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PubMed1998

Gastrointestinal dysfunction in Parkinson's disease.

Gastrointestinal dysfunction is a frequent and occasionally dominating symptom of Parkinson's disease (PD). Features of gastrointestinal dysfunction include disordered control of saliva, dysphagia, gastroparesis, constipation in the sense of decreased bowel movement frequency, and defecatory dysfunction necessitating increased straining and resulting in incomplete evacuation. Excess saliva accumulates in the mouth because of decreased swallowing frequency. Dysphagia develops in approximately 50% of patients and may be a reflection of both central nervous system and enteric nervous system derangement. Gastroparesis may produce a variety of symptoms, including nausea, and also may be responsible for some of the motor fluctuations seen with levodopa therapy. Bowel dysfunction in PD may be the result of both delayed colon transit and impaired anorectal muscle coordination.

Deglutition Disorders↗
PubMed1995

Intestinal peptides and their relevance in pediatric disease.

Gastrointestinal (GI) endocrinology has undergone rapid change during recent years. A greater appreciation has been gained for the role of gut peptides in the regulation of GI motility, secretion, blood flow, absorption, and immunity. Furthermore, it is increasingly recognized that these peptides function in both the brain and the gut as neurotransmitters. Many effects initially attributed to hormonal influences are now known to be neurocrine in origin. GI peptides can be classified into families based on their structural homology. In this article, the physiology of the major gut peptides is reviewed, and their role in the pathophysiology of GI disorders is highlighted.

Child↗
PubMed2004

High-resolution ultrasonography in gastrointestinal graft-versus-host disease.

Gastrointestinal graft-versus-host disease (GVHD) is one of the main causes of therapy-related death after allogeneic hemopoietic stem cell transplantation. Early diagnosis and immediate treatment are probably essential for improving clinical outcome. High-resolution sonography allows the evaluation of single bowel wall layers throughout the small and large bowel. We report the sonographic findings of seven consecutive patients with histologically confirmed GVHD grade II-IV of the gastrointestinal tract. The patients were examined sonographically within the 1st week after onset of clinical symptoms. Dilatation of the colon and striking bowel wall thickening were early and common features in these patients. Sonography may become a useful tool for diagnosis of patients with gastrointestinal GVHD. Its role for preclinical diagnosis, grading of severity of disease, and guiding therapy of patients with gastrointestinal GVHD warrants evaluation in prospective studies.

Adult↗
PubMed2005

Clinical and endoscopic features for alimentary tract cytomegalovirus disease: report of 20 cases with gastrointestinal cytomegalovirus disease.

BACKGROUND: The clinical presentations and endoscopic features of cytomegalovirus (CMV) infection in the gastrointestinal (GI) tract are diverse, and can mimic other inflammatory gastrointestinal diseases. METHODS: From 1987 to 2003 at Chang-Gung Medical Center, 20 patients with CMV infections of the GI tract who were assessed using endoscopic examinations and diagnosed via pathologic studies were retrospectively reviewed. RESULTS: Most of the patients were adults with immunocompromised conditions (10/20). GI tract bleeding was the most common clinical manifestation (11/20). Five patients presented with abdominal pain, and two patients presented with diarrhea. Fifteen patients suffered from fever. The endoscopic abnormalities could be classified into four main groups: inflammatory mucosa alone (3/20), ulceration alone (7/20), inflammatory mucosa associated with ulcer (9/20) and sub-mucosal tumor with ulcer (1/20). Of the 17 patients with ulcer lesions, ten had multiple ulcers and 12 had large ulcers exceeding 2 centimeters in diameter. Of the six patients followed up with colonoscopy, one was free of disease, one had a single ulcer, and four had colitis and were CMV positive on repeat biopsy. Two patients had colon strictures with persistent CMV colitis. CONCLUSION: Many patients with GI tract CMV infection are immunocompromised. Gastrointestinal bleeding is the most common initial presentation of gastrointestinal CMV disease. Fever is the most common associated toxic sign. Sigmoidoscopy cannot replace colonoscopy for detecting CMV colitis. The most common feature is multiple ulcers with at least one large ulcer. Endoscopic follow-up in patients with CMV colitis is recommended to investigate for possible persistent colitis and strictures.

Adolescent↗
PubMed2005

Moderate alcohol consumption and diseases of the gastrointestinal system: a review of pathophysiological processes.

BACKGROUND/AIMS: Alcohol drinking is responsible for a number of gastrointestinal diseases and cancers. Although heavy drinking episodes and chronic drinking are well linked to mechanisms of disease, moderate alcohol consumption and its effects are less well known. This review attempts to fill a gap in the literature surrounding moderate alcohol consumption. METHODS: A systematic review of the English literature using PubMed was used. RESULTS: A dose-response risk relationship exists between alcohol consumption and digestive disease risk. Acetaldehyde is the main factor in alcohol-related damage in moderate alcohol consumption and acts through numerous methods to exert damaging effects. CONCLUSION: Zero alcohol intake is recommended for lowest risk of alcohol-related digestive tract diseases and conditions. However, given the lowest overall mortality is associated with moderate drinking, moderate drinking with no bingeing episodes is recommended.

Adult↗
PubMed2006

Disability and poor quality of life associated with comorbid anxiety disorders and physical conditions.

BACKGROUND: Evidence has been emerging that anxiety disorders are associated with several physical health conditions. We used the first community survey, which assessed physical conditions based on physician assessment and included standardized diagnostic assessment of mental disorders by trained health professionals, to examine the relationship between anxiety disorders and physical conditions. METHODS: The German Health Survey (N = 4181; response rate, 87.6%; ages 18-65 years) used the Composite International Diagnostic Interview to assess Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mood, substance use, and anxiety disorders (panic disorder, social phobia, specific phobia, generalized anxiety disorder, agoraphobia, obsessive-compulsive disorder) and a standardized medical interview supplemented by laboratory data to assess a broad range of physical conditions. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was used to measure health-related quality of life. Number of days of role impairment was used to measure past 30-day disability. RESULTS: After adjusting for sociodemographic factors and other common mental disorders, the presence of an anxiety disorder was significantly associated with thyroid disease, respiratory disease, gastrointestinal disease, arthritis, migraine headaches, and allergic conditions (adjusted odds ratios between 1.39 and 2.12; P<.05). Compared with physical disorders alone, the presence of comorbid anxiety disorder with 1 or more physical disorders was associated with poorer physical component scores on the SF-36 (adjusted mean scores for physical condition alone and physical condition with anxiety disorder, 48.50 and 45.86, respectively; P<.001) and past 30-day disability due to physical problems (adjusted odds ratio, 1.69; 95% confidence interval, 1.20-2.37). CONCLUSION: Anxiety disorders are independently associated with several physical conditions in the community, and this comorbidity is significantly associated with poor quality of life and disability.

Adolescent↗
PubMed2006

Colorectal cancer after start of nonsteroidal anti-inflammatory drug use.

PURPOSE: Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, have been consistently shown to reduce the risk of colorectal cancer (CRC) in non-experimental studies, but little is known of the factors associated with starting and continuing regular NSAID use and their effect on the NSAID and CRC association. SUBJECTS AND METHODS: We performed a prospective cohort study of 22,071 healthy male physicians aged 40 to 84 years without indications or contraindications to regular NSAID use at baseline. Annual questionnaires assessed quantity of NSAID use, occurrence of cancer, and risk factors for CRC. Propensity for regular NSAID use (>60 days/year) was estimated using generalized estimating equations. We used a time-varying Cox proportional hazards model to estimate the association between duration since initiation of regular NSAID use and risk for CRC. RESULTS: Regular non-aspirin and any NSAID use increased from 0% to 12% and 1% to 56% over time, respectively and was predicted by age, body mass index, alcohol consumption, medication use, coronary artery disease, gastrointestinal diseases, arthritis, hypertension, and headaches. Over a median follow-up of 18 years, 495 physicians were diagnosed with CRC. There was no trend of CRC risk with increased duration of regular NSAID use. Five or more years of regular use of any NSAID were associated with a relative risk for CRC of 1.0 (95% confidence interval: 0.7-1.5), after adjustment for predictors of regular NSAID use. CONCLUSION: Regular NSAID use was not associated with a substantial risk reduction of CRC after controlling for time-varying predictors of both NSAID use and CRC.

Adult↗
PubMed2003

The association between chronic diseases and fatigue in the working population.

OBJECTIVE: The aims of this study were to examine (a) whether employees with a chronic disease report more fatigue than employees without a chronic disease, (b) whether number or type of chronic disease is related to fatigue, and (c) whether differences in fatigue level in various types of chronic diseases are related to psychological distress. METHODS: Data were taken from 12,137 employees. Fatigue was measured with the Checklist Individual Strength (CIS). RESULTS: Employees with a chronic disease reported more fatigue (OR=2.9, 95% CI=2.7-3.2). Small differences were observed in the level of fatigue in various types of diseases. A strong linear association between the number of chronic diseases and fatigue was found. Psychological distress explained the higher level of fatigue in some chronic diseases (gastrointestinal diseases and migraine). CONCLUSIONS: Fatigue is more common in employees with a chronic disease. A strong association between number of chronic diseases and fatigue exists. Fatigue in employees with a chronic disease can partly be explained by psychological distress. Some chronic diseases show a stronger association between psychological distress and fatigue.

Adolescent↗
PubMed2000

Empirical findings on the use of hypnosis in medicine: a critical review.

Recent changes in health care have been characterized by an increased demand for empirically supported treatments in medicine. Presently, there is moderate support for the integration of hypnotic techniques in the treatment of a number of medical problems. This critical review of the research literature focuses on the empirical research on the effectiveness of hypnotic treatments as adjuncts to medical care for anxiety related to medical and dental procedures, asthma, dermatological diseases, gastrointestinal diseases, hemorrhagic disorders, nausea and emesis in oncology, and obstetrics/gynecology. Wider acceptance of hypnosis as an intervention to assist with medical care will require further research.

Anxiety↗
PubMed1983

Inebriation and mortality.

Three experiences familiar to heavy drinkers were related to mortality over a 12-year and 23-year follow-up period. Weibull survival models were used to test the significance of associations and to produce estimates of relative risk. Age and marital status were controlled for by including them into the models, and social class by analysing the data separately for the 462 upper and 1614 lower social group males. The experiences studied were the occurrence of alcohol intoxication, that of hangover, and that of hangover drinking. All three had some prognostic value. Significant associations were found for mortality from pulmonary tuberculosis, cancer of the lung, digestive cancer, coronary heart disease, respiratory diseases, gastrointestinal diseases, injuries, and all causes of death. The number of significant associations found over the 23-year follow-up period was smaller than over the 12-year follow-up period.

Adult↗
PubMed2003

Widening socioeconomic inequalities in mortality in six Western European countries.

OBJECTIVES: During the past decades a widening of the relative gap in death rates between upper and lower socioeconomic groups has been reported for several European countries. Although differential mortality decline for cardiovascular diseases has been suggested as an important contributory factor, it is not known what its quantitative contribution was, and to what extent other causes of death have contributed to the widening gap in total mortality. METHODS: We collected data on mortality by educational level and occupational class among men and women from national longitudinal studies in Finland, Sweden, Norway, Denmark, England/Wales, and Italy (Turin), and analysed age-standardized death rates in two recent time periods (1981-1985 and 1991-1995), both total mortality and by cause of death. For simplicity, we report on inequalities in mortality between two broad socioeconomic groups (high and low educational level, non-manual and manual occupations). RESULTS: Relative inequalities in total mortality have increased in all six countries, but absolute differences in total mortality were fairly stable, with the exception of Finland where an increase occurred. In most countries, mortality from cardiovascular diseases declined proportionally faster in the upper socioeconomic groups. The exception is Italy (Turin) where the reverse occurred. In all countries with the exception of Italy (Turin), changes in cardiovascular disease mortality contributed about half of the widening relative gap for total mortality. Other causes also made important contributions to the widening gap in total mortality. For these causes, widening inequalities were sometimes due to increasing mortality rates in the lower socioeconomic groups. We found rising rates of mortality from lung cancer, breast cancer, respiratory disease, gastrointestinal disease, and injuries among men and/or women in lower socioeconomic groups in several countries. CONCLUSIONS: Reducing socioeconomic inequalities in mortality in Western Europe critically depends upon speeding up mortality declines from cardiovascular diseases in lower socioeconomic groups, and countering mortality increases from several other causes of death in lower socioeconomic groups.

Adult↗
PubMed1983

Hyperkalaemia in patients in hospital.

Significant hyperkalaemia occurred in 406 out of 29 063 patients admitted to a major Scottish teaching hospital in one year (1.4%). Mortality was higher in these patients than in control patients and was strongly correlated with the severity of the hyperkalaemia. Overall seven deaths were directly due to hyperkalaemia (out of 58 deaths among patients with hyperkalaemia). Factors contributing to a poor prognosis were severity and speed of onset of hyperkalaemia and the presence of appreciable renal impairment. Patients with hyperkalaemia were older and more likely to be male; this trend was present in all diagnostic subcategories. Genitourinary disease, gastrointestinal disease, and cancer were significantly more common among the patients with hyperkalaemia than the controls. Hyperkalaemia due to drug treatment was invariably mild and non-fatal, whereas genitourinary disease was often associated with moderate to severe hyperkalaemia, which in two cases proved fatal. Use of electrocardiographic monitoring was rare, and although the treatment of hyperkalaemia was effective, it was often used when not required. Hyperkalaemia is a potential hazard in diabetic ketoacidosis, and use of potassium supplements should be carefully monitored during correction of the acidosis.

Diabetic Ketoacidosis↗
PubMedDate not supplied

Placebo and placebo effect: their impact on the evaluation of drug response in patients.

Placebo, defined as any therapeutic procedure, without any specific activity, given deliberately to have an effect on a patient, symptom, syndrome or disease, has a great impact in the evaluation of drug response. The possible pathways via which the possible effect brings about clinical and physiological changes remain unknown, but a humoral mechanism seems to be implicated in some placebo effects (e.g. placebo-induced analgesia). The placebo effect depends on many factors, including the type of patient, the personality of the physician, the doctor-patient relationship and the type and even the colour of the drug preparation. Placebo control is important particularly when the disease is characterized by frequent spontaneous periods of acute exacerbation and remission. Functional (such as dyspepsia and irritable bowel syndrome) and organic (such as peptic ulcer and inflammatory bowel disease) gastrointestinal diseases have got great benefit from placebo-controlled clinical trials. In such trials the more effective the placebo is, the more difficult it will be to demonstrate the efficacy of active drug in statistical terms. Nevertheless, provided the use of placebo be ethical for a given condition, placebo-controlled trials are the only objective way of assessing correctly drug response in patients.

Drug Evaluation↗
PubMed2000

Communicable Diseases Surveillance

Communicable diseases surveillance highlights for May 2000 (vaccine preventable diseases, bloodborne diseases, gastrointestinal diseases, quarantinable diseases, sexually transmissible diseases, vectorborne diseases, other diseases), and surveillance outcomes from several reporting series as follows: National Notifiable Diseases Surveillance System tables, 1 to 28 May 2000; Laboratory Serology and Virology Reporting Scheme tables, 1 to 31 May 2000; Australian Sentinel Practice Research Network report tables, 1 to 28 May 2000; HIV and AIDS surveillance, reporting period 1 to 31 January 2000, assessed as at 30 April 2000. In the March 2000 issue an additional summary table was introduced. Table 1 presents 'date of notification' data, which is a composite of three components: (i) the true onset date from a clinician, if available, (ii) the date the laboratory test was ordered, or (iii) the date reported to the public health unit. Table 2 presents data by report date for information only. In Table 2 the report date is the date the public health unit received the report. Table 1 now includes the following summary columns: total current month 2000 data; the totals for previous month 2000 and corresponding month 1999; a 5 year mean which is calculated using previous, corresponding and following month data for the previous 5 years (MMWR Weekly Feb 25, 2000:49(07);139-146); year to date (YTD) figures; the mean for the year to date figures for the previous 5 years; and the ratio of the current month to the mean of the last 5 years.

Australia↗
PubMed2003

Communicable diseases surveillance: Highlights for 3rd quarter, 2003.

Communicable diseases surveillance highlights for 3rd quarter, 2003 (bloodborne diseases, gastrointestinal disease, vaccine preventable diseases, vectorborne diseases, zoonoses, other bacterial infections), and surveillance outcomes from several reporting series as follows: National Notifiable Diseases Surveillance System tables, 1 July to 30 September 2003; Laboratory Serology and Virology Reporting Scheme tables, 1 July to 30 September 2003; Australian Sentinel Practices Research Network, reporting period 1 July to 30 September 2003; Gonococcal surveillance, reporting period 1 April to 30 June 2003; HIV and AIDS surveillance, reporting period 1 April to 30 June 2003, assessed as at 30 September 2003; Australian childhood immunisation coverage, 1 April to 30 June 2003 cohort, assessed as at 30 September 2003; National Enteric Pathogens Surveillance System, reporting period 1 July to 30 September 2003. These national data collections are complemented by intelligence provided by State and Territory communicable disease epidemiologists and/or data managers. This additional information has enabled the reporting of more informative highlights each quarter.

