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Biomedical subjects

M Hiele

Publications and source records attributed to M Hiele.

At least 55 records · Page 3Linked to original sources
PubMed1993

Metabolism of erythritol in humans: comparison with glucose and lactitol.

The metabolism of erythritol was assessed in six normal volunteers by measuring the amount of 13CO2 excretion and H2 excretion in breath, and erythritol in urine after intake of 25 g 13C-labelled erythritol. The results were compared with the same variables obtained after intake of 25 g 13C-labelled glucose and 13C-labelled lactitol. In addition, the H2 production by faecal flora supplemented with small amounts of erythritol, glucose and lactitol was measured in vitro, as an index of bacterial metabolism of non-absorbed substrate. In contrast to the results obtained after intake of glucose and lactitol, no increase in breath 13CO2 and H2 was observed after intake of erythritol, and erythritol was nearly completely recovered in urine. The in vitro experiments showed that no H2 was formed by faecal flora from erythritol as compared with glucose and lactitol. It is concluded that erythritol is a substrate that is readily absorbed, and undergoes no metabolism by the host. If part of it escapes absorption, it is not metabolized by faecal flora.

Adult↗
PubMed1993

Endoscopic injection therapy to prevent rebleeding from peptic ulcers with a protruding vessel: a controlled comparative trial.

Seventy five patients with severely bleeding peptic ulcer were included in a controlled comparative trial to assess the efficacy and safety of endoscopic injection therapy in preventing rebleeding from peptic ulcers that presented at endoscopy with a protruding vessel. Twenty five patients were treated with injection of epinephrine followed by polidocanol, 25 were treated with injection of absolute alcohol, and 25 with sham injection. Rebleeding occurred in 44% of patients in the sham group, 40% of those treated with epinephrine and polidocanol, and in 20% of those treated with absolute ethanol. The difference in the haemostasis rate between the control and ethanol treated subjects nearly reached significance (p = 0.07). A second therapy session resulted in haemostasis rates of 68% in the epinephrine-polidocanol group and of 88% in the absolute ethanol group. These rates after two treatments as well as the emergency surgery rates (32% in the epinephrine-polidocanol group and 8% in the absolute ethanol group; p = 0.07) were not significantly different. In eight of the 11 patients with rebleeding in the sham treatment group, definitive haemostasis was achieved by elective injection therapy. Overall transfusion requirements were mean (SD) 6.0 (0.7) units in the sham group, 6.0 (0.9) in the epinephrine-polidocanol group, and 3.9 (0.5) in the absolute ethanol group. Only the difference between ethanol and sham was significant (p = 0.02). This study shows that injection with absolute ethanol reduces rebleeding in these patients and significantly lowers transfusion requirements. Absolute ethanol was superior to epinephrine-polidocanol, which was not significantly better than sham therapy.

Adult↗
PubMed1993

Significance of a low serum ferritin level in elderly in-patients.

Iron deficiency, defined as a serum ferritin level less than or equal to 50 micrograms/l was found in 28 (11%) of 252 consecutive elderly in-patients (mean age 81 years). Sixteen among them were anaemic and only five had a microcytic anaemia. In a separate study, 15 anaemic and 13 non-anaemic iron-deficient elderly in-patients were investigated in order to evaluate the prevalence of gastrointestinal symptoms and lesions in both groups. In nine of the anaemic and seven of the non-anaemic patients a potential cause for the iron deficiency was established. Most anaemic and non-anaemic patients lacked the symptoms described as suggestive of underlying gastrointestinal pathology. Thus, a ferritin level less than or equal to 50 micrograms/l justifies a gastrointestinal investigation if the general condition allows for it as well in anaemic as in non-anaemic elderly hospitalized patients. Therefore, serum ferritin should be part of the routine biochemical investigation of elderly in-patients.

Aged↗
PubMed1992

Effects of acarbose on starch hydrolysis. Study in healthy subjects, ileostomy patients, and in vitro.

The effect of acarbose on hydrolysis of a pure starch meal was investigated in normal subjects and ileostomy patients by means of 13CO2 breath tests and blood glucose levels as parameters of absorption, and of H2 breath tests, serum acetate levels, and ileal loss of carbohydrate as parameters of malabsorption. Additional information on the effect of acarbose on alpha-amylase activity was obtained by in vitro experiments. Acarbose (200 and 400 mg) significantly delayed starch absorption. Serum acetate was found to be a less sensitive marker of malabsorption than breath H2 excretion. After intake of 50 g starch plus 400 mg acarbose, 23-71% of the starch load was lost in the ileostomy effluent, for a large part as starch. This suggests that acarbose considerably inhibits alpha-amylase, and not only brush-border enzymes. In vitro experiments confirm that an inhibition of two thirds of alpha-amylase activity can be expected from pharmacologically used doses of acarbose.

Acarbose↗
PubMed1992

Rifabutin and ethambutol do not help recurrent Crohn's disease in the neoterminal ileum.

We tested the efficacy of rifabutin and ethambutol in combination in healing severe recurrent Crohn's disease in the neoterminal ileum. Sixteen patients who had undergone an ileal resection with partial colectomy and ileocolonic anastomosis and who had severe recurrent lesions in the neoterminal ileum at baseline ileocolonoscopy were included in the study. The patients received rifabutin in a dose of 5 mg/kg together with ethambutol, 20 mg/kg. Ten patients were treated for 6 months; six patients dropped out because of adverse events. As no effect was observed after 6 months, five patients completed a 12-month therapy course. Follow-up ileocolonoscopy was performed at 3, 6, and 12 months. In none of the 10 patients who completed the 6-month trial and in none of the five patients who completed 12 months of therapy was endoscopic improvement of the lesions observed. In four patients the disease was clinically progressive, and two patients underwent a reresection after 6 and 8 months, respectively. This study shows that long-term therapy with rifabutin and ethambutol does not heal Crohn's disease in the neoterminal ileum and does not prevent recurrence of symptoms and complications.

Adult↗
PubMed1992

Prevalence and causes of anaemia in a geriatric hospitalized population.

Of 732 consecutive patients admitted to an acute geriatric ward, 178 (24%) were found to be anaemic (haemoglobin of 115 g/l or below). An appropriate cause responsible for anaemia was identified in 83%. The anaemia of chronic disorders (ACD) (35%) and iron deficiency anaemia (15%) were the commonest causes. The spectrum of disorders associated with ACD is much broader than the classical category of infectious, inflammatory and malignant disorders. The relatively high prevalence of the myelodysplastic syndrome (5%) is striking and this syndrome as a cause of anaemia in geriatric patients deserves more attention than it has so far received. No obvious cause was found in 17%. The clinical significance of this finding remains unclear.

Aged↗
PubMed1991

Effect of faecal stream diversion on recurrence of Crohn's disease in the neoterminal ileum.

Aphthous lesions recur in the neoterminal ileum within the first few months after curative resection of the distal ileum in patients with Crohn's disease. These lesions do not originate from microscopic disease that is already present at the time of surgery. To investigate the importance of faecal stream in the pathogenesis of recurrent Crohn's lesions, we have studied 5 patients with Crohn's disease who had ileal resection. After curative resection and ileocolonic anastomosis, a diverting terminal ileostomy was constructed 25-35 cm proximal to the anastomosis thereby excluding the neoterminal ileum, the anastomosis, and the colon from intestinal transit. After six months of exclusion, endoscopy of the ileocolon was undertaken and biopsy specimens were taken. Transit was then restored. Six months after reanastomosis further biopsy specimens were taken. These patients were compared with a control group of 75 patients with Crohn's disease who underwent a one-step ileal resection and ileocolonic anastomosis. None of the 5 patients had endoscopic lesions in the neoterminal ileum after six months of exclusion and biopsies did not show inflammatory changes characteristic of Crohn's disease. By contrast, 53 of 75 patients with one-step surgery had endoscopic recurrence in the neoterminal ileum within six months of surgery. All 5 patients had an important recurrence of disease, both endoscopically and histologically, at ileocolonoscopy six months after reanastomosis. Our findings strongly support the view that recurrence of Crohn's disease in the neoterminal ileum after curative ileal resection is dependent on faecal stream.

Adult↗
PubMed1991

Influence of nutritional substrates on the formation of volatiles by the fecal flora.

The influence of metabolic substrates on the formation of volatile compounds by the colonic flora was measured in a fecal incubation system. The presence of carbohydrates (0, 25, and 50 mg/20 mL fecal suspension) led to a dose-related increase in the formation of alcohols and H2 and to a dose-related decrease in the formation of toxic mercaptans. This effect seemed to be independent of pH. The presence of albumin or fat (50 mg/20 mL fecal suspension) as substrates for the colonic flora gave rise to the formation of significantly higher amounts of methanethiol. Small amounts of pentane were found in the headspace after incubation with oil. These data show that the formation of volatile metabolites by the colonic flora is greatly influenced by the available substrates.

1-Propanol↗
PubMed1991

Effects on bowel motility of misoprostol administered before and after meals.

Prostaglandin analogues, used in the treatment of duodenal and benign gastric ulcer and in the prevention of gastric ulceration caused by non-steroidal anti-inflammatory drugs, are frequently associated with gastrointestinal side effects, particularly diarrhoea and abdominal cramps. We investigated the effects of misoprostol, a prostaglandin E1 derivative, on bowel motility and faecal loss of fat, water and bile acids in relation to its postprandial vs. preprandial administration. Twelve healthy subjects participated in a double-blind crossover study comparing three 5-day courses of therapy with a washout period of 1-2 weeks between courses. Following a Latin Square design, the dosing regimens were (a) 400 micrograms misoprostol b.d. after meals and placebo b.d. before meals; (b) 400 micrograms misoprostol b.d. before meals and placebo b.d. after meals; (c) placebo before and after meals. Orocaecal transit time measured by H2 breath tests following lactulose administration, was shortest during pre-prandial dosing but was also significantly decreased during post-prandial dosing. The overall treatment difference was highly significant (P less than 0.001), and the difference between each pair of treatments was also statistically significant. Whole bowel transit time studied by means of 3H-PEG 4000 determination in stools, was shorter for the two misoprostol regimens but statistical significance was borderline. The number of stools passed per day was similar in the three groups. During both misoprostol dosing periods, stools were less formed and their content of water, fat and bile acids was higher. There was also more urgency, flatulence, abdominal pain and nausea. It is concluded that the gastrointestinal side effects caused by misoprostol are mainly based on an increased orocaecal transit time. The effects are more important when the drug is administered before meals than after meals.

Adolescent↗
PubMed1990

[Vitamin B12 (cobalamin)-deficiency in the elderly].

In order to determine the relevance of low vitamin B12 concentration in elderly persons (greater than 65 years), serum vitamin B12 levels were measured in 292 consecutive patients upon their admission to a geriatric ward. Eighty (27%) of them were anaemic (haemoglobin less than or equal to 7.14 mmol/l). The vitamin B12 concentration was not statistically different between males and females, nor between the anaemic and non-anaemic groups. Twenty-two patients (7.5%) had a low vitamin B12 level; of these, 10 had a haemoglobin concentration higher than 7.14 mmol/l and a mean corpuscular volume lower than 98 fl. In addition, serum vitamin B12 levels were also measured in 178 consecutive anaemic patients hospitalized in the same ward. Seventeen (9.5%) of them had a vitamin B12 deficiency although in 11 the MCV was lower than 98 fl. Hypersegmented polymorphonuclear leukocytes were rarely observed in the peripheral blood smear. Pernicious anaemia could only be diagnosed in 1 patient. Serum vitamin B12 estimation may be necessary to detect vitamin B12 deficiency but a low level requires additional diagnostic investigation.

Aged↗
PubMed1990

Predictability of the postoperative course of Crohn's disease.

Eighty-nine patients who had been treated by ileal resection for Crohn's disease between 1979 and 1984 were included in a prospective cohort follow up to study the natural course of early postoperative lesions. Recurrent lesions were observed endoscopically in the neoterminal ileum within 1 year of surgery in 73% of the patients, although only 20% of the patients had symptoms. Three years after surgery, the endoscopic recurrence rate had increased to 85% and symptomatic recurrence occurred in 34%. The ultimate course of the disease was best predicted by the severity of the early postoperative lesions, as observed at ileoscopy. Clinical parameters that influenced outcome were preoperative disease activity, the indication for surgery, and the number of surgical resections. When patients were stratified for preoperative disease activity, the severity of lesions found at endoscopy remained a strong predictive factor for symptomatic recurrence. In 22 other patients submitted to "curative" ileal resection and ileocolonic anastomosis, the segment to be used as neoterminal ileum was carefully examined during surgery, and two large biopsies were taken before making the anastomosis. An ileoscopy was performed 6 months after surgery. Although all patients had a macroscopically normal neoterminal ileum and 19 had entirely normal biopsies at the time of surgery, 21 patients were found at ileoscopy to have developed ileitis involving a 15-cm segment (range, 4-30 cm), and 20 had unequivocal microscopic lesions on biopsies. These studies suggest that early lesions in the neoterminal ileum after Crohn's resection do not originate from microscopic inflammation present in this bowel segment at the time of surgery. The early postoperative lesions in the neoterminal ileum seem to be a suitable model to study the pathogenesis of Crohn's disease and also to evaluate new therapeutic modalities, either to prevent development of these early lesions or to treat progressive recurrence.

Actuarial Analysis↗
PubMed1990

13CO2 breath test to measure the hydrolysis of various starch formulations in healthy subjects.

13CO2 starch breath test was used to study the effect of physicochemical characteristics of starch digestion. As starch is hydrolysed to glucose, which is subsequently oxidised to CO2, differences in 13CO2 excretion after ingestion of different starch products must be caused by differences in hydrolysis rate. To study the effect of the degree of chain branching, waxy starch, containing 98% amylopectin, was compared with high amylose starch, containing 30% amylopectin, and normal crystalline starch, containing 74% amylopectin. The effect of the extent of gelatinisation was studied by comparing extruded starch and crystalline starch. Finally, the possible inhibitory effect of adding wheat fibre to extruded starch on the hydrolysis rate was studied. The 13CO2 excretion from two to four hours after intake of crystalline starch was significantly lower than that of extruded starch. Waxy starch was hydrolysed much faster than high amylose starch, but there was no significant difference between waxy starch and normal crystalline starch. Addition of wheat fibre did not influence the hydrolysis rate. The 13CO2 starch breath test is an attractive test for the study of factors affecting carbohydrate assimilation.

Adult↗
PubMed1989

Comparison of endoscopic polidocanol injection and YAG laser therapy for bleeding peptic ulcers.

392 patients were examined by endoscopy for acute upper gastrointestinal bleeding; 140 had ulcers containing an actively bleeding visible vessel or a non-bleeding visible vessel and were enrolled in a randomised trial of three endoscopic methods of haemostasis--adrenaline (1/10(4] alone, adrenaline plus polidocanol 1%, and adrenaline followed by yttrium-aluminium-garnet (YAG) laser photocoagulation. For patients with non-bleeding visible vessels sham treatment was significantly less effective in achieving haemostasis (8 of 20 patients) than were adrenaline plus polidocanol (18 of 20; p = 0.002) and adrenaline plus laser (16 of 20; p = 0.012). All three treatments significantly reduced total transfusion needs compared with sham treatment. For the whole group of patients, adrenaline plus polidocanol was significantly more effective than adrenaline alone in achieving permanent haemostasis; adrenaline plus laser was also more effective than adrenaline alone, but not significantly so. The efficacy of the three treatments was enhanced by repeated application on recurrence of bleeding. Since injection therapy with adrenaline and polidocanol was at least as effective as adrenaline plus laser therapy, it should be preferred over laser therapy because it is cheaper, easier to use, and perhaps also safer.

Acute Disease↗
PubMed1989

Porous-layer open-tubular gas chromatography in combination with an ion trap detector to assess volatile metabolites in human breath.

A method is described for the quantification of major volatile substances in human breath without preconcentration. Methanol, ethanol, acetaldehyde and acetone are well separated by porous-layer open-tubular column gas chromatography. Low-level detection was possible by means of an ion trap detector. Halothane has been used as internal standard.

Acetaldehyde↗
PubMed1989

Risk factors which determine the long term outcome of Neodymium-YAG laser palliation of colorectal carcinoma.

We have analysed the long term results of YAG laser palliation for incurable colorectal carcinoma in 88 patients. Although initial palliation was achieved in 82%, good palliation could only be maintained in 51% and 41% of patients surviving 6 months and 12 months respectively. The relative inefficacy of YAG laser therapy for palliation of rectal cancer is due to the failure to control extraluminal tumour growth, complications of YAG laser therapy and the poor general condition of these elderly patients. Factors influencing the efficacy of palliation, besides life expectancy, included T classification, and length of the neoplastic stricture. Treatment-related mortality due to perforation was 2.3%. YAG laser therapy, applied as the sole therapeutic modality, is effective for short term palliation of incurable colorectal carcinoma, but is not adequate for long term palliation in most patients. Trials should be conducted to study the effect of combined treatment (e.g. laser + radiotherapy) on palliation.

Aged↗
PubMed1989

Starch digestion in normal subjects and patients with pancreatic disease, using a 13CO2 breath test.

A 13CO2 starch breath test was developed to study starch digestion in 13 healthy volunteers and 16 patients with pancreatic disease. As starch is hydrolyzed to glucose that is subsequently oxidized to CO2, the excretion of 13CO2 after starch intake, compared with the excretion of 13CO2 after glucose intake, should be a measure of starch hydrolysis. In normal subjects both the hourly 13CO2 excretion rate and the cumulative percentage of 13CO2 excretion after starch ingestion were significantly different from those after glucose ingestion. Comparable differences were found with the patient group. In addition, the 13CO2 excretion after starch intake in normal subjects was markedly different from that of patients with pancreatic disease. Even after correction for endocrine pancreatic insufficiency by calculating the ratio of 13CO2 excretion after starch intake over 13CO2 excretion after glucose intake, the difference between the control group and the patient group was statistically significant. This study indicates that starch hydrolysis is the rate-limiting step in starch digestion. It also confirms recent findings suggesting that starch digestion is impaired in some patients with pancreatic disease. The 13CO2 starch breath test may prove to be useful in evaluating the digestibility of various starch preparations in physiologic and pathological conditions.

Adult↗