Prokinetic effect of cisapride on pedicled stomach, small bowel and colon grafts replacing the esophagus after esophageal resection

Cisapride is a potent third generation prokinetic agent acting on postganglionic receptors by increasing the release of acetylcholine. In a prospective, self-controlled study the prokinetic action of cisapride was tested on pedicled stomach, jejunum and colon grafts used for substitute after esophageal resection. Between 1995 and 1998 15 patients with gastric pull up, 10 patients with colon replacement or bypass and eight patients with free jejunum transplant or jejunum replacement were evaluated. Esophageal transit scintigraphy was performed before and after cisapride administration. From the time-activity curves, the half-life of radiolabeled bolus in the esophagus was calculated and preadministration and postadministration half-lives were compared. Cisapride significantly reduced the half-life of radiolabeled bolus in the substitute in the case of stomach and jejunum replacement, while for colon replacement the results were dispersed too widely to yield significant difference. Cisapride exerts prokinetic effect on pedicled stomach and jejunum substitutes after esophageal resection.

Issues to debate on the Women's Health Initiative: estrogen: an instrument or the conductor of the orchestra?

Although it is well known that cyclic production of sex hormones is essential to establish reproductive function and female characteristics, distant impacts of the activity of the female endocrine system result from a concert of delicate mechanisms. Estrogen is rather an instrument than a conductor in this physiological orchestra of the female. Thus, controversies in the explanation of results from studies on hormone replacement therapy (HRT) and cardiovascular disease (CVD) prevention might be eliminated, if we analyse not only the role of estrogen but a broader spectrum of factors leading to CVD. Authors would like to hypothesize that haemorheological changes in women around menopause, such as increased blood and plasma viscosity, haematocrit and fibrinogen, are largely responsible for the increased mortality in the post-menopausal life period. We believe that a cyclic withdrawal bleeding establishes a more favourable haemorheological condition, thus, sequentially administered estrogen might be protective in post-menopausal women. Nevertheless, other factors, that decrease blood viscosity, such as daily exercise, intake of ample amount of fluids as well as ideal nutrition, are equally important. We are confident that sequential HRT, as well as healthy life style and risk prevention programmes have their proper place in the management of this issue.

Occurrence of osteopenia among adolescent girls with oligo/amenorrhea

The occurrence of reduced bone mineral density (BMD) among adolescent girls with oligomenorrhea or secondary amenorrhea, due to 'pure' dysfunction of the hypothalamo-pituitary-ovarian (HPO) axis (without anorexia nervosa, excessive sport or ballet, slimming diet, etc.) was examined. The study group consisted of 19 adolescent girls (age 16-18 years) with oligo/amenorrhea. Clinical (height, weight, age at menarche, duration of amenorrhea, body mass index (BMI)), hormonal (follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, testosterone, prolactin), and ion (calcium, sodium, potassium, phosphate, chloride) parameters and the BMD of the lumbar spine were investigated. Correlations between BMD and other parameters were also examined. Twenty healthy volunteers (same age and regular cycles) served as controls. Three girls had osteoporosis, with a BMD below -2 standard deviations (SD). Ten showed osteopenia, with a BMD value between -1 and -2 SD. Only six of the study group had a normal BMD within +/- 1 SD. A positive correlation was observed between the BMD and the BMI (r = 0.73; p < 0.05). All the controls had normal hormonal, ion and BMD parameters. 'Pure' dysfunction of the HPO axis in adolescents, causing oligomenorrhea or secondary amenorrhea, might result in reduced BMD and, consequently, lower peak bone mass. Treatment of menstrual cycle disorders is necessary for the prevention of osteoporosis.

Nutritional and life-quality consequences of aboral pouch construction after total gastrectomy: a randomized, controlled study

AIMS

The aboral pouch, a new type of gastric substitute, has been introduced after total gastrectomy and compared to simple Roux-en-Y reconstruction in a prospective, randomized study. Anthropometric data, serum nutritional parameters, small intestinal passage, lipid and carbohydrate absorption and quality of life were measured 6 and 12 months after total gastrectomy.

PATIENTS AND METHODS

Between September 1997 and April 2000 46 patients entered the study, 24 to the aboral pouch group and 22 to the control, simple Roux-en-Y group.

RESULTS

Interim analysis of the data revealed significantly higher serum cholesterol levels, better lipid absorption and quality of life in patients who underwent aboral pouch construction.

CONCLUSION

Aboral pouch construction is a feasible reconstruction method after total gastrectomy providing better lipid absorption and quality of life for patients after total gastrectomy.

Comparison of quality of life and nutritional parameters after total gastrectomy and a new type of pouch construction with simple Roux-en-Y reconstruction: preliminary results of a prospective, randomized, controlled study

The aim of the study was to introduce a new type of gastric substitute, the aboral pouch, after total gastrectomy and to compare nutritional, motility, and quality of life parameters of patients with an aboral pouch to those undergoing simple Roux-en-Y reconstruction in a prospective, randomized, and controlled trial. To date 40 patients have entered the study. In 22 of them the aboral pouch was created; the remaining 18 patients with simple Roux-en-Y reconstruction served as the control group. Laboratory measurements, passage studies, lipid and carbohydrate absorption tests, and quality of life interviews were carried out as follow-up examinations. Preliminary results suggest that the aboral pouch has some advantages over simple Roux-en-Y reconstruction. Serum immunoglobulin M level and the quality of life estimated by the gastrointestinal quality of life index, yielded significantly better results in the pouch group.

[Dipyridamole test in the early detection of cerebrovascular disorders?]

The diagnosis of transient ischaemic attack (TIA) is mainly based on the clinical symptoms presented by the patient. Professionals in nuclear medicine have made a successful attempt to detect TIA by single photon emission tomography (SPECT) imaging. Improved sensitivity of the examination using stress test (e.g. acetazolamide) is well known in the literature. The dipyridamole stress test combined with SPECT imaging was regularly performed in patients (n = 100) with ischaemic heart disease. After injecting dipyridamole intravenously it found various forms of transient neurological deficits in 23% of the patients with considerably higher incidence reported previously in the literature (1.22/10,000). The so called "TIA positive" patients were examined further using the combination of dipyridamole stress test and brain SPECT imaging. The aim of this study was to analyse the relationship between transient neurological symptoms provoked by DPD test and the change in regional cerebral blood flow indicated by brain SPECT imaging. It is emphasized, that perfusion abnormalities revealed by brain SPECT were topographically consistent with the neurological deficits. In this article the attention was drawn to advantages of this test which may be suitable to provoke TIA safely. Combined with brain SPECT it may have an important role in the neurologic diagnostic procedures and in the prevention of stroke.

[Comparing aboral pouch construction with Roux-en-Y reconstruction after total gastrectomy]

The aim of this study was the introduction of a new type of gastric substitute, the aboral pouch after total gastrectomy and comparing the motility, nutritional and quality of life parameters of the patients with aboral pouch to the simple Roux-en-Y group in a prospective, randomized, controlled trial. Between September of 1997 and February of 1999 25 patients entered the study. In the pouch group after Roux-en-Y reconstruction aboral pouch was created as a side to side anastomosis approximately 50 cms distal to the esophagojejunostomy, 15 cms in length. In the control group simple Roux-en-Y reconstruction was performed. During the follow up examinations nutritional measurements, scintigraphic evaluation of the gastrointestinal passage, absorption tests and quality of life interviews were carried out. In the first year of the study 15 patients underwent pouch construction, while 10 patients served as controls. Preliminary results suggest that there is no marked difference in the postoperative adaptation between the two groups. However serum immunoglobulin and serum iron measurements, lipid absorption test and quality of life questionnaires predict a slight superiority of the patients with aboral pouch over the simple Roux-en Y group.

[Lower bone density (osteopenia) in adolescent girls with oligomenorrhea and secondary amenorrhea]

Occurrence of reduced BMD among adolescent girls and young women due to certain specific oligomenorrhea or amenorrhea (anorexia nervosa, excessive sport or ballet, etc.) is well known. However the prevalence of osteopenia among 16-18 years old girls with the cycle disorders mentioned above--caused by "pure" hypothalamo-pituitary-ovarian insufficiency--is not yet sufficiently examined. The hormonal (FSH, LH, prolactin, LH/FSH, estradiol. testosterone, progesterone) and ion (Ca++,PO4(3-),Na+,K+,Cl-) parameters and the bone mineral density (BMD) of the lumbar spine of 19 girls age 16-18 with oligomenorrhea or secondary amenorrhea, due to hypothalamo-pituitary-ovarian axis insufficiency were investigated, and correlation were searched for among them. In 3 of the case significant BMD reduction was found with a value lower than the -2 SD. compared to the age, sex and race matched control values, showing definite osteoporosis. The BMD of 10 girls was between the -2.SD. and -1 SD.: they had osteopenia. Only 6 of them had normal BMD ranging from the -1 SD. to the +1 SD. Neither the ion or hormonal values, nor the clinical parameters (height, weight age, age at menarche, duration of amenorrheic period) showed correlation with the BMD values, except of the body mass index (BMI), which showed a loose positive linear correlation. The measured low BMD values have a significance, referring to a possible reduction in the peak BMD. Patients having low peak BMD have an inclination for earlier, and more sever osteoporosis and fractures in the climacteric decades. These results emphasize the need of effective and early treatment of adolescent bleeding disorders from the point of view of prevention of osteoporosis as well.

[Comparative study of verapamil and bisoprolol in the secondary prevention of myocardial infarction]

The effect of Ca-antagonist, long-acting verapamil and the selective beta-1 blocking bisoprolol were investigated and compared in the secondary prevention after myocardial infarction. Eighty-seven patients were enrolled, 27 patients were not included because of the exclusion criteria, 30 patients were treated with verapamil and 30 patients with bisoprolol. During the 540 days of follow up period treadmill ergometry and dobutamine stress-test with SPECT investigation were performed two times. Both clinically and the data of our investigations the effect of the two drugs in the secondary prevention was good, and even at the 540th day the protective effect was still excellent.

[Ergometric, hemorheologic and myocardial perfusion studies and their evaluation by pattern recognition method in ischemic heart disease]

A large number of noninvasive and invasive methods are used in establishing the diagnosis of ischemic heart disease. Coronary angiography is an expensive method and a restricted capacity exists in Hungary. The aim was to elaborate an optimal combination of different noninvasive methods which can select the real positive cases for coronary angiography with maximal efficiency. Besides routine examinations, dobutamine pharmacological test was carried out and hemorheological parameters were also determined. After evaluating the results, patients were divided into three groups: absence of IHD, probable IHD and IHD. The clustering of patients into these groups was made by using their multivariable classifier algorithm (PRIMA) and 27 different parameters of 44 patients were taken into account. The groups were well separable as the class-distances indicated. The maximal ST segment depression during exercise, pharmacological test and hemorheological parameters were found to be the most powerful discriminating factors. Though the validation of the results is still in progress, based on their previous data they feel that the examination of hemorheological parameters and the application of pattern recognition method can be useful in the diagnosis of ischemic heart disease.

[The effect of high blood viscosity, caused by secondary polycythemia, on pulmonary circulation and gas exchange in patients with chronic cor pulmonale]

Blood viscosity, pressure of pulmonary artery, pulmonary functions, arterial and mixed venous oxygen content, cardiac output, oxygen transport capacity, oxygen consumption, ejection fraction have been examined at 25 patients with or without hypoxic cor pulmonale with or without secondary polycythaemia. Although secondary polycythaemia occurs in patients with hypoxic cor pulmonale as a compensatory process to increase the oxygen carrying capacity of the blood theoretically but as our findings: 1. The rise of haematocrit causes rise in blood viscosity significantly. 2. Polycythaemia secondary over 0.50 l/l of haematocrit contributes the rise of pressure in pulmonary artery. 3. The systemic oxygen carrying capacity is increasing with the rise of haematocrit up to 0.45 l/l but decreasing over 0.50 l/l. 4. Oxygen consumption is decreasing parallel with the rise of haematocrit. 5. Pulmonary functions, cardiac output do not change by the rise of haematocrit.

Influence of blood viscosity on circulatory parameters determined by first-pass radionuclide angiocardiography in cor pulmonale

First-pass radionuclide angiocardiography (FPRNA) with 99mTc-albumin was performed in 19 patients with cor pulmonale. Pulmonary circulation time (PCT), mean transit time (MTT), pulmonary stagnation index (PSI) were calculated from the time-activity curves for the estimation of cardiopulmonary circulation. Whole blood viscosity (WBV), plasma viscosity (PV) and hematocrit (HTC) were also measured on the same day. Significant prolongation of all parameters was observed (WBW: 5.04 +/- 1.19 mPas; PV: 1.36 +/- 0.17 mPas; HTC: 47.6 +/- 2.37%; PCT: 7.10 +/- 2.15 s; MTT: 9.33 +/- 4.11 s; PSI: 1.30 +/- 0.37) in patients with cor pulmonale. Significant positive correlations were found between PCT and WBV (r = 0.552; 0.001 < P < 0.01), MTT and WBV (r = 0.34; P < 0.05), furthermore between PCT and HTC (r = 0.356; P < 0.05). The results suggest that hemorheological parameters may influence the results of FPRNA, therefore, they should be determined in addition to the radionuclide study.

[Correlations between radionuclide first passage, hemodynamic and respiratory function parameters in cor pulmonale patients]

37 patients with chronic cor pulmonale have been investigated with radionuclide first passage, microcatheter-technique, respiratory function investigation, furthermore blood gas analysis. Significant positive correlation have been found between the pulmonary circulation time and the pulmonary artery pressure; between the pulmonary mean transit time and the pulmonary artery pressure; furthermore between the pulmonary stagnation index was calculated for the characterization of peripheral pulmonary stagnation and the pulmonary artery pressure. Significant negative correlation have been found between the pulmonary circulation time, the pulmonary mean transit time and the vital capacity, the FEV1, furthermore the O2-saturation values. The authors establish, that on the base of the close correlations between the isotopic circulation parameters and the clinical data, the radionuclide first passage investigation is suitable for the demonstration of the current conditions of cardiopulmonary circulation.

Effect of metoclopramide treatment on thyrotropin and prolactin levels in sick neonates

The present study was carried out to define whether dopaminergic mechanisms contribute to the regulation of thyrotropin (TSH) and prolactin PRL release in the immediate neonatal period. 14 full-term neonates with a mean birth weight of 3,240 g and a mean gestational age of 39.1 weeks were administered metoclopramide (MTC), a specific dopamine antagonist, in a dose of 0.1 mg/kg/day to treat delayed gastric emptying, regurgitation and abdominal distension. Prior to and after 3-day MTC administration, blood samples were taken to determine serum TSH and PRL levels using a radioimmunoassay method. It has been demonstrated that in response to MTC administration PRL increased significantly from 4,010 +/- 383 to 5,478 +/- 441 mU/l (p less than 0.01), while TSH showed only a tendency to rise independent of the pretreatment hormone levels (from 2.85 +/- 0.44 to 3.06 +/- 0.38 mU/L. In healthy control infants and in those infants with similar functional gastrointestinal disturbances who were treated without MTC, serum PRL levels fell significantly from days 3-4 to days 6-7, serum TSH, triiodothyronine and free thyroxine, however, remained unaltered. It is concluded that dopaminergic inhibitory mechanism may be involved in the control of pituitary PRL and TSH release already in the neonatal period.

Application of the parametric scan in the investigation of uteroplacental blood flow

We developed a new radioisotope technique to measure placental blood flow for the early detection of placental insufficiency. Using the parametric scan, placental perfusion was measured in 80 late-pregnant women. The T-maximum pictures obtained made it possible to differentiate between the vascular and intervillous phases of placental blood flow. The time period of intervillous phase calculated as the percentage of the whole placental Tmax was given as the intervillous perfusion index (IPI). It was demonstrated that the IPI was significantly higher in pregnancies complicated with intrauterine growth retardation (64.2% +/- 16.5%), hypertension (60.0 +/- 15.2) and oedema (57.9% +/- 10.1%) than in the control group (33.7% +/- 10.5%). These data suggest that the first sign of placental insufficiency is the prolongation of the IPI which is likely to precede the quantitative reduction of placental perfusion.

Determination of the intervillous perfusion index in pregnancies with intrauterine growth retardation

The authors developed a new radioisotope technique to measure placental blood flow for early detection of placental insufficiency. Using this method placental perfusion has been measured in 20 healthy pregnant women and in 15 pregnancies complicated with intrauterine growth retardation (IUGR). The T-maximum pictures obtained made it possible to differentiate between the vascular and intervillous phases of placental blood flow. The time period of intervillous phase calculated as the percent of the whole placental T-maximum was given as the intervillous perfusion index (IPI). It has been demonstrated that IPI is significantly longer in IUGR pregnancies (67.0 +/- 14.6) than in the control group (31.6 +/- 10.7). These data suggest that the first sign of placental insufficiency is the prolongation of IPI, which is likely to precede the quantitative reduction of placental perfusion.

Cholinergic and catecholaminergic interaction and fluid intake in the rat

The effect of simultaneous topical application of adrenergic agonists was investigated on the polydipsia caused by direct carbachol (CCh) stimulation of the rat brain. In addition, fluid selection (4-choice arrangement) was studied. Noradrenaline and isoprenaline fully antagonized the CCh effect after either intracerebroventricular, intraseptal or intrapreoptic application. Phenylephrine inhibited CCh polydipsia after intracerebroventricular or intrahypothalamic but not after intraseptal injection. Previous experiments had shown that adrenergic agonists also exerted a marked modulatory influence on an affective behavioural reaction pattern (rage reaction) of the cat. The results of the present experiments corroborate the assumption that, also in non-striatal brain structures, adrenergic modulation of cholinergic behavioural patterns is perhaps a more general and important phenomenon than had been assumed so far.

Atropine stereotypy and its inhibition by intracaudate triperidol in the rat

One component (rearing) of the stereotyped behavior of the rat was quantitated using erigometer, a new device developed in this laboratory. Intraperitoneal injection of atropine, but not methylatropine, caused dose-related stereotyped behavior in the rat and this effect was antagonized by intracaudate injection of triperidol in a dose-related manner. It is concluded that stereotypy can be evoked also in the case when the striatal dopaminergic tone is normal or even below normal: it is the equilibrium of the striatal cholinergic-dopaminergic systems which must be shifted towards dopamine, which is necessary for the development of this behavioral manifestation.