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Biomedical subjects

M Horowitz

Publications and source records attributed to M Horowitz.

At least 235 records · Page 13Linked to original sources
PubMed1996

Hyperglycaemia affects proximal gastric motor and sensory function in normal subjects.

OBJECTIVE: Hyperglycaemia delays gastric emptying in normal subjects and patients with diabetes mellitus by uncertain mechanisms and may affect the perception of somatic sensations. The effects of hyperglycaemia on the motor function of the proximal stomach and the perception of gastric distension were evaluated in normal subjects. DESIGN: Paired studies were performed in randomized order in 10 healthy volunteers on separate days during euglycaemia and hyperglycaemia (blood glucose approximately equal to 15 mmol/l). METHODS: With a barostat and a balloon positioned in the proximal stomach, tasting subjects underwent a stepwise gastric distension. Each 2 mmHg step was maintained at a constant pressure for 2 min. The volume of the barostat balloon was measured and perception of the sensations of fullness, desire to belch, nausea, abdominal discomfort and hunger was scored at each step. RESULTS: Hyperglycaemia was associated with an increase in proximal gastric compliance (P < 0.01) evident from 2 mmHg above basal intragastric pressure. Perception scores for the sensations of nausea and desire to belch were greater during hyperglycaemia than euglycaemia (P < 0.05) in relation to both pressure at each step and volume. Hyperglycaemia did not affect perception of the sensations of abdominal discomfort, fullness or hunger. CONCLUSIONS: Hyperglycaemia increases proximal gastric compliance, reflecting a reduction in gastric tone. This may contribute to the previously observed delay in gastric emptying associated with hyperglycaemia. Hyperglycaemia appears to increase the perception of some of the sensations induced by gastric distension.

Abdominal Pain↗
PubMed1996

Disturbances in anorectal function in patients with diabetes mellitus and faecal incontinence.

OBJECTIVE: The pathophysiology of faecal incontinence in diabetes mellitus is poorly understood. The study was designed to document the anorectal dysfunctions in diabetic patients with faecal incontinence. METHODS: Multiport anorectal manometry and electromyography were done in 11 diabetic patients with faecal incontinence and in 20 healthy controls. RESULTS: Basal and squeeze pressures were reduced (P < 0.05) in the diabetic patients compared with the control subjects. During basal recording six patients showed regular oscillations in anal electrical activity and pressure with an amplitude of 10-40 (median: 25) cmH2O and a frequency of 6-10 (median: 8) min-1. Nine patients also exhibited spontaneous transient anal relaxations with an amplitude of 15-50 (median: 40) cmH2O and a duration of 15-720 (median: 60)s, and in six of them leakage occurred as the anal pressure fell below the rectal pressure. None of the control subjects showed oscillation or spontaneous relaxations. In patients there was a greater tendency for repetitive rectal contractions in response to rectal distension and reduced rectal compliance (P < 0.01). During rectal distension four patients showed no anal relaxation, and in the remainder relaxation occurred at an abnormally high threshold. However, the residual pressures were lower (P < 0.05) than in control subjects and often fell below rectal pressure, whereupon leakage occurred. There was no significant difference in the distension thresholds for rectal sensation between patients and control subjects, but in 9/11 patients the perception of rectal sensation was delayed by more than 2s (P < 0.05). CONCLUSION: These results indicate that aetiology of faecal incontinence in diabetic patients is multifactorial and, suggest for the first time, that instability of the internal sphincter probably plays a major role.

Adult↗
PubMed1996

Effects of glyceryl trinitrate on the pyloric motor response to intraduodenal triglyceride infusion in humans.

The retardation of gastric emptying induced by infusion of triglyceride into the small intestine is associated with suppression of antral pressure waves and stimulation of basal pyloric tone in combination with phasic pressure waves localized to the pylorus. The role of nitric oxide (NO) mechanisms in the control of pyloric motility was evaluated in 12 healthy male subjects (21-43 years), using the NO donor glyceryl trinitrate (GTN). Antropyloric pressures were measured with a manometric assembly incorporating nine sideholes, spanning the antrum and proximal duodenum, and a pyloric sleeve sensor. On separate days, an intraduodenal triglyceride infusion (10% intralipid at 1 mL min-1) was started during antral phase I activity and continued for 60 min. On one of the days GTN (600 micrograms) was given sublingually 20 min after start of the triglyceride infusion. The tonic pyloric motor response to triglyceride [5.6 (SEM 0.8,) vs. 2.7 (1.3) mmHg, P < 0.001] and both the number 3.2 (0.2) vs. 2.2 (0.2) min-1, P < 0.05] and amplitude [40 (4) vs. 27 (5) mmHg, P < 0.05] of phasic isolated pyloric pressure waves were reduced by GTN. These observations suggest that NO mechanisms are involved in the regulation of pyloric motor activity in humans.

Adolescent↗
PubMed1996

Effects of mediastinal irradiation on oesophageal function.

Although it is well recognised that oesophageal symptoms are common during therapeutic mediastinal irradiation of intrathoracic malignant diseases, the effects of mediastinal irradiation on oesophageal function are poorly defined. To clarify the pathogenesis of these sequelae a prospective study was performed to document comprehensively the effects of mediastinal irradiation on oesophageal function. Oesophageal symptoms, barium swallow, endoscopy, and combined radionuclide scintigraphy and oesophageal manometry were evaluated in eight patients with potentially curable intrathoracic malignant disease before treatment, during the last week of mediastinal irradiation, and six to eight weeks after its completion. Before irradiation, structural abnormalities were excluded by barium swallow and endoscopy. All but one patient experienced odynophagia or dysphagia, or both, during mediastinal irradiation (p < 0.001) but endoscopic abnormalities were observed in only three patients and there was no correlation between oesophageal symptoms and endoscopic changes. Irradiation, however, had no significant effect on oesophageal motility or transit. It is concluded that oesophageal symptoms which develop during mediastinal irradiation are not a result of altered oesophageal motility or transit and may reflect increased mucosal sensitivity.

Aged↗
PubMed1996

Effects of cisapride on gastric emptying of oil and aqueous meal components, hunger, and fullness.

To evaluate the effects of cisapride on gastric emptying of extracellular fat and hunger and fullness 10 volunteers consumed a meal consisting of 60 ml technectium-99m (99mTc)-V-thiocyanate labelled olive oil and 290 ml indium-113m (113mIn) labelled soup after taking cisapride (10 mg four times daily orally) and placebo, each for four days, in randomised, double blind fashion. Gastric emptying was quantified scintigraphically. Hunger and fullness before and after the meal were evaluated using visual analogue scales. Cisapride accelerated gastric emptying of oil and aqueous components by reducing the lag phase mean (SEM) (20.3 (7.0) min v 40.7 (4.1) min (p < 0.05) for oil and 4.1 (2.5) min v 10.0 (3.1) min (p < 0.05) for aqueous). Cisapride had no effect on the post-lag emptying rate of oil. Treatment with cisapride was associated with reduced retention of oil in the proximal stomach (p < 0.05). Subjects were more hungry before ingestion of the meal while receiving cisapride (6.7 (0.9) v 3.9 (0.7), p < 0.001). The scores for hunger at 120 and 180 minutes were inversely related to gastric emptying of oil on both cisapride (r > -0.62, p < 0.05) and placebo (r > -0.86, p < 0.001). Fullness increased after the meal while receiving placebo (p < 0.01), but not cisapride and postprandial fullness was less with cisapride at (30 min; 0.4 (0.3) v 3.3 (1.0), p < 0.05). With placebo, but not cisapride, the score for fullness at 15 minutes was inversely related to emptying of the aqueous phase (r = 0.68, p < 0.05). These results show that in normal volunteers after ingestion of an oil/aqueous meal: (a) postprandial hunger is inversely related to gastric emptying of oil, while fullness is inversely related to gastric emptying of the aqueous phase, (b) cisapride affects the intragastric distribution and accelerates gastric emptying of both oil and aqueous meal components, and (c) cisapride increases preprandial hunger and reduces postprandial fullness.

Adolescent↗
PubMed1996

Scintigraphic measurement of gastric emptying and ultrasonographic assessment of antral area: relation to appetite.

BACKGROUND: Ultrasound measurement of gastric emptying has potential advantages over scintigraphy, but there is little information about its accuracy. AIMS: The relation between ultrasonographic measurements of antral area and (a) scintigraphic measurements of gastric emptying and intragastric distribution of liquids (b) postprandial satiation, were evaluated. SUBJECTS: Seven normal volunteers were studied. METHOD: Each subject drank 75 g dextrose dissolved in 350 ml of water (300 kcal) or beef soup (20 kcal), both labelled with technetium-99m sulphur colloid on separate days and had measurement of gastric emptying by scintigraphy and ultrasound. RESULTS: Scintigraphic and ultrasound 50% emptying times (T50s) were comparable and longer (p < 0.001) for dextrose than soup mean (SEM) (dextrose 107 (16) min v 108 (18) min, soup 24 (4) min v 23 (5) min). There were close correlations between scintigraphic and ultrasound T50s (dextrose r = 0.94, p < 0.005, soup r = 0.97, p < 0.001) and between the time at which the distal stomach content decreased from its maximum value by 50% (measured scintigraphically) and the ultrasound T50 (dextrose r = 0.95, p < 0.005, soup r = 0.99, p < 0.0001). In contrast, there was no significant relation between the distal stomach content when expressed as a percentage of the maximum content in the total stomach and the ultrasound T50. After dextrose, fullness was related (r = 0.92, p < 0.01) to the postprandial increase in antral area measured by ultrasound. CONCLUSIONS: Ultrasound measurements of gastric emptying are: (a) of comparable sensitivity to scintigraphy in quantifying emptying of both low and high nutrient liquids (b) correlate with postprandial satiation, suggesting that the latter may be mediated by antral distension.

Adult↗
PubMed1996

Appetite regulation by carbohydrate: role of blood glucose and gastrointestinal hormones.

To investigate the mechanisms by which intestinal carbohydrate affects eating behavior, seven fasted, healthy male volunteers received intraduodenal infusions of glucose or saline over a 90-min period while blood glucose levels were matched by use of intravenous glucose and saline infusions. A second study examined the effect of intraduodenal glucose on eating behavior when the gastrointestinal hormone response was inhibited by intravenous octreotide. Intravenous glucose infusion did not affect hunger or satiety. In contrast, intraduodenal infusion of glucose suppressed hunger, increased fullness and satiety ratings, reduced energy intake, and resulted in higher plasma insulin responses compared with the intravenous glucose infusion. Octreotide abolished the plasma insulin response to intraduodenal glucose and reversed the changes in ratings and eating behavior. This study has shown that the effects of intestinal glucose on appetite are not mediated via an increase in blood glucose but are likely to reflect small intestinal stimulation of release of either insulin or intestinal incretins.

Adult↗
PubMed1996

Effects of increasing solid component size of a mixed solid/liquid meal on solid and liquid gastric emptying.

This study evaluated the hypothesis that an increase in the volume of the solid component of a mixed solid/nutrient liquid meal will result in more rapid emptying of the solid but slower liquid emptying. Eight normal volunteers were studied on two occasions after ingesting a meal containing 150 ml of 10% dextrose with either 100 g(small) or 400 g (large) of ground beef. Subjects ingested the solid component before the liquid. For the solid component, the lag phase was longer for the larger meal (56 vs. 31 min, P < 0.001). However, the absolute emptying rate for the proximal stomach and the postlag emptying rate of solid from the total stomach, when expressed as kilocalories per minute, were greater with the larger meal (P < 0.002). The lag phase was prolonged (P < 0.03) and the rate of emptying of liquid from the total and proximal stomach was slower (P < 0.001) in the large compared with the small meal. The total amount of energy delivered to the duodenum (from solid and liquid components) after the solid lag phase was greater for the larger meal (4.8 vs. 2.5 kcal/min, P < 0.002). These results indicate that an increase in the volume of the solid component of a mixed solid/liquid meal 1) prolongs the lag phase but accelerates the postlag emptying rate of solid and 2) retards intragastric distribution and emptying of liquid.

Adult↗
PubMed1996

Hyperglycemia affects proximal gastric motor and sensory function during small intestinal triglyceride infusion.

Hyperglycemia slows gastric emptying in normal individuals and patients with diabetes mellitus and may affect both somatic and visceral sensation. The effects of hyperglycemia on proximal gastric motility and sensation during intraduodenal infusion of a triglyceride emulsion were evaluated using a barostat in six normal subjects during euglycemia and hyperglycemia (approximately 15 mmol/l). Isobaric distension induced greater bag volumes during hyperglycemia compared with euglycemia at 3 (452 +/- 26 vs. 343 +/- 12 ml, P < 0.05) and 4 mmHg (600 +/- 55 vs. 497 +/- 50 ml, P < 0.05) above basal pressure. During isovolumetric distension, intrabag pressure was less during hyperglycemia at 500 (2.5 +/- 0.3 vs. 3.5 +/- 0.5 mmHg above basal pressure, P < 0.05) and 600 ml (3.0 +/- 0.4 vs. 4.5 +/- 0.5 mmHg above basal pressure, P < 0.05). Perception of nausea (P < 0.05) and fullness (P < 0.05) was increased during hyperglycemia compared with euglycemia. We conclude that hyperglycemia 1) reduces proximal gastric tone during intraduodenal triglyceride infusion, an effect that may contribute to delayed gastric emptying, and 2) increases the intensity of nausea and fullness during intraduodenal triglyceride infusion and proximal gastric distension, indicative of an effect on visceral sensation.

Adult↗
PubMed1996

Evidence for contribution of effector organ cellular responses to the biphasic dynamics of heat acclimation.

The involvement of cellular processes in the biphasic dynamics of heat acclimation was studied. Key steps in the cholinergic signal transduction pathway for water secretion were measured in the submaxillary gland of acclimating [2-day short-term heat acclimation (STHA) and 30-day long-term heat acclimation (LTHA) at 34 degrees C] or acute heat-stressed (2 h at 40 degrees C) rats in vitro. Both the carbamylcholine (CCh)-induced maximal fractional rate and the total 86Rb+ efflux, reflecting K+ efflux and water transport, transiently decreased in STHA (P < 0.001). In LTHA, the total K+ efflux increased (P < 0.001), whereas the maximal fractional rate of efflux increased only slightly. During STHA, the density of the high-affinity binding site of the muscarinic receptors (MRs) increased by 50% and their affinity for the muscarinic antagonist [3H]-N-methylscopolamine decreased transiently by 87%. Basal cytosolic Ca2+ concentration ([Ca2+]i) decreased (P < 0.05), but the peak CCh-induced [Ca2+]i increase resembled the control values. In LTHA, MR density continued to increase (100%; P < 0.05), whereas affinity resumed control values. Basal and CCh-induced [Ca2+]i increases returned to control levels. We conclude that glandular cellular processes follow a biphasic pattern with major apparent changes attributable to events distal to the [Ca2+]i rise. This was further validated by employing heat stress, which produced qualitatively different effects on the MR profile with a decrease in 86Rb+ efflux comparable to STHA. Hence, although heat-induced changes in the proximal components of the signal transduction pathway may contribute to altered regulatory span, the predominant apparent cellular effect is on the distal part of the pathway.

Acclimatization↗
PubMed1996

Assignment of the human prosaposin gene (PSAP) to 10q22.1 by fluorescence in situ hybridization. Giraffidae, okapi (Okapiajohnstoni), and giraffe (Giraffa camelopardalis): evidence for ancestral telomeres at the okapi polymorphic rob (4;26) fusion site.

The human prosaposin gene (PSAP) was previously localized to 10q21-->q22 by isotopic in situ hybridization using a human prosaposin cDNA as a probe. The present study, using fluorescence in situ hybridization with a mouse genomic prosaposin fragment as probe, confirms the localization of PSAP and precisely maps it to band 10q22.1.

Animals↗
PubMed1996

An unusual presentation of adult Wilms' tumor.

Wilms' tumor (nephroblastoma), a primary renal neoplasm containing primitive blastema and embryonic glomerulotubular structures, is the most common malignant tumor of the urinary tract in children. There have been about 240 cases of adult Wilms' tumor reported in the world literature, however due to some differences in histologic findings, many cases have been reclassified as rhabdoid or clear cell sarcomas, both of which are recognized as separate entities. We report a case of an adult Wilms' tumor and discuss the clinical, radiographic and histologic features of this tumor.

Female↗
PubMed1996

Self-regard: a new measure.

OBJECTIVE: The status of patients and research subjects is usually considered in terms of self-reported symptoms. Measures seldom include disturbances in a conscious sense of the self. An additional brief measure of the sense of current self-regard is desirable, since a conscious lapse in an integrated self-concept may occur under stressful circumstances. The authors constructed and tested such a measure. METHOD: Clinical interviews had indicated five common experiences that occurred more frequently as complaints during stress-induced regressions in the sense of the self as a functioning mind-body agency. An anchored five-item scale, the Self-Regard Questionnaire, was constructed and tested with 79 subjects who were in the midst of grief from the death of a spouse. Data analyses included checks on the internal coherence of questionnaire scale scores and their association with symptom, personality, and social desirability measures. RESULTS: The five-item Self-Regard Questionnaire was completed quickly, in less than a minute, and led to internally consistent and unique data. Low levels of overall self-regard were correlated with higher levels of distress and predicted prolonged distress. CONCLUSIONS: These results suggest that the questionnaire is a useful, quick, and easy-to-score self-report tool for assessing, and reassessing over time, current experiences of the self. The five questions may also be useful to clinicians who evaluate patients in contexts other than research.

Adult↗
PubMed1996

Aging and bone metabolism in African American and Caucasian women.

There is limited information concerning bone mineral density (BMD) and its determinants across a wide spectrum of ages in African American females (AAF). Therefore, we have performed a cross-sectional study of 54 AAF and 39 Caucasian females (CF), aged 20-90 yr, to quantify femoral and lumbar bone mineral density, total body calcium, as well as the potential determinants of bone density. BMD decreased with age in all sites after age 40 yr in both racial groups. Bone density was greater in AAF than in CF, although there was considerable overlap between the two groups. There was no significant difference in the rate of age-related bone loss between the two groups. At the femoral neck, BMD was below the fracture threshold in 28% of the postmenopausal AAF compared to 47% of postmenopausal CF. L1-L4 BMD was below the fracture threshold in 8% of postmenopausal AAF and 11% of postmenopausal CF. Serum-25 hydroxyvitamin D (25OHD) was inversely related to age in both othnic groups and lower (P < 0.05) in premenopausal AAF than CF. Twenty-four percent of the AAF and 22% of the CF had serum 25OHD levels of 8 ng/L or less. Serum PTH was directly related to age (r = 0.43; P = 0.003 in AAF and r = 0.55; P = 0.002 in CF), and 25OHD was inversely related to age (r = -0.43; P = 0.003 in AAF and r = -0.65; P < 0.001 in CF). PTH was higher (P < 0.05) in postmenopausal AAF than in CF. Serum testosterone was greater in AAF than in CF (P < 0.05). Serum estradiol was greater in premenopausal AAF than in CF. Serum dehydroepiandrosterone sulfate was inversely related to age (r = 0.42; P = 0.004 in AAF and r = 0.51; P = 0.005 in CF). Serum osteocalcin was related to age in AAF (r = 0.47; P = 0.001), but not in CF. There was also a trend for an increase in urinary dipyridinoline (expressed per 100 mg urinary creatinine) with age (r = 0.31; P = 0.055 in AAF and r = 0.37; P = 0.066 in CF). Both lean and fat mass were major determinants of femoral neck BMD in AAF. Femoral BMD was directly related to body weight and body mass index in both races. Serum 25OHD and dehydroepiandrosterone sulfate approached statistical significance as independent predictors of femoral BMD in AAF. We conclude that in AAF, 1) bone density is higher than in CF, but there is a significant risk of fracture in a substantial number of subjects on the basis of BMD; 2) there is no difference in rates of age-related bone loss compared to those in CF; 3) both lean and fat mass are significant determinants of bone density; 4) serum estradiol and testosterone were higher than those in CF; and 5) aging is associated with increased bone turnover, 25OHD deficiency, and secondary hyperparathyroidism in both races. The absence of a difference in rates of bone loss between AAF and CF despite higher serum levels of PTH is compatible with the concept of a relative skeletal resistance to PTH in AAF.

Adolescent↗
PubMed1996

Heat acclimation: cardiovascular response to hot/dry and hot/wet heat loads in rats.

Body temperature, blood pressure (BP) and heart rate (HR) of rats before and after acclimation to heat were studied in chronically cannulated sedentary conscious rats in different hot environmental conditions [hot/dry: 40 degrees C, 20% relative humidity (RH) and hot/wet: 35 degrees C, 70% RH]. During exposure to heat stress, acclimated rats showed an attenuated increase in colonic temperature (Tc) compared to non-acclimated rats. Concomitantly, an abrupt decrease in HR, delayed and attenuated elevation in mean arterial BP and improved cardiac efficiency were recorded. Differences were observed upon exposure to the hot/wet and hot/dry climates: the hot/dry climate imposed a greater physiological burden than the hot/wet climate. The data suggest that for sedentary rats dry heat produces a greater load than humid heat. Thus, the conventional heat load indices do not apply universally but have a thermoregulatory pattern specificity.

Acclimatization↗
PubMed1996

Hyperglycemia affects cardiovascular autonomic nerve function in normal subjects.

OBJECTIVE: To evaluate the effect of acute hyperglycemia on autonomic nerve function in normal subjects. RESEARCH DESIGN AND METHODS: Six healthy volunteers ages 19-32 years underwent paired studies during euglycemia (blood glucose 5.1 +/- 0.04 mmol/l) and hyperglycemia (blood glucose 15.7 +/- 0.48 mmol/l) induced by intravenous infusion of glucose and maintained for 150 min. The order of the two studies was randomized. In each experiment, supine heart rate, heart rate variation with respiration, ratio of the maximum to minimum R-R interval after standing ("30:15" ratio), systolic blood pressure response to standing, and diastolic blood pressure response to sustained handgrip were measured. Data were analyzed using repeated measures analysis of variance. RESULTS: The supine heart rate was greater (P = 0.04) and the "30:15" ratio less (P = 0.03) during hyperglycemia than during euglycemia. Hyperglycemia had no significant effect on any of the other cardiovascular reflex tests. CONCLUSIONS: These observations indicate that acute hyperglycemia affects autonomic nerve function in healthy humans.

Adult↗
PubMed1996

Demucosalized augmentation gastrocystoplasty with bladder autoaugmentation in pediatric patients.

PURPOSE: Potential metabolic complications in urinary reconstruction with bowel or stomach are due to the presence of the gastrointestinal mucosal layer. The advantage or disadvantage of each tissue has been debated. We report a procedure in which the mucosa of a gastric pedicle flap is removed and the remaining muscularis flap is transferred to an autoaugmented bladder. MATERIALS AND METHODS: Seven female and 4 male patients underwent the procedure at our institutions from October 1992 to November 1994. A retrospective chart review was performed to compare preoperative to postoperative urodynamic findings, continence status and complications. RESULTS: Mean followup was 23 months (range 8 to 33). Preoperative urodynamics showed an average bladder capacity of 109 cc (range 45 to 200) and compliance of 3 ml./cm. water (range 1 to 6). Urinary continence was achieved in 10 patients on clean intermittent catherization every 3 to 4 hours and 1 was wet due to low urethral resistance. All patients underwent postoperative urodynamics. Bladder capacity increased to 236 cc (range 150 to 300) with an average compliance of 9 ml./cm. water (range 5 to 14). No metabolic complications were noted. CONCLUSIONS: The gastric muscularis appears to be preserved along with the native urothelium to provide a compliant tissue that can be an alternative to bowel and stomach for bladder augmentation. Because the procedure involves demucosalizing the gastric patch as well as performing bladder autoaugmentation, operative time is increased compared to normal gastrocystoplasty or enterocystoplasty. However, the lack of metabolic complications and mucus-free urine are important considerations and substantial advantages.

Adolescent↗