Antispasmodic and vasodilator activities of <Emphasis Type="Italic">Morinda citrifolia</Emphasis> root extract are mediated through blockade of voltage dependent calcium channels

Background  

Morinda citrifolia (Noni) is an edible plant with wide range of medicinal uses. It occurs exclusively in tropical climate zone from India through Southeast Asia and Australia to Eastern Polynesia and Hawaii. The objective of this study was to explore the possible mode(s) of action for its antispasmodic, vasodilator and cardio-suppressant effects to rationalize its medicinal use in gut and cardiovascular disorders.     

Addressing the confounding role of joint hypermobility syndrome and gastrointestinal involvement in postural orthostatic tachycardia syndrome

Quantitative and qualitative abnormalities in visceral function have been demonstrated in postural orthostatic tachycardia syndrome. Joint hypermobility is frequently associated with both postural orthostatic tachycardia syndrome and gastrointestinal symptoms. Future studies in this area should appropriately and systematically control for the presence of joint hypermobility syndrome.     

Determinants of survival after inferior vena cava trauma.

Inferior vena cava (IVC) injuries continue to be associated with mortality rates of 21 to 66 per cent despite advances in prehospital, surgical, and critical care. The purpose of this study was to evaluate outcome of patients with IVC injury after treatment at a major urban trauma center and to identify factors predictive of survival. Between 1989 and 1995, 158 patients presented to the Los Angeles County + University of Southern California Medical Center with IVC injuries. One hundred thirty-six patient records were available for review, and 69 data points were collected and analyzed. Mean age was 26 years (range, 6-54), and 122 (90%) patients were male. Mechanism of injury included gunshot in 88 (65%) patients, stab in 23 (17%) patients, shotgun in 7 (5%) patients, and blunt trauma in 18 (13%) patients. The mean Injury Severity Score was 25. Seventy (52%) patients were hypotensive. Eleven (8%) patients died before surgical intervention, and 25 (18%) patients died before operative repair. Repair (79), ligation (20), or observation (1) was accomplished in 100 (74%) patients. Overall survival was 48 per cent and 65 per cent in the 100 patients surviving to operative repair, including 5 of 20 patients requiring IVC ligation. Significant differences (P<0.001) between survivors and nonsurvivors included Injury Severity Score, Glasgow Coma Score, hematocrit, hypotension, emergent thoracotomy, blood loss, level of injury, tamponade, and associated aortic injury. Logistic regression analysis identified hypotension, anatomic level of injury, and associated aortic injury as significant predictors of outcome (P = 0.001). Survival is predominantly determined by severity and anatomic accessibility of the IVC injury and by the absence of associated major vascular injuries. Ligation may control otherwise exsanguinating injuries and should be considered early in the management of complex injuries.     

Effet antihypertenseur des feuilles d’Inula viscosa

Inula viscosa (Asteraceae) is amedicinal plant widely used by Mediterranean population in folk medicine to treat different diseases. The antihypertensive effect of the aqueous extract obtained from Inula viscosa leaves was studied in hypertensive rats. Systolic blood pressure was measured using the indirect tail-cuff plethysmographic method (TCP). Three groups of rats were used: control group received water; L-NAME treated group received NG-nitro-L-arginine methylester (30 mg/kg per day) and group received simultaneously L-NAME (30 mg/kg per day) and aqueous extract of Inula viscose (250 mg/kg per day). After four weeks of treatment, the group receiving the L-NAME alone have developed an arterial hypertension (systolic blood pressure (SBP) = 164 ± 3 mmHg), whereas the group receiving the L-NAME and the aqueous extract of Inula viscosa have developed a SBP of 145 ± 2 mmHg. These results showed that the studied extract prevented significantly the development of hypertension induced by L-NAME. Moreover, the study of the cardiac effect of the Inula viscosa aqueous extract on the model of isolated and perfused rat heart, according to the method of Langendorff, showed a dose-dependent negative inotropic effect, which may contribute to antihypertensive effect.     

Unexplained gastrointestinal symptoms and joint hypermobility: is connective tissue the missing link?

Background Unexplained gastrointestinal (GI) symptoms and joint hypermobility (JHM) are common in the general population, the latter described as benign joint hypermobility syndrome (BJHS) when associated with musculo‐skeletal symptoms. Despite overlapping clinical features, the prevalence of JHM or BJHS in patients with functional gastrointestinal disorders has not been examined. Methods The incidence of JHM was evaluated in 129 new unselected tertiary referrals (97 female, age range 16–78 years) to a neurogastroenterology clinic using a validated 5‐point questionnaire. A rheumatologist further evaluated 25 patients with JHM to determine the presence of BJHS. Groups with or without JHM were compared for presentation, symptoms and outcomes of relevant functional GI tests. Key Results Sixty‐three (49%) patients had evidence of generalized JHM. An unknown aetiology for GI symptoms was significantly more frequent in patients with JHM than in those without (P < 0.0001). The rheumatologist confirmed the clinical impression of JHM in 23 of 25 patients, 17 (68%) of whom were diagnosed with BJHS. Patients with co‐existent BJHS and GI symptoms experienced abdominal pain (81%), bloating (57%), nausea (57%), reflux symptoms (48%), vomiting (43%), constipation (38%) and diarrhoea (14%). Twelve of 17 patients presenting with upper GI symptoms had delayed gastric emptying. One case is described in detail. Conclusions & Inferences In a preliminary retrospective study, we have found a high incidence of JHM in patients referred to tertiary neurogastroenterology care with unexplained GI symptoms and in a proportion of these a diagnosis of BJHS is made. Symptoms and functional tests suggest GI dysmotility in a number of these patients. The possibility that a proportion of patients with unexplained GI symptoms and JHM may share a common pathophysiological disorder of connective tissue warrants further investigation.