ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We describe a randomized, double-blind, placebo-controlled, crossover trial with spiramycin in a single patient with aquired immune deficiency syndrome (AIDS) and a severe secretory diarrhea caused by cryptosporidium. Spiramycin, a potentially harmful antibiotic, had no clinical or microbiological effect in this patient. The application of the single patient (N of 1) trial to common clinical problems is a simple way to analyze the value of different therapeutic approaches. The time-consuming, expensive, multi-patient trial with ultimate extrapolation to the individual patient can be avoided. Single-patient trials can influence management and improve patient care and have potentially wide use in patients with gastrointestinal disease.

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A prospective clinical, endoscopic, and histopathologic study of the esophagus was carried out in 24 patients with advanced liver disease who underwent esophageal variceal sclerotherapy (EVS) and who eventually came to autopsy. Patients were arbitrarily divided into three groups: acute (group I), intermediate (group II), and chronic (group III) based on the interval between the first EVS and death. EVS with sodium tetradecyl sulphate (STS) initially produced thrombosis with varying degrees of necrosis and inflammation followed by ulceration, recanalization, and eventually fibrosis with obliteration of varices. Recurrent variceal hemorrhage (VH) leading to death was highest in the acute group since all patients died of uncontrollable VH (100%); it ranged between 50–60% in both the intermediate and chronic groups. Despite variceal obliteration, recurrent hemorrhage developed in the chronic group due to gastric varices or other venous channels in the esophagus or stomach. Additionally, we describe findings not previously reported, such as the presence of sclerosant outside the varices after intravariceal injection, thrombosis of gastric varices after esophageal injections, and the development of muscular wall thickening.

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We used published results from clinical trials to evaluate the efficacy of ranitidine and cimetidine as maintenance therapy following healing of acute duodenal ulcers. Only studies in which patients were treated with an evening-meal or bedtime dose of ranitidine (150 mg) or cimetidine (400 mg) over a 12-month period were used. The results from the analysis of seven clinical trials where ranitidine was directly compared to cimetidine indicated that 8.4% fewer patients experienced an ulcer recurrence on ranitidine (p < 0.01). The estimate of the common odds ratio was 1.63, which indicated higher odds of recurrence versus nonrecurrence for cimetidine than ranitidine patients. The 95% confidence interval for the odds ratio ranged from 1.21 to 2.21. When data from placebo trials were included in the analysis, ulcer recurrence was 6.8% lower for ranitidine than for cimetidine (p < 0.01).

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We studied gastric emptying of solid food, using a radionuclide technique, in 18 patients with chronic renal failure patients on hemodialysis: nine with nausea and vomiting or postprandial bloating and nine without. Both groups were compared with a group of normal subjects. Gastric emptying was consistent with a linear elimination in all groups. The regression coefficients of the symptomatic, asymptomatic, and control groups were −0.48 ± 0.1%, −0.5 ± 0.14%, and −0.58 ± 0.15% min, respectively. These were not statistically different. Half-emptying times were 116.4 ± 7.1 min, 97.8 ± 13.7 min, and 98.7 ± 5.6 min, respectively. These also were not statistically different. Values of percentage retention at 2.5 hours for the same groups were 31.6 ± 5, 24.8 ± 6.4, and 18.6 ± 4.4, respectively, again with no statistical difference. Patients with chronic renal failure on hemodialysis, symptomatic or asymptomatic, have no obvious impairment of gastric emptying of solids.

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The history of immunosuppressant drug use, both azathioprine (Aza) and 6-mercaptopurine (6-MP), in inflammatory bowel disease (IBD) over the past 20 years is briefly reviewed. The two drugs appear identical in their pharmacologic and biologic effects. Azathioprine is converted to 6-MP while in the body. Conflicting reports on the effectiveness of Aza have been published. The major National Cooperative Crohn's Disease Study (NCCDS) has found no advantage in Aza over placebo. In contrast, 6-MP was found to be effective in a large randomized trial. The shortcomings of the NCCDS reports are discussed with possible explanations for their negative findings. Our own studies, dating from 1968, are reviewed with 38 patients having been treated for up to 18 years, always in combination with small doses of steroids. Our results with Aza are similar to those of Present and Korelitz with 6-MP; about 70% of previously intractable patients improved substantially. Both Aza and 6-MP bring about healing and closure of most fistulas. Side effects can be serious but are usually manageable and, to some extent, preventable by appropriate dosage schedules. Since Aza has been approved for another benign, presumably autoimmune disease—rheumatoid arthritis—and because of its extensive use in other autoimmune diseases, we prefer to use Aza in selected patients with Crohn's disease who have failed to respond to more conventional modes of therapy. The use of immunosuppressants in ulcerative colitis is less clearly indicated.

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Thirty-two transplant recipients with cytomegalovirus (CMV) infection documented by positive culture of blood and/or organs other than the liver were evaluated for hepatic involvement. Thirteen of the 32 (41%) had evidence of hepatic involvement with CMV. Inclusions alone were present in three patients; liver cultures alone were positive for CMV in three; and both were present in seven. Although the presence of CMV inclusions was the only histological feature that clearly separated the groups with and without hepatic involvement, two items helpful in finding inclusions were lobular aggregates of polymorphonuclear cells and portal karyorrhexic debris. The presence of liver involvement had a significant correlation with multiple organ infection, indicating it is a good marker of widely disseminated disease. This study indicates that liver histology and culture are useful and complementary methods for documentation of hepatic involvement (hence, tissue invasion) in immunocompromised patients with CMV infection.

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID