摘要:

Esophageal strictures from a variety of benign and malignant causes require dilation therapy when patients develop symptoms of dysphagia. Dilation can be accomplished using a variety of dilating devices and adjunctive techniques. The approach to management of esophageal strictures is reviewed with a focus on dilation technique and special considerations for various stricture types.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundTherapy with &bgr;-blocker and nitrate has been reported to improve survival of patients with bleeding esophageal varices and to decrease esophageal rebleeding. However, there is little information available concerning the efficacy of these medications on rebleeding risk and survival in gastric variceal bleeding after initial hemostasis.MethodsWe conducted an open trial to observe the roles of &bgr;-blocker and nitrate in the long-term outcome of bleeding gastric varices. Eighty-three patients were included and evaluated on the basis of age, gender, gastric variceal size, associated esophageal variceal size, Child–Pugh classification, existence of hepatoma and portal vein thrombosis, &bgr;-blocker or nitrate therapy, and follow-up histoacryl injection. Survival analysis and multivariate analysis with the Cox proportional hazards model were performed to evaluate independent risk factors.ResultsLarger gastric varices have been shown to be the only risk factor for rebleeding (adjusted odds ratio, 4.50; 95% CI, 1.30–15.59). &bgr;-Blocker and nitrate did not significantly reduce the incidence of rebleeding (adjusted odds ratio, 0.37; 95% CI, 0.08–1.66). Although medical treatment was shown to improve the overall survival by Kaplan–Meier method (p< 0.01), multivariate analysis showed Child–Pugh class B or C and advanced hepatoma with portal vein thrombosis to be the real independent risk factors that influence survival (Child–Pugh class B or C odds ratio, 2.72; 95% CI, 1.53–4.84; portal vein thrombosis odds ratio, 6.99; 95% CI, 2.42–20.16). &bgr;-Blocker and nitrate did not significantly prolong survival independently.Conclusions&bgr;-Blocker and nitrate did not decrease the risk of rebleeding and did not improve the overall survival independently. The poor prognosis was correlated with Child–Pugh class B or C, and the advance hepatoma, with portal vein thrombosis.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The use of intranasal (IN) midazolam in adults for sedation in upper gastrointestinal endoscopy has been evaluated in a controlled clinical study. Eighty-one patients with a mean age of 37.02 ± 12.50 years who underwent upper gastrointestinal endoscopy for various reasons were included in the study. Three groups were formed according to the sedation regimen. In the first group (n = 30), patients received IN midazolam. In the second group (n = 28) intravenous (IV) midazolam was given for sedation, and the third group of patients (n = 23) received placebo before the procedures. Patients were monitored (using a pulse oximeter with an interval of 5 minutes until the 45th minute after the procedure) for arterial oxygen saturation, heart rate, systolic and diastolic arterial blood pressure, and respiratory rate. Efficacy of sedation, amnesia, side effects, and patients' preferences were evaluated. Superior results regarding the efficacy of sedation has been documented with the use of IV midazolam (p< 0.001), and this was the preferred route for drug application according to the patients' answers (p< 0.01). However, regarding amnesia, IN midazolam was found to be almost equally effective as IV midazolam (p< 0.05); moreover, IN route of drug application caused significantly fewer side effects than did the IV form (p< 0.001 ). Intranasal application of midazolam for gastrointestinal endoscopy appeared to be an interesting alternative to the IV route, the usage of which might be limited because of its potentially serious side effects. In contrast to the IV application of midazolam, the IN route may not even necessitate the monitoring of the patient during upper gastrointestinal endoscopy.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

GoalsTo assess the impact of upper endoscopy and biopsy on the outcome of patients with isolated thickened gastric folds found on barium upper gastrointestinal series (UGIS).StudyA total of 8,325 consecutive UGIS reports were reviewed to identify 182 patients who were found to have isolated thickened gastric folds. Patients with other serious radiographic abnormalities were excluded. The 182 patients were studied by a systematic review of the esophagogastroduodenoscopy (EGD) findings, gastric biopsy results, and clinical outcome.ResultsThe study included 96 men (52.7%) and 86 women (47.3%) who had isolated thickened gastric folds on the UGIS. Seventy-four patients underwent EGD; 108 patients did not. The two groups were similar in demographic and clinical features. The EGD results were normal, 18 (24.3%); thick gastric folds, 12 (16.2%); hiatal hernia, 12 (16.2%); erythema/inflammation, 11 (14.9%); erosions, 8 (10.8%); portal gastropathy, 3 (4.1%); and gastric ulcer, 1 (1.4%). Forty-eight of the 74 EGD patients had a gastric biopsy. The findings were chronic active gastritis, 39 (81.3%); and chronic gastritis, 5 (10.4%). Evidence forH. pyloriinfection was present in 91.7% of the gastric biopsies. Outcome (mean follow-up, 28.5 months) was assessed in 49 patients in the EGD group and in 55 patients in the non-EGD group. There were no cases of serious or new UGI problems in either group.ConclusionsIsolated thickened gastric folds found on UGIS are frequently associated withH. pyloriinfection. Performing endoscopy and biopsy did not appear to alter the outcome in these patients.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundUlcerative colitis (UC) is rare in Asia. Singapore is an ethnically heterogeneous city–state with a population made up of Chinese (77%), Indians (7.5%), and Malays (14%). This study describes and compares the characteristics of Chinese, Malay, and Indian patients with UC.StudyRetrospective chart review was performed of 235 patients seen in the largest tertiary care hospital in Singapore between 1971 and June 2000.ResultsThere were 169 (72%) Chinese, 24 (10%) Malays, and 42 (18%) Indians with UC. Male-to-female ratio was 1.8:1 (150:85). Most patients in all three races presented between the ages of 20 and 39 years. No bimodal peak in the age at presentation was seen. The median period from onset of symptoms to diagnosis was 1 month in all three races. More Malay (57%) and Indian (55%) patients had colitis extending proximal to splenic flexure at presentation compared with Chinese (32%) patients (p= 0.04). There were more Indian patients (29%) with severe disease at onset compared with Chinese (12%) and Malay (22%) patients (p= 0.035). Thirty-one percent of patients had only one episode of colitis, 12% were steroid dependent, and 4% were steroid refractory. Proctocolectomy was needed in 31 (18.3%) Chinese, 3 (12.5%) Malay, and 4 (9.5%) Indian patients. Extraintestinal manifestations were found in 6% of the Chinese, 12% of Malay patients, and 14% of Indian patients. The most common extraintestinal manifestation was arthritis, present in 6.4% of patients.ConclusionThere were more Indians with UC than expected in this population. Whereas Indian and Malay patients have more extensive and severe disease at presentation than Chinese patients, this does not predict for more refractory disease or a greater need for surgery.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Infliximab is efficacious for refractory Crohn's disease, but delayed hypersensitivity reactions preclude retreatment for patients experiencing this complication. We report the results of four patients offered enrollment in an open label trial of thalidomide as “salvage” therapy for their refractory disease. Two patients with active fistulous disease and two with lumenal disease received open-label thalidomide 200 mg every night and were evaluated monthly at the University of Chicago Clinical Research Center for 12 weeks. Before administration, patients signed an informed consent form discussing the potential risks of thalidomide use. Female patients of child-bearing age underwent serum pregnancy testing every 4 weeks. Response was defined as an absolute decrease in Crohn's Disease Activity Index (CDAI) by 100 points or improvement in two of three clinical parameters for fistulous disease. A patient with a single perirectal fistula had complete closure by 4 weeks, the other had noticeable improvement of five perianal fistulae at 4 weeks and complete closure by 12 weeks. One lumenal patient had a CDAI decrease of 250 points in 4 weeks. The fourth patient withdrew secondary to sedation after only a week of therapy. Two patients (one fistula, one lumenal) continued thalidomide past the 3-month study period and remained in remission at 5 and 7 months. Side effects reported were sedation (four of four patients), hypertension (one of four), and peripheral neuropathy (one of four). Thalidomide appears to be a safe and effective alternative for short-term healing in patients who develop infliximab-induced delayed hypersensitivity reaction and may be an alternative strategy for those at risk.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

GoalsSurgery accounts for one half, and hospitalizations for one third, of overall costs for patients with Crohn's disease (CD). Infliximab induces remission and heals fistulas in CD but is more costly than traditional therapies. Its impact upon resource use in CD is unknown.StudyThe medical records were reviewed for all CD patients managed at our institution for at least 1 full year both before and after initial infliximab infusion. The incidences of hospitalizations, hospitalized days, surgeries, endoscopies, radiologic examinations, outpatient and emergency room (ER) visits were studied (weighted according to time period).ResultsThere were 79 patients (59% female, mean age 38.6 years). A decrease was seen in the annual incidence of all surgeries (38%,p< 0.01), gastrointestinal (GI) surgeries (18%,p< 0.05), endoscopies (43%,p< 0.01), ER visits (66%,p< 0.05), all outpatient visits (16%,p< 0.05), outpatient GI visits (20%,p< 0.01), all radiologic examinations (12%,p< 0.01), and non-plain films (13%,p< 0.01). Fistula patients (n = 37) had decreases in hospitalizations (59%,p< 0.05); GI surgeries (59%,p< 0.01); all surgeries (66%,p< 0.01); all, GI, and surgical outpatient visits (27%, 26%, and 70%, respectively,p< 0.05 for all); ER visits (64%,p< 0.05); all radiologic examinations (40%,p< 0.05); and non-plain films (61%,p< 0.05). Patients with luminal disease(n = 42) had decreases in endoscopies (52%,p< 0.05), and ER visits (69%,p< 0.05). Patients of both genders and all ages experienced decreases in resource use.ConclusionPatients with CD decreased their use of some services, with a decreased number of hospitalizations and a decrease in the use of surgical services seen primarily in the patients infused for fistulas. This decrease in use of healthcare resources raises the potential of overall cost savings in CD patients receiving this drug.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Microscopic polyangiitis is a pauci-immune, necrotizing, small-vessel vasculitis without evidence of granulomatous inflammation. Gastrointestinal involvement is rare and is predominantly limited to abdominal pain. Until now, the gold standard for diagnosis has been an invasive lung or kidney biopsy. We report the case of a 59-year-old woman with microscopic polyangiitis presenting as painless rectal bleeding, which was diagnosed by rectal mucosal biopsy. This is the first reported case of microscopic polyangiitis with initial presentation of rectal bleeding and diagnosis made by rectal mucosal biopsy.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Hydatid disease constitutes a serious public health problem throughout the world, especially in endemic areas, despite the use of various kinds of preventive measures. Currently, there are three treatment options for hepatic hydatid disease including surgery, PAIR (puncture, aspiration, injection, and re-aspiration), and chemotherapy with benzimidazole compounds. Each of these therapeutic modalities has limitations depending on the individual case. The authors review the use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary hydatid disease (HHD) to clarify its place in the treatment algorithm among surgical, medical, and percutaneous measures. ERCP in the preoperative period: (1) defines the cystobiliary relationship to help in surgery planning, (2) permits evaluation for acute conditions like cholangitis and obstruction so that subsequent surgery can be performed on an elective basis, (3) may give permanent cure specifically in cases of frank intrabiliary rupture if evacuation of biliary tract and cystic cavity is manageable, and (4) when combined with preoperative endoscopic sphincterotomy may decrease the incidence of the development of postoperative external fistula. ERCP in the postoperative period: (1) can help to clarify the causes of ongoing or recurrent symptoms or laboratory abnormalities, (2) may help to resolve the obstruction or cholangitis due to residual material in biliary ducts, (3) may provide the chance to manage postoperative external biliary fistulae, and (4) may be a realistic solution for secondary biliary strictures. Considering the current literature and adding this experience, the authors propose a new treatment algorithm in HHD including medical, surgical, PAIR, and ERCP-related therapies. To illustrate the algorithm, a case is presented of a patient who had a persistent external biliary fistula in the postoperative period and was managed successfully by endoscopic approach.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundIntraductal papillary mucinous tumor of the pancreas is a rare neoplasm managed by operative resection of the affected segment of the pancreas.GoalsTo evaluate the role of peroral pancreatoscopy in the diagnosis and preoperative localization of the affected region of the pancreatic duct and to undertake the appropriate operation for each patient.StudyFive patients with suspected intraductal papillary mucinous tumor of the pancreas were studied using endoscopic retrograde cholangiopancreatography, computed tomography of the abdomen, endoscopic ultrasonography, and peroral pancreatoscopy. The findings from these studies were compared, and operative resection was performed in each patient based on pancreatoscopic findings.ResultsOf the five patients with suspected intraductal papillary mucinous tumor, only four had histologically confirmed tumor, and the remaining one patient had a retention cyst of the pancreas. Pancreatoscopy correctly identified all four patients with the tumor while excluding the diagnosis of papillary tumor in one.ConclusionPeroral pancreatoscopy is valuable in the preoperative evaluation of intraductal papillary mucinous tumor of the pancreas, especially in the localization of such tumor.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID