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  • 1
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The purpose of this paper is to report five patients with chronic secretory diarrhea (maximum stool volume greater than 1 liter per day, duration 6 weeks to 8 years) in whom we could find no evidence of an endocrine tumor or of surreptitious laxative ingestion. All except one had severe hypokalemia. There was apparent improvement after treatment with prednisone in two patients and loperamide in one. The diarrhea resolved spontaneously in three patients and has undergone several temporary remissions in one patient. The last patient died after a severe unremitting illness. Extensive investigations failed to establish the etiology, but intestinal perfusion (carried out in four of the five patients) revealed secretion or abnormally low absorption of water and electrolytes in the jejunum and abnormally low absorption in the colon. The management of patients with chronic watery diarrhea is discussed.
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  • 3
    ISSN: 1573-2568
    Keywords: gastric cancer ; gastric ulcer ; endoscopy ; prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The pathologic features and five-year survival of patients in whom gastric cancer masquerades at endoscopy as a benign gastric ulcer has been poorly characterized. We reviewed retrospectively all cases of gastric adenocarcinoma in three hospitals for a five-year period. Of 266 patients with gastric adenocarcinoma, 169 (63.5%) had endoscopy with biopsy prior to diagnosis of cancer. In 159 of these 169 patients (94.1%), the endoscopic findings suggested cancer, while in the remaining 10 patients (5.9%) the endoscopic appearance suggested benign ulcer. In six of these 10 patients, the initial endoscopic biopsies did not reveal cancer and correct diagnosis was delayed for as long as 14 months. Three of the 10 patients had “early gastric cancer” by pathologic criteria at gastrectomy, although one had lymph node metastasis. The other seven patients had pathologic criteria for advanced gastric cancer, and three had lymph node metastasis. In spite of advanced cancer and/or lymph node metastasis in eight of our 10 patients, five-year survival in these patients with benign-appearing ulcers was 70%, as compared to 17% in patients whose gastric lesions appeared malignant at endoscopy.
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  • 4
    ISSN: 1573-2568
    Keywords: FLUDROCORTISONE ; SPIRONOLACTONE ; SECRETORY DIARRHEA ; SODIUM ABSORPTION ; INTESTINAL ADAPTATION
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The response of the colon to aldosterone isbelieved to be an important adaptive mechanism toexcessive sodium losses in diarrhea. However, the degreeto which mineralocorticoid activity actually influences fecal output of sodium in people with diarrheais unknown. To gain insight into this question, 10normal people were treated with placebo, fludrocortisone(an aldosterone agonist), and spironolactone (an aldosterone antagonist) during threeexperimental periods lasting nine days. On days 5-8,diarrhea was induced by ingestion of phenolphthalein.Diet was controlled. Fecal sodium was 40 meq/day onplacebo and 29 meq/day on fludrocortisone, consistentwith mineralocorticoid stimulation of intestinal sodiumabsorption. However, contrary to our expectations,spironolactone therapy was also associated with a fall in fecal sodium output, to 28 meq/day. Toexplain this paradoxical effect of spironolactone, wesuggest that sodium depletion caused by spironolactone'snatriuretic action on the kidney caused the release of an unknown stimulant of intestinalsodium absorption, whose action more than overcame thereduced colonic absorption resulting from inhibition ofaldosterone activity by spironolactone. This interpretation implies that the intestinaladaptation to sodium depletion in diarrhea involves bothaldosterone and an aldosterone independent factor,working in concert to reduce fecal sodiumoutput.
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  • 5
    ISSN: 1573-2568
    Keywords: growth hormone ; intestinal absorption ; intestinal secretions ; human ; jejunum ; intestinal perfusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Previous studies in rats showed that the administration of recombinant human growth hormone markedly increased intestinal absorption of electrolytes and water and suggested that growth hormone would be a useful antidiarrheal agent. We therefore examined the effect of recombinant human growth hormone on the human jejunum in vivo, using a triple lumen nonabsorbable marker technique. Healthy subjects were studied on two different test days, one as a control and a second where recombinant human growth hormone was injected subcutaneously in a dose of 100 μg/kg. With this dose we achieved equal or higher growth hormone serum levels than in previous rat studies. However the administration of recombinant human growth hormone did not stimulate absorption or inhibit secretion of water and electrolytes in the human jejunum in vivo. We believe that the discrepancy between humans and rats is most likely due to the species difference rather than to differences in methods that were used. Therefore recombinant human growth hormone cannot be considered a useful proabsorptive antidiarrheal agent in humans.
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  • 6
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Gastric and small-intestinal contents of normal human subjects were analyzed for sodium, potassium, calcium, chloride, bile salts, osmolality, pH, and-for polyethylene glycol (if this volume indicator was included in the test meal) following the ingestion of 2 meals. From the results, osmotic constituents of
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  • 7
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The clinical, radiologic, and histologic features of 16 patients hospitalized with clindamycin-associated colitis are presented. The findings are tabulated and compared to 33 cases reported in the literature. The majority of patients were caucasian females over 40 years of age. The clinical presentation varied from mild persistent diarrhea to acute surgical abdomen. Proctoscopic examination revealed nonspecific colitis in 9 and pseudomembranous colitis in 7 cases. No specific radiologic or histologic findings for postantibiotic colitis were found. Therapy was nonspecific and varied according to the severity of the clinical course. Clinically, there appeared to be some benefit from systemic steroid therapy. 4 of the 16 patients died. None of the recovered patients have had spontaneous relapses off medication during follow-up evaluation. The pathogenic mechanism for postantibiotic colitis secondary to clindamycin remains unknown and does not appear dose related. Clindamycin therapy should be limited to disorders with specific indications.
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  • 8
    ISSN: 1573-2568
    Keywords: prostaglandins ; gastrin ; misoprostol ; gastric secretion ; meal stimulation ; intragastric titration
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In a randomized, double-blind, crossover trial, the effects of 50-, 100-, and 200- Μg doses of misoprostol on meal-stimulated gastric acid secretion were compared with placebo in 16 healthy male subjects. Compared with placebo, the 100- and 200- Μg doses produced significant reductions in acid output for 2 and 3 hr, respectively, following the test meal (P=0.05). Misoprostol did not influence either the fasting or postprandial serum gastrin levels as compared with placebo. No adverse experiences were reported by any of the subjects. One subject experienced a transient rise in SGPT as compared with baseline, which may have been due to ethanol intake. This study provides a scientific rationale on which to base additional trials of misoprostol in patients with disease related to gastric acid production.
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  • 9
    ISSN: 1573-2568
    Keywords: amiloride ; colon ; water absorption ; electrolyte absorption ; potential difference ; sodium transport
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In vitrostudies under short-circuited conditions suggest that amiloride, a diuretic agent which is thought to block apical membrane sodium entry, has significant effects on sodium absorption by the human colon. To evaluate this in vivo,we studied the effect of amiloride applied in concentrations of 10−5 and 10 −4 M on sodium transport and potential difference (PD) in human colon during steadystate perfusion. Net sodium absorption was reduced 25% by amiloride and chloride absorption by 15%; potassium and bicarbonate secretion rates were enhanced. In other studies the colon was divided into a proximal and distal test segment by endoscopic introduction of a collection channel to the descending colonsigmoid junction. Comparison of tritiated water absorption by the two segments indicated that the distal segment comprised approximately 20% of the total colon surface area. However, the distal test segment only accounted for 5–7% of total sodium, chloride, or water absorption; in contrast, 17–20% of total potassium or bicarbonate secretion occurred there. In the proximal test segment, amiloride reduced net sodium absorption by almost one third from 21.0 to 14.4 mmollhr (P〈0.02) but had no significant effect on PD. In the distal test segment, amiloride produced a 25% reduction in mean sodium absorption from 1.2 to 0.9 mmollhr, but this reduction was not statistically significant;however, potential difference was significantly reduced by 33% (P〈0.02). These results suggest that most sodium absorption in normal human colon in vivois mediated by transport processes which are insensitive to these doses of amiloride. An effect of amiloride on potential difference was only evident in the distal colon, suggesting differences in the transport processes or in the permeability properties of the proximal and distal colon in vivo.
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  • 10
    ISSN: 1573-2568
    Keywords: bile acid ; chronic diarrhea ; malabsorption ; Crohn's disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Patients with ileectomy can present with severe steatorrhea due to bile acid depletion. While exogenous bile acid would seem to be ideal therapy for this condition, it is not often used because it is though that the bile acid would be malabsorbed and would enter the colon, producing a secretory diarrhea. This report describes a patient who had an ileectomy and partial right colon resection for Crohn's disease and then developed severe steatorrhea due to bile acid malabsorption. Although steatorrhea was reduced from 134 to 9 g/24 hr with chronic ingestion of ox bile extract, stool weight did not increase with ox bile (stool weight 669 g/24 hr before therapy and 507 g/24 hr after therapy). In this patient, oral bile acid supplementation reduced fat excretion markedly, but did not aggravate diarrhea, even though the colon was still present. This result may have been due to impaired solubility of bile acid in fecal fluid due to an acid pH or to binding of bile acid with particles of solid stool. Ingestion of ox bile extract does not necessarily increase stool weight in patients with defective fat absorption due to bile acid malabsorption and can be tried with caution in an effort to diminish steatorrhea.
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