Gastroenterology
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Randomized Controlled Trial Comparative Study Clinical Trial
A double blind crossover comparison of loperamide with diphenoxylate in the symptomatic treatment of chronic diarrhea.
Loperamide, a novel antidiarrheal agent, was compared with diphenoxylate in a double blind crossover study of 23 patients with chronic diarrhea of various etiologies. Both agents were found to be capable of controlling or greatly reducing chronic diarrhea. Loperamide was superior to diphenoxylate in its abiltiy to decrease the frequency and improve the consistency of the stools, even at a 2.5-fold lower dose level.
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Portal and hepatic indicator dilution curves (IDC) were obtained after injection of a mixture of 51Cr-labeled red blood cells ([51Cr]RBC) and 125I-albumin microaggregates (125I-AMA) into the cranial mesenteric artery in dogs. The extraction (E) of 125I-AMA from portal blood was measured during one passage through the hepatic reticuloendothelial system. Using [51Cr]RBC as a vascular reference substance, E-125I-AMA was calculated by comparing simultaneous [51Cr]RBC and 125I-AMA portal and hepatic IDC, and was expressed as percentage of 125I-AMA flowing through the portal vein. ⋯ In cirrhotics, the decreased E-125I-AMA can be related to part of portal blood bypassing Kupffer cells (intrahepatic portohepatic shunts) and/or to sinusoidal changes responsible for ineffective phagocytosis. Thus, E-125I-AMA can be used as an estimation of the functional portal blood supply to the liver in cirrhotics. Using portal and hepatic IDC after injection of [51Cr]RBC and 125I-AMA into the superior mesenteric artery, the portal fraction of hepatic blood flow and the functional portal blood supply can be estimated simultaneously in patients with portal hypertension before portacaval shunts.
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A patient with a clinical and angiographic diagnosis of nonocclusive mesenteric ischemia had phenoxybenzamine directly infused into the superior mesenteric artery to counteract the existing splanchnic vasoconstriction. The diagnosis was confirmed by later operative intervention and the patient recovered. Vasodilatory drugs may play a significant role in the management of patients with nonocclusive mesenteric ischemia.