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Gallego D, Ortega O, Arenas C, López I, Mans E, Clavé P. The effect of levosulpiride on in vitro motor patterns in the human gastric fundus, antrum, and jejunum. Neurogastroenterol Motil 2016; 28:879-90. [PMID: 26842870 DOI: 10.1111/nmo.12788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/06/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Levosulpiride is a 5HT4 agonist/D2 antagonist prokinetic agent used to improve gastric emptying in patients with functional dyspepsia or gastroparesis. The aim of this study was to characterize its effect on the main in vitro motility patterns in the human fundus, antrum, and jejunum. METHODS Circular muscle strips from human stomach (antrum and fundus) and jejunum, obtained from 46 patients undergoing bariatric surgery, were studied using organ baths. Enteric motor neurons (EMNs) were stimulated by electrical field stimulation (EFS). KEY RESULTS Levosulpiride, caused an increase in the EFS-induced cholinergic contractions in the gastric antrum (+37 ± 15.18% at 100 μM, pEC50 = 4.46 ± 0.14; p < 0.05, n = 8) and jejunum (+45.4 ± 22.03% at 100 μM, pEC50 = 3.78 ± 6.81; p < 0.05, n = 5), but not in the gastric fundus. It also caused a slight decrease in tone and frequency of spontaneous contractions in the jejunum, but did not have any major effect on tone or spontaneous contractions in the stomach. It did not have any effect on EFS-induced relaxations mediated by nitric oxide (NO) in the stomach (antrum and fundus) and by NO and ATP in the jejunum. CONCLUSIONS & INFERENCES Our results suggest that the prokinetic effects of levosulpiride in humans are mainly due to the facilitation of the release of acetylcholine by enteric motor neurons in the gastric antrum and the jejunum.
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Affiliation(s)
- D Gallego
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - O Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Arenas
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - I López
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - E Mans
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Clavé
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain.,Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain.,Health Sciences Research Institute of the Germans Trias i Pujol Foundation, Barcelona, Spain
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Berdún S, Bombuy E, Estrada O, Mans E, Rychter J, Clavé P, Vergara P. Peritoneal mast cell degranulation and gastrointestinal recovery in patients undergoing colorectal surgery. Neurogastroenterol Motil 2015; 27:764-74. [PMID: 25677271 DOI: 10.1111/nmo.12525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 01/14/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Degranulation of peritoneal mast cells (MCs) induced by intestinal manipulation has been proposed as a pathophysiological factor in postoperative ileus (POI). We aimed to explore the relationship between peritoneal and colonic MC degranulation and gastrointestinal (GI) recovery following colectomy. METHODS Patients undergoing elective laparoscopic cholecystectomy (using a laparoscope and small abdominal incisions, n = 14), and elective laparoscopic (n = 32) or open partial colectomy (through a large abdominal incision, n = 10) were studied. MC protease tryptase and chymase were studied in peritoneal fluid at the beginning, middle, and end of each surgical intervention. Density of MCs in colectomy samples were examined and oro-caecal transit time by breath test, GI function recovery by clinical composite endpoint GI-2 and association between MC proteases and clinical recovery. KEY RESULTS Open and laparoscopic colectomy caused greater peritoneal release of tryptase and chymase (323.0 ng/mL [IQR: 53.05-381.4] and 118.6 ng/mL [IQR: 53.60-240.3]), than cholecystectomy (41.64 ng/mL [IQR: 11.17-90.93]) at the end of the surgical intervention. However, there were no differences between laparoscopic and open colectomy. Increased peritoneal protease release during surgery was observed in patients who developed POI after colectomy. CONCLUSIONS & INFERENCES Colorectal surgery causes protease release from peritoneal MCs. Protease release does not differ between both types of colectomy (laparoscopy vs laparotomy). However, MC activation is increased in colectomy patients developing POI. Therefore, degranulation of peritoneal MCs as a factor contributing to human POI after colectomy might be considered in future studies as a target to avoid POI.
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Affiliation(s)
- S Berdún
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Bombuy
- Department of Surgery, Consorci Sanitari del Maresme (CSdM) - Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - O Estrada
- Department of Surgery, Consorci Sanitari del Maresme (CSdM) - Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Mans
- Department of Surgery, Consorci Sanitari del Maresme (CSdM) - Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Rychter
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
| | - P Clavé
- Department of Surgery, Consorci Sanitari del Maresme (CSdM) - Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
| | - P Vergara
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
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Serra-Prat M, Mans E, Palomera E, Clavé P. Gastrointestinal peptides, gastrointestinal motility, and anorexia of aging in frail elderly persons. Neurogastroenterol Motil 2013; 25:291-e245. [PMID: 23240772 DOI: 10.1111/nmo.12055] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The mechanisms involved in anorexia in frail elderly people remain unclear. The objective of this study was to establish whether fasting and postprandial levels of gastrointestinal peptides, gastrointestinal motility, and hunger are modified by age and frailty. METHODS Three groups of subjects were studied: (a) frail elderly (>70 years) persons, (b) non-frail elderly (>70 years) persons, and (c) healthy adults (aged 25-65 years). After an overnight fast, participants ingested a 400 Kcal liquid meal and appetite, hormonal, and gastrointestinal responses were monitored during early (0-60 min) and late (60-240 min) postprandial periods. KEY RESULTS Frail persons showed poor nutritional status, sarcopenia, and almost absence of hunger during fasting and postprandial periods. Older persons presented higher levels of glucose and insulin during fasting, enhanced postprandial CCK release in early postprandial period and postprandial hyperglycemia and hyperinsulinemia, but similar ghrelin levels than younger adults. Ultrasound scan showed that the fasting antral area was higher and antral compliance lower in old persons. The paracetamol absorption test showed enhanced postprandial gastric emptying in the frail. Non-gallbladder contractors showed no CCK peak in younger and non-frail groups, but the same high CCK peak as contractors in the frail. CONCLUSIONS & INFERENCES Frailty was associated with anorexia, risk of malnutrition, and sarcopenia. Frail persons showed impaired gastric motility (larger antral area at rest, impaired antral compliance, and enhanced postprandial emptying), impaired gallbladder motility, and fasting and/or postprandial alterations in CCK, glucose, and insulin release. Further studies are needed to determine if these factors may contribute to anorexia of aging in frail persons.
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Affiliation(s)
- M Serra-Prat
- Research Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain.
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van Dijk J, Verhamme C, van Schaik I, Schelhaas H, Mans E, Bour L, Stegeman D, Zwarts M. P12-20 Age-related changes in motor unit number estimates in adult patients with Charcot-Marie-Tooth type 1A. Clin Neurophysiol 2010. [DOI: 10.1016/s1388-2457(10)60724-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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van Dijk JP, Verhamme C, van Schaik IN, Schelhaas HJ, Mans E, Bour LJ, Stegeman DF, Zwarts MJ. Age-related changes in motor unit number estimates in adult patients with Charcot-Marie-Tooth type 1A. Eur J Neurol 2010; 17:1098-104. [PMID: 20443982 DOI: 10.1111/j.1468-1331.2010.03027.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J P van Dijk
- Department of Clinical Neurophysiology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Abstract
In the initial experience of liver transplantation, complete thrombosis and portal vein occlusion were considered to be absolute contraindications for liver transplantation. The incidence of portal thrombosis in patients being prepared for transplantation varies between 5% and 15% according to published series. There are 2 surgical techniques to solve absent or low portal vein flow due to thrombosis. The most widely used technique is thrombectomy and the second technique is insertion of a shunt with a venous graft in the permeable portion of the superior mesenteric vein or in a vein in the splanchnic territory. Portal thrombosis recurrence rates vary among series, ranging from 0% to 25% or even 30%, depending on its extension and severity and also on time the transplantation was performed. Although overall survival is somewhat lower, there are no significant differences in most of the series when patients with portal thrombosis who underwent transplantation are compared with those without.
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Affiliation(s)
- R Charco
- Liver Transplantation Unit, IMDiM, Hospital Clinic i Provincial, Barcelona, Spain.
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Amador A, Charco R, Martí J, Ferrer J, Mans E, Fondevila C, Fuster J, Grande L, Visa J, Rimola A, Navasa M, García-Valdecasas JC. One Thousand Liver Transplants: The Hospital Clinic Experience. Transplant Proc 2005; 37:3916-8. [PMID: 16386583 DOI: 10.1016/j.transproceed.2005.09.167] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Our goal was to study a consecutive series of 1000 liver transplants performed in our institution to evaluate the changes over time in donors, recipients, and results. PATIENTS AND METHODS With the aim to evaluate differences between transplantation in the first period and the present period, the first consecutive 100 liver transplants performed from June 1988 to June 1990 (first period) were compared with the last consecutive 200 liver transplants performed from January 2001 to June 2003 (second period). RESULTS Increased donor age, change in donor cerebral death etiology, and increasing numbers of grafts from alternative methods using cadaveric donors were observed in the second period. Piggy-back technique and the biliary anastomosis without a t-tube was also started in the second period. One-year actuarial patient survival was higher in the second period (84% vs 91.3%). The need for retransplantation in the overall series was 95%. One-, 5-, and 10-year actuarial retransplant survival was 67.7%, 51.3%, and 39.4%, respectively. CONCLUSIONS Technical innovations, better understanding of donor and recipient aspects, and global improvements were the reasons for time-related improved results of liver transplantation.
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Affiliation(s)
- A Amador
- Institut de Malaties Digestives i Metabólícas, Hospital Clínic i Provincial, Barcelona, Spain
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Amador A, Charco R, Marti J, Alvarez G, Ferrer J, Mans E, Fuster J, Fondevila C, Garcia-Valdecasas JC. Cost/efficacy clinical trial about the use of T-tube in cadaveric donor liver transplant: preliminary results. Transplant Proc 2005; 37:1129-30. [PMID: 15848645 DOI: 10.1016/j.transproceed.2005.01.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
UNLABELLED Biliary reconstruction is the most common cause of morbidity associated with orthotopic liver transplantation. Our objective was to assess the complications and hospital resources related to the use of a T-tube. MATERIAL AND METHODS Among 95 liver transplants performed from October 2002 to November 2003, 84 patients were randomized to receive a T-tube or no T-tube. We analyzed all patients with a follow-up of at least of 3 months. RESULTS Fifty-five transplants were analyzed with 8 months mean follow-up, including twenty eight with T-tube and twenty seven without a T-tube. No patient died during the follow-up. The overall rate of biliary complications was 45.4% (25/55) including 21/28 (75%) in the T-tube group and 4/27(14.8%) in the non-T-tube group (P < .0001). Complications related to T-tube extraction occurred in 48.2% (13/27), including 3 cholangitis and 10 leaks. The costs of hospital resources due to radiological studies were 5329 capital JE, Ukrainian for the T-tube group vs 5785 capital JE, Ukrainian for the non-T-tube group. The costs of hospital resources due to treatment were 28,280 capital JE, Ukrainian for the T-tube group vs 10,088 capital JE, Ukrainian for the non-T-tube group. CONCLUSIONS Use of a T-tube during orthotopic liver transplantation does not seem justified. Biliary anastomosis stenting is followed by an increased incidence of complications, most of which are related to its use. Hospital stay, radiological studies, and cost of hospital resources are higher among the T-tube patients. Therefore its systematic use is not advisable.
