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Biomedical subjects

M H Mellow

Publications and source records attributed to M H Mellow.

29 records · Page 2Linked to original sources
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↗
PubMed1980

Effect of sublingual nitroglycerin and long-acting nitrate preparations on esophageal motility.

The effect of nitroglycerin and long-acting nitrates in normal humans is unknown. Therefore, we studied the effect of commonly used clinical doses of nitrate preparations on the esophagus in normal subjects. Three minutes after administration of sublingual nitroglycerin 0.6 mg, a significant reduction in lower esophogeal sphincter pressure occurred (19.0 +/- 2.6 to 12.7 +/- 2.2 mmHg (P < 0.01). This effect was transient, and no effect was seen on amplitude, duration of esophageal contractions or peristaltic wave velocity measured 6 min after nitroglycerin administration. Neither nitroglycerin ointment, 1.5 in. applied to the forearm, nor 20 mg oral isosorbide dinitrate, resulted in a major change in any measured parameter of esophageal motility. In addition, pretreatment with long-acting nitrates did not alter lower esophageal sphincter response to intravenous pentagastrin.

Adult↗
PubMed1978

Effect of acute hypercalcemia on human esophageal motility.

In order to evaluate the effect of acute moderate hypercalcemia on both smooth and skeletal muscle function of the human esophagus, 12 subjects were given intravenous calcium chloride in normal saline. Serum calcium increased from a basal value of 9.6 +/- 0.1 mg per dl (mean +/- 1 SEM) to 11.4 +/- 0.2 mg per dl at 90 min after initiation of calcium infusion (P less than 0.01). Both amplitude and Dp/Dt of esophageal contractions decreased significantly in the skeletal muscle segment; however, amplitude and Dp/Dt increased significantly in the smooth muscle segment. Lower esophageal sphincter pressure remained unchanged. Duration of contractions and peristaltic wave speed were unaltered. Possible explanations for the divergent effect of hypercalcemia on the two types of esophageal muscle are discussed.

Acute Disease↗
PubMed1976

Endoscopy - related bacteremia. Incidence of positive blood cultures after endoscopy of upper gastrointestinal tract.

A prospective study was undertaken to determine the frequency of bacteremia after endoscopy of the upper gastrointestinal tract. Three of 100 patients (3%) demonstrated positive blood cultures after the endoscopic procedure. Bacteriologic surveys disclosed that routine cleansing procedures of the endoscopy room and the endoscope itself frequently failed to achieve optimal sterile conditions. Particularly noteworthy was the growth of Enterobacter liquefaciens and Candida albicans on one occasion from the endoscope tip. We conclude that, although the incidence of postendoscopy positive blood cultures is low, a more vigorous approach to using clean equipment in clean surroundings is needed when dealing with a potentially susceptible host.

Candida↗
PubMed1976

Return of esophageal peristalsis in idiopathic achalasia.

A 47-year-old male was diagnosed as having idiopathic achalasia on the basis of clinical, roentgenographic, and manometric criteria. He was on no medication and had no disorders known to impair esophageal motility. He was treated by pneumatic dilation with a good clinical response. On reexamination 7 years later, several features considered to be typical of achalasia were no longer present. Changes included return of peristaltic activity throughout most of the body of the esophagus, failure of a direct-acting cholinergic agent to produce an increase in base line intraesophageal pressure, and failure of a direct-acting cholinergic agent to produce a heightened response at the lower esophageal sphincter (LES). Incomplete LES relaxation in response to swallowing persisted. This represents the first reported case of return of esophageal peristalsis in idiopathic achalasia.

Bethanechol Compounds↗
PubMed1972

Digoxin.

Explore the source record for details and available documents.

Animals↗
PubMedDate not supplied

Endoscopic laser therapy as an alternative to palliative surgery for adenocarcinoma of the rectum--comparison of costs and complications.

Endoscopic laser therapy has been used as an alternative to surgery for rectal cancer in certain patients with metastases or at high surgical risk. This report analyzes 35 patients undergoing surgery and 21 undergoing laser therapy for rectal cancer. The cost of treatment was compared as well as the length of hospital stay, intensive care stay, complications, and survival. In the surgical patients, complications, length of stay, and intensive care stay were all significantly greater than for patients treated by endoscopic laser. Mean total cost for surgery was $23,156 compared with $5333 for inpatient laser treatment (p less than 0.001) and $2263 for outpatient laser treatment (p less than 0.001). Lifetime cost calculated in patients with metastases treated by surgery was $22,900 compared with $12,154 for laser therapy (p less than 0.05). Mean survival in patients with metastases was 28 weeks in the surgery group and 36 weeks for laser treatment. We conclude that the cost of endoscopic laser therapy is significantly less, and that hospital stay, intensive care time, and complications are significantly greater in patients undergoing palliative surgery for rectal cancer.

Adenocarcinoma↗