Aminopyrine breath test in Dubin Johnson and Gilbert's syndromes.
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Biomedical subjects
Publications and source records attributed to T Gilat.
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During endoscopic retrograde cholangiopancreatography, pressures of the common bile duct, the pancreatic duct and the sphincter of Oddi were recorded in 64 patients with various diseases of the pancreaticobiliary system. The manometric study was found to be helpful in the diagnosis of papillary dysfunction and in the assessment of the adequacy of papillotomy and the size of a choledochoduodenostomy. Furthermore, it is possible that nitrates may be effective in the treatment of patients with papillary dysfunction.
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A selective screening program for the early detection of colorectal tumors was carried out in the Tel-Aviv area. The criteria for inclusion were based, in part, on relevant epidemiologic data which showed that European- and American-born immigrants were at the highest risk for developing this cancer, followed by Israel-born Jews. The Tel-Aviv area, because of its large elderly population of European origin, has a high incidence of colorectal cancer. Families of patients with colon cancer are known to have an increased risk for developing colon tumors. These relatives were actively searched for, and were, along with the control group, examined by Hemoccult testing and flexible sigmoidoscopy. The color tumor (cancer or adenomatous polyps) rate was 6.3% in the group with a family history of colon cancer, as contrasted to 3.8% in a smaller control group without this history. This increased yield, greater than usually found in an unselected population, emphasizes the economic value of selective screening utilizing relevant epidemiologic data and the family history.
We evaluated the hypothesis that a healthy population taking a high-fiber diet may develop deficiencies of various minerals and nutrients in three groups of healthy subjects: 1) sixty-eight people regularly supplementing their diet with at least 2 tablespoons of bran for at least 6 months (mean 3 tablespoons for 13 months); 2) forty-three controls not consuming bran supplements; and 3) twenty vegetarians (eight of them consuming bran supplements) who had a very high fiber consumption for many years. The mean serum levels of iron, total iron binding capacity, calcium, phosphorus, alkaline phosphatase, zinc, magnesium, vitamin A, and cholesterol were within the normal range in all the three groups. In the bran eaters, vitamin A was higher, and alkaline phosphatase and magnesium lower than in the other two groups. In the vegetarians, the phosphorus level was higher and cholesterol and iron binding capacity lower than in the other two groups. There was no correlation between the amount of bran consumed and the blood level of nutrients. The fiber consumption of the vegetarians was very high, more than three times that of the controls. Our study indicates that a moderately or even extremely high consumption of fiber for a long time does not by itself cause mineral or nutrient deficiencies in a western type population.
The effect of a long-acting nitrate, isosorbide dinitrate (ID) 5 mg sublingually, on the lower oesophageal sphincter was tested in 24 patients with achalasia. The drug caused a reduction in LOS pressure in all cases. The mean LOS pressure fell from 46.32.7 mmHg to 15.31.8 mmHg (p less than 0.01). The pressure began to drop after several minutes, reaching its lowest levels after 15 minutes. This measured manometric effect lasted for 60 minutes or more in 10 patients studied. The reported clinic effect lasted for two to three hours, permitting the ingestion of a meal. Twenty-three patients were followed clinically for two to 19 months while receiving the drug three times daily before meals. Nineteen reported a marked to complete relief of dysphagia. Five of these patients had previous pneumatic dilatation, cardiomyotomy, or both, and had recurrence at time of study. Side-effect, mainly headache, were reported in eight patients. In six this was alleviated by substituting oral isosorbide dinitrate, 10 mg. Two patients became refractory to treatment after two to six months. The potential role of long-acting nitrates in the treatment of achalasia has yet to be established.
Changes in arterial oxygen and carbon dioxide tensions were determined in 56 patients, mean age 67 years, during elective upper gastrointestinal endoscopy with standard or pediatric instruments. All the patients received intravenous atropine, diazepam, and either meperidine or fentanyl premedication. There was an immediate and significant fall in PaO2 levels (20.3%-16.5%) after both narcotic injections. The oxygen tension remained significantly depressed during the endoscopic examinations except in the group receiving fentanyl premedication and examined with the narrow pediatric instrument. To minimize hypoxemia in elderly patients during endoscopy, a short-acting narcotic or, preferably, no narcotic at all should be used in the premedication, and a narrow, pediatric instrument be used.
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Four patients with cold urticaria and six control subjects were studied. Gastric acid output was measured for 1 hr before and 1 hr after the immersion of both hands in ice cold water. The mean acid output fell in the control group by 16.3%. Acid output in the cold urticaria patients rose in each case following the cold challenge. In three cases it rose by a mean of 52.6% and in one case by 1707%. Histamine is released locally and systemically during the reaction of cold urticaria. This is the most likely cause of the increase in gastric acid secretion.
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The cholyl glycine-1-14C breath test was evaluated in a variety of gastrointestinal disorders. 138 tests were performed in 106 patients. Methods of data expression were evaluated and the cumulative 8-hour value was used. In 27 control patients the upper limit of the normal was found to be 78. A good correlation was found between the peak values and the cumulative 8-hour values (r = 0.95, p less than 0.01). The reproducibility of the test was good (r = 0.985, p less than 0.05). Abnormal results were found in 12 out of 13 cases with resection of the ileum and 11 out of 14 cases with Crohn's disease of the distal small bowel. The test was normal in cases with diseases of the proximal small bowel (celiac, Whipple's and Chron's diseases). The test was also normal in patients with colitis. It was abnormal in some of the cases after cholecystectomy and in most cases with carcinoma of the pancreas. The breath test was useful in monitoring the results of treatment in bacterial overgrowth of the small bowel. False negative results were observed after antibiotic treatment. The method seems to be more sensitive than the Schilling test in diagnosing disease of the distal small bowel.
Measurement of arterial oxygen tensions in elderly patients undergoing upper gastrointestinal endoscopy and in a matched control group undergoing colonoscopy showed a slight but significant fall in the PaO2 in both groups following premedication. The initial fall in PaO2 was probably due to the intravenous atropine, diazepam, and meperidine, mainly the latter. This fall of the oxygen tension continued in the gastroscopy group until the instrument was removed, while the controls rapidly returned to basal levels. This persistently reduced PaO2 in the former group is therefore most likely due to the physical presence of the endoscope in the pharynx. To minimize the occurrence of hypoxemia during gastroscopy, narcotics should probably not be used in the premedication of elderly patients. The procedure should be carried out after optimal oxygenation of the patient and be of short duration, and a narrow instrument may be useful in this group.