摘要:

We evaluated the effect of different types of preparations on the diagnostic yield of colonoscopy (total or limited) in mild to moderate active ulcerative colitis. Our ability to determine the extent of disease and see the mucosa beyond the inflamed areas was assessed in patients receiving no preparation (group A, 72 examinations) and those receiving diphosphosoda enemas (group B, 181 examinations). There were three failures in group A and 11 in group B. In the majority of patients (71% of group A, 83% of group B) the scope could be passed under optimal viewing conditions at least one segment beyond the involved area. In group A the cecum was reached in 16% of the procedures and in group B in 18%. We conclude that in mild to moderate active ulcerative colitis, colonoscopy can be performed without preparation, and still achieve the same results as with preparatory enemas.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The effects of prokinetic treatment with cisapride in patients with constipation-predominant irritable bowel syndrome (IBS) were evaluated in a randomized, doublelind, placebo-controlled study. Sixty-nine IBS patients were assigned to a 12-week treatment with either 5 mg cisapride or placebo t.i.d.; this dosage could be changed of necessary. The mean weekly number of days on which stool was passed in the cisapride and placebo group ncreased to 5.3 and 4.4 (p < 0.05) during weeks 8–12 of reatment, and the number of days with stools of normal consistency increased to 3.5 and 1.9 (p < 0.05), respectively. At week 12, the reduction in severity and frequency scores for abdominal pain was significantly reater (p ≤ 0.05) in the cisapride group (60 and 61%) than in the placebo group (40 and 32%), as it was for abdominal listension (p < 0.05). Cisapride tended to be better than placebo in diminishing flatulence. In 71% versus 39% of he patients the overall rating for the response to treatment was good or excellent at week 12. Cisapride was well tolerated. These results suggest that the drug will be useful for the management of constipation-predominant BS.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Involvement of the pancreas by human immunodeficiency virus (HIV) infection has not been adequately addressed and is the object of this review. I analyzed the English language literature, including single case reports of pancreatic involvement and larger series reporting detailed pathological findings of patients with HIV infection. Nonspecific pathological changes in the pancreas are frequently seen at autopsy of HIV-infected patients, but are not more common than in controls. Several types of infections (mainly cytomegalovirus,Cryptococcus neoformans, andMycobacteria) and neoplasms (lymphoma and Kaposi's sarcoma) can involve the pancreas because they are usually disseminated. Although the serum amylase may be elevated, the patient remains asymptomatic. Occasional instances of severe and even fatal pancreatitis have been reported with HIV infections and attendant drug toxicity. Pentamidine has a predictable incidence of hypoglycemic episodes and 2‘,3’-dideoxyinosine provokes pancreatitis in a minority of treated patients. Such drug toxicity seems to deserve greater clinical concern than opportunistic infections or neoplasms.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

So assess whether gallbladder motility is altered in patients with irritable bowel syndrome (IBS) or essential Hyspepsia (ED), we studied gallbladder function in 25 healthy volunteers, 20 patients with IBS, and 22 with ED. By real time ultrasonography, we studied the following parameters: (a) fasting gallbladder volume, (b) maximum percent of gallbladder emptied, (c) time required for maximal contraction, (d) residual volume after maximal contraction, and (e) percent fasting volume at 2 h. All parameters, except fasting gallbladder volume, were measured after a high-fat meal. The fasting gallbladder volume, maximum percent of gallbladder emptied, time required for maximal contraction, residual volume after maximal contraction, and percent fasting volume at 2 h in controls and patients with IBS was 19.3 ± 8.8 ml and 4.4 ± 9.7 ml, 67.1 ± 10.7% and 67.6 ± 13.5%, 41 ± 20.6 min and 49.7 ± 25.3 min, 6.2 ± 3.3 ml and 7.6 ± 5.3 ml, and 38.1 ± 12.2% and 40.7 ± 14.5%, respectively. The differences between the two groups were statistically not signignificant. The corresponding values in patients with ED were 15.5 ± 6.3 ml, 57.6 ± 16.5%, 51.8 ± 29.3 min, ± 3.2 ml, 44.1 ± 17%, respectively. Compared with controls there was no statistically significant difference in these parameters, except the maximum percent of gallladder emptied, which was significantly less than that in controls (57.6 ± 16.5% vs. 67.1 ± 10.7%; p < 0.05). Therefore, we could not find that patients with IBS have my abnormality of gallbladder function; postprandially, patients with ED have submaximal contraction of the allbladder.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Granulomatous hepatitis is a common cause of fever of unknown origin in up to 13% of patients with prolonged ever. Attempts to define an exact etiology of the granumatous hepatitis frequently does not yield a precise siagnosis, so that the physician must consider empiric eatment. In this paper we retrospectively review 23 patients in whom granulomatous hepatitis was found as part of the initial assessment of fever of unknown origin, and we report on their outcomes after an overall prospec-we follow-up of 37 months. In 26% a precise diagnosis was established at the time of assessment: Q-fever in pree, mycobacterial disease in two, and histoplasmosis one. In the remaining 74% no etiology was established after 44 months follow-up. Forty-one percent of the diopathic group resolved spontaneously without therapy, and 18% received short-term prednisone or indomethacin with a favourable outcome. The remaining 41% required long-term prednisone therapy for a mean of 33.1 months, put all have remained afebrile and otherwise healthy after 19.6 months follow-up. We conclude that patients with ever of unknown origin who are diagnosed as having diopathic granulomatous hepatitis have an excellent rognosis, even the minority who require long-term corticosteroids.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Disposable biopsy forceps have recently been introduced into the field of endoscopy. We have analyzed biopsy size and histologic interpretation of samples obtained with the disposable forceps and compared them to those obtained with reusable forceps. In the 18 patients studied, 49 samples were collected with the reusable forceps and 47 samples with the disposable. Biopsy sites included the colorectum in 50%, esophagus in 22%, small bowel in 17%, and stomach in 11% of the patients. We found that statistically smaller samples were collected by the disposable biopsy forceps than by the reusable (2.48 ± 1.11 mm versus 1.99 ± 0.55 mm, p = 0.006). The smaller biopsy size with disposable forceps was not clinically important since all but one of 47 specimens were interpreted as adequate for histologic diagnosis. The convenience, potential cost savings, and prevention of the spread of communicable agents afforded by disposable biopsy forceps make them a possible alternative to conventional forceps in some clinical settings.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Acetaminophen overdose is generally treated with oralN-acetylcysteine. WhileN-acetylcysteine is protective, in additional effective mode of treatment is desirable in Inlarge overdoses. A growing body of evidence suggests that cimetidine significantly reduces the hepatotoxicity of in acetaminophen overdose and that its hepatoprotective action may be additive to that ofN-acetylcysteine. We report a case of acetaminophen overdose treated with ralN-acetylcysteine in conjunction with cimetidine by continuous i.v. infusion. The 4-h acetaminophen level was 410 μg/ml, and the highest measured level of serum utamic oxaloacetic transaminase was 83 IU/L on day 3, indicating minimal hepatic toxicity.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A 66-year-old man without history of heart disease or symptoms of left ventricular (LV) failure was admitted with transudative ascites. Echocardiography showed no valvular or pericardial disease and normal LV function, Gated pool scintigraphy confirmed normal LV systolic function but demonstrated severe right ventricular systolic dysfunction. Catheterization revealed left ventricular diastolic dysfunction as the cause of right-sided failure. The clinician evaluating transudative ascites cannot exclude LV failure on the basis of noninvasive assessment of systolic function alone. Appreciation of an elevated central venous pressure remains the most important evidence of a cardiac source of ascites.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We report an unusual case of a typically canine rickettsial disease, ehrlichiosis, in a 56-year-old man. Although only occasionally affecting humans with a mild illness, exposure to a tick bite in our patient led to severe multisystemic disease with intense cholestasis. Coma, acute renal failure and respiratory failure requiring mechanical ventilation ensued. Imaging procedures showed no biliary obstruction. A liver biopsy demonstrated bile stasis and sinusoidal lymphoid infiltrates. The diagnosis was confirmed serologically. Only partial improvement occurred with tetracycline therapy, but total resolution of all abnormalities eventually followed therapy with chloramphenicol.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We report a 33-year-old man who developed cutaneous lecrosis of the lower extremities with extensive bulla formation after i.v. administration of vasopressin for the reatment of bleeding esophageal varices. Due to its lotent nonselective vasoconstrictive action, vasopressin lot only may induce cardiac and gastrointestinal ischenia, but cutaneous ischemia as well. As in our patient, this may lead to extensive necrotic skin lesions at sites listant from the infusion.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID