By means of fiberendoscopic injection sclerotherapy, it was possible to achieve eradication of es... more By means of fiberendoscopic injection sclerotherapy, it was possible to achieve eradication of esophageal varices in 18 patients. At the onset of treatment 9 patients had small varices (grade II) and other 9 had big varices (grade III). It was found in the big varices group there was needed more courses (p less than 0.01) and a greater amount of sclerosing agent (p less than 0.001) than in the group with small varices. Since those patients with big varices required more courses and more volume of sclerosing agent, and in fact they have more risk to rebleed during the pre-eradication period. It is proposed as a solution during this period, the use of a B receptor blocking agent (Propranolol) simultaneously with sclerotherapy.
Fifteen patients suffering from different types of constipation were studied by means of radiopaq... more Fifteen patients suffering from different types of constipation were studied by means of radiopaque markers in order to know: a) If there is a correlation between the clinical state and the physiopathological motor variables of idiopatic constipation. b) The efficacy of a compound that combines its bulk action to its stimulation of the intestinal wall. Based on the results it is concluded that: The methodology is not useful in order to differentiate the colon motor behaviours in idiopatic constipation if these differences really exist. The evacuative effect of the compound was easily and objectively demonstrated by the acceleration of the radiopaque markers along the right colon. There was a good correlation between the subjective assessment done by the physician, and the patient and the objective results.
We describe a technique used for fiberendoscopic sclerosis of esophageal varices. The addition of... more We describe a technique used for fiberendoscopic sclerosis of esophageal varices. The addition of a balloon around the endoscope is advocated for three uses: 1) ingurgitation of varices allows better visualization, 2) the methods avoid the quick clearing of the sclerosing agent, 3) it can be used as hemostatic agent in case of necessity. The sclerosant agent used is an association of ethanolamine oleate, hypertonic glucose solution (50%) and natural conjugated strogens.
As there is an increased incidence of gastroesophageal reflux (GER) in asthmatic patients compare... more As there is an increased incidence of gastroesophageal reflux (GER) in asthmatic patients compared with the normal population, in the present trial we have tried to establish the following: 1) Possible differences in pH-metric variables between patients with GER and asthma, and asthmatic patients with or without GER 2) The usefulness of simultaneous evaluation and correlation of reflux episodes with the respiratory peak flow (EPF) in asthmatic patients. 31 patients divided in four groups were compared. A) 16 patients with typical symptoms of GER without respiratory symptoms. B) 10 asthmatic patients with GER symptoms. C) 5 asthmatic patients without GER symptoms. D) 15 asthmatic patients who represents the sum of B and C. In all patients ambulatory computerized, four hours pH recordings were obtained after standard meal. The study was divided in two equal periods (upright and recumbent). The EPF was measured before starting the study and every 20 min during the recumbent period. From de following pH-metrics variables: total number of reflux episodes, percentage of recording time when intra-oesophageal pH < 4 in the upright position or recumbent position and for the total period, duration of longest reflux episode, number of episodes longer than five minutes, and correlation between reflux episodes and patients symptoms. Only differences were seen when the time of the longer period with GER and the number of patients with more than five minutes episodes were compared between groups A and D. From the results we conclude that the GER in asthmatic patients.(ABSTRACT TRUNCATED AT 250 WORDS)
The effects of pinaverium bromide on colonic motility were investigated in a controlled, controll... more The effects of pinaverium bromide on colonic motility were investigated in a controlled, controlled, cross-over study in 32 patients with irritable bowel syndrome. Constipation was clearly predominant in one group of 16 patients, and diarrhea in the other group of 16. Manometric measurements were taken of the colonic motor response generated by distention of a balloon inserted to the rectosigmoid junction. Measurements were taken before and one hour after ingestion of two tablets containing placebo or two tablets each containing 50 mg of pinaverium bromide. Following intake of placebo the motility index increased from the basal value in patients with constipation, and resistance to distention decreased in the diarrhea group. These changes were attributable to repetition of the mechanical stimulus within a relatively brief time lapse, or more probably to the ingestion of liquid which accompanied intake of tablets. Compared with placebo, pinaverium bromide induced inhibition of both effects. From the therapeutic point of view, the decrease in motility index seen in patients with irritable bowel syndrome and constipation is particularly interesting.
This study was performed in 15 healthy control subjects (8 males- age 23-70 and 7 females age 20-... more This study was performed in 15 healthy control subjects (8 males- age 23-70 and 7 females age 20-74) as a way to compare the total and segmental colonic transit time with two different type of radiopaque markers. One type of markers was 3 mm cut sections of a radiopaque polietilene 14 French Levine tube, with a medium weight of 64.3 mg and a specific gravity (SG) of 1.28. The other type were 7 mm lenticular insoluble barium (lentils) with medium weight of 231 mg and a SG of 1.87. Each subject ingested 20 markers of each type with the breakfast and front and profile plain films of the abdomen were taken 24 and 48 hs after. The total colonic transit time for the polietilene markers was 17.7 hs and 27.3 hs for the barium type (BM) (p < 0.001). The segmental transit time for right colon was 2.4 hs (PM) and 9.7 hs (PM) and 9.7 hs (BM) (p < 0.001) in the left colon 9.5 hs (PM) and 11.3 hs (BM) and in rectoanun 5.9 hs (BM) with no statistical significance. Conclusion: the physical characteristics of the radiopaque markers can modify the results of the colonic transit times.
Background and aims: In a previous uncontrolled experiment, oral vancomycin improved the symptoms... more Background and aims: In a previous uncontrolled experiment, oral vancomycin improved the symptoms (S) of chronic constipation (CC). The aim of this 21 day controlled pilot study was to determine if a low lincomycin dose improved the S of CC patients unresponsive to a high fiber diet. Methods: On days 0-to-10, patients were randomized to 500 mg oral lincomycin + high fiber (L + F) or to placebo + high fiber (P + F). Participants and patients were blinded. From days 10-to-21, patients were continued solely on the high fiber diet. The primary efficacy endpoint was the difference in S between L + F and P + F from days 0-to-21 using a visual analog scale (VAS) calibrated from 0 = severe S to 10 = asymptomatic. Results: The means of all S were significantly improved by L + F but not by P + F. A significant higher proportion of L + F patients increased the VAS > or = 3 points. Conclusions: The initial course of L facilitated the effect of F probably by its effect on the colon flora. This sequence of flora-altering biologics + F may serve as model to replace chronic use of drugs.
La pseudoobstrucción intestinal crónica (SOIC) es un cuadro clínico caracterizado por episodios r... more La pseudoobstrucción intestinal crónica (SOIC) es un cuadro clínico caracterizado por episodios recurrentes de oclusión o suboclusión intestinal, sin una alteración anatómica mecánica que pueda explicarlos. Se presenta el caso de una mujer de 80 años con antecedentes de enfermedad de Parkinson y episodios reiterados de SOIC. Refiere constipación crónica severa (pueden pasar más de 15 días sin evacuar), marcada distensión abdominal, asas intestinales visibles y marcado timpanismo percutorio. El empleo de un esquema secuencial de antibóticos y probióticos, no logró reducir la elevada excreción de metano en el aire espirado, sino que, al contrario, se incrementó en forma significativa. Solo la limpieza colónica con dosis elevadas de polietilengicol 3350, de modo semejante a la que se obtiene durante las preparaciones en los estudios endoscópicos del colon, logró reducir, aunque no suprimir totalmente la metanogénesis y mejorar la sintomatología de la paciente. Palabras claves. Pseudoobstrucción intestinal crónica, test del aire espirado con lactulosa, flora metanogénica, PEG3350.
A simple way to evaluate the rectal sensorial threshold has been the sloped distention of a recta... more A simple way to evaluate the rectal sensorial threshold has been the sloped distention of a rectal balloon, as a way to obtain the required volume to induce desire to defecate (VDE) and pain (VTM). Six medical groups belonging to the Argentine Motility Circle, studied in 14 patients (7M, 7F age 51 +/- 10.1) the VDE and VTM. The measurements were repeated in the same subjects with intervals longer than 24 Hs. The estimate of precision established a coefficient of variation (CV) for VDE of 10.23% (2CV = 20.46%). And so Reproducibility was found to be not acceptable. The CV for VMT was 1.44 (2CV = 2.88%) this could be considered a very good reproducibility. In conclusion, the VTM appears to be a reproducible measurement suitable for clinical and pharmacological studies of the rectal sensorial perception.
Introduction: Colorectal cancer is a major health problem worldwide because it is the third most ... more Introduction: Colorectal cancer is a major health problem worldwide because it is the third most common cancer and the third leading cause of cancer mortality in western countries. Screening for colorectal cancer in asymptomatic patients is crucialfor reducing the incidence and colonoscopy is one of the methods of choice. The ability of colonoscopy in detecting small lesions is clearly influenced by the quality of the colonic preparation. Objectives: To know which are the variablesrelating to the patient and the type ofpreparation that affect the quality of colonic cleansing. Materials and methods: It was designed a cross-sectional study. It was administered a questionnaire for the enrolled subjects to assess the presence offactors that could affect the quality of colonic cleansing. Then they underwent a colonoscopy. The different variables between subjects with adequate or inadequate colonic cleansing were compared. Results: We evaluated 277 subjects. In multivariate analysis the only variables that showed significant differences are split dose [OR 0.45 (0.21 to 0.99)] and age [OR 1.02 (1-1.05)]. Obesity showed no significant differences in multivariate analysis [OR 1.84 (0.9-3.78)]. Conclusions: Age and split-dose were the only variables significantly associated with the quality of bowel preparation prior to colonoscopy. Not so constipation or the presence ofdiverticula, so these patients do not require special preparation regimes.
By means of fiberendoscopic injection sclerotherapy, it was possible to achieve eradication of es... more By means of fiberendoscopic injection sclerotherapy, it was possible to achieve eradication of esophageal varices in 18 patients. At the onset of treatment 9 patients had small varices (grade II) and other 9 had big varices (grade III). It was found in the big varices group there was needed more courses (p less than 0.01) and a greater amount of sclerosing agent (p less than 0.001) than in the group with small varices. Since those patients with big varices required more courses and more volume of sclerosing agent, and in fact they have more risk to rebleed during the pre-eradication period. It is proposed as a solution during this period, the use of a B receptor blocking agent (Propranolol) simultaneously with sclerotherapy.
Fifteen patients suffering from different types of constipation were studied by means of radiopaq... more Fifteen patients suffering from different types of constipation were studied by means of radiopaque markers in order to know: a) If there is a correlation between the clinical state and the physiopathological motor variables of idiopatic constipation. b) The efficacy of a compound that combines its bulk action to its stimulation of the intestinal wall. Based on the results it is concluded that: The methodology is not useful in order to differentiate the colon motor behaviours in idiopatic constipation if these differences really exist. The evacuative effect of the compound was easily and objectively demonstrated by the acceleration of the radiopaque markers along the right colon. There was a good correlation between the subjective assessment done by the physician, and the patient and the objective results.
We describe a technique used for fiberendoscopic sclerosis of esophageal varices. The addition of... more We describe a technique used for fiberendoscopic sclerosis of esophageal varices. The addition of a balloon around the endoscope is advocated for three uses: 1) ingurgitation of varices allows better visualization, 2) the methods avoid the quick clearing of the sclerosing agent, 3) it can be used as hemostatic agent in case of necessity. The sclerosant agent used is an association of ethanolamine oleate, hypertonic glucose solution (50%) and natural conjugated strogens.
As there is an increased incidence of gastroesophageal reflux (GER) in asthmatic patients compare... more As there is an increased incidence of gastroesophageal reflux (GER) in asthmatic patients compared with the normal population, in the present trial we have tried to establish the following: 1) Possible differences in pH-metric variables between patients with GER and asthma, and asthmatic patients with or without GER 2) The usefulness of simultaneous evaluation and correlation of reflux episodes with the respiratory peak flow (EPF) in asthmatic patients. 31 patients divided in four groups were compared. A) 16 patients with typical symptoms of GER without respiratory symptoms. B) 10 asthmatic patients with GER symptoms. C) 5 asthmatic patients without GER symptoms. D) 15 asthmatic patients who represents the sum of B and C. In all patients ambulatory computerized, four hours pH recordings were obtained after standard meal. The study was divided in two equal periods (upright and recumbent). The EPF was measured before starting the study and every 20 min during the recumbent period. From de following pH-metrics variables: total number of reflux episodes, percentage of recording time when intra-oesophageal pH < 4 in the upright position or recumbent position and for the total period, duration of longest reflux episode, number of episodes longer than five minutes, and correlation between reflux episodes and patients symptoms. Only differences were seen when the time of the longer period with GER and the number of patients with more than five minutes episodes were compared between groups A and D. From the results we conclude that the GER in asthmatic patients.(ABSTRACT TRUNCATED AT 250 WORDS)
The effects of pinaverium bromide on colonic motility were investigated in a controlled, controll... more The effects of pinaverium bromide on colonic motility were investigated in a controlled, controlled, cross-over study in 32 patients with irritable bowel syndrome. Constipation was clearly predominant in one group of 16 patients, and diarrhea in the other group of 16. Manometric measurements were taken of the colonic motor response generated by distention of a balloon inserted to the rectosigmoid junction. Measurements were taken before and one hour after ingestion of two tablets containing placebo or two tablets each containing 50 mg of pinaverium bromide. Following intake of placebo the motility index increased from the basal value in patients with constipation, and resistance to distention decreased in the diarrhea group. These changes were attributable to repetition of the mechanical stimulus within a relatively brief time lapse, or more probably to the ingestion of liquid which accompanied intake of tablets. Compared with placebo, pinaverium bromide induced inhibition of both effects. From the therapeutic point of view, the decrease in motility index seen in patients with irritable bowel syndrome and constipation is particularly interesting.
This study was performed in 15 healthy control subjects (8 males- age 23-70 and 7 females age 20-... more This study was performed in 15 healthy control subjects (8 males- age 23-70 and 7 females age 20-74) as a way to compare the total and segmental colonic transit time with two different type of radiopaque markers. One type of markers was 3 mm cut sections of a radiopaque polietilene 14 French Levine tube, with a medium weight of 64.3 mg and a specific gravity (SG) of 1.28. The other type were 7 mm lenticular insoluble barium (lentils) with medium weight of 231 mg and a SG of 1.87. Each subject ingested 20 markers of each type with the breakfast and front and profile plain films of the abdomen were taken 24 and 48 hs after. The total colonic transit time for the polietilene markers was 17.7 hs and 27.3 hs for the barium type (BM) (p < 0.001). The segmental transit time for right colon was 2.4 hs (PM) and 9.7 hs (PM) and 9.7 hs (BM) (p < 0.001) in the left colon 9.5 hs (PM) and 11.3 hs (BM) and in rectoanun 5.9 hs (BM) with no statistical significance. Conclusion: the physical characteristics of the radiopaque markers can modify the results of the colonic transit times.
Background and aims: In a previous uncontrolled experiment, oral vancomycin improved the symptoms... more Background and aims: In a previous uncontrolled experiment, oral vancomycin improved the symptoms (S) of chronic constipation (CC). The aim of this 21 day controlled pilot study was to determine if a low lincomycin dose improved the S of CC patients unresponsive to a high fiber diet. Methods: On days 0-to-10, patients were randomized to 500 mg oral lincomycin + high fiber (L + F) or to placebo + high fiber (P + F). Participants and patients were blinded. From days 10-to-21, patients were continued solely on the high fiber diet. The primary efficacy endpoint was the difference in S between L + F and P + F from days 0-to-21 using a visual analog scale (VAS) calibrated from 0 = severe S to 10 = asymptomatic. Results: The means of all S were significantly improved by L + F but not by P + F. A significant higher proportion of L + F patients increased the VAS > or = 3 points. Conclusions: The initial course of L facilitated the effect of F probably by its effect on the colon flora. This sequence of flora-altering biologics + F may serve as model to replace chronic use of drugs.
La pseudoobstrucción intestinal crónica (SOIC) es un cuadro clínico caracterizado por episodios r... more La pseudoobstrucción intestinal crónica (SOIC) es un cuadro clínico caracterizado por episodios recurrentes de oclusión o suboclusión intestinal, sin una alteración anatómica mecánica que pueda explicarlos. Se presenta el caso de una mujer de 80 años con antecedentes de enfermedad de Parkinson y episodios reiterados de SOIC. Refiere constipación crónica severa (pueden pasar más de 15 días sin evacuar), marcada distensión abdominal, asas intestinales visibles y marcado timpanismo percutorio. El empleo de un esquema secuencial de antibóticos y probióticos, no logró reducir la elevada excreción de metano en el aire espirado, sino que, al contrario, se incrementó en forma significativa. Solo la limpieza colónica con dosis elevadas de polietilengicol 3350, de modo semejante a la que se obtiene durante las preparaciones en los estudios endoscópicos del colon, logró reducir, aunque no suprimir totalmente la metanogénesis y mejorar la sintomatología de la paciente. Palabras claves. Pseudoobstrucción intestinal crónica, test del aire espirado con lactulosa, flora metanogénica, PEG3350.
A simple way to evaluate the rectal sensorial threshold has been the sloped distention of a recta... more A simple way to evaluate the rectal sensorial threshold has been the sloped distention of a rectal balloon, as a way to obtain the required volume to induce desire to defecate (VDE) and pain (VTM). Six medical groups belonging to the Argentine Motility Circle, studied in 14 patients (7M, 7F age 51 +/- 10.1) the VDE and VTM. The measurements were repeated in the same subjects with intervals longer than 24 Hs. The estimate of precision established a coefficient of variation (CV) for VDE of 10.23% (2CV = 20.46%). And so Reproducibility was found to be not acceptable. The CV for VMT was 1.44 (2CV = 2.88%) this could be considered a very good reproducibility. In conclusion, the VTM appears to be a reproducible measurement suitable for clinical and pharmacological studies of the rectal sensorial perception.
Introduction: Colorectal cancer is a major health problem worldwide because it is the third most ... more Introduction: Colorectal cancer is a major health problem worldwide because it is the third most common cancer and the third leading cause of cancer mortality in western countries. Screening for colorectal cancer in asymptomatic patients is crucialfor reducing the incidence and colonoscopy is one of the methods of choice. The ability of colonoscopy in detecting small lesions is clearly influenced by the quality of the colonic preparation. Objectives: To know which are the variablesrelating to the patient and the type ofpreparation that affect the quality of colonic cleansing. Materials and methods: It was designed a cross-sectional study. It was administered a questionnaire for the enrolled subjects to assess the presence offactors that could affect the quality of colonic cleansing. Then they underwent a colonoscopy. The different variables between subjects with adequate or inadequate colonic cleansing were compared. Results: We evaluated 277 subjects. In multivariate analysis the only variables that showed significant differences are split dose [OR 0.45 (0.21 to 0.99)] and age [OR 1.02 (1-1.05)]. Obesity showed no significant differences in multivariate analysis [OR 1.84 (0.9-3.78)]. Conclusions: Age and split-dose were the only variables significantly associated with the quality of bowel preparation prior to colonoscopy. Not so constipation or the presence ofdiverticula, so these patients do not require special preparation regimes.
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