Stanley M. Chernish

Hypotonic colon examination with glucagon.

In a clinical double-blind crossover study, the effects on barium enema examinations of intramuscular injections of a placebo, glucagon, atropine sulfate, and glucagon plus atropine sulfate were compared in 12 male volunteers for a total of 48 studies. With either atropine sulfate or glucagon there were decreased colon tonicity and increased comfort during the examination. Number and intensity of side effects were less with either placebo or glucagon than with atropine sulfate alone or combined with glucagon. The subject is more comfortable, the colon and small bowel more relaxed, intracolonic pressure less, and the examination more quickly completed after glucagon than after placebo or atropine sulfate.

Detection of surgical lesions of the small bowel by enteroclysis

Enteroclysis is an examination in which barium is infused directly into the small intestine, and compression radiographs are taken on each segment. This method eliminates many of the inherent limitations of the conventional small bowel follow-through examination. This report concerns 45 patients with 48 small bowel lesions. They were missed on the conventional examination but detected within 3 months by subsequent enteroclysis and confirmed surgically. There were 15 patients with Meckels diverticula, 7 with obstructive adhesive bands, 5 with Crohns disease, 5 with blind pouch syndrome (1 with a leiomyoma inside the blind pouch), 2 with other leiomyomas, 3 with metastatic carcinoma, two with primary carcinoma 3 with radiation stricture, two with sinus tract lesions and fistulas, and 1 with another lesion. Improved intubation techniques and better barium mixtures make enteroclysis possible in most hospitals. As surgeons appreciate the value of enteroclysis, they can request this examination for appropriate patients to sooner find many surgical lesions of the small bowel which frequently go undiagnosed.

Gastric emptying of enteric-coated tablets

To evaluate the gastric emptying time of pharmaceutical dosage forms in a clinical setting, a relatively simple dual-radionuclide technique was developed. Placebo tablets of six different combinations of shape and size were labeled with indium-111 DTPA and enteric coated. Six volunteers participated in a single-blind and crossover study. Tablets were given in the morning on a fasting stomach with 6 oz of water containing99mTc pertechnetate and continuously observed with a gamma camera. A scintigraph was obtained each minute. The results suggested that the size, shape, or volume of the tablet used in this study had no significant effect in the rate of gastric emptying. The tablets emptied erratically and unpredictably, depending upon their time of arrival in the stomach in relation to the occurrence of interdigestive myoelectric contractions. The method described is a relatively simple and accurate technique to allow one to follow the gastric emptying of tablets.

Hypotonic Duodenography with Glucagon

In a double blind crossover study, the effects of 2 mg glucagon and 1 mg atropine sulfate on duodenal tonicity and motility were compared to placebo in 6 asymptomatic men. In a similar study, 2 mg glucagon and 30 mg propantheline bromide were compared to placebo. In 10 to 30 minutes after intramuscular administration of the drug there was a significant decrease in duodenal motility and tonicity with glucagon. Both tonicity and motility were near normal at 60 minutes. Responses to atropine sulfate and propantheline bromide were sometimes evident at 10, 30, and 60 minutes, but were variable and not consistently greater than with placebo. With atropine sulfate and propantheline bromide, intensity of reported side effects was greater than with placebo or glucagon.

Gastrointestinal radiography with glucagon.

This report summarizes the results of nine diagnostic radiographic studies done double blind crossover comparing glucagon to placebo and to anticholinergic drugs in volunteers. In seven studies the subjects were administered drug intramuscularly and in two studies intravenously. There were five diagnostic studies of the upper gastrointestinal tract, one for esophageal varices and three of the colon. The results indicate that glucagon can be given intramuscularly and intravenously. When given intravenously it has a rapid onset and predictable length of action depending on the dose given. Reports of side effects were few consisting primarily of nausea and or vomiting. These results indicate that glucagon is the drug of choice for hypotonic diagnostic examinations.

Nasointestinal tube for decompression or enteroclysis: Experience with 150 patients

The initial clinical experience with the use of a triple lumen long tube designed for gastrointestinal decompression and enteroclysis is reported in 150 patients. Based on clinical observations, this tube is effective in suctioning retained gastric and intestinal fluid but requires frequent irrigation of the sump port for effective decompression of distended small bowel. In all patients with a preexisting nasogastric tube, the replacement by the decompression/enteroclysis tube was considered more comfortable by the patients. Successful placement of the tube in the jejunum was achieved in 147 of 150 consecutive patients on the initial attempt. The use of this tube obviates dual intubations for decompression and enteroclysis, the attendant discomfort on the patient, and it expedites subsequent performance of enteroclysis if needed. The complications reported with other long intestinal tubes were not observed with this device.

Double-Blind Radiographic Study of Dose Response to Intravenous Glucagon for Hypotonic Duodenography

This study was undertaken to determine a dose response to glucagon during hypotonic duodenography. Fifteen male and female volunteers received placebo and 0.25 mg, 0.5 mg, 1 mg, and 2 mg of glucagon intravenously, double-blind, and crossover. Onset of drug effect occurred in approximately 45 seconds, regardless of the dose of glucagon given. There was a significant (p less than 0.01) decrease in gastrointestinal tonicity with all doses. The larger the dose, the greater the duration of drug action. Satisfactory stomach, duodenal, and small bowel hypotonicity for radiography were obtained with 0.25 to 0.5 mg of glucagon given intravenously with few side effects.

Dose response to intramuscular glucagon during hypotonic radiography.

In a study to determine a dose response to glucagon during hypotonic duodenography, 15 male and female volunteers received placebo and 0.25 mg 1 mg and 2 mg glucagon intramuscularly, double-blind and cross-over. When 0.25 mg glucagon was given, the onset of drug effect was approximately 13--18 min: the mean duration of moderate hypotonicity was approximately 4--7 min. The larger the dose, the greater the duration of drug action. When 2 mg glucagon was given, the onset of drug effect occurred in approximately 4--7 min; the mean duration of moderate hypotonicity was 22--32 min. There were no changes in pulse or blood pressure attributable to the drug with these doses, and reports of nausea and diarrhea did not increase significantly until a dose above 1 mg was given. One mg glucagon given IM is useful in hypotonic upper Gl radiographic examinations. The onset of hypotonicity was 8--10 min with a duration of 12--27 min when this dose was given. Few reports of side effects were attributable to this dose.

Adsorption of Propoxyphene Hydrochloride by Activated Charcoal

(1972). Adsorption of Propoxyphene Hydrochloride by Activated Charcoal. Clinical Toxicology: Vol. 5, No. 3, pp. 317-329.

The minimum effective dose of glucagon in upper gastrointestinal radiography

The effect of small intravenous doses (0.025 and 0.05 mg) of glucagon was evaluated in 22 patients. All 12 patients given 0.05 mg demonstrated hypotonicity of the stomach and duodenum at 1 min and beginning return of peristalsis at 2 1/2 min. Subsequently, 100 patients with radiographically normal upper gastrointestinal examinations who received 0.05 mg of glucagon intravenously were compared to 100 patients with normal examinations without it. Comparison was made to determine the effect of glucagon on gastric mucosal coating and distention of the stomach and duodenum. In all areas of the stomach, mucosal coating was significantly improved in the glucagon group. There was also increased distention of the distal antrum, duodenal bulb, and duodenal loop. No adverse effects were reported. Because of the short duration of action of glucagon, the examination needs to be coordinated and done rapidly. The routine use of a small dose of glucagon increased the performance time slightly with small additional cost but was compensated for by the increased diagnostic quality of the examination.