ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Liver biopsy is still the most reliable procedure for the diagnosis of chronic, diffuse liver disease, so it is performed routinely to elucidate chronic alterations of liver tests. However, expensive and invasive, it is not exempt from risk and has limitations due to sampling error and to the size and quality of the tissue obtained. Moreover, many patients who undergo liver biopsy get no further treatment or do not benefit from treatment when the biopsy results are known. In addition, new biochemical tests have been developed in recent years as noninvasive tools to diagnose liver diseases, particularly fibrosis and cirrhosis. Thus, the role of liver biopsy in the improvement of outcome and quality of life of patients with chronic, diffuse liver diseases should be reconsidered. Many liver biopsies might well be avoided with the rational use of these noninvasive methods without any deleterious effect on patient care. Current tests and future developments in this field should help us to select those patients who would best benefit from a liver biopsy.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The Yale-Affiliated Gastroenterology Program (YAGP) originated in 1965 from the informal arrangements of two gastroenterologists, one university based and the other in a community hospital. Conceived at a time when there was little central authority, either on a national or on a hospital/medical school level, its links were forged by the personal relationships of its directors. The process of growth remained informal and flexible enough for the directors to meet the special requirements of their own community and hospital. YAGP provided an important model for improving medical care and education in community hospitals since it addressed personnel needs, contributed to the education of physicians, and fostered clinical research in digestive diseases. YAGP evolved its own standards and its own accreditation mechanism, but faltered when the Accreditation Committee on Graduate Medical Education provided national rather than local criteria. Increased controls by hospitals and medical schools led to more formal ties and programs, and YAGP ceased to matter. Still, there may be lessons from what was in its time an innovation, on a local and state level rather than on a national level.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The role of psychosocial factors in peptic ulcer remains controversial. We have investigated the relationship between socioeconomic status, concrete stressors, and ulcers in a longitudinally followed, population-based cohort, taking confounding risk factors into account. A total of 6,928 adults completed the Alameda County Study's baseline questionnaire in 1965; 4,595 ulcer-free on enrollment responded again in 1973-1974. Reported cases of “stomach or duodenal” ulcer during the year before each of the two surveys were examined with relation to 1965 characteristics: 288 subjects reported ulcers at baseline, and 104 reported new ulcers on follow-up. Sociodemographic characteristics associated with incident ulcers (age-adjusted) were, in women, low education, a blue-collar household, overcrowding, unemployment, marital strain, and children's problems; in men, nonwhite race. Prevalent ulcers were associated in women with sociability and children's problems; in men, with blue-collar occupation, low education, financial difficulties, marital strain, children's problems, and a sense of failure. Adjustment for smoking, alcohol, chronic bronchitis, arthritis, liver disease, and skipping breakfast weakened but did not eliminate these associations; adjustment for socioeconomic status further attenuated the associations of specific problems. Low socioeconomic status and concrete life difficulties are associated with peptic ulcer in the general population cross-sectionally and prospectively after adjustment for major physical risk factors, lending credence to a relationship between psychological stress and peptic ulcer.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Chronic gastritis (CG) is the chronic inflammation of gastric mucosa associated with varying degrees of damage of superficial and glandular epithelia. The causes of CG are exogenous (mainlyHelicobacter pylori) and endogenous. The process is concluded by atrophy of parenchyma. CG is associated with dyspepsia in ~ 50% of cases, but frequently with gastric and duodenal ulcer. The role of chronic atrophic gastritis (AG) is relevant in development of cancer or of other tumors like carcinoids and polyps. The specific secretive cells of the glandular parenchyma and of the superficial epithelium reveal a good correlation with secretory component behavior, but they are only partially influenced byH. pylori.It emerges that CG is an anatomic-functional condition. The cytofunctional profile in AG causes achlorhydria and therefore chronic luminal alkalosis. This condition favors intestinal metaplasia (IM) and important intraluminal troubles. Finally, nutritional deficiencies orH. pyloriseem to interfere with the intragastric metabolism and therefore play a relevant role in the rise of IM.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

A multicenter, multiyear, case-controlled colonoscopic study of 41 patients with gastric polyps undergoing colonoscopy analyzed whether patients with gastric polyps, particularly adenomas, run an increased risk of having colonic polyps. The primary controls were 109 patients undergoing colonoscopy matched for age and colonoscopy indications. A secondary control group was 69 of these 109 patients who, in addition to matching for age and colonoscopy indications with study patients, had no gastric polyps demonstrated by upper gastrointestinal examination. Patients with nonmalignant mucosal gastric polyps had a significantly greater incidence than primary controls of colonic polyps [odds ratio (OR) = 3.19, OR confidence interval = 1.46 – 6.99, p < 0.004, x2], colonic neoplasms (OR = 3.58, OR confidence interval = 1.56 –8.23, p < 0.006, x2), and colonic cancer (OR = 4.5, OR confidence interval = 1.05 – 19.4, p < 0.04, Fisher's exact test). Moreover, patients with gastric adenomas had a significantly greater incidence than did primary controls of colonic polyps (OR = 7.6, OR confidence interval = 1.29 – 44.7, p < 0.02, Fisher's exact test). The association between gastric and colonic polyps did not arise as an artifact of the significantly higher frequency of females in the study group because this association remained after patient stratification by sex. The higher risk of colonic polyps in study patients did not arise as an artifact of unappreciated gastric polyps in the primary controls because study patients also had a significantly higher risk of colonic polyps than the secondary controls (OR = 3.21, OR confidence interval = 1.35 – 7.63, p < 0.01, x2). Our retrospective case-controlled study suggests that gastric adenomas may be a new, significant risk factor for colonic polyps. A strong association would require that patients with gastric adenomas undergo surveillance colonoscopy to diagnose and remove colonic polyps. However, before we apply this finding to clinical practice, the apparent association should be confirmed by another, preferably prospective, study.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

To compare and characterize retrospectively the clinicopathologic features of gastric cancers with and without previousHelicobacter pyloriinfection, we determined the preoperative seropositivity ofH. pyloriin 151 patients who had undergone gastric resection for primary gastric adenocarcinoma between 1988 and 1993. The overall seroprevalence ofH. pyloriwas 60.9%.H. pylori-positive gastric cancers were frequently associated (p < 0.05) with macroscopic localized types (Borrmann I and II) in which negative cancer associated with infiltrative types (Borrmann III and IV) and cancer invasion of the duodenum. Multivariate analysis showed thatH. pyloriseropositivity was not an independent prognostic factor. Pathologic tumor–node–metastases (TNM) stage remained the only prognostic indicator. Our study suggests thatH. pylorihas a significant impact on the clinically relevant tumor biology of gastric cancer. Investigation along this line is warranted.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Although several prognostic indicators for gastric carcinoma have been reported, characteristics of long-term survivors with advanced gastric carcinoma have not yet been clarified. We compared clinicopathologic features of 54 patients who survived for >10 years after resection for advanced gastric carcinoma with those of 72 patients who died of recurrence. Long-term survivors were characterized by small tumor size (6.2 cm vs. 8.1 cm, p < 0.01), negative serosal invasion (50% vs. 32%, p < 0.05), few lymph node metastases (fewer than seven) (89% vs. 56%, p < 0.01), limited lymph node metastases (n0, n1) (89% vs. 40%, p < 0.01), and earlier stage (I or II) (50% vs. 16%, p < 0.01). These results indicate that small tumor size, negative serosal invasion, and fewer than seven positive nodes were the predictors of long-term survival after resection for advanced gastric carcinoma.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Until recently, it was only possible to make inferences about small bowel motility from experimental animal models, but manometric techniques now allow prolonged recordings of small bowel motor activity in humans. We have studied the effect of abdominal surgery on motor behavior of the small intestine and here report our observations after various surgical procedures (total gastrectomy, Billroth I and II gastrectomy, ileoanal anastomosis). We discuss the data together with the experiences of others.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Hyperbaric oxygen has been used in the management of perianal Crohn's disease on the assumption that tissue oxygenation is impaired. The Dead Sea region of Israel is the lowest point on earth (402 m below sea level), and therefore the oxygen pressure is increased. We hypothesized that this elevation in oxygen pressure over an extended time might be as effective as shorter periods of high-pressure oxygen in a hyperbaric chamber. So we investigated whether the Dead Sea environment might affect the activity and perianal complications of Crohn's disease. Six patients with Crohn's disease unresponsive to medical treatment spent periods of 1–3 weeks at the Dead Sea. Four patients had discharging perianal fistulas. All were given advice concerning diet, physical activity, and immersion in the Dead Sea. The Clamp–Softley modification of the Harvey–Bradshaw Crohn's disease activity index was used to assess disease activity initially and at weekly intervals during treatment. Drug therapy was tailored to patient symptoms. Mean disease activity index before treatment was 9.0 ± 1.4 (mean ± SEM) and after a week at the Dead Sea 3.5 ± 0.3 (p = 0.006). After 2 weeks the index decreased to 2.0 ± 0.4 (p = 0.037) in four patients. In one patient complete healing of perianal fistulae occurred after 2 weeks, and in two others there was striking improvement. Two patients with active Crohn's disease and on high-dose corticosteroids were able to stop all medication during their stay. Decrease in activity index occurred rapidly, whereas the improvement in perianal disease was more gradual. The Dead Sea environment was highly effective in managing patients with severe Crohn's disease, including perianal complications in this small, uncontrolled series.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID