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Biomedical subjects

P Kerlin

Publications and source records attributed to P Kerlin.

72 records · Page 4Linked to original sources
PubMed1984

Rice flour, breath hydrogen, and malabsorption.

In contrast to the incomplete intestinal absorption of many dietary carbohydrates in healthy humans, it has been suggested that rice flour is completely absorbed. The aims of this study were (a) to confirm efficient absorption of rice flour in healthy individuals, (b) to evaluate a "rice breath hydrogen (H2) test" in the investigation of patients with suspected malabsorption, and (c) to compare H2 results with quantitative fecal fat excretion. The test meal consisted of 100 g of carbohydrate in the form of rice pancakes. End expiratory breath samples were collected at 30-min intervals over 8 h and the H2 concentration was analyzed by gas chromatography. Three-day stool fat collections were performed on a 70-g fat intake. The results of the experiment indicated that healthy controls (n = 23) produced minimal H2 [mean increase (delta) +/- SE] = 6.9 +/- 1.4 parts per million (ppm). Patients with pancreatic disease produced 43.2 +/- 8.0 ppm. Complete or partial correction was achieved in each of 6 subjects with oral pancreatic supplements. Twenty-two patients with a variety of small bowel diseases produced a mean increase of 73.2 +/- 21.4 ppm. Breath H2 excretion was maximal in patients with bacterial overgrowth. Disease controls (n = 10) with diarrhea of colonic origin did not produce significant H2. The sensitivity of the rice-breath H2 test compared favorably with quantitative fecal fat excretion. Within individuals, there was a lack of correlation between breath H2 data (an index of CHO malabsorption) and daily stool weight that reflects the presence or absence of diarrhea. This lack of correlation supports the concept that the endogenous microflora salvage considerable quantities of unabsorbed carbohydrate.

Adult↗
PubMed1983

Rapid intubation of the ileo-colonic region of man.

The relative inaccessibility of the ileo-cecal region of man has restricted study of, and limited the information available on, normal functions of this region. Intubation of the distal bowel from above may be slow, even in the presence of normal patterns of motility in the stomach and small intestine. This report documents that addition of a small balloon at the "lead-point" of the tube alters motor patterns and allows rapid transit to the colon.

Cecal Diseases↗
PubMed1983

Differential transit of liquids and solid residue through the human ileum.

We determined transit of liquids and the solid residue of a mixed meal through the ileocecal region of six healthy men. A multilumen polyvinyl tube was passed from above into a 20-cm segment of terminal ileum, and flow of liquid was assessed by indicator dilution techniques. Three test meals were eaten in random order at 5-hourly intervals. Meal A contained baked beans and polyethylene glycol (PEG 4000). Recovery of PEG 4000 from the ileum served to mark transit of the liquid phase, whereas arrival of solid residue (beans) in the cecum was heralded by a signal of H2 in the breath. PEG 4000 appeared promptly in ileal aspirates, peaking at 1-1.75 h postprandially. Breath H2 excretion was first detected at 1.5-2.5 h after meal A and always peaked later than PEG 4000. When meals shown to be unassociated with generation of breath hydrogen (meals B and C) followed meal A, an augmentation of hydrogen excretion was noted in the early postprandial period. The total volume calculated to pass from ileum to cecum over 24 h was 1,790 +/- 234 ml (range, 1,180-2,515 ml). Ileal flow increased promptly and significantly after each meal (P less than 0.005) and remained high for 3 h or more. These results confirm that, in healthy humans, about 2 liters of chyme pass from ileum to colon each 24 h and ileal flow increases postprandially. They also suggest that the liquid and solid phases of a mixed meal are separate in the ileocecal region.

Adult↗
PubMed1983

Hepatic adenoma and focal nodular hyperplasia: clinical, pathologic, and radiologic features.

