摘要:

GoalsTo determine the significance of performing routine duodenal biopsies during upper intestinal endoscopy in a pediatric population and to evaluate their contribution to the overall diagnosis.BackgroundPerforming duodenal biopsy during every upper endoscopy regardless of the indication for endoscopy and the macroscopic findings, is a controversial topic. Advocates of performing routine biopsies argue that unexpected pathology such as villous atrophy, may have significant clinical implications. Opponents argue that the yield of performing a biopsy on an apparently normal mucosa is low.StudyDuodenal biopsies, routinely taken from 201 pediatric patients during upper endoscopy over a 26-month period were retrospectively reviewed. Duodenal biopsies taken during this period for suspected mucosal lesions were not included in the analysis. Indications for endoscopy included suspected peptic disease, gastroesophageal reflux, unexplained vomiting, abdominal pain, iron deficiency anemia and Crohn disease.ResultsOf the 201 sets of biopsies reviewed, 159 (79.1%) were normal, 7 had insufficient material for evaluation and 35 (17.4%) carried abnormalities that included: 10Giardia lamblia(4.9%), 13 mild chronic inflammation (6.5%), and 8 increased intraepithelial lymphocytes (3.9%). Two biopsies showed mixed acute and chronic inflammation, 1 showed lymphatic dilatation and 1 had a mild mucosal lesion. The risk for microscopic pathology in the duodenum was higher when Helicobacter pylori was present in the gastric biopsy (25.98% vs. 12.16%P< 0.02). The negative predictive value of a normal appearing duodenal mucosa was 81.5%, implying that a normal appearing mucosa does not rule out pathology. No complications were encountered in our series.ConclusionWe suggest that the inclusion of routine duodenal biopsies as part of upper endoscopy in pediatric patients should be considered favorably. This practice may yield additional pathologic findings that otherwise could have been missed. It should be done regardless of the indication for endoscopy or the gross appearance of the mucosa. This practice does not increase the risk of the procedure.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundAlthough the etiology of idiopathic ulcerative colitis (UC) remains poorly understood, the intestinal flora is suspected to play an important role. Specific, consistent abnormalities in flora composition peculiar to UC have not yet been described, howeverClostridium difficilecolitis has been cured by the infusion of human fecal flora into the colon. This approach may also be applicable to the treatment of UC on the basis of restoration of flora imbalances.GoalTo observe the clinical, colonoscopic and histologic effects of human probiotic infusions (HPI) in 6 selected patients with UC.Case ReportsSix patients (3 men and 3 women aged 25–53 years) with UC for less than 5 years were treated with HPI. All patients had suffered severe, recurrent symptoms and UC had been confirmed on colonoscopy and histology. Fecal flora donors were healthy adults who were extensively screened for parasites and bacterial pathogens. Patients were prepared with antibiotics and oral polyethylene glycol lavage. Fecal suspensions were administered as retention enemas within 10 minutes of preparation and the process repeated daily for 5 days. By 1 week post-HPI some symptoms of UC had improved. Complete reversal of symptoms was achieved in all patients by 4 months post-HPI, by which time all other UC medications had been ceased. At 1 to 13 years post-HPI and without any UC medication, there was no clinical, colonoscopic, or histologic evidence of UC in any patient.ConclusionsColonic infusion of donor human intestinal flora can reverse UC in selected patients. These anecdotal results support the concept of abnormal bowel flora or even a specific, albeit unidentified, bacterial pathogen causing UC.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Goals, BackgroundThe elderly population has been increasing during the last half a century and it would be important to know how aging influences the occurrence and biologic behavior of cancers.StudyWe investigated clinicopathologic characteristics of colorectal cancer in 1354 patients who underwent colorectal cancer resection and compared the results between extremely elderly patients (over 80 years old) and middle-aged/elderly patients (40 to less than 80 years old). Furthermore, we also examined expression of tumor suppressor genes and Cox-2 using frozen samples of colorectal cancer obtained from 62 patients ranging in age from 45 to 87 years.ResultsThe results obtained in the extremely aged patients were: (1) higher ratio of women, (2) higher incidence at the proximal site, (3) higher incidence of cases with deeper invasion, (4) higher incidence of cases with lymph node metastasis (5) poorer survival rate as compared with middle-aged/elderly patients, and (6) lower mRNA expression levels of p27 and p53.ConclusionsThese findings taken together suggest that poor prognosis of colorectal cancer in patients over 80 years is associated with down-regulation of mRNA expression of some tumor suppressor genes.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Goals and BackgroundFibrosing colonopathy causing severe thickening of the colon wall was recently described in cystic fibrosis (CF). Since it has been suspected that subclinical colon-wall thickening is a common feature in CF patients, bowel-wall thickness was measured in a series of patients and compared with controls. Additionally, possible clinical factors influencing wall thickness were investigated.StudyIn 83 CF patients and 31 controls transabdominal ultrasound was performed in the terminal ileum, cecum, ascending and descending colon. The relation of the measured wall thickness to age, sex, pancreatic enzyme intake, and intestinal diseases was analyzed.ResultsIn controls, mean wall thickness depending on gut region was 1.1 to 1.3 mm (SD 0.19–0.23). In CF patients, no evidence of severe thickening or stricture was found, but wall thickness was significantly higher than in controls in all measured regions (1.5–1.6 mm; SD 0.31–0.41). Patients with meconium ileus and distal intestinal obstruction syndrome had significantly increased thickness of the terminal ileum compared with patients without these complications. Neither the intake of high-strength enzymes nor enzyme dosage, age or sex were associated with wall thickness.ConclusionsWe found no evidence that a subclinical stage of fibrosing colonopathy is prevalent among the CF patients. Slightly thickened gut walls in CF can be interpreted as an expression of glandular dysfunction in the CF intestine.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundWith the extensive use of COX-2 inhibitors to treat inflammatory and pain syndromes, gastrointestinal adverse effects are being increasingly observed.Case reportAn 87-year-old white man with chronic peptic esophageal stricture presented to us with dysphagia and odynophagia. The patient was taking Celecoxib for 5 months for trigeminal neuralgia. An upper endoscopy revealed severe desquamative esophagitis. Celecoxib was discontinued and the patient was started on esomeprazole. The patient's symptoms improved in 1 month. Three months later, EGD revealed complete healing of the esophageal mucosa.DiscussionBecause recent studies have shown that COX-2 inhibitors are similar to NSAIDs with regards to absorption, in contrast to premarketing trials, extensive use of COX-2 inhibitors is likely to demonstrate gastrointestinal adverse effects similar to those caused by traditional NSAIDs. Our patient had severe esophagitis caused by Celecoxib and aggravated by reflux of achlorhydric gastric contents after dilatation of the stricture.SummaryWe report for the first time severe esophagitis caused by the COX-2 inhibitor Celecoxib.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Chronic hepatitis B virus (HBV) is associated with increased morbidity and mortality in patients with chronic renal failure (CRF) and renal transplant recipients. Lamivudine (3TC) has been shown to be a potent inhibitor of HBV replication. It appears to be safe and effective in patients with CRF, though experience is still limited. We describe 4 patients with CRF on hemodialysis who showed a rapid and full response to 3TC, administered for a median of 10 months. All patients had serum alanine transferase (ALT) levels 3 to 6 times the upper limit of normal prior to treatment, and different degrees of histologic inflammatory activity (Knodell score 4 to 8, median 6). All were serum HBsAg- and HBeAg-positive, with serum HBV DNA 1–3.9 × 107copies/mL (median 1 × 107copies/mL). Within 4 to 8 weeks of initiation of therapy, HBV DNA became undetectable and serum ALT normalized. Serum HBeAg disappeared in all 4 patients, with the emergence of anti-HBeAb in 3 of them. Three patients also lost HBsAg with the evolution of a protective anti-HBsAb titer. One patient has already undergone successful kidney transplantation with no evidence of HBV recurrence (serum HBV DNA negative) 16 months postoperatively.Although our study sample is small, these data suggest that 3TC can induce a complete biochemical, virological and serological response in patients with CRF and HBV infection. Its use may enable safe kidney transplantation in selected patients.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The results of lamivudine therapy in 4 patients with chemotherapy–induced hepatitis B virus (HBV) reactivation are reported. Cancer chemotherapy-induced reactivation is a known complication in patients with chronic HBV infection or history of HBV infection with recovery. Reactivation of HBV infection has a broad spectrum of manifestations ranging from mild elevation of aminotransferase levels to fatal fulminant hepatitis. Lamivudine is a nucleoside analogue and a potent inhibitor of HBV reverse transcription. The 4 patients treated with lamivudine included 1 woman with breast cancer and 3 men with non-Hodgkin lymphoma, ranging from 41 to 63 years of age. All 4 patients were undergoing standard, multi-agent chemotherapy when they presented with HBV reactivation manifested by sudden onset of fatigue, jaundice, and HBV serology consistent with active HBV infection (detectable serum HBV DNA) in the absence of other known causes of acute hepatitis. Lamivudine therapy (100 mg/d in 3 patients and 150 mg/d in 1 patient) was initiated from 1 to 18 days following the diagnosis of HBV reactivation. All 4 patients showed rapid decrease in aminotransferase levels within 2 weeks after initiating lamivudine therapy. Unfortunately, hepatic synthetic function failed to improve in 2 patients, who both died. The remaining 2 patients had suppression of HBV DNA to undetectable levels after 1 and 4 months of treatment and had biochemical and clinical improvement. The 2 patients who died received lamivudine therapy for 8 days and for 3 weeks. There have been no randomized clinical trials to study the role of lamivudine for prophylaxis or treatment of HBV reactivation associated with chemotherapy. However, based on our limited experience, lamivudine may be efficacious in suppressing potentially fatal HBV reactivation secondary to chemotherapy in patients with chronic HBV infection or prior infection with recovery. Patients who undergo chemotherapy should be screened for the presence of markers of chronic hepatitis B infection or previous HBV infection. We recommend that patients with chronic HBV infection (positive HBV DNA and/or positive HBsAg) or history of HBV infection with recovery (positive hepatitis B core antibody with or without HBsAb) be considered for prophylactic lamivudine use to prevent chemotherapy-induced HBV reactivation.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundImmunosuppression following solid organ transplantation has been associated with a higher prevalence of cancers including colon cancer. However, the risk of colorectal adenoma following liver transplantation is unknown. The objective of this pilot study is to determine whether the prevalence of colorectal adenoma is increased in liver transplant recipients.MethodsIn this retrospective study, 25 patients who had liver transplantation at our institution between 1994 to 1997 and who underwent routine posttransplantation colonoscopy were compared with 50 controls who were undergoing routine screening colonoscopy. Transplant recipients who were younger than 45 years, survived less than 3 years following liver transplant, with history of inflammatory bowel disease, or prior history of colonic adenoma or cancer were excluded from the study. In both groups, colonoscopic diagnosis of polyp was confirmed by pathologic diagnosis of adenoma on biopsy.Results25 (12M/13F, mean age 53 ± 7 years) liver transplant recipients were compared with 50 controls (19M/31F, mean age of 59 ± 7 years). In transplant recipients, colonoscopy was performed 41 ± 19 months after liver transplantation. Seven (28%) liver transplant recipients (5M, 2F) and 4 (8%) controls (3F, 1M) were found to have adenomatous polyp (OR 4.5, 95% CI 1–21.2,P= 0.049). Malignant polyps were not detected in both groups.ConclusionLiver transplant recipients appear to have an increased risk for developing colorectal adenoma. Early screening colonoscopy is warranted for this group of patients.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundPostoperative strictures due to hepatic hydatid disease caused by Echinococcus surgery is considered to be a rare cause of benign bile duct strictures, especially in the Western world.GoalsThe aim of this retrospective study is to demonstrate possible characteristics of the strictures as well as the effectiveness of long-term endoscopic stenting.StudyBetween 1994 and 2001, we treated 10 of these cases in our clinic. All patients had surgery for hepatic Echinococcus disease one or more times. These types of benign biliary strictures, secondary to surgery of hepatic hydatid disease, were multiple and located in the proximal common bile duct. Endoscopic stent therapy was carried out in all cases containing transpapillary approach with plastic prostheses (7.5–11 French) or transhepatic approach withYamakawa® prostheses (16 French). Nine patients were available for follow-up.ResultsIn 6 patients (66%), the stents were removed after a median period of 22.5 months with radiologic and clinical signs of improvement. Three patients required prolonged dilatation therapy because of stricture-recurrence. There was low overall morbidity and we recognized no therapy-associated mortality.ConclusionsEndoscopic stent therapy is a safe nonoperative method for the treatment of postoperative benign biliary strictures due to hepatic hydatid disease.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Acute hepatitis A virus (HAV) infection is frequent in developing countries. Although some gallbladder abnormalities are defined during the course, an acute cholecystitis is extremely rare. We here report 2 additional cases of cholecystitis due to acute HAV infection and review the previously reported 2 cases. One of our patients was admitted with jaundice and a suspicious portal mass with a presumed diagnosis of cholagiocarcinoma. The other presented with jaundice, abdominal pain, and constitutional symptoms. Both patients were planned to be operated on. During the follow-up, absence of fever, leukocytosis, acute-phase protein response, and calculus in biliary system were against the diagnosis of a bacterial cholecystitis. Moreover the course of cholecystitis was closely parallel to that of the HAV infection. Both patients were managed conservatively. It was concluded that rare, acute viral cholecystitis can develop during the course of acute HAV infection.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID