ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;Preneoplastic epithelia of the gut have been given several different names, but the one most often used is dysplasia. Dysplasias of the gut are diagnosed by pathologists, using a set of cytologic and architectural features, and are divided into two grades: low‐ and high‐grade. Although the definitions imply that all low‐grade dysplasias are similar (as are all high‐grades), in reality, there is significant heterogeneity in the appearances of each grade of dysplasia. Thus, separating low‐ from high‐grade epithelium may be difficult. In addition, the features that characterize low‐grade epithelia are very similar to many examples of epithelial regeneration, and so these may not be readily separable. Such cases may be classified as being indefinite for dysplasia. For these reasons, and because the implications for patient care are significant, the interpretations of biopsies taken for dysplasia surveillance are considered challenging by most pathologists. Clinicians must understand the challenging nature of these biopsies, communicate with the pathologists who will interpret such biopsies, and obtain an adequate sample of the mucosa to ensure that dysplasia, if present, will be biopsied and appropriately diagnosed.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;There is mounting evidence from studies on experimental cancer in rodents, interventional studies in patients with familial adenomatous polyposis, and some, but not all, epidemiologic investigations, that suggests a chemopreventive effect of aspirin and nonaspirin nonsteroidal anti‐inflammatory drugs (NSAIDs) against colorectal cancer. In addition, the mechanisms by which these agents modulate tumorigenesis are being elucidated in laboratory experiments. Currently available NSAIDs are unlikely to have an acceptable benefit‐to‐risk ratio for long‐term use in an asymptomatic population. Once the discrete chemopreventive mechanisms are established and the genetic background and risk factor profile of individuals who will benefit from chemoprevention are clarified, a low‐dose combination of NSAIDs with different targets may optimize efficacy and minimize toxicity. At present, however, colectomy is still the treatment of choice for patients with familial adenomatous polyposis, and early screening and regular surveillance colonoscopies are the choices for those at risk for hereditary nonpolyposis colorectal cancer. In the average‐risk individual, endoscopic screening and surveillance will remain the core of efforts to prevent sporadic colorectal cancer.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;Botulinum toxin was initially used in medicine to produce a potent neuromuscular blockade. It was later found to interfere with acetylcholine release in the myenteric plexus and inhibit contraction in gastrointestinal smooth muscle, leading to its use in the treatment of various conditions. It is frequently used in the treatment of achalasia in elderly patients who may be poor surgical candidates. It has been used successfully in the management of various conditions, including anal fissure and biliary dyskinesia. Large controlled trials are needed to establish the role of botulinum toxin and its safety in gastroenterology.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;Recurrence of peptic ulcer after successful eradication ofHelicobacter pyloriis closely associated with reinfection. The aim of this study was to examine the recurrence of peptic ulcer and reinfection withH. pyloriafter successful eradication. To eradicateH. pyloriinfection, patients with active peptic ulcer disease were assigned to two treatment groups depending on the year of their enrollment (AM group and OAMR group). Patients in the AM group received 400 mg of cimetidine twice per day, 300 mg of amoxicillin three times per day, and 250 mg of metronidazole three times per day for 2 weeks. Patients in the OAMR group received 20 mg of omeprazole once per day, 500 mg of amoxicillin granules three times per day, 250 mg of metronidazole three times per day, and 150 mg of roxithromycin twice per day for 1 week. After endoscopy verified ulcer scarring and successful eradication ofH. pyloriinfection, study patients were followed up monthly and did not undergo acid‐suppressive therapy. Endoscopy was performed at 6‐month intervals for the 1st year. After the 1st year, follow‐up endoscopies were performed annually. In total, 107 patients with peptic ulcer (duodenal ulcer [DU], 65; gastric ulcer [GU], 42) were followed up for a mean period of approximately 2 years. Recurrence of infection occurred in 10 (9.3%) of 107 patients (AM group, 9; OAMR group, 1) after 210 patient‐years of follow‐up; the recurrence rate was 4.8% per patient‐year. Recurrence ofH. pyloriinfection was significantly higher in the AM group (23.1%) than in the OAMR group (1.5%).H. pyloriinfection recurred in two patients 6 months after eradication therapy, in seven 1 year after, and in one 2 years after. Thereafter, no further cases ofH. pylorirecurrence were observed. During follow‐up periods, seven cases of ulcer recurrence were observed (DU, 4; GU, 3). The rate of peptic ulcer recurrence within 2 years after eradication therapy was significantly higher than that after more than 2 years. Four cases of ulcer recurrence (DU, 3; GU, 1) also had recurrence ofH. pyloriinfection. One recurrent case of DU without reinfection was associated with nonsteroidal anti‐inflammatory drugs. The remaining two cases of GU recurred withoutH. pylorireinfection. In conclusion, peptic ulcer recurrence rarely occurred (3 [2.9%] of 103) in patients cured ofH. pyloriinfection. Reinfection after apparent successful eradication was rarely noted when a powerful therapeutic regimen in eradication was used. Therefore, to eradicateH. pylori, a highly effective therapeutic regimen should always be used.