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Biomedical subjects

S N Sullivan

Publications and source records attributed to S N Sullivan.

At least 37 records · Page 2Linked to original sources
PubMed1986

The supersensitive hypertensive lower esophageal sphincter. Precipitation of pain by small doses of intravenous pentagastrin.

The clinical and investigative features of eight patients with attacks of epigastric pain believed due to a hypertensive lower esophageal sphincter (LES) are described. Radionuclide esophageal transit studies were normal in all but one patient. Two patients had positive acid perfusion studies. Only three had an abnormal baseline esophageal manometry, but after small intravenous doses of pentagastrin all subjects experienced their presenting pain coincident with increases in LES pressure ranging from 75 to 140 mmHg. Five patients eventually required surgical myotomy of the LES, but pain relief which was immediate and complete in all proved permanent in only one. Two of the operated patients continued to experience severe attacks of pain refractory to medical therapy. The diagnosis of a hypertensive LES is best made by pentagastrin stimulation of the sphincter, but cutting the sphincter may not cure the patient.

Adolescent↗
PubMed1986

Reduction by morphine of human postprandial insulin release is secondary to inhibition of gastrointestinal motility.

The effect of morphine (0.1 mg/kg) on insulin secretion stimulated by oral, intraduodenal, or intravenous administration of glucose was studied in seven healthy volunteers. When glucose was given intravenously, morphine had no effect on plasma glucose, insulin, glucose-dependent insulinotropic polypeptide (GIP), or pancreatic glucagon. Following oral glucose, morphine slowed gastric emptying and reduced plasma concentrations of glucose, insulin, and GIP. During intraduodenal infusion of glucose, insulin concentrations in plasma were also decreased by morphine, an effect best explained by decreased small intestinal transit with delayed absorption of glucose and delayed release of GIP. We conclude that clinically relevant doses of morphine have no direct effect on insulin secretion and that the changes observed were secondary to slowed gastric emptying and small intestinal transit.

Adolescent↗
PubMed1985

Chest pain--esophageal, cardiac, or both?

The esophagus may be the origin of chest pain clinically indistinguishable from that of ischemic heart disease. In some patients the esophageal origin of the pain may only be recognized by pharmacological provocation during manometry. We describe nine patients with chest pain which could be explained by disorders of esophageal motility--diffuse spasm in four, high pressure lower esophageal sphincter in three, and "nutcracker esophagus" in two. Methacholine provoked the pain and manometric abnormalities in five patients who had normal baseline tracings. However, seven patients given methacholine developed ischemic changes on the electrocardiogram. In one patient these were typical of Prinzmetal's variant angina. The manometric and electrocardiographic abnormalities were reversed by intravenous atropine. Ischemic heart disease and esophageal motor disorders may occur concomitantly and pose a dilemma in diagnosis and management.

Aged↗
PubMed1984

Budd-Chiari syndrome with inferior vena cava obstruction associated with systemic lupus erythematosus.

The Budd-Chiari syndrome is an uncommon condition in which hepatic venous outflow is obstructed by thrombosis of the major hepatic veins. Many of the cases are idiopathic, but it has been described in association with vena caval webs, abdominal trauma, retroperitoneal neoplasms, and hypercoagulable states. A patient with systemic lupus erythematosus (SLE) who developed the Budd-Chiari syndrome with inferior vena cava thrombosis led to a review of the possible association between SLE and the Budd-Chiari syndrome. The therapy of the Budd-Chiari syndrome with associated vena cava thrombosis is also discussed.

Adult↗
PubMed1983

Management of the irritable bowel syndrome: a personal view.

One hundred fifty-four of 184 consecutive patients diagnosed as having the irritable bowel syndrome were followed for an average of 29 months. Diagnosis was based on history, physical examination, and sigmoidoscopy. Seventy-eight percent of the patients had some form of gastrointestinal radiologic investigation, the majority ordered by the referring physicians. Treatment was restricted to reassurance, explanation, and a high-fiber diet. Twenty-five patients continued to take or had prescribed by their family physicians antispasmodics, minor tranquilizers, or laxatives. Eleven patients required psychiatric referral or major psychotropic medication. At follow-up, 79% felt their symptoms were better, much better, or gone completely. Outcome was not affected by identified psychiatric problems. During follow-up, an organic cause for symptoms was identified in six patients. The change in diagnosis was the result of clinical suspicion plus failure to respond to conservative therapy.

Adolescent↗
PubMed1983

Hemobilia after percutaneous liver biopsy: role of endoscopic retrograde cholangiopancreatography and sphincterotomy.

Hemobilia is a rare complication of percutaneous liver biopsy. We present such a case that demonstrates the usefulness of endoscopic retrograde cholangiopancreatography in establishing the diagnosis, the importance of localization of the bleeding site by angiography, and the therapeutic usefulness of arterial embolization for the control of persistent bleeding. Also, we propose a possible indication for endoscopic sphincterotomy in the rare case where retained intrabiliary blood clot causes progressive obstructive jaundice complicated by severe pain and sepsis.

Adult↗
PubMed1983

Effect of Morphine and butorphanol on gallbladder emptying.

In the search for the most appropriate analgesic for patients with biliary tract and pancreatic pain, the authors compared the effect of morphine and the opiate agonist-antagonist butorphanol on gallbladder contraction and emptying stimulated by cholecystokinin octapeptide. Morphine markedly inhibited gallbladder emptying while butorphanol only slightly delayed it. Compared with morphine, the effect of butorphanol was minimal; the latter, therefore, seems to be a suitable analgesic for the treatment of pain of biliary tract or pancreatic origin.

Adult↗
PubMed1983

The effect of a synthetic enkephalin analogue on postprandial gastrointestinal and pancreatic hormone secretion.

The effect of the synthetic enkephalin analogue Sandoz FK33-824 (DAMME) on gastric emptying and the postprandial secretion of upper gastrointestinal and pancreatic hormones was investigated in six healthy subjects. Gastric emptying was delayed as was the postprandial rise in glucose. There was significant blunting of insulin and gastric inhibitory polypeptide secretion, with complete abolition of the normal postprandial increases in pancreatic polypeptide and motilin. The secretion of gastrin was prolonged. These results demonstrate that pharmacological doses of opiate peptides inhibit gastric emptying and may have direct and indirect effects on gastrointestinal and pancreatic hormone secretion.

Adult↗
PubMed1982

Enkephalin inhibits relaxation of the lower oesophageal sphincter.

Five healthy volunteers were studied for the effect on oesophageal motility of a single subcutaneous injection of a synthetic analogue of enkephalin as compared with an injection of an equivalent volume (0.5 ml) of saline. The injections were given at random on separate days, and each was followed after 40 minutes by 2 mg naloxone given intravenously. Pressures were measured by manometry after dry and wet (5 ml) swallows at one-minute intervals, and traces were coded and analysed "blind". Twenty-five minutes after the injection of enkephalin the percentage relaxation of the lower oesophageal sphincter pressure was significantly less (p less than 0.005) than at the same time after saline. Within two minutes after intravenous naloxone this effect had disappeared completely. Enkephalin had no noticeable effect on pressure of the sphincter or on amplitude and duration of oesophageal peristalsis. The mechanism of action of enkephalin in selectively inhibiting relaxation of the lower oesophageal sphincter remains to be determined. That naloxone rapidly reversed the inhibition may be relevant in achalasia and warrants further study.

D-Ala(2),MePhe(4),Met(0)-ol-enkephalin↗
PubMed1982

Aortoenteric fistula. Incidence, presentation recognition, and management.

Twenty-two patients developed one or more aortoenteric fistulae following aortic reconstruction with a dacron graft. Endoscopy was performed on 11 of these patients on 17 occasions and a preoperative diagnosis was made in eight patients. Fistulous communication was most common between the aorta and duodenum (60%), and a further 30% penetrated into the jejunum and ileum. The mean period from operation to time of diagnosis was 36 months and the mean length of bleeding was 25 days, allowing ample time for preoperative evaluation. Surgery was performed on 21 of the 22 patients with an overall mortality of 77%. The best surgical results were obtained with graft resection, closure of the aorta, and maintenance of circulation by an axillofemoral graft.

Adult↗