Based on strict predefined histologic criteria, we identified 23 patients with hepatic adenoma and 41 patients with focal nodular hyperplasia seen at this institution between 1961 and 1980. Patients with hepatic adenoma were young and 91% were female. When a reliable history was available, 89% had used oral contraceptives; 53% presented acutely or with pain. Eleven of 11 radionuclide scans were abnormal; 15 of 15 angiograms showed a hypervascular mass with 7 of 15 showing areas of hypovascularity. Eighteen resections were performed with one operative death. Two tumors contained areas of unequivocal hepatocellular carcinoma. Fifteen of 18 patients followed for 82 +/- 11 mo were living and well and had discontinued oral contraceptives. Focal nodular hyperplasia patients were older, 88% were female, and 58% had used oral contraceptives. Their lesions were discovered accidentally. Seven of 12 radionuclide scans demonstrated voids, while 13 of 13 angiograms showed hypervascular lesions with no areas of hypovascularity. Seventeen tumors were resected. Twenty-three of 24 patients followed for 45 +/- 7 mo were living and well. One died of nonhepatic causes. Based on the findings of this review, we believe that if the clinical suspicion of hepatic adenoma or focal nodular hyperplasia is strong, elective laparotomy for diagnosis is usually the best approach. Hepatic adenoma should be resected if technically feasible. Intraoperative wedge biopsy is appropriate for focal nodular hyperplasia.

Abdomen↗
PubMed1983

Motor responses to food of the ileum, proximal colon, and distal colon of healthy humans.

Intraluminal pressures and motility indexes were recorded from ileum, ascending colon, rectosigmoid colon, and rectum of 6 healthy men. Three different test meals were eaten at 5-hour intervals. During fasting, migrating motor complexes were identified in the ileum. In ascending colon, irregular, isolated peaks of pressure were common; when bursts of continuous activity occurred, their predominant frequency was 6/min. Regular contractile activity occurred in distal colon at a frequency of 2.5-3.5/min. although 3 subjects also demonstrated rates of 7/min. There were both synchronous and independent contractions of the rectosigmoid and rectum, and no temporal relationship was obvious between motor activities of ascending and distal colons. When the preprandial hour contained no migrating motor complex, all meals increased the ileal motility index by 50%. The motility index of ascending and rectosigmoid colons were enhanced by solid meals, but not by meals containing amino acids. We conclude that motor patterns in the colon vary regionally, both fasting and after food. Results obtained at one site of the large intestine should not be extrapolated to others.

Adult↗
PubMed1982

Variability of motility of the ileum and jejunum in healthy humans.

Motor patterns of the distal small bowel were defined in healthy humans, using a multilumen polyvinyl tube, passed by mouth in 11 healthy subjects. Five recording sites, spanning 100 cm of tube and featuring a nitrogen hydraulic infusion system, were used to obtain records during 6 h of fasting and 6 or more hours after ingestion of a 600-kcal liquid test meal. The loci of recordings were designated as jejunal, ileal, or terminal ileal, as judged by the length of tube within the intestine and by fluoroscopy. During fasting, the migrating motor complex was present in all subjects and at all levels of the small intestine, but it could not be traced into the colon. Interdigestive cycles were defined primarily by the presence of an "activity front" (phase 3 of the migrating motor complex). Ninety-six migrating motor complexes occurred each 97 min (grand mean for all loci), but intervals between individual activity fronts varied markedly (15-195 min), in contrast to what is reported in other species. The velocity of aboral migration was 4.7 +/- 1.8, 1.3 +/- 0.4, and 0.9 +/- 0.2 cm . min-1 (mean +/- SD) in jejunal, ileal, and terminal ileal, respectively. Rates of continuous, rhythmic contractions during activity fronts declined distally: 12.5 to 10.5 (jejunal), 10.9 to 9.3 (ileal), and 10.0 to 8.6 cycle/min (terminal ileal), respectively. In individual subjects, maximum rates of contraction and velocities of migration always declined distally, but the duration of activity fronts was unrelated to the level of recording. Food interrupted the fasting cycles of motility for periods ranging from 2.75 to greater than 10 h. The transition from the fasting to the fed pattern was prompt and the postprandial motility was that of irregular bursts of contractions interspersed with transient quiescence. These studied demonstrate that the migrating motor complex occurs throughout the human small intestine, and that inter- and intraindividual variations are marked; food disrupts the complex for variable periods. These variations must be considered when abnormalities are being sought in disease states.

Adult↗
PubMed1982

Relationship of motility to flow of contents in the human small intestine.

To measure simultaneously motility and flow of intestinal contents, a multilumen polyvinyl tube was passed by mouth in 10 healthy volunteers. Motility was recorded at five sites, spanning 100 cm of tube, to allow recognition of migrating motor complexes during fasting and during their disruption by food. Loci were designated as jejunal, ileal, and terminal ileal, as judged by length of tube in the intestine and by fluoroscopy. Flow of intestinal contents was measured by indicator (phenolsulfonphthalein) dilution over a 20-cm segment; flow was related to motility at the perfusion site. A liquid test meal of 400 ml and 600 kcal, containing polyethylene glycol 4000, was eaten after 6 h of fasting. During fasting, flow of intestinal contents was intermittent at all levels and varied with the presence of or absence of the activity front ("phase 3" of the migrating motor complex). The activity-front periods contributed 50% of total flow, but occupied less than one-third of the total recording time. Flow corrected for time was significantly greater with the presence of activity front than with phases 1 or 2 of the migrating motor complex (p less than 0.001). In addition, of 45 increments in flow of greater than 0.75 ml . min-1, the majority (82%) were associated with an activity front. The flow rate increased promptly after a meal and fluctuated markedly during the postprandial period in most studies. By the time migrating motor complex had returned, more than 90% of meal marker (polyethylene glycol) was accounted for in intestinal aspirates. In contrast, only 56%-73% of marker was recovered postprandially in those studies in which the migrating motor complex had not returned by the time the study was terminated. Thus, flow of intestinal content is largely intermittent during fasting, peaks of flow being associated with passage of the activity front of the migrating motor complex; on the other hand, half the fasting flow is unassociated with the activity front. Reappearance of the migrating motor complex at any level after a liquid test meal signals clearing of the liquid meal from the more proximal intestine.

Adult↗
PubMed1981

Ricinoleic acid causes secretion in autotransplanted (extrinsically denervated) canine jejunum.

To examine the role of extrinsic nerves and hormones in intestinal secretion of fluid, we studied the effect of ricinoleic acid on absorption by isolated, autotransplanted jejunal loops in four dogs. Compared to perfusion with control solution, the addition of ricinoleic acid caused reversible secretion of water and electrolytes and inhibition of glucose absorption, as previously described in the innervated intestine. In contrast, oral castor oil caused diarrhea but had no effect on absorption from the denervated loop. Thus, the secretory action of ricinoleic acid is maintained without the influence of extrinsic nerves; in addition, further support is added to the proposal that hormones do not mediate secretion in this model. These findings support a local mechanism for the secretion induced by ricinoleic acid.

Animals↗
PubMed1981

Renal kallikrein excretion in alcoholic cirrhosis. Relationship to other vasoactive systems.

Severe liver disease is often associated with renal hemodynamic changes, and these changes may involve vasoactive hormones. The vasodilatory renal kallikrein-kinin system has received little previous study in these patients. We measured urinary kallikrein in nine patients with alcoholic cirrhosis under rigid metabolic conditions and simultaneously evaluated renin, aldosterone and urinary prostaglandins. Plasma renin and aldosterone were generally increased as expected but urinary kallikrein was surprisingly diminished (13.3 +/- 3.7 vs. 38.8 +/- 11.1 SE, E.U./day, P less than 0.05), despite adequate creatinine clearance (81 +/- 9 ml./min.). Administration of prostaglandin inhibitors reduced urinary prostaglandin E by 72% and creatinine clearance by 56% but did not alter urinary kallikrein. Mineralocorticoid inhibition by spironolactone induced a natriuresis in four patients with ascites (from 1.4-140 mEq.Na+/day) but also failed to alter kallikrein. Thus, kallikrein excretion is paradoxically reduced and seemingly unresponsive to alterations in the prostaglandin and renin-aldosterone systems. If urinary kallikrein quantitatively reflects intrarenal kallikrein-kinin activity, the impairment in this vasodilatory system may mediate the altered renal hemodynamics of severe liver disease.

Adult↗
PubMed1980

Genetic studies in human and murine giardiasis.

Genetic markers were analysed in 48 adults who appeared to have a prolonged infection with Giardia lamblia. The frequency of ABO blood groups, Rhesus blood groups, and Gm phenotypes was similar to that in control subjects. However, there was a higher than expected frequency of HLA antigens A1 (observed 46 . 7%, expected 32%) and B12 (observed 47 . 8%, expected 25 . 8%) and a higher than expected frequency of the phenotypes A1/A2 and B12/B27. Genetic studies were also performed with inbred strains of mice showing relatively rapid (BALB/c) and defective (C3H/He) spontaneous elimination of Giardia muris. From analysis in backcross mice several genes appeared to influence susceptibility to prolonged infection with G. muris.

Adolescent↗
PubMed1979

Iron deficiency anaemia--a prospective study.

A prospective study was performed over 15 months to determine the cause of iron deficiency in adult males and postmenopausal females attending a general hospital. The laboratory computer identified all subjects with a haemoglobin less than 10.6 g/dl and a mean corpuscular volume less than 86 fl. Patients becoming anaemic after trauma or recent surgery were excluded. The iron status of each patient was assessed by serum iron studies, serum ferritin or sternal marrow aspiration. Reduced red cell indices and blood film morphology were not diagnostic of iron deficiency. Of 215 patients assessed, about half (103) were found to be iron replete. This group had a variety of disorders--malignancy, chronic inflammation, chronic renal and non-malignant haematological diseases. The other group of 104 patients satisfied criteria for iron deficiency, and 100 of these were investigated further. The cause of iron deficiency was found in all but three subjects. Inadequate dietary intake was a contributing factor in over half of the patients and 40 regularly took salicylates. Investigation defined a source of chronic gastrointestinal blood loss in most instances.

Adult↗
PubMed1978

Removal of duodenal foreign body with endoscopic snare.

The extraction of a thermometer wedged in the duodenum, which utilized fibrendoscopic techniques, is described. A brief review of methods which are available to the endoscopist to retrieve ingested foreign bodies is presented.

Aged↗
PubMed1978

The Mallory-Weiss lesion: a five-year experience.

A retrospective survey has been made of patients with the Mallory-Weiss lesion who presented with upper gastrointestinal tract bleeding during the period 1972 to 1976. The lesion was diagnosed endoscopically in 78 cases, representing 7.7% of the total number of patients admitted with upper gastrointestinal tract bleeding. Patients ranged in age from 18 to 86 years (mean 43 years). The male-female ratio was 3:1. A history of retching and vomiting clearly preceded the bleeding in 60 patients. Significant alcohol intake within 48 hours of bleeding was reported in 53% of patients. Other upper gastrointestinal tract conditions, or migraine, may have induced vomiting in some instances. Previously known Mallory-Weiss lesions were rare (two patients), but 21% of patients had well documented past upper gastrointestinal tract bleeding from other causes. The tears were situated at the cardio-oesophageal junction in 47% of patients and were entirely gastric in 30%; 23% were oesophageal. Blood replacement was required in 31 patients (40%), and 16 of these were transfused with five or more units. Of those patients requiring transfusion, half had other significant pathological lesions. The mean hospital stay was four days and prolonged stay in hospital was usually necessary only in the presence of other disease. In no instance was surgery required primarily to control bleeding from mucosal tears. This study suggests that the Mallory-Weiss lesion is a relatively common cause of upper gastrointestinal tract bleeding, but that it is usually a benign condition, unless it complicates some other disorder.

Adolescent↗
PubMed1978

Prevalence of Giardiasis: a study at upper-gastrointestinal endoscopy.

The prevalence of giardiasis was assessed in 1000 consecutive adult patients undergoing upper-gastrointestinal endoscopy for the usually accepted indications. Patients with upper-gastrointestinal bleeding were excluded. The diagnosis was established by examination of duodenal aspirate and duodenal mucosal impression smears. In 21 patients (2.1%) trophozoites were detected both in the duodenal juice and stained mucosal impression smears. All were treated with metronidazole or tinidazole. In 14 of 16 patients who had subsequent duodenal intubation, eradication of the parasite was confirmed. In five patients previously existent abdominal pain disappeared with clearing of the parasite, and no other cause for their abdominal pain was discovered. A search for Giardia lamblia infestation may be a worthwhile additional procedure at the time of endoscopy when no other cause for abdominal pain is found.

Abdomen↗
PubMedDate not supplied

Radiolabelled unprocessed bran: validation of a practical labelling technique and evaluation of gastrointestinal transit profiles in health.

Using a radiolabelled bran preparation, a large field of view gamma-camera and a computer, a method has been developed to define and analyse the gastrointestinal transit profile of solids. Unprocessed bran, labelled with technetium (99mTc) sulphur colloid is incorporated into biscuits cooked in a microwave oven. With this preparation, less than 3.4% of the isotope dissociated from the bran in a gastric milieu, and more than 90% of recovered radionuclide activity, were retained with the solid phase during small intestinal transit in subjects with stable ileostomy function. A normal range for gastric emptying (GE), small intestinal transit (IT) and colonic filling (CF) was established in 15 healthy volunteers. Anterior and posterior images were taken until all isotope was present in the colon. Using regions of interest for the stomach and colon, decay corrected geometric mean curves for GE and CF were generated. GE was characterized by a lag phase followed by a linear emptying phase. The GE profile (mean and standard deviation) was described by 'power exponential' parameters of half-emptying time (1.6 +/- 0.4 h) and beta (1.5 +/- 0.2). The IT time was 3.9 +/- 1.5 h. The onset of CF was determined visually (4.1 +/- 1.5 h), and the time of 50% CF filling was determined from the colonic filling curve (5.5 +/- 1.4 h). This technique should provide a useful, practical, clinical and research test to study the pathophysiology and pharmacology of intestinal motor disorders.

Adult↗
PubMedDate not supplied

Child-Pugh class, nutritional indicators and early liver transplant outcomes.

BACKGROUND/AIMS: Patients with chronic liver disease undergoing liver transplantation have reduced body fat and muscle mass. The extent to which nutritional indicators and Child-Pugh class are predictive of postoperative outcome in adults is unclear. The aims of this study were to determine in adult patients undergoing transplant 1) the influence of preoperative Child-Pugh class and nutritional indicators on early transplant outcomes and one-year survival, 2) the relationship between nutritional indicators and Child-Pugh class and disease type. This study included 80 patients (1990-1994). METHODOLOGY: The nutritional indicators utilized were grip strength, triceps skinfold thickness and uncorrected mid-arm muscle area. Measured outcomes were ventilator time, intensive care stay, postoperative hospital stay and one-year survival. RESULTS: Early morbidity was determined in survivors. Child-Pugh class C patients required longer ventilation and spent more time in the intensive care unit than Child-Pugh classes A and B. No significant relationships were found for length of hospital stay. Relationships between the nutritional indicators (when controlled for Child-Pugh class) and early morbidity could not be determined due to insufficient data. No relationship was established between one-year survival and Child-Pugh class or the nutritional indicators. Grip strength and mid-arm muscle area were lower in the patients in Child-Pugh classes B and C. Parenchymal liver disease was associated with lower grip strength and mid-arm muscle area when compared to cholestatic disease. CONCLUSIONS: Child-Pugh class C is associated with greater early postoperative morbidity. Advanced Child-Pugh class is also associated with diminished muscle status and parenchymal disease.

Adolescent↗