ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Optimal nutrition in early infancy is the success behind good health, growth, and development of children. This article presents an overview of failure to thrive in children younger than 2 years of age. This article reviews normal growth, growth indices, common etiology, and an approach to evaluation and management of failure to thrive.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Stool antigen test forHelicobacter pylori, a noninvasive assay, is emerging as a strong competitor to urea breath test (UBT). Nevertheless, although the UBT delta value is a semiquantitative indicator ofH. pyloriintragastric load, until now theH. pyloristool antigen test has been used only as a qualitative investigation. We report here the results of a study performed with the aim of obtaining a semiquantitative measurement of bacterial amount in stools. We studied 15 patients with dyspepsia usingH. pyloripositivity at histology, the rapid urease test, UBT, and theH. pyloristool antigen test. The result of this last test was expressed by a numerical value we obtained by applying the principle of “standard points” to the absorbance units at spectrophotometric reading. This measurement was previously validated by testing probe sampling ofH. pyloristool antigen with known pure and stool-mixed bacterial amounts. A numerical result forH. pyloristool antigen was correlated to UBT delta for each patient using Pearson's r test. Finally, a Studentttest was performed to investigate possible differences in UBT andH. pyloristool antigen test values between anti-CagA–positive and -negative patients. We obtained a curve of saturation with both known amount of pure and stool-mixed bacteria. Pearson's r test showed a significant correlation between UBT delta value and H. pylori stool antigen measurement (r = 0.77;p< 0.001). Urea breath test delta andH. pyloristool antigen test values were significantly higher in anti-CagA–positive patients. Our data suggest that a numerical estimation ofH. pyloristool antigen may be feasible. This evaluation, similarly to UBT delta, may represent a semiquantitative determination of bacterial intragastric load.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundHelicobacter pylorieradication rates seem to decrease. This study evaluates the effect of retreatment with ranitidine bismuth citrate (RBC) 400 mg B.I.D., clarithromycin (C) 500 mg B.I.D., and metronidazole (M) 500 mg every morning and 1,000 mg every evening for 14 days [RBC·C·M].StudyNine gastroenterologic units included patients with unsuccessful eradication ofH. pyloriin a preceding randomized trial. Previous treatment was either omeprazole (O) 20 mg, C 250 mg, and M 500 mg [O·C·M] or RBC 400 mg, tetracycline (T) 1,000 mg, and M 500 mg [RBC·T·M]; all drugs were given twice daily for 7 days.ResultsTwenty-sixH. pylori–positive patients were included (nine males, 17 females; mean age, 54 years; range, 39–74 years). The eradication rates in the groups previously treated with O·C·M and RBC·T·M were three of nine (33%) (95% CI = 12–65) and 15 of 17 (88%) (95% CI = 66–97) respectively (p= 0.008). The corresponding results in a “per-protocol” analysis were three of eight (38%) (95% CI = 13–69) and 10 of 10 (100%) (95% CI = 72–100), respectively (p= 0.007). A side effect score was 21.8 compared with 8.3 in the previous study (p< 0.001).ConclusionsThe effect of a retreatment regimen depends on the preceding treatment. The RBC·C·M regimen is effective in nonresponders to RBC·T·M, but it seems unsuitable after failure of the O·C·M regimen.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundPush enteroscopy is increasingly used as an investigative tool for the evaluation of gastrointestinal bleeding, and studies from specialized centers have shown an overall diagnostic yield of push enteroscopy in such patients ranging from 38% to 75%. The aim of our study was to characterize the yield and clinical effect of push enteroscopy to determine the applicability of prior observations to other academic centers.StudyWe retrospectively studied patients who underwent push enteroscopy between January 1995 and December 2000 at our institution. Detailed clinical history, endoscopic findings, endoscopic therapy, and subsequent medical treatment were obtained through review of medical records and our endoscopic database. Medications prescribed after enteroscopy and whether medical management was affected by the findings of push enteroscopy were also recorded.ResultsOver the 6-year study period, 126 patients (48% men; mean age, 62 years; range, 15–91 years) underwent push enteroscopy. The most common indications for push enteroscopy were gastrointestinal bleeding in 57 patients (45%) and iron-deficiency anemia in 32 (25%). The results of push enteroscopy were normal in 44 patients (35%), and the most frequent endoscopic lesions were angiectasias in 24 patients (19%), gastric erosions in 10 (8%), gastric ulcer in four (3%), jejunal ulcer in three (2%), and esophagitis in three (2%). The identified lesions (n = 89) were within reach of a standard upper endoscope in 42 patients (47%). Endoscopic therapy was performed in 12 patients (13%), and the management of 50 patients (40%) was changed based on findings at push enteroscopy.ConclusionsPush enteroscopy has a high diagnostic yield, similar to reports from specialized centers suggesting the potential clinical benefit of more widespread use.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Intramural dissection of the esophagus is a rare esophageal disorder that is characterized by a long laceration between the esophageal mucosa and submucosa but without perforation. It reveals characteristic radiologic and endoscopic features. The etiology of intramural dissection of the esophagus remains uncertain. The most common presenting symptoms are sudden retrosternal pain, hematemesis, odynophagia, dysphagia, and back pain. Conservative management is usually thought to be adequate. We report a case of spontaneous intramural esophageal dissection, in which the symptom of dysphagia did not improve with the conservative management, and an endoscopic incision of the septum between true and false lumens using a needle-type diathermy knife was done safely and effectively.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Nutritional abnormalities almost uniformly accompany the metabolic disturbances of severe chronic liver disease and may adversely affect patient well-being and survival, especially surrounding liver transplantation surgery. The exact metabolic alterations responsible for malnutrition and its consequences in these patients have been debated and are a focus of this review. Disturbances in energy production and utilization, as well as macro- and micronutrient metabolism have been appreciated but are not always easily identified or quantifiable. Interestingly, the manifestations of poor nutritional status can vary substantially between patients, even in those having the same etiology and severity of illness. Proper assessment of patients with liver disease for malnutrition carries its own challenges, but some of the more easily applied techniques, such as anthropometry, can be comparable in accuracy to more sophisticated measuring tools. Gaining an appreciation and understanding of how nutritional disturbances develop and can contribute to morbidity and mortality will help combat inappropriate nutritional losses in this specialized group of patients. In many instances, simple adjustments in diet can offset losses and stabilize or improve the patient's nutritional status.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Lens culinarisagglutinin-reactive alpha-fetoprotein (AFP-L3) is known to be a useful marker for the diagnosis of hepatocellular carcinoma (HCC). Recent studies have shown that positive AFP-L3 results after treatment predicts tumor recurrence and poor clinical outcome. This study was to evaluate the role of pretreatment AFP-L3 as a prognostic marker for response to transcatheter arterial chemoembolization (TACE) and survival in patients with HCC. Forty-six patients with HCC who underwent TACE were analyzed. Agglutinin-reactive AFP was measured by lectin-affinity electrophoresis coupled with antibody-affinity blotting. Agglutinin-reactive AFP results larger than 24.4% were considered to be positive. Agglutinin-reactive AFP fractions were positive in 32 patients. Agglutinin-reactive AFP-positive patients had poorer performance status, larger tumors, frequent portal vein thrombosis, and higher levels of serum AFP. The partial response rate to TACE was lower in AFP-L3–positive patients than in AFP-L3–negative ones (37.5% vs. 78.6%,p= 0.01). Tumor size and AFP-L3 were two independent predictive factors for response to TACE. The 2-year survival rate was lower in AFP-L3–positive patients than in AFP-L3–negative ones (21.2% vs. 78.6%,p= 0.01). Child-Pugh class, AFP-L3, the presence of portal vein thrombosis, and response to TACE were independent prognostic factors for survival. In conclusion, pretreatment status of AFP-L3 could be considered a useful marker for predicting clinical outcome in patients with HCC who underwent TACE.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

GoalsA good response to diuretics is obtained initially in the treatment of cirrhotic ascites. However, unresponsiveness to therapy and various complications may develop with disease progression. This makes obligatory the search for new treatment methods that may be alternative to standard diuretics. In our study, we investigated the effect of mannitol infusion on current therapies in patients with cirrhotic ascites who were using diuretic treatment.BackgroundThirty cirrhotic patients with ascites who were using diuretic treatment were included in the study. The patients were randomly divided into two groups; a dose of 100-mL 20% mannitol was administered to the first group, and 100-mL 5% dextrose solution was administered to the second group. The patients' urinary volumes and serum and urine electrolyte levels (sodium, potassium) were determined before and after the test.ResultsIn the mannitol group, a significant increase in urinary volume was observed (p< 0.05). However, in the control group no significant differences in urinary sodium excretion were observed after the test (p> 0.05). In the mannitol group, a concomitant increase in urinary volume and sodium excretion was observed in eight cases (53%). The urinary sodium excretions and serum sodium levels before the test were significantly lower in patients who responded to mannitol than in patients who did not respond (p= 0.001 andp= 0.04, respectively).ConclusionsAs a result, short-term mannitol therapy makes a significant contribution to diuretic therapy in approximately half of cases with cirrhotic ascites. The results we obtained suggest that mannitol may be a useful alternative in the treatment of ascites.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A 36-year-old male patient, after 3 months' treatment with fluvastatin 40 mg/d for hypercholesterolemia, presented with acute pancreatitis. The pancreatitis was mild, and the patient settled on medical treatment. Other causes of the disease were ruled out. Some months later, the patient reintroduced fluvastatin on his own initiative, which caused a recurrence of pancreatitis within a few days. Previous reports are reviewed, showing that statin-induced acute pancreatitis may occur within the first day of therapy or after several months. It is generally mild and runs a benign course, and no mortality has been reported. The frequency of this side effect is unknown, but it is most likely rare.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID