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PubMed1983

Alcoholic liver disease in Scotland and northeastern England: presenting features in 510 patients.

A study of 510 patients in Scotland and northeastern England with histological evidence of alcohol-induced liver disease showed no difference in the age of presentation between males and females. Single men and widowed females were particularly susceptible to alcoholic liver disease. The social class distribution was similar to the population in general. Women were more reluctant to volunteer a history of alcoholism than men, they had a higher incidence of previous psychiatric illness (usually due to alcohol abuse) and they developed liver disease at lower consumption thresholds of alcohol than men. Patients under 40 years of age were more likely to have alcoholic fatty liver and less likely to have active cirrhosis than those over 40. Most often, the presenting symptoms were non-specific and tended to be related to the gastrointestinal system, particularly in women. Five per cent of patients were asymptomatic and 14% came to hospital for conditions other than alcoholic liver disease. Important clues to asymptomatic alcoholic liver disease included hepatomegaly, clubbing of the fingers and abnormal liver function tests. Gastro-oesophageal varices accounted for 40% of instances of haemorrhage and the mortality from upper gastrointestinal bleeding was 17%. Anaemia was the most common haematological abnormality. Alcoholic hepatitis was observed more frequently in the Glasgow area then elsewhere.

Adult↗

PubMed2006

Glucagon-like Peptide-2.

Multiple peptide hormones produced within the gastrointestinal system aid in the regulation of energy homeostasis and metabolism. Among these is the intestinotrophic peptide glucagon-like peptide-2 (GLP-2), which is released following food intake and plays a significant role in the adaptive regulation of bowel mass and mucosal integrity. The discovery of GLP-2's potent growth-promoting and cytoprotective effects in the gastrointestinal (GI) tract stimulated interest in its use as a therapeutic agent for the treatment of GI diseases involving malabsorption, inflammation, and/or mucosal damage. Current research has focused on determining the physiological mechanisms contributing to the effects of GLP-2 and factors regulating its biological mechanisms of action. This chapter provides an overview of the biology of GLP-2 with a focus on the most recent findings on the role of this peptide hormone in the normal and diseased GI tract.

Adaptation, Physiological↗

PubMed1999

The role of brain-gut peptides in the control of sodium appetite.

Ingestion of food and fluid stimulates release of a number of peptides from the gastrointestinal system. These peptides are recognized to act as neurotransmitters/neuromodulators and act at both peripheral and central receptors. Many studies indicate that these peptides are important signals in terminating meals. Recent studies suggest that bombesin, a peptide related to gastrin-releasing peptide, suppresses sodium appetite. We have investigated the role of cholecystokinin (CCK) in the control of sodium appetite. Our studies indicate that CCK is effective at reducing saline intake. We found that exogenous, intraperitoneal CCK octapeptide suppresses saline intake. Moreover, administration of trypsin inhibitor to stimulate endogenous CCK release resulted in suppression of saline intake. Finally, intraperitoneal administration of the CCK receptor antagonist lorglumide resulted in increased saline intake. These observations extend the potential role of gastrointestinal peptides in the modulation of ingestive behavior.

Animals↗

PubMed1983

Intensive melphalan chemotherapy and cryopreserved autologous bone marrow transplantation for the treatment of refractory cancer.

Thirty-three adult and pediatric patients with refractory malignancies were treated with escalating doses of melphalan (120-225 mg/m2 IV over 3 days) followed by reinfusion of previously harvested and cryopreserved autologous marrow. The hematological and nonhematological toxicities and the therapeutic effects of this regimen were evaluated. Increasing doses of melphalan did not alter the rate of decline nor the recovery of peripheral blood counts. Granulocyte (greater than 500/microL) and platelet count (greater than 20,000/microL) recovery occurred in a median of 19 (range 12-54) and 24 (range: 12-54) days after bone marrow transplantation, respectively. Five patients experienced severe infection, three of which were fatal, and one patient died due to thrombocytopenic hemorrhage. Toxicity to the gastrointestinal system was dose limiting. The maximum tolerated dose of melphalan was 180 mg/m2; only three of 24 patients experienced severe stomatitis, esophagitis, and diarrhea at this level or less, while eight of nine patients at 225 mg/m2 were affected (p less than 0.005). Administration of cyclophosphamide (300 mg/m2 IV) 1 week before melphalan therapy did not reduce the incidence of severe gastrointestinal toxicity. Plasma melphalan concentration peaked 30-60 min after infusion (4.8-11.5 micrograms/mL) but declined rapidly. Cerebrospinal fluid concentration was 10% of the corresponding plasma concentration and was undetectable at 3 hours. Antitumor responses occurred in nine of 13 patients with malignant melanoma (five complete and four partial remissions), and ranged 2-12+ months with a median of 5 months. Four of six neuroblastomas demonstrated responses (three complete and one partial remission( lasting a median of 7.5 (range: 5-10) months. Other tumors in which this regimen had activity included breast cancer and Ewing's sarcoma. The overall response rate for the 33 patients was 30% complete remissions (10 patients) and 21% partial remissions (seven patients). High dose melphalan and autologous bone marrow transplantation is a promising therapy for patients with malignancies for which no effective treatment is known or for patients whose cancer is refractory to conventional therapeutic agents.

Adolescent↗

PubMed2006

Acute pseudo-obstruction of the colon (Ogilvie's syndrome) following instrumental vaginal delivery.

Acute pseudo-obstruction of the colon (Ogilvie's syndrome) is an adynamic ileus without mechanical obstruction of the bowel. Predisposing factors include: abdominal and pelvic surgery, or trauma, or severe pre-existing systemic illness. In obstetrics, many cases have been reported after caesarean delivery, but none following a vaginal delivery. Conservative and pharmacological therapies are effective in many patients, but surgical intervention may be required. Early diagnosis and appropriate treatment is imperative to avoid caecal rupture, faecal peritonitis and the associated high maternal mortality. High index of clinical suspicion and proper assessment of the gastrointestinal system in the post-surgical patient are vital to the management of this uncommon but potentially serious condition met with in obstetrics practice.

Adult↗

PubMed1988

Hereditary hemorrhagic telangiectasia with malignant lymphoma. An autopsy case.

A 60-year-old Japanese woman was diagnosed at autopsy as having had hereditary hemorrhagic telangiectasia (HHT) associated with systemic hemangiomas. In her reproduction period, premenstrual epistaxis frequently occurred. At the age of 60, the patient died of malignant lymphoma. At autopsy, multiple telangiectatic spots were noted on the face, limbs and trunk. The paraaortic lymph nodes, which were enlarged and irregularly conglomerated, were histologically diagnosed as malignant lymphoma of the diffuse large cell type. Submucosal telangiectatic lesions were found in the gastrointestinal system from the oral cavity to the rectum. Cavernous hemangiomas were present in various visceral organs including the liver, spleen, small and large intestines, rectum, appendix, uterus, and jejunal and colonic mesenteries. There was an arteriovenous fistula in the left lung. Examination of her family pedigree showed that the patient had an autosomal dominant trait of inheritance. The pathogenesis of the systemic visceral hemangiomas observed in this patient was considered to be similar to that of harmartoma.

Female↗

PubMed1983

Colonization of particulates, mucous, and intestinal tissue.

The gastrointestinal system consists of myriad small ecological "niches" within which most bacteria grow in glycocalyx-enclosed microcolonies that form highly structured consortia in biofilms on the surfaces of both tissue and digesta. Bacteria in the lumen of the system are attached to their nutritive substrates by chemotaxis and they then adhere to insoluble nutrients (e.g. cellulose) or position themselves in microcolonies in locations having maximal concentrations of soluble nutrients (e.g. monomeric sugars). Thus, the digestion of even simple foods involves the simultaneous and specific colonization of many different "microniches" by bacteria. Specific bacteria have been shown to colonize tissues within the gastrointestinal tract and some of these taxonomically distinct populations have been shown to cooperate in the physiological activities of some of the colonized tissues. Highly abraded tissues and tissues exposed to extremes of acid concentration may be colonized by a single species of bacteria or yeast, because special adhesion mechanisms or acid resistance are required for persistence, but most nonsecretory epithelia within the tract are heavily colonized by a rich mixture of bacteria. We have developed techniques to retain the mucous blanket on the secretory epithelia of the intestine, and we find that the majority of bacteria and protozoa in these organs are associated with the mobile viscous layer and are thus functionally apposed to the epithelial tissues. Notable exception are the bacteria and protozoa that adhere avidly to the epithelial tissues by special adhesion mechanisms and must therefore remain stationary within the mobile mucous blanket.

Animals↗

PubMed1981

Age-related physiological changes and their clinical significance.

Physiological changes occur with aging in all organ systems. The cardiac output decreases, blood pressure increases and arteriosclerosis develops. The lungs show impaired gas exchange, a decrease in vital capacity and slower expiratory flow rates. The creatinine clearance decreases with age although the serum creatinine level remains relatively constant due to a proportionate age-related decrease in creatinine production. Functional changes, largely related to altered motility patterns, occur in the gastrointestinal system with senescence, and atrophic gastritis and altered hepatic drug metabolism are common in the elderly. Progressive elevation of blood glucose occurs with age on a multifactorial basis and osteoporosis is frequently seen due to a linear decline in bone mass after the fourth decade. The epidermis of the skin atrophies with age and due to changes in collagen and elastin the skin loses its tone and elasticity. Lean body mass declines with age and this is primarily due to loss and atrophy of muscle cells. Degenerative changes occur in many joints and this, combined with the loss of muscle mass, inhibits elderly patients' locomotion. These changes with age have important practical implications for the clinical management of elderly patients: metabolism is altered, changes in response to commonly used drugs make different drug dosages necessary and there is need for rational preventive programs of diet and exercise in an effort to delay or reverse some of these changes.

Age Factors↗

PubMed1995

Causes of mortality among sows in Danish pig herds.

The likely causes of sow mortality in Danish pig herds were investigated in a sample of 598 of the breeding animals delivered to a large rendering plant in the winter seasons of 1992 and 1993. In 263 cases information about the circumstances of the death or euthanasia and the herd characteristics were available, including the size of the herd, its health status, the age at weaning, the method of feeding and the use of straw for bedding. For these animals the distribution of likely causes of death or euthanasia was: leg weakness, 28.5 per cent; problems related to farrowing and late pregnancy, 20.9 per cent; disorders of the digestive system, 17.1 per cent; disorders of the urinary system, 13.1 per cent; physical injuries, 10.7 per cent; and other disorders, 9.5 per cent. For the other 335 sows the distribution of likely causes of death was: leg weakness, 16.1 per cent; problems related to farrowing and late pregnancy, 10.7 per cent; disorders of the digestive system, 21.2 per cent; disorders of the urinary system, 15.2 per cent; other disorders, 15.0 per cent; and unknown causes of death, 21.8 per cent. According to the official statistics from Danish rendering plants, more than 60,000 carcases of breeding pigs were processed during 1992, corresponding to a mortality rate of 5 to 6 per cent in the sow herds. The mortality rate appeared to increase with increasing herd size, and in herds with more than 100 sows the mortality rate was three times the mortality in herds with fewer than 50 sows. Compared with previous reports, the proportion of disorders involving the gastrointestinal system has increased during the past 20 years. Gastric dilation is particularly common, probably as a result of the intensification of pig production and the associated changes in management practises. The use of straw bedding was marginally significant (P = 0.06) and associated with a low frequency of gastrointestinal disorders.

Animals↗

PubMed1993

5-HT3 receptor antagonists. 3. Quinoline derivatives which may be effective in the therapy of irritable bowel syndrome.

A series of quinolinecarboxylic acid derivatives has been previously described as a new class of 5-HT3 receptor antagonists due to deviation of a carbonyl moiety from the place of an aromatic ring in their minimum-energy conformations. These derivatives were evaluated in a wrap-restraint stress-induced defecation model in rats. Reference compounds, ondansetron (1), granisetron (2), and YM060 (4), potently inhibited a stress-induced increase in stools excreted from fed rats (ID50 = 0.27, 0.12, and 0.0052 mg/kg, po, respectively). However, quinoline derivatives exhibited different activities depending on structural class. 4-Hydroxyquinoline-3-carboxylic acid derivatives 5 and 6a possess high affinity for the 5-HT3 receptor (Ki = 6.1 and 1.5 nM, respectively) and exhibit potent activity in the Bezold-Jarisch (B-J) reflex test (ED50 = 0.0017 and 0.000 10 mg/kg, i.v., respectively), but they did not effectively inhibit the increase in fecal pellet output at the dose of 1 mg/kg, po. On the other hand, most of 1-substituted 2-oxoquinoline-4-carboxylates 10 showed less potent activity in the B-J reflex test than 1 or 2 but inhibited restraint stress-induced defecation more potently than 1 or 2. The ID50 value of endo-8-methyl-8- azabicyclo[3.2.1]oct-3-yl 1-isobutyl-2-oxo-1,2-dihydro-4- quinolinecarboxylate 10e was 0.013 mg/kg, po. With respect to the selected compounds 6a and 10e, effects of 5-HT- and thyrotropin-releasing hormone (TRH)-induced defecation, castor oil-induced diarrhea and wrap-restraint stress-induced colonic propulsion in rats were examined. These 5-HT3 receptor antagonists did not effectively inhibit castor oil-induced diarrhea, which has been reported not to be mediated via the 5-HT3 receptor. Although 10e showed 800-fold decreased potency compared with 4 in the B-J reflex test, 10e exhibited activity as potent as 4 in 5-HT- and TRH-induced defecation assays; 10e exhibited 7-fold increased potency compared with 4 in wrap-restraint stress-induced colonic propulsions. From these results, 10e appears to interact selectively with 5-HT3 receptors in the gastrointestinal system and might be effective in the therapy of irritable bowel syndrome (IBS).

Animals↗

PubMed2006

Changes in pulse oximetry levels and factors affecting oxygen saturation during routine upper gastrointestinal endoscopy with or without sedation.

BACKGROUND/AIMS: We aimed to investigate whether endoscopy or midazolam as premedication causes oxygen desaturation and to determine factors which may affect the occurrence of oxygen desaturation. METHODS: Totally 200 patients with various indications (103 men and 97 women), who presented to the Endoscopy Unit of Dicle University Hospital for upper gastrointestinal endoscopy examination, were included in the study. Anamnesis and anthropometric values of the patients were taken. Preoperative oxygen saturation, hemoglobin levels and heart rate per minute were recorded. Patients with initial oxygen saturation levels <90% were excluded. Patients were divided into two groups. The first group included 100 patients who underwent endoscopic examination without sedation and the second group included 100 patients who underwent endoscopic examination with sedation [midazolam (2-5 mg)]. At the end of endoscopy, intravenous flumazenil (0.2 mg) was administered to the premedication patients. Patients were monitored for oxygen saturation and heart rate starting before the sedation and oropharynx anesthesia and lasting until 1 min after the end of the procedure. During the endoscopic examination, minimum oxygen saturation and maximum heart rate values were recorded. The duration of the oxygen saturation <90% was recorded throughout the procedure and the relation of this time with the total time of the endoscopic examination was evaluated. RESULTS: The mean age of the 200 patients included in the study was 45 and 44 years for Group 1 and Group 2, respectively. No differences were found between the two groups in terms of body mass index, smoking, hemoglobin and basal maximum pulse rate, duration of endoscopy, minimum basal oxygen saturation, duration of hypoxia and time to hypoxia. No relation was determined between oxygen desaturation and gender, duration of the endoscopy, basal pulse rate or hemoglobin level. It was found that smoking made significant contributions to the oxygen desaturation. CONCLUSION: Midazolam premedication for upper gastrointestinal system endoscopy is a reliable procedure and does not contribute an additional risk in individuals without serious comorbidities. Smoking habits should be taken into account in endoscopy patients.

Adult↗

PubMed1985

[Stress and the endogenous opioid system. II. Stress, stress models and endogenous opioid peptides].

Biochemical and pharmacological findings indicate an activation of the opioid system under certain stress influences. In this paper findings are discussed, according to which the activation of the opioid system depends on the temporary distribution pattern and the kind of the stressor. In response to stress opioid peptides are involved in excitatory and inhibitory processes. The participation of different types of opioids in central and peripheral stress-induced effects is discussed. Some findings suggest that beta-endorphin acts mainly centrally rather than peripherally, whereas the enkephalins take part in peripheral regulatory processes (gastrointestinal system, adrenal glands). Now there is evidence that the endogenous opioids modulate stress-induced effects, but there has been much controversy on how this fact should be established. These controversies mainly resulted from the many factors that influence activation.

Animals↗

PubMed1989

The gastrointestinal and hepatic manifestations of the acquired immunodeficiency syndrome.

Eighty-five patients with the acquired immunodeficiency syndrome (AIDS) were treated at Fairfield Infectious Diseases Hospital between April 1984 and June 1987. Sixty per cent of patients suffered gastrointestinal symptoms during the period of study, and in a further 15% of patients, abnormalities of the gastrointestinal tract were found incidentally. The principal manifestations were oropharyngeal ulceration, dysphagia/odynophagia, abdominal pain, diarrhoea, gastrointestinal bleeding, and perianal lesions. Opportunistic diseases involving all parts of the gastrointestinal system were encountered, the most prevalent being infections that were caused by Candida spp., cytomegalovirus, Mycobacterium avium-intracellulare and herpes simplex, and Kaposi's sarcoma. Abnormal liver-function test-results were found in 41 patients; most commonly, these were attributable to minor drug reactions, and cytomegalovirus or Myco. avium-intracellulare infection. Only one patient became jaundiced clinically. We conclude that involvement of the gastrointestinal tract is common in patients with AIDS, and that gastrointestinal lesions are an important cause of morbidity and mortality in these patients.

Acquired Immunodeficiency Syndrome↗

PubMed2000

Primary and metastatic diseases in malignant melanoma of the gastrointestinal tract.

In this review, the gastrointestinal (GI) manifestations of malignant melanoma including primary mucosal melanoma of the GI tract and metastatic melanoma to the GI tract are discussed. Although malignant melanoma most commonly arises in the skin, primary melanomas can also arise from the mucosal epithelial lining of the gastrointestinal tract. The vast majority of gastrointestinal melanoma is metastatic from a cutaneous primary; however, there is evidence that melanoma can arise de novo from within certain areas of the gastrointestinal system. The sporadic nature and small numbers of patients reported in the literature with mucosal melanomas have prevented a good understanding of the pathogenesis, natural history, and optimal treatment of this uncommon presentation of melanoma.

Diagnosis, Differential↗

PubMedDate not supplied

Impact of organ malperfusion on mortality and morbidity in acute type A aortic dissections.

BACKGROUND: Organ malperfusion is a serious complication of acute type A aortic dissection. Management and outcome of malperfusion has been discussed in this study. METHODS: Between November 1994 and May 2003, 118 patients with acute type A aortic dissections were operated. Fifty-seven patients (48.3%) were complicated with organ malperfusion, which is considered as group I. Seventy-three ischemic events were seen in 57 patients with organ malperfusion. Patients in group I were divided into four subgroups according to affected organ system including limb (38 events), coronary (9 events), renal (2 events), visceral (9 events), and cerebral (15 events) ischemia. Sixty-one patients without organ malperfusion constitute group II. RESULTS: The hospital mortality rate was 42.1% (24 of 57) in patients with malperfusion, 14.75% (9 of 61) in group II (p = 0.001), and 27.9% (33 of 118) in all patients. Postoperative complications such as mediastinal hemorrhage, low cardiac output, gastrointestinal system complications, acute renal failure, and multiple organ failure were higher in group I. Mesenteric and limb ischemia associated with high mortality. Multivariate analysis reveals that visceral malperfusion is the strongest predictor of postoperative mortality (odds ratio: 25.09, p = 0.000). Isolated coronary malperfusion had the lowest mortality (one patient, 16.6%) among the patients with organ malperfusion. CONCLUSIONS: Acute type A aortic dissections with organ malperfusion has higher postoperative mortality and morbidity. Immediate aortic repair is our management strategy in patients with limb, coronary, and neurological malperfusion. To reduce the extremely high mortality with mesenteric malperfusion, new strategies should be investigated such as surgical delay with interventional procedures.

Acute Disease↗

PubMedDate not supplied

Characterization of in vitro proteolytic processing of beta-endorphin by reversed-phase HPLC.

In vitro, central and peripheral proteolytic processing of beta-endorphin by membrane-bound enzymes results in the formation of specific active fragments that have been recently shown to function in behavior, intestinal motility and in the central control of urinary bladder activity. A high resolution, reversed phase high performance liquid chromatography system capable of separating 28 beta-endorphin related fragments simultaneously was used to study the time-course processing of beta-endorphin by membrane associated peptidases in the brain and regions of the small intestine. The hypothesis we tested was that a homeostatic balance between alpha- and gamma-type endorphins exists in these tissues. The results of the study show that the rate and quantity of fragments produced between the mucosa and nerve-muscle regions of the small intestine are significantly different. Metabolic rates, pattern, and the ratio of alpha/gamma-type endorphins in the brain were very similar to the nerve-muscle region of the small intestine. This suggests that beta-endorphin processing to active fragments is occurring at the nerves of the small intestine and that a specific and similar balance of alpha/gamma-type endorphin exists in the brain and gastrointestinal system at neutral pH.

Animals↗

PubMed1983

Retention and dosimetry of 106Ru inhaled along with inert particles by Fischer-344 rats.

This study was done to provide data useful for predicting the deposition, retention and radiation dose patterns for humans who might be exposed to an aerosol containing 106RuO4 and respirable particles. Ruthenium-106 tetroxide was introduced into air containing inert particles. The inert particles were monodisperse. 0.69 micrometer diameter fused aluminosilicate and very small residue particles from nebulized droplets. A complex exposure atmosphere resulted. In addition to condensation of 106RuO4 on pre-existing particles, self-nucleation occurred, presumably resulting from the formation of RuO2. It appears there was a significant amount of 106RuO4 present in the inhalation exposure system. When a group of Fischer-344 rats inhaled this exposure atmosphere, approx. 12% of the initial body burden reached the pulmonary region of the respiratory tract. Of the remaining 88% of the initial burden, 60% was deposited in the upper respiratory tract, 10% in the tracheobronchial region and 18% was external contamination, primarily on the nares and head skin. Most of the initial body burden was cleared via the gastrointestinal system and excreted via feces. Clearance of 106Ru from the pulmonary region had an effective half-time of approx. 30 days and was predominantly by dissolution. Relative radiation doses accumulated to 100 days after inhalation exposure, normalized to a lung dose of 1.0, were nasopharyngeal mucosa, 11; trachea and larynx, 5; lower large intestine, 5; upper large intestine, 2; liver, 0.9; and kidneys, 0.9. Other tissues and organs received lesser relative doses. Comparable results are predicted for man inhaling a similar exposure atmosphere, which could be encountered under certain circumstances in nuclear industry operations.

Aerosols↗

PubMed2006

The natural course of progressive systemic sclerosis patients with interstitial lung involvement.

OBJECTIVE: The aim of the study is to assess the natural course of systemic sclerosis (SSc) in patients with interstitial lung involvement and to evaluate the effects of treatment. MATERIALS AND METHODS: Sixty SSc patients with interstitial lung involvement were included in the study and history and retrospective data records of the patients were reviewed. RESULTS: It was observed that 47 patients (78.3%) had Raynaud's phenomenon, 7 patients (11.7%) had skin involvement, 5 patients (8.3%) had joint involvement, and 1 patient (1.7%) had gastrointestinal system involvement as the first manifestation of the disease. Lung involvement had developed on an average of 113 +/- 106 months after the first manifestation of the disease and was apparent within the first year in 10 patients (16.7%), between 1 and 2 years in 3 patients (5%), between 2 and 3 years in 2 patients (3.3%), between 3 and 4 years in 5 patients (8.3%), between 4 and 10 years in 21 patients (35%), and after 10 years in 19 patients (31.7%). When the symptoms of lung involvement appeared, 37 patients (61.7%) were not receiving treatment while 23 (38.3%) were using an immunosuppressive agent. The time interval of lung involvement for the treated patients was 131 +/- 95 months while it was 101 +/- 112 months in untreated patients (p>0.05). CONCLUSION: In SSc patients with interstitial pulmonary involvement, the disease frequently starts with Raynaud's phenomenon and pulmonary symptoms tend to appear at a mean of 7 years after the onset of disease. The first sign of the disease, the probability of interstitial pulmonary involvement, is highest during the first 15 years after. Although this probability decreases after 15 years, in up to 10% of the patients, interstitial pulmonary involvement can still occur even up to 40 years. Immunosuppressive treatment is not effective in preventing the development of pulmonary involvement. However, it delays the manifestation of pulmonary symptoms for nearly 4 years.

Adult↗