Biomedical subjects
Publications and source records attributed to P Peter.
Left hemiparkinsonism was the first symptom of increased intracranial pressure in a 14-year-old girl. The parkinsonism resolved when the increased intracranial pressure was relieved by a ventriculo-peritoneal shunt. This is the first case of parkinsonism associated with hydrocephalus caused by non-neoplastic aqueductal stenosis.
A total of 1512 hospital patients was screened by ultrasound to evaluate the prevalence of asymptomatic gallstones. Before ultrasound examination each patient filled in a form about his or her symptoms. In 1122 subjects no gallstones were found. 134 subjects had been cholecystectomized, 165 subjects had symptomatic and 91 subjects had asymptomatic gallstones, respectively. An asymptomatic gallstone was prospectively defined being "silent" when no abdominal complaints had occurred. Women had gallstones or cholecystectomy twice as often as men. 34% of the gallstones in men and 36% of the gallstones in women being asymptomatic. Seventy nine percent of the subjects with an asymptomatic stone did not know about their gallstones. The fraction of subjects with gallstones or cholecystectomy and the fraction of gallstones being asymptomatic, both increased with age. Nausea occurred in 5% of the subjects with asymptomatic gallstones, but in 39% of those with symptomatic gallstones or cholecystectomy. Subjects with asymptomatic gallstones complained about food intolerance significantly less often than subjects with symptomatic gallstones or subjects after cholecystectomy.
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In a retrospective study the reliability of ultrasound and computed tomography was compared and evaluated using the subsequent intraoperative findings. The analysis comprised ultrasound and computed tomography data of 111 consecutive patients in whom both investigations were performed within one week and whose diagnoses could be ascertained intraoperatively within two weeks. The correct diagnosis was made preoperatively in 80 out of 111 patients by ultrasound (sensitivity 72%) and in 95 out of 111 patients by computed tomography (sensitivity 85%). The results show that computed tomography is superior to ultrasound in preoperative diagnosis of intraabdominal diseases (P less than 0.025). In particular, liver and adrenal tumours and diseases of the air-filled gastrointestinal tract can be diagnosed more reliably preoperatively by computed tomography than by ultrasound.
The target appearance of grey scale ultrasound is thought to be a characteristic sign of gastrointestinal wall thickening. It consists of a strong echogenic center surrounded by a sonolucent rim. In a prospective controlled study, the sensitivity and specificity of the ultrasonic B-scan for Crohn's disease were investigated. Fifty-one patients with Crohn's disease and 124 control subjects were studied. Sensitivity and specificity of the ultrasonic target appearance for Crohn's disease were 76% and 88%, respectively. When additional ultrasonic signs of inflammatory bowel disease were considered, sensitivity and specificity rose to 84% and 91%, respectively. Both colon and ileum were affected in 85% of the true-positive and in 8% of the false-negative targets. The Crohn's disease activity index was 213 +/- 136 in patients with true-positive targets and 167 +/- 118 in patients with false-negative target appearances. Most false-positive target phenomena arose from gastrointestinal tumors. It is concluded that ultrasound is a suitable complementary method for the detection of Crohn's disease.
It has been speculated that impaired salivary flow and contents contribute to abnormal acid clearance in patients with reflux esophagitis. To test this hypothesis, salivary secretion of volume, bicarbonate, and N-acetylneuraminic acid was measured in patients with reflux esophagitis, in age- and sex-matched controls, and in healthy young volunteers. Resting saliva was collected by permitting the saliva to drip into a flask every 30 s. Parotid saliva was collected by means of a Lashley capsule during stimulation by oral infusion of 1 ml/min of 2% citric acid. Total mixed saliva was collected by a dental sucker during esophageal perfusion with water and 10-mM hydrochloric acid. The volume of resting saliva and its concentration of bicarbonate were similar in the three groups. The concentration and the output of N-acetylneuraminic acid were higher in the young volunteers than in the two other groups. The volume flow and the composition of stimulated parotid saliva were similar in the three groups of subjects. Volume of total mixed saliva and concentration of bicarbonate and N-acetylneuraminic acid during esophageal perfusion with water were higher in patients with reflux esophagitis than in age- and sex-matched controls and were similar to the values found in young healthy volunteers. Acid perfusion increased the secreted volume of total mixed saliva by 150% and the concentration of bicarbonate by 30% in healthy young volunteers, but not in patients with reflux esophagitis and in the healthy age- and sex-matched controls; the concentration of N-acetylneuraminic acid was left unaffected by acid perfusion in all three groups. These findings disprove the hypothesis of impaired salivation in reflux esophagitis. The age-related loss of salivary response to acidic esophageal perfusion might be the reason why reflux esophagitis with peptic lesions affects predominantly elder people.
In a prospective study the reliability of the sonographic diagnosis of hepatic cirrhosis and metastases was investigated in 101 patients. Sonographic diagnoses were checked by laparoscopy. Hepatic cirrhosis was accurately diagnosed in 78% of the cases and hepatic metastases were correctly diagnosed in 92% of cases. The absence of cirrhosis or metastases was correctly recognised in 93% and 98%, respectively. The sonographic diagnosis of liver cirrhosis is based on five criteria: convexity of the ventral surface, caudal margin greater than 45%, rigid contours on palpation diffuse density of the internal structure, and splenomegaly. The most important criterium for the diagnosis of metastases is the presence of circumscribed contour changes. In 32 patients with cirrhosis and in 12 patients with metastases one diagnosis was incorrect. Thus sonography has a high accuracy in the diagnosis of hepatic cirrhosis and metastases.
Predictors of duodenal ulcer healing and relapse were examined in a population known to have a high healing incidence. Two double-blind prospective studies were performed in 134 patients over 4 wk and in 66 patients over 1 yr, respectively. Short-term treatment consisted either of cimetidine 1 g/day, pirenzepine 75 mg/day, or placebo. In a multiple stepwise linear regression analysis the following factors proved to increase healing incidence in decreasing order of importance: female sex, moderate alcohol consumption, abstinence from smoking, young age, and cimetidine treatment. The following factors had no influence on duodenal ulcer healing: number and total area of peptic lesions, concomitant disease, relatives with duodenal ulcer, duration of duodenal ulcer disease, and status as a migrant worker. In the long-term study, treatment consisted either of cimetidine 400 mg at bedtime, pirenzepine 30 mg at bedtime, or placebo. Cimetidine prevented ulcer relapse. Smoking favored duodenal ulcer relapse in the placebo group, but not in the cimetidine and pirenzepine group. For all the other factors no statistically significant effect was found. It is concluded that in a population with high spontaneous healing incidence (a) factors other than drug treatment such as sex, alcohol intake, smoking, and age are at least as important predictors of the outcome of short-term treatment as the drug treatment itself; (b) moderate alcohol intake might favor ulcer healing; (c) the unfavorable effect of smoking on ulcer relapse is overcome by low-dose, long-term, antisecretory treatment.
The effect of long-term prophylaxis of duodenal ulceration with cimetidine was tested in a double blind trial. In 20 patients treated with cimetidine there was a four-fold reduction in the relapse rate when compared with 18 placebo-treated patients. However, treatment of the acute phase of ulceration with cimetidine increased the recurrence rate more than five-fold when compared with placebo treatment. Slow healing of ulceration was followed by a two-fold incidence of recurrence when compared with rapid healing. From the results it is concluded that recurrence occurs in patients after slow healing and (or) previous cimetidine treatment if long-term prophylaxis with cimetidine is not carried out.
In a double-blind trial of patients with duodenal ulcer at three centres the healing rate after a four-week course of treatment (1 g cimetidine daily) was 79% (30 out of 38 patients), compared with 58% (23 out of 40 patients) on placebos. Cimetidine did not effect subjective symptoms or the need for antacids to relieve pain, except for a minor beneficial effect on diurnal ulcer symptoms during the second week of treatment. Results of long-term administration suggest that cimetidine at 400 mg daily prevent s relapses, but the possibility of an increased relapse rate after cimetidine withdrawal can not as yet be excluded.
Transneuronal degeneration in secondary brainstem auditory nuclei has been described following cochlear lesions, and Marchi studies have revealed degeneration in the trapezoid body after such lesions. These findings support the view of some early neuroanatomists that primary auditory afferents project beyond the cochlear nuclei. Silver impregnation studies of degenerating cochlear afferents have failed to support this claim, leaving the question unresolved. Using [3H] amino acids auditory projections in the monkey were traced autoradiographically from labeled ganglion cells: (1) in all portions of the spiral ganglion, (2) in apical and middle turns of the cochlea and (3) primarily in the basal turn of the cochlea. Labeling of the entire spiral ganglion resulted in profuse transport of isotope to parts of all cochlear nuclei [anteroventral (AVCN), posteroventral (PVCN), and dorsal (DCN) cochlear nuclei]. Labeled axons entering the trapezoid body (TB) projected ipsilaterally to: (1) the lateral trapezoid nuclei (LTN), (2) the lateral superior olivary nucleus (LSO), (3) the dorsal dendritic zone of the medial superior olivary nucleus (MSO), and (4) the pericollicular or cortical nucleus of the inferior colliculus (IC). Auditory fibers crossing the midline in the TB projected contralaterally to: (1) the medial trapezoid nucleus (MTN), (2) the ventral dendritic zone of the MSO, (3) the ventral nucleus of the lateral lemniscus (VNLL), and (4) the central nucleus of the inferior colliculus (CNIC). Selective labeling of cells in the apical and middle ganglionic turns ofthe cochlea resulted in a similar pattern of centripetal transport. Selective [3H] uptake primarily by ganglion cells in the basal turn of the cochlea resulted in: (1) labeling of restricted parts of all cochlear nuclei, and (2) a considerable reduction of isotope transported beyond the cochlear nuclei. Labeled fibers in the TB were distributed sparsely in the ipsilateral LTN, LSO and dorsal dendritic zone of the MSO. Fibers in the TB were not labeled contralaterally in these animals. Interpretation of these data considers the possibility of transneuronal isotope transport. The pattern of isotope transported beyond the cochlear nuclei does not correspond to the secondary projections of any individual cochlear nucleus, although it bears some resemblance to that of the AVCN. The current study suggests that some primary auditory afferents project beyond the cochlear nuclei.
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In four controlled studies on 771 consecutive patients we tested the value of premedication before passing a fiberendoscope. Following local anaesthesia of the throat, 10 mgs of diazepam in patients less than 60 years and 5 mgs in those over 60 years quickly injected intravenously caused a sufficient premedication for fiberendoscopy. Premedication with diazepam is better than placebo. We fell that omission of premedication is not justifiable. Flunitrazepam, for premedication, in doses of 1-2 mgs did not prove to be suitable. 20 patients were radiologically controlled for signs of aspiration following premedication and endoskopy. They showed no signs of aspiration.
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A double-blind trial of (+)-cyanidanol-3 (2 g/day) versus placebo tablets was carried out in 100 patients with acute viral hepatitis. 51 received the drug and 49 placebo. (+)-Cyanidanol-3 accelerated the disappearance of HBsAg from the blood, lowered serum-bilirubin, and relieved symptoms such as anorexia, nausea, and pruritus. The drug was well tolerated. None of the patients had a relapse of acute hepatitis. Chronic active hepatitis developed in 1 of the placebo-treated patients. Thus, (+)-cyanidanol-3 seems to be of benefit in acute viral hepatitis.
A double blind controlled study on prophylaxis of postoperative gastrointestinal bleeding from stress lesions was performed. Both tragant sulfate, a pepsin inhibitor, and deglycyrrhizinized liquorice extract proved to be without prophylactic effect.
Among 5776 patients operated on under general anaesthesia there was an increased risk of postoperative gastro-intestinal bleeding from stress lesions among those aged over 70 years, after major surgery, or with complications such as hypovolaemia, septicaemia or respiratory failure (n = 551). In this group of patients the incidence of fatal haemorrhage was 0.5%. Stress lesions were a certain cause of bleeding from the gastro-intestinal tract in 5.1% and a probable one in 5.1%. Time of year, sex, past history of peptic ulcer, or anticoagulation did not increase the risk of bleeding.
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