3 micrograms/dl) was significantly less than the esophagitis group (57 +/- 4 micrograms/dl) or the normals (58 +/- 5 micrograms/dl). There was no significant difference in tissue zinc content (measured as micrograms zinc/g wet weight of tissue, mean +/- SEM) among cancerous tissue (57 +/- 5 micrograms/g) and adjacent normal tissue (61 +/- 4 micrograms/g), esophagitis tissue (66 +/- 6 micrograms/g) and adjacent normal tissue (61 +/- 6 micrograms/g), or normal esophageal tissue (59 +/- 6 micrograms/g). We conclude that deficiencies of zinc or vitamin A may be cofactors in the induction of human esophageal cancer, but a mechanism cannot be accounted for by differences in epithelial zinc content.

Carcinoma, Squamous Cell↗
PubMed1985

Endoscopic laser therapy for malignancies affecting the esophagus and gastroesophageal junction. Analysis of technical and functional efficacy.

Thirty consecutive patients with far-advanced cancer affecting the esophagus and gastroesophageal junction underwent palliative endoscopic neodymium-YAG laser therapy. No patients were excluded from treatment, regardless of age, extent of disease, or performance status. Sessions were performed every other day and concluded when an endoscope could be easily passed beyond the previously obstructed area. Treatment was completed in 3.3 sessions (seven days). Luminal patency was achieved in 97%, but did not always equate with functional success. Seventy percent (21 patients) were able to ingest all necessary calories and leave hospital for home (functional success). Reasons for discrepancy between technical success and functional success included radiation-induced pharyngeal dysphagia, anorexia, painful tumor load and debility, and treatment complications. Endoscopic laser therapy of far-advanced esophageal or gastroesophageal junction carcinoma was almost always technically feasible, with relatively low morbidity. While technical success could not always be equated with functional success, therapy was "completely" functionally successful in 70% of patients with far-advanced disease. Poor performance status at accession correlated best with poor functional outcome.

Adenocarcinoma↗
PubMed1984

Endoscopic therapy for esophageal carcinoma with Nd:YAG laser: prospective evaluation of efficacy, complications, and survival.

Eleven consecutive patients who underwent endoscopic Nd: YAG laser therapy for palliation of esophageal carcinoma were prospectively evaluated between July 1, 1982, and December 31, 1982. All patients with tumor recurrence after radiotherapy or surgery (eight patients) or whose medical condition precluded surgery or full-course radiotherapy (three patients) underwent treatment. Mean tumor length was 8.1 cm and most had almost complete luminal occlusion. Survival was compared with patients with esophageal cancer treated at our institution during the 3 years prior to initiation of laser therapy (1978-1981). Treatment was completed in a mean of 3.3 sessions (range, 2 to 6). Dysphagia improved in all and performance status improved in eight patients, some markedly. Five patients with tumor re-occlusion were retreated at a mean of 10 weeks after initial therapy. No concurrent dilations were employed. Compared with our institution's historical controls, laser-treated patients' survival was significantly increased, whether measured from time of onset of radiotherapy (36 vs. 17 weeks, p = 0.02) or from time of recurrent symptoms after radiotherapy (25 vs. 8 weeks, p less than 0.05).

Adult↗
PubMed1983

Plasma zinc and vitamin A in human squamous carcinoma of the esophagus.

Zinc deficiency enhances experimental esophageal tumor induction. Vitamin A supplementation inhibits carcinogenesis in animals. Plasma zinc and plasma vitamin A levels are reduced in several human squamous cancers, but have not been studied in a US population with esophageal cancer. Therefore, we measured plasma zinc and vitamin A in patients with newly diagnosed esophageal cancer. In addition, we assessed hepatic and nutritional status and attempted to control for other factors known to influence plasma zinc and vitamin A levels. Plasma zinc and vitamin A were both significantly less in esophageal carcinoma than in age-matched healthy controls (plasma zinc 65.7 +/- 3.3 micrograms/dl [mean +/- SEM] in esophageal cancer versus 80.5 +/- 2.4 micrograms/dl in controls, P less than 0.01; plasma vitamin A 32.6 +/- 3.4 micrograms/dl in esophageal cancer versus 60.2 +/- 4.2 in controls, P less than 0.001). Overall, 15 of 17 patients with esophageal cancer had decreased plasma zinc and/or decreased plasma vitamin A. Our findings are compatible with a hypothesis that zinc or vitamin A deficiency may be co-factors in the induction of human esophageal carcinoma.

Aged↗
PubMed1983

Esophageal acid perfusion in coronary artery disease. Induction of myocardial ischemia.

Although coronary artery disease and gastroesophageal reflux disease are common conditions which, therefore, may coexist, it is unknown whether or not the presence of one affects the other. We performed esophageal acid perfusion tests, with concurrent blood pressure, heart rate, and 12-lead electrocardiographic monitoring, in 37 patients, 25 with angiographically documented coronary disease and 12 with normal coronary arteries. Rate-pressure product, an index of myocardial work load, was calculated. In patients with coronary disease who developed chest pain during acid perfusion, rate-pressure product increased from 10.0 +/- 1.0 x 10(3) (mean +/- SEM) basally to 15.2 +/- 1.5 x 10(3) (p less than 0.001), and 3 of 9 patients showed concomitant electrocardiogram evidence of myocardial ischemia. In addition, in coronary disease, 64% of patients with infrequent or absent reflux symptoms by history had positive acid perfusion tests, and 56% of patients with coronary disease who developed pain during esophageal acid perfusion could not distinguish that pain from their usual angina. We conclude that in coronary disease, acid perfusion (and, presumably, gastroesophageal reflux) resulting in chest pain causes rate-pressure product elevation and can induce myocardial ischemia. The presence of esophageal acid sensitivity is not accurately predicted by clinical history in coronary disease, and pain of esophageal origin is often confused with angina.

Angina Pectoris↗
PubMed1983

Esophageal motility during food ingestion: a physiologic test of esophageal motor function.

It is unknown whether esophageal motility, as assessed by standard motility testing, bears close relationship to motility occurring during food ingestion. Certainly, many patients, while reporting symptoms during food ingestion, are asymptomatic during standard motility testing; thus, a direct link between abnormal motility and symptomatology is often lacking. Twelve normal subjects and 5 patients with symptomatic esophageal motility disorders, therefore, underwent motility testing during upright ingestion of a meal which consisted of beef cubes and gravy. In normals, contraction parameters during food ingestion could not have been predicted by values obtained during standard testing (r = 0.2, p greater than 0.05). All 5 patients, although asymptomatic during standard testing, reported dysphagia during food ingestion. Evidence of abnormal motility could be observed simultaneously. Patterns of abnormality included nonperistaltic contractions (7.2 +/- 2.5 episodes per meal), instances of incomplete lower esophageal sphincter relaxation (2.8 +/- 0.8 episodes per meal), and instances of lack of complete lower esophageal sphincter relaxation during ongoing esophageal contractions (4.6 +/- 1.0 episodes). These abnormalities were significantly more frequent in patients than in controls (p less than 0.001), and most had not been observed during standard testing in the patients. In addition, bethanechol significantly increased abnormal motility and increased dysphagia during food ingestion in the patients, but was without significant effect in controls. It was concluded, therefore, that recording of esophageal motility during upright food ingestion appears to be of value in the diagnosis and characterization of motor abnormalities in patients with symptoms of esophageal motor dysfunction.

Adult↗
PubMed1982

Effect of isosorbide and hydralazine in painful primary esophageal motility disorders.

Five patients with painful primary esophageal motility disorders underwent pharmacologic testing with isosorbide and hydralazine. While neither agent affected baseline amplitude or duration of distal esophageal contractions, pretreatment with hydralazine significantly blunted the response to bethanechol (mean esophageal contraction duration, 31.4 +/- 4.8 s after bethanechol alone vs. 12.7 +/- 1.8 s after bethanechol and hydralazine p less than 0.005). Premedication with isosorbide was significantly less effective. In addition, while all 5 patients experienced chest pain in response to bethanechol alone, only 1 of 5 experienced chest pain in response to bethanechol after previous hydralazine administration; 3 patients had chest pain after previous administration of isosorbide. Patients who were placed on long-term oral hydralazine therapy experienced improvement in chest pain and dysphagia with concomitant decrease in amplitude and duration of esophageal contractions on repeat motility study (176.5 +/- 23.8 mmHg to 97.3 +/- 27.0 mmHg, p less than 0.05, 7.5 +/- 0.8 s to 5.2 +/- 0.5 s, p less than 0.005). Hydralazine appears to be of value in the treatment of diffuse esophageal spasm and other painful primary esophageal motility disorders.

Adult↗
PubMed1981

Insensitivity of guaiac slide tests for detection of blood in gastric juice.

Two guaiac slide tests (Hemoccult and Fe-Cult) were evaluated for their ability to detect blood in gastric juice and other fluid mixtures relevant to clinical testing in upper gastrointestinal hemorrhage. Blood was added to these fluid mixtures in various amounts sufficient to yield concentrations from 20 microL blood/dL to 4000 microL/dL. With these agents we frequently could not detect blood in unbuffered gastric juice at concentrations as great as 4000 microL/dL. Buffering of gastric juice to pH 4 with either of two antacids only slightly restored sensitivity for blood detection. In contrast, blood in gastric juice obtained from subjects previously given intravenous cimetidine tested positive at concentrations as low as 50 microL/dL. The ability of both test agents to detect blood in gastric juice was considerably enhanced by neutralizing gastric juice with 0.1 N NaOH.

Adult↗