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Affiliation(s)
- A Amador
- Liver Transplantation Unit, ICMDM, Hospital Clinic i Provincial, Barcelona, Spain
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Visser J, Mans E, de Visser M, van den Berg-Vos RM, Franssen H, de Jong JMBV, van den Berg LH, Wokke JHJ, de Haan RJ. Comparison of maximal voluntary isometric contraction and hand-held dynamometry in measuring muscle strength of patients with progressive lower motor neuron syndrome. Neuromuscul Disord 2003; 13:744-50. [PMID: 14561498 DOI: 10.1016/s0960-8966(03)00135-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Context. Maximal voluntary isometric contraction, a method quantitatively assessing muscle strength, has proven to be reliable, accurate and sensitive in amyotrophic lateral sclerosis. Hand-held dynamometry is less expensive and more quickly applicable than maximal voluntary isometric contraction. Objective. To investigate if hand-held dynamometry is as reliable and valid as maximal voluntary isometric contraction in measuring muscle strength in patients with an adult-onset, non-hereditary progressive lower motor neuron syndrome. Design. Two testers performed maximal voluntary isometric contraction and hand-held dynamometry measurements in six muscle groups bilaterally in patients with progressive lower motor neuron syndrome to assess reliability and validity of both the methods. Setting. Outpatient units of an academic medical center. Patients. A consecutive sample of 19 patients with non-hereditary progressive lower motor neuron syndrome (median disease duration 32.5 months, range 10-84) was tested. Outcome measures. Comparison between maximal voluntary strength contractions as measured by hand-held dynamometry and maximal voluntary isometric contraction. Results. Low intra- and interrater variation in all muscle groups were found, intraclass correlation coefficients vary between 0.86 and 0.99 for both methods. Both methods correlated well in all muscle groups with Pearson's correlation coefficients ranged between 0.78 and 0.98. Scatter plots indicated a trend to under-estimate muscle strength above 250 N by hand-held dynamometry as compared with maximal voluntary isometric contraction. Conclusions. For longitudinal evaluation of muscle strength in patients with progressive lower motor neuron syndrome (i.e. between 0 and 250 N), muscle strength can be accurate quantified with both hand-held dynamometry and maximal voluntary isometric contraction. Hand-held dynamometry has the advantage of being cheap and quickly applicable. However, our results indicate that hand-held dynamometry is less sensitive than maximal voluntary isometric contraction in detecting subnormal muscle strength in strong muscle groups (i.e. >250 N), due to limited strength of the tester.
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Affiliation(s)
- J Visser
- Department of Neurology (H2-222), Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
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Rüddel H, Jürgensen R, Terporten G, Mans E. [Rehabilitation outcomes of a psychosomatic clinic integrating fully inpatient and partial hospitalization rehabilitation approaches: a comparison]. Rehabilitation (Stuttg) 2002; 41:189-91. [PMID: 12007044 DOI: 10.1055/s-2002-28450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
As publications from the domain of psychosomatic rehabilitation pertaining to the conceptual approaches and effects of partial-hospitalization rehabilitation have so far relied on very small case numbers, the effectiveness of partial-hospitalization rehabilitation was analysed in 318 patients in comparison to a large sample of rehabilitants who had participated in fully inpatient rehabilitation. No relevant differences were found among the groups studied in sociodemographic respects or range of diagnoses. The same was true concerning the level of complaints present at the onset of rehabilitation. Good rehabilitation outcomes were achieved in both groups, however, the effect sizes found for changes in depressiveness and indulgence to complaining ("Klagsamkeit") (GSI from the SCL-90) were lower in the partial-hospitalization group than in the patients in fully inpatient rehabilitation. Also, the relatively high share of partial-hospitalization patients discharged unable to return to work might be clinically significant. While our findings confirm the good results reported from other disciplines, they nevertheless are a reminder of the need for very careful selection of patients for partial-hospitalization rehabilitation, in order not to withhold "better" rehabilitation than could be provided on a partial-hospitalization basis from patients with special sociomedical problems. The best rehabilitation outcomes seem to be achieved by those patients who, towards the end of fully inpatient rehabilitation, were granted transition to the partial-hospitalization programme.
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Affiliation(s)
- H Rüddel
- Psychosomatische Fachklinik St. Franziska-Stift, Bad Kreuznach, Germany.
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Fondevila C, Mans E, Fuster J, Grande L, García-Valdecasas J, Ferrer J, Visa J. Tumor de Klatskin con invasión de la vena porta. Utilización de injertos vasculares criopreservados tras la resección quirúrgica radical. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71878-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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