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Biomedical subjects

R E Clouse

Publications and source records attributed to R E Clouse.

At least 73 records · Page 4Linked to original sources
PubMed1992

Depression in adults with diabetes.

Depression in diabetes is a prevalent and chronic condition. The etiology is unknown but is probably complex; and biological, genetic, and psychological factors remain as potential contributors. Several neuroendocrine and neurotransmitter abnormalities common to both depression and diabetes have been identified, adding to etiological speculations. Pharmacotherapy of depression may improve both mood and glucose regulation in diabetes, although controlled studies of the efficacy of psychotherapy and pharmacotherapy for depression in diabetes are not yet available. Depression has potential interactions with diabetes on multiple levels and remains an important clinical focus independent of the medical disease.

Adult↗
PubMed1992

Mast cell granules within endothelial cells: a possible signal in the inflammatory process?

Mast cell-endothelial cell interactions have long been suspected to be important in inflammation. The detail of the pathways of communication have yet to be elucidated. In this report we describe, for the first time, mast cell granules within endothelial cells of colonic capillaries in a patient with florid colitis, as well as rats with experimentally induced mast cell degranulation. We postulate that this phenomenon may occur more generally during immunologically mediated inflammatory cell degranulation, and may be one mechanism of communication to endothelium.

Adult↗
PubMed1991

Do life events or depression exacerbate inflammatory bowel disease? A prospective study.

OBJECTIVE: To determine whether depressed mood or life events are associated with an exacerbation of inflammatory bowel disease. DESIGN: A prospective study of a consecutive sample of patients with relapsing inflammatory bowel disease, followed by monthly questionnaires and periodic office visits. SETTING: A referral-based gastroenterology clinic at a medical school. PATIENTS: A consecutive sample of 32 patients with inflammatory bowel disease who had had at least one relapse in a 2-year period after entry into the study. MEASUREMENTS AND MAIN RESULTS: The Social Readjustment Rating Scale (measuring life events), the Beck Depression Inventory (a visual analog scale for depressed mood) and an inventory of intestinal symptoms were completed monthly by each subject with a 78% rate of compliance. A mean of 2.2 exacerbations was seen per subject during the study period. Life events were not temporally associated with changes in intestinal symptoms. Significant associations were found between intestinal symptoms and the two mood scales (P less than 0.05 for each), but no directionality in symptom occurrence could be detected in a time-lagged analysis. The results were similar when the months preceding exacerbations of inflammatory bowel disease were analyzed separately. CONCLUSIONS: Although these findings suggest that mood changed concurrently with exacerbation of inflammatory bowel disease, no evidence indicated that stressful life events or depressed mood precipitated exacerbations in this study group.

Colitis, Ulcerative↗
PubMed1991

Esophageal motility in children with Hirschsprung's disease.

Esophageal motility was studied in 12 children with Hirschsprung's disease to see if extracolonic motor dysfunction was present in this disorder. Manometric tracings were compared with those from eight children with idiopathic megacolon and from 10 children without esophageal disease or constipation. Amplitude of esophageal contraction waves was significantly higher in children with Hirschsprung's disease than in the other two groups. Swallows that were followed by simultaneous contractions or double-peaked waves were also more common in the group with Hirschsprung's disease (subjects with Hirschsprung's disease, subjects with megacolon, and controls; 57%, 10%, and 8%, respectively). Lower esophageal sphincter characteristics did not differ among the three groups. The increase in simultaneous contractions and double-peaked waves persisted in those children who were reexamined following surgery for Hirschsprung's disease, whereas wave amplitudes fell to a level similar to that observed in the other groups. These data suggest that gastrointestinal motor dysfunction in persons with Hirschsprung's disease is not restricted to the colon, and that some of the observed abnormalities in esophageal motility do not reflect nonspecific responses to megacolon or colonic obstruction.

Adolescent↗
PubMed1991

Value of subject height in predicting lower esophageal sphincter location.

Subject height and lower esophageal sphincter location were determined in 213 children and adults to determine whether the anthropometric variable could be used to accurately predict sphincter location across all age ranges. The upper margin of the lower esophageal sphincter was determined with a nasally placed manometry catheter. Height was highly predictive of lower esophageal sphincter location across all subject groups (r2 = .96) and in the youngest subset of subjects (< or = 2 years of age, r2 = .88). The predictive ability of height remained significant but progressively decreased in the four older subject groups (> 2 and < or = 10 years of age, r2 = .74; > 10 and < or = 20 years of age, r2 = .66; > 20 and < or = 40 years, r2 = .58; and > 40 years, r2 = .49). The regression equation that described subjects 2 years of age or younger (L = 0.22[H] + 4.92, where L is the location in centimeters from the nares and H is the height in centimeters) correctly predicted lower esophageal sphincter location within 1.0 cm in 90% of these subjects. In the older subject groups, predicted lower esophageal sphincter location was in error by greater than 2 cm in 25% to 35% of the subjects, even when age group-specific regression equations were used. Decreased predictive ability related to both increasing age and increasing height. We conclude that lower esophageal sphincter location can be predicted from height in subjects up to 2 years of age. The prediction is sufficiently accurate in this age group to allow placement of pH probes without manometric measurements.

Adolescent↗
PubMed1991

Clinical correlates of abnormal sensitivity to intraesophageal balloon distension.

Sixty-five patients with esophageal complaints were studied to determine clinical associations with abnormal sensitivity to intraesophageal balloon distension (esophageal sensory dysfunction). Associations were examined in four categories: motility, esophageal symptoms, recent psychological symptoms, and general clinical features. A positive response to balloon distension (pain with less than or equal to 8 ml volume) was found in 29 (45%) of the subjects. This response was associated with specific findings in each category except recent psychological symptoms. A multiple logistic regression analysis indicated that an increased frequency of multipeaked waves on motility testing, presence of dysphagia, and shorter height of the subject each had an independent association with positive response to balloon distension (P less than or equal to 0.05 for each). Further comparison of subjects with sensory dysfunction, motor dysfunction, or both (sensorimotor dysfunction) indicated that subjects with the combined disorder appeared more symptomatic than those with either finding alone. These observations indicate that: (1) esophageal motor and sensory dysfunction are partially associated, but both contribute to the symptomatic state; (2) dysphagia may be representative of sensory dysfunction in some cases; and (3) subject height should be taken into consideration when interpreting balloon distension results.

Body Height↗
PubMed1991

Achalasia in the elderly. Effects of aging on clinical presentation and outcome.

Clinical and manometric data from 13 elderly subjects with idiopathic achalasia (mean age 79 +/- 2 years) were compared with findings from younger subjects with the same disease (n = 79) to see if aging altered the presentation and outcome of this motor disorder. Fewer elderly subjects complained of chest pain (27% vs 53%), and the pain was significantly less severe (P less than 0.01). Other presenting features (including sex, duration of symptoms, and presence and severity of dysphagia) did not differ between the groups. Across all patients, age weakly and inversely correlated with residual postdeglutitive lower esophageal sphincter; (LES) pressure (R = -0.34), and residual pressure was significantly lower in the older subjects (8.0 +/- 1.3 mm Hg vs. 11.9 +/- 0.8 mm Hg; P = 0.02). No differences in basal LES pressure or esophageal-body contraction amplitudes were present between the groups. Initial success with pneumatic dilation was similar in the two subject groups, but the number of older subjects available for analysis was too small to draw strong conclusions. These results indicate that aging decreases the elevation of LES residual pressure that occurs with achalasia. As elderly achalasia patients also present with less chest pain, the findings may be interrelated.

Adult↗
PubMed1991

Reevaluation of manometric criteria for vigorous achalasia. Is this a distinct clinical disorder?

Clinical and manometric data from 97 consecutive patients with idiopathic achalasia were analyzed to see if a distinct subset with vigorous achalasia could be identified. Statistical analyses failed to detect a unique group of subjects based on the distribution of contraction wave amplitudes alone. Because of this, patients falling above the 95th percentile (N = 4, mean wave amplitude greater than 100 mm Hg for each) were compared with those having mean amplitudes above the conventional threshold for the diagnosis of vigorous achalasia (mean amplitude 60-100 mm Hg, N = 4), and with the remainder (N = 89, mean amplitude less than 60 mm Hg). Subjects with mean amplitudes less than 60 mm Hg and with mean amplitudes 60-100 mm Hg closely resembled each other in all measured clinical features, whereas subjects with mean amplitudes greater than 100 mm Hg were all male, were older (67 +/- 4 years vs 47 +/- 2 years; P less than 0.01), and appeared to have somewhat longer duration of symptoms when compared with the remainder (82 +/- 41 vs 44 +/- 10 months; P = 0.4). Chest pain and other esophageal symptoms, basal and residual lower sphincter pressures, and response to first treatment did not differ among the three groups. These data indicate that high-fidelity manometry techniques identify a rare subset of achalasia patients with mean contraction amplitudes exceeding 100 mm Hg that, although older and possibly with greater duration of symptoms, presents similarly to others with idiopathic achalasia. Outcome from conventional treatment is also similar for the "vigorous" and "nonvigorous" patients, making the distinction of questionable value.

Aged↗
PubMed1991

Achalasia, diffuse spasm and non-specific motor disorders.

Achalasia is the best understood of the motor disorders described in this chapter. The pathogenesis involves loss of intramural neurones, a process that subsequently results in poor lower sphincter relaxation and atony of the oesophageal body. Treatment is appropriately focused on mechanical or pharmacological alleviation of LOS obstruction. In contrast, the pathophysiology of DOS and the non-specific disorders remains poorly understood. Some of the non-specific disorders, such as the vigorous contraction wave abnormalities (including 'nutcracker oesophagus'), appear closely related to DOS. Treatment for patients with these findings has been based on assumptions about mechanisms of symptom production. The non-specific disorders are common in referred patients with oesophageal symptoms, and the importance of these findings deserves further study. We use a method for categorization of these manometric abnormalities which aids understanding of this difficult area and recommend its more widespread use.

Esophageal Achalasia↗
PubMed1991

Psychiatric disorders in patients with esophageal disease.

Psychiatric disorders have potentially important roles in the manifestations of esophageal disease. A primary causative role for psychiatric factors in the common motility disorders associated with chest pain (esophageal spasm and the nonspecific motor disorders) remains unproven, but psychiatric disorders appear particularly prevalent in this group. In most other esophageal diseases, psychiatric factors interact through recognized psychophysiologic or behavioral mechanisms to affect the clinical presentation. Recognizing the possible levels of interaction has significant therapeutic implications.

Esophageal Achalasia↗
PubMed1991

Shortening of the esophagus in response to swallowing.

Esophageal shortening accompanies peristalsis in laboratory animals and is attributed to longitudinally oriented fibers in esophageal muscle layers. To evaluate this phenomenon in humans, esophageal shortening during suspended respiration in response to swallows was measured in five normal volunteers (median age, 23 yr). Metal mucosal clips were endoscopically placed at and 10 cm above the gastroesophageal junction, and their movement was recorded by videotaped fluoroscopy. All subjects demonstrated esophageal shortening with each swallow in a characteristic pattern with small interswallow variance. Early, minimal shortening of the proximal segment (6.0 +/- 2.4 mm) was followed by delayed, prominent distal segment shortening (18.9 +/- 9.3 mm) that principally accounted for overall change in total esophageal length (18.0 +/- 8.1 mm). The degree of esophageal shortening did not correlate with circular muscle contraction wave parameters that were obtained with intraluminal manometrics in a separate study (P greater than 0.2 for each correlation), and distal segment shortening uniformly preceded the onset of contraction waves in the same region. These findings indicate that patterned esophageal shortening with swallows occurs in humans, most prominently in the distal esophagus. The technique may be useful in determining the participation of axial esophageal movement in esophageal motility disorders.

Adult↗
PubMed1991

Topography of the esophageal peristaltic pressure wave.

Topographic plots constructed from conventional esophageal manometric waves were examined in 12 healthy volunteers to better understand spatial relationships of peristaltic contractions. Typical postdeglutitive waves were spatially interconnected using a computerized gridding and plotting system. Contour plots of the resultant peristaltic contraction revealed a consistent separation of a proximal pressure segment from the prominent distal contraction at 21.7 +/- 1.3% of the esophageal length. A second trough in the contraction sequence was found in 11 (91.7%) of the subjects at 64.0 +/- 2.7% of esophageal length separating the distal (smooth muscle) esophagus into two contraction segments. Similar topographic studies were also performed in eight symptomatic patients with frequent double-peaked waves. Poor alignment of the two distal contraction segments was observed in six (75%) of the eight patients. These topographic plots demonstrate previously unrecognized wave relationships and suggest that two neuromuscular contraction units can be detected in the distal smooth muscle esophagus. This technique should be useful in understanding altered relationships of these units under differing physiological conditions or with disease.

Adult↗
PubMed1991

Reproducibility of the rapid pull-through technique for categorizing lower esophageal sphincter pressure.

Duplicate measurements of basal lower esophageal sphincter (LES) pressure using a triple-lumen catheter and the rapid pull-through technique (RPT) were performed in 250 consecutive patients to determine their reproducibility for categorizing LES pressures as normal, hypertensive, or hypotensive. For all subjects, mean LES pressure did not differ for the two measurements (25.3 +/- 1.0 vs. 26.2 +/- 1.0 mm Hg, p greater than 0.5), but the correlation coefficient was only modest (r = 0.73). Reproducibility of categorization was 92% (230 of 250 subjects), and was best for subjects with normal (170/179, 95%) or hypotensive (24/26, 92%) values (for hypertensives: 36/45, 80%). Interstudy variability was least for the hypotensive group (1.8 +/- 0.2 mm Hg) and greatest for the hypertensive group (16.4 +/- 1.9 mm Hg). Likewise, the range of individual values from the triple-lumen catheter was least for the hypotensive subjects (4.7 +/- 0.7 mm Hg) and greatest for those with hypertensive LES pressure (32.5 +/- 2.6 mm Hg). These data show that, despite its interstudy variability, the RPT reproducibly categorizes basal LES pressure in greater than 90% of cases. The technique appears least reliable in determining hypertensive LES pressure, where diaphragmatic contraction may most significantly contribute to measurement variability.

Analysis of Variance↗
PubMed1991

Small intestinal lesion resembling graft-vs-host disease. A case report in immunodeficiency and review of the literature.

We report graft-vs-host disease-like histology in a small intestinal biopsy specimen that was obtained from a patient with common variable immunodeficiency and related T-cell defect. We include findings from immunohistochemical studies and follow-up information. Review of the literature yielded only a small number of histologically documented cases of this lesion without previous bone marrow transplantation. Awareness of this clinicopathologic entity is important in the interpretation of gastrointestinal biopsy specimens.

Biopsy↗
PubMed1991

Incomplete lower esophageal sphincter relaxation in subjects with peristalsis: prevalence and clinical outcome.

Incomplete lower esophageal sphincter relaxation is recognized in achalasia and has been reported in subjects with esophageal spasm. We reviewed 500 consecutive manometric studies from a 3-yr period to determine the prevalence of this manometric finding, its association with other motility abnormalities, and the clinical outcome of subjects without associated aperistalsis (i.e., without achalasia). We identified 60 subjects with incomplete lower sphincter relaxation, 17 of whom had at least some normal peristalsis (3.4% of the total). Mean lower sphincter residual pressure for these 17 subjects (4.5 +/- 2.8 mm Hg) was intermediate between those with achalasia (11.7 +/- 6.8 mm Hg) and those with normal relaxation (0.1 +/- 0.2 mm Hg). Both peristaltic and contraction abnormalities in the esophageal body were prevalent in the 17 subjects compared with those who had normal relaxation. Outcome with conservative medical therapy after a mean follow-up of 3.3 yr was not significantly related to presence of peristaltic or contraction abnormalities at presentation, and 71% of subjects with or without these concomitant findings had improvement or complete resolution of symptoms. Only one subject worsened and was treated with pneumatic dilation. We conclude that incomplete relaxation of the lower esophageal sphincter without aperistalsis is uncommon, symptom regression occurs with conservative therapy, and pneumatic dilation appears rarely required over a modest follow-up period.

Adult↗
PubMed1990

Effect of mucosal thickening near gastric carcinoma on the endoscopic diagnosis of malignancy.

Gastric mucosal thickening of variable degree occurs in the vicinity of gastric carcinomas and is possibly related to simultaneous tumor expression of epidermal growth factor and its receptor. Seventeen cases in which both endoscopic biopsy and subsequent resection for gastric carcinoma had been performed were studied to see if putative tumor-related mucosal thickening had an effect on endoscopic biopsy sensitivity. Biopsy fragment positivity rate was greater in cases with exophytic, protruding tumor masses (46.8 +/- 8.5%) than in all other cases (17.0 +/- 4.7%; P = 0.02). Thickness of nontumorous mucosa adjacent to carcinomas did not significantly affect the biopsy fragment positivity rate in cases with exophytic masses ("thin" subgroup, 51.0 +/- 16.2%; "thick" subgroup, 44.0 +/- 10.8%; P = 0.7) but did reduce the positivity rate significantly (P = 0.05) in ulcerative or infiltrative tumors without exophytic components ("thin" subgroup, 23.3 +/- 4.1%; "thick" subgroup, 8.4 +/- 2.1%). This reduction in biopsy sensitivity related to mucosal thickening occurring adjacent to nonprotuberant lesions may explain, at least in part, the variable rates of positive biopsies observed with gastric cancers.

Aged↗