The effect of the Gulf War on upper-gastrointestinal bleeding.

Upper-gastrointestinal bleeding may be related to tension or fear, which are commonly aggravating factors in digestive diseases. A survey was made of patients living in and around Hadera (located in Israel's central coastal region) during the Gulf War (January 18 through February 28, 1991) who suffered from upper-gastrointestinal bleeding; they were compared with patients seen during 1990 and 1992-1993 at the same time of the year. We found no appreciable difference in the rate of upper-gastrointestinal bleeding during the analogous periods covered in the survey.

Clinical course of recent-onset atrial fibrillation treated with oral propafenone.

Atrial fibrillation (AF) is one of the most common cardiac arrhythmias in the adult population. Propafenone is a class 1c antiarrhythmic agent that has an electrophysiologic profile suggesting that it might be potentially effective in recent-onset AF. The present study was undertaken, therefore, to examine the time course as well as the frequency of successful conversion in patients with recent-onset AF treated with propafenone administered orally. Fifty patients with recent-onset AF were recruited into 2 groups: 25 patients were given propafenone, 150 mg every 4 h, and 25 patients served as a control group and received verapamil (a drug known to slow the ventricular response but not to restore sinus rhythm) 40 mg, every 4 h and up to 48 h or until conversion to sinus rhythm occurred. Of the 50 patients, 2 refused to continue the study and another 2 were excluded because of left heart failure. Conversion to sinus rhythm occurred in 21 of 24 patients (87 percent) in the propafenone group as compared with 9 of 22 (41 percent) in the verapamil group (p < 0.001). In 10 patients in the propafenone group, conversion occurred within 12 h, within 24 h in another 9 patients, and between 24 and 48 h in the remaining 2 patients. There was no correlation between the duration of AF prior to entry into the study and the subsequent incidence of and time to conversion with propafenone. With respect to cause of AF, all groups showed a high incidence of conversion. Two patients developed heart failure during treatment and one patient (in the verapamil group) developed embolic stroke while still having atrial fibrillation. We conclude that in patients with AF, the prognosis for conversion to sinus rhythm within 48 h, with propafenone, is excellent (87 percent) and safe.

Inspiratory muscle training in patients with bronchial asthma.

In patients with asthma, the respiratory muscles have to overcome the increased resistance while they become progressively disadvantaged by hyperinflation. We hypothesized that increasing respiratory muscle strength and endurance with specific inspiratory muscle training (SIMT) would result in improvement in asthma symptoms in patients with asthma. Thirty patients with moderate to severe asthma were recruited into 2 groups; 15 patients received SIMT (group A) and 15 patients were assigned to the control group (group B) and got sham training in a double-blind group-comparative trial. The training was performed using a threshold inspiratory muscle trainer. Subjects of both groups trained five times a week, each session consisted of 1/2-h training, for six months. Inspiratory muscle strength, as expressed by the PImax at RV, increased significantly, from 84.0 +/- 4.3 to 107.0 +/- 4.8 cm H2O (p < 0.0001) and the respiratory muscle endurance, as expressed by the relationship between Pmpeak and PImax from 67.5 +/- 3.1 percent to 93.1 +/- 1.2 percent (p < 0.0001), in patients of group A, but not in patients of group B. This improvement was associated with significant improvements compared with baseline for asthma symptoms (nighttime asthma, p < 0.05; morning tightness, p < 0.05; daytime asthma, p < 0.01; cough, p < 0.005), inhaled B2 usage (p < 0.05), and the number of hospital (p < 0.05) and sick-leave (p < 0.05) days due to asthma. Five patients were able to stop taking oral/IM corticosteroids while on training and one in the placebo group. We conclude that SIMT, for six months, improves the inspiratory muscle strength and endurance, and results in improvement in asthma symptoms, hospitalizations for asthma, emergency department contact, absence from school or work, and medication consumption in patients with asthma.

Inspiratory muscle training combined with general exercise reconditioning in patients with COPD.

We compared, in a controlled clinical trial, the effect of specific inspiratory muscle training combined with general exercise reconditioning, for six months, with that of general exercise reconditioning alone on inspiratory muscle strength, endurance, and exercise performance in patients with COPD. Thirty-six patients were recruited into three groups; 12 patients received specific inspiratory muscle training combined with general exercise reconditioning, 12 patients underwent general exercise reconditioning alone, and the remaining 12 patients received no training. Specific inspiratory muscle training, for six months, improved the inspiratory muscle strength and endurance in patients with COPD. This training combined with general exercise reconditioning also provided improvement in exercise tolerance, and this improvement was significantly greater than that of general exercise reconditioning alone.

[Thrombocytopenia due to glibenclamide].

A 45-year-old male, admitted for severe thrombocytopenia and bleeding tendency related to treatment with glibenclamide is presented. Thrombocytopenic purpura associated with glibenclamide, a short-acting sulfonylurea, is rare. We suggest that platelet counts be performed shortly after initiation of glibenclamide administration, and every 3 months thereafter.

[Inspiratory muscle training for bronchial asthma].

In patients with asthma the respiratory muscles have to overcome increased resistance while they become progressively disadvantaged by hyperinflation. We hypothesized that increasing respiratory muscle strength and endurance with specific inspiratory muscle training would improve asthmatic symptoms. Of 8 women and 12 men, aged 17-55, with moderate to severe asthma, 10 received such training (group A) and 10 were controls who were given sham training (group B) in a double-blind, group comparative trial. Both groups trained 3 times a week in 1-hour sessions for 6 months. Inspiratory muscle strength, as expressed by the PImax at RV, increased from 72.6 +/- 3.9 to 97.0 +/- 4.6 cm H2O (p less than 0.001) and respiratory muscle endurance, as expressed by the relationship between PmPeak and PImax, increased from 70.6 +/- 3.8 to 94.6 +/- 4.6% (p less than 0.001), in group A patients, but not those of group B. This improvement was associated with significant improvement in asthmatic symptoms: night-time asthma (p less than 0.05), morning tightness (p less than 0.05), daytime asthma (p less than 0.01), cough (p less than 0.005), use of inhaled B2 (p +/- 0.05), and hospital days (p less than 0.05) and days of sick-leave due to asthma. 5 patients were able to stop oral or IM corticosteroids during training, but only 1 in the sham training group. We conclude that 6-months of specific inspiratory muscle training in asthmatic patients improves inspiratory muscle strength and endurance and results in improvement in asthmatic symptoms, hospitalizations for asthma, emergency room contacts, absence from school or work, and use of medication.

Colonic pseudo-obstruction: a late complication of jejunoileal bypass.

Three cases of jejunoileal bypass, performed for morbid obesity, were complicated 3 to 4 years later by symptoms of colonic pseudo-obstruction. In each case the colon was enlarged, dilated and atonic with no demonstrable organic obstruction. In the patient with end-to-side anastomosis, the entire colon was dilated. In the two patients with end-to-end anastomosis, the dilatation affected the colon distal to the anastomosis with the defunctionalized small bowel. Treatment with antianaerobic antibiotics resulted in a dramatic disappearance of symptoms. It is suggested that bacterial overgrowth in the defunctionalized loops of small bowel may play an important role in the development of colonic pseudo-obstruction as a late complication of jejunoileal bypass.