Australia↗
PubMed2000

[The structure and antibiotic sensitivity of the causative agents of community-acquired infectious diseases of bacterial origin in children].

Four hundred and forty pediatric patients at the age of 7 days to 15 years with various infections admitted to the Hospital within a month were examined. The biological material was inoculated to blood agar on the first days of the patient admittance to the Hospital and after the growth the organisms were isolated and identified. Antibiotic susceptibility of the isolates was assayed with the disk diffusion method. 479 strains in all were tested. The most frequent cases requiring hospitalization and antibiotic therapy were those of respiratory tract infections (54.09 per cent), urinary tract infections (26.36 per cent), cutaneous and subcutaneous fat diseases, gastrointestinal diseases and others (about 25 per cent of the cases in all). The main pathogens were Streptococcus viridans, S.aureus and S.epidermidis, as well as Enterobacteriaceae (chiefly E.coli) whose frequencies were practically equal (in 25-35 per cent of the cases). The Pneumococcus isolates amounted to 6.3 per cent. Nonfermenting bacteria (Pseudomonas aeruginosa and Acinetobacter) and some representatives of Enterobacteriaceae (Citrobacter, Serratia, Morganella) were isolated from 7 per cent of the patients. The frequency of Klebsiella and Enterobacter was about 11 per cent. The main pathogens were tested for their susceptibility to amoxycillin/clavulanic acid, ampicillin, oxacillin and gentamicin. The least active antibiotic was ampicillin. 88.8 per cent of the E.coli isolates and 100 per cent of the Klebsiella, P.mirabilis, Morganella, Citrobacter, Enterobacter and Serratia isolates were resistant to it. 53.2 per cent of the Streptococcus isolates including 64.5 per cent of the Pneumococcus isolates were as well resistant to ampicillin. 59.5 per cent of the Streptococcus isolates (mainly S.viridans and Enterococcus) was susceptible to oxacillin, 22.2 per cent of them being moderately susceptible. 62.5 per cent of the Pneumococcus isolates and 78.1 per cent of the Staphylococcus isolates were also susceptible to oxacillin. The highest susceptibility of the isolates was that to amoxycillin/clavulanic acid, i.e. 90.1 per cent of the strains, 79.9 per cent of them being highly susceptible. All the isolates of Citrobacter, Serratia and Morganella and some isolates of P.aeruginosa, Acinetobacter, Enterobacter, Klebsiella and E.coli were resistant to amoxycillin/clavulanic acid. As for the latter 5 organisms their susceptibility to amoxycillin/clavulanic acid was comparable with that to gentamicin. The susceptibility of the Streptococcus and Staphylococcus isolates to amoxycillin/clavulanic acid was significantly much higher than that to oxacillin, gentamicin and ampicillin: 93 per cent of the Streptococcus isolates (62.7 per cent of the Pneumococcus isolates) and 90.7 per cent of the Staphylococcus isolates.

Adolescent↗
PubMed1995

[Clinical medicine of P. F. von Siebold].

The author elucidates some aspects of the clinical medicine of P.F. von Siebold (1796-1866) by studying a manuscript titled "Rampō-kuden, namely, dictative teaching of Dutch medicine by P.F. von Siebold", which has not been studied enough yet. From this manuscript the author considers the descriptions about cancers, gynecological diseases, syphilitic diseases, urinary diseases, ophthalmic diseases, skin diseases, pulmonary diseases, gastrointestinal diseases and osteo-articular diseases, and thereby shows the concepts and therapeutic techniques of P.F. von Siebold regarding these diseases. To make his therapeutics more clearly understood, the author comments on blood-letting, opiates, emetics, purgatives, peruvian bark, digitalis, physiotherapy, abdominal paracentesis and surgical operations written in this manuscript.

Germany↗