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;Over the past few years, many reports have pointed out that open, but not minimally invasive, cholecystectomy was associated with reduced immune functions. Also, after laparoscopic surgery, a reduced impairment of T cell functions and lower levels of proinflammatory cytokines, epinephrine, and norepinephrine were found in comparison with those detected in patients who underwent conventional cholecystectomy. We investigated polymorphonuclear cell‐ and monocyte‐mediated phagocytosis and killing and T‐cell‐mediated antibacterial activity in 12 patients who underwent open cholecystectomy versus another group of 12 patients who underwent laparoscopic cholecystectomy. Our data show that polymorphonuclear and monocyte killing activities are preserved or are less affected in patients who undergo laparoscopy when compared with patients who undergo conventional operation. On the other hand, in both groups of patients, T‐cell‐mediated antibacterial activity was significantly reduced in the preoperative period, and, therefore, we could not draw conclusions on the effects of the surgical techniques used on the above immune parameter. The overall data suggest that laparoscopic cholecystectomy is a valid alternative to open surgery because of the moderate postoperative immune suppression and decreased risk of postsurgical infections.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background:Pyloric metaplasia (PYME) is seen frequently in ileal resections from patients with Crohn's disease (CD). It represents a nonspecific reparative reaction in intestinal ulcers. The presence of PYME in terminal ileum biopsies (TIbxs) of CD has not received much attention and has been considered a rare finding.Study:We reviewed 45 TIbxs from 45 adult patients with indisputable clinicopathologic diagnosis of CD. Endoscopic biopsies were obtained with an Olympus CIF 140 videoscope. The samples were fixed in 10% buffered formalin and were processed routinely.Results:Pyloric metaplasia was identified in 10 TIbxs from 10 patients. Most of the metaplastic glands formed small aggregates in the mucosal base, and they were frequently noted below regenerating crypts and in the vicinity of granulation tissue and ulceration.Conclusions:In our material, 22.2% of the TIbxs revealed PYME. The single previous study with similar data showed an incidence of 2.27%. The difference could reflect the stage of the disease or the thoroughness of the endoscopic and pathologic examinations. Pyloric metaplasia, despite its lack of specificity, remains a sensitive indicator of persistent ulceration with inflammation. Because PYME is not as rare as previously thought, it should be carefully looked for in TIbxs to support the diagnosis of CD in the appropriate clinical setting.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;Laparoscopy‐assisted percutaneous endoscopic gastrostomy was successfully performed to replace gastrostomy tubes that had been inadvertently withdrawn. With this less‐invasive surgical technique, gastrostomy tubes in elderly patients can be replaced safely and definitely without laparotomy. We suggest that this technique be performed when indicated.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;Gastric mucosa‐associated lymphoid tissue (MALT)‐associated B‐cell proliferation may range from benign to malignant, andHelicobacter pyloriis the only identified critical antigenic stimulus to the development of gastric MALT. Monoclonal gammopathy of undetermined significance (MGUS) is characterized by B‐cell hyper‐activation and clonal expansion and is know to predispose to B‐cell malignancies. We report a patient with MGUS andH. pyloriinfection in whom we noted the progression of gastritis to acquired gastric MALT and gastric MALT to MALT lymphoma during a 3‐year follow‐up.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;Two cases of multiple lymphomatous polyposis (MLP) are presented, involving different segments of the gastrointestinal tract. Both cases display the characteristic clinical and pathologic features of MLP. In addition, we were able to document, for the first time, the endoscopic ultrasonographic findings in this disease. This new ancillary diagnostic technique was found to be very helpful in the evaluation of the structural changes of the wall of the gastrointestinal tract and in the detection of affected lymph nodes.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID