Objective:
We evaluated the effects of cisapride (10 mg t.d.s. and 20 mg b.d.) on gastrointestinal symptoms and gastric myoelectrical activity in patients with functional dyspepsia. Myoelectrical activity was measured by electrogastrography.
Methods:
Patients with functional dyspepsia, defined as discomfort in the epigastrium, a negative endoscopy, and clinical symptoms of dyspepsia, were enrolled. A total of 38 patients participated in the study (23 female; 15 male; 24–72 years of age). Screening electrogastrography identified those with a normal electrogastrogram (14 subjects) and those with an abnormal electrogastrogram (24 patients). Patients were randomly assigned to 2 weeks of placebo or 2 weeks of cisapride (10 mg t.d.s.); both groups then received 2 weeks of cisapride (20 mg b.d.). Electrogastrograms were repeated at the end of each 2‐week treatment period.
Results:
Cisapride 10 mg t.d.s. significantly improved symptoms in all patients. An additional 2 weeks of treatment with cisapride 20 mg b.d. led to continued improvement in symptoms in all patients, with significant improvement in the group with abnormal baseline electrogastrograms. Cisapride significantly improved postprandial bloating and discomfort in patients with abnormal baseline electrogastrograms. Cisapride also significantly improved postprandial gastric myoelectrical activity as measured by electrogastrography in patients with abnormal baseline electrogastrograms.
Conclusion:
Cisapride provides symptomatic relief and improves gastric myoelectrical abnormalities in patients with functional dyspepsia.
A 60‐year‐old male with a history of pulmonary fibrosis and lung transplant presented to clinic with a three week history of cutaneous eruption on the extremities associated with nausea and fatigue. His medications included prednisone and azathioprine. Exam revealed the patient was afebrile with multiple perforating nodules and subcutaneous nodules in a sporotrichoid pattern over the extremities. Tissue was sent for histopathological evaluation, and culture for bacteria, acid‐fast bacteria, and deep fungal organisms was performed. Histopathology revealed necrotizing panniculitis, but no organisms were found, and tissue cultures were negative. Due to choreoathetoid movements of the right extremities and persistence of cutaneous nodules, the patient was hospitalized and an extensive search for infectious etiology of his condition undertaken. Empiric antibacterial and antifungal therapy was given, but he progressed to multiorgan failure and expired. Autopsy revealed rare amoebic trophozoite forms in the skin in addition to cysts in the lung and brain. Cause of death was determined to be disseminated Acanthamoebiasis. Review of initial skin biopsy showed rare trophozoites. Differing from Entamoeba, Acanthamoeba is a rare but important emerging pathogen. Histopathological diagnosis of Acanthamoeba rests on high index of suspicion in cases of suspected infectious etiology.
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