ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We investigated psychologic influences on duodenal ulcer by examining the effect of personality, stress, and mood, measured at diagnosis, on subsequent ulcer healing. Stressful life events, psychopathology (assessed using the Minnesota Multiphasic Personality Inventory), anxiety, depression, smoking, alcohol consumption, nonsteroidal antiinflammatory drug use, and serum pepsinogen I levels were determined immediately after endoscopy showed duodenal ulcer craters in 70 patients with recent onset of symptoms. Endoscopy was repeated following 6 weeks of ranitidine therapy. Six ulcers (8.6%) persisted, and the duodenum remained inflamed in an additional five cases, for a total of 16% with incomplete healing. The only baseline characteristic significantly associated with poor healing was anxiety (p = 0.03 for ulcer persistence, p = 0.02 for incomplete healing). Being in the highest anxiety tertile was associated with a more than fourfold elevation in the risk of incomplete healing (p = 0.02). The association between anxiety and poor healing was not changed by modification of the anxiety score to eliminate gastrointestinal symptom items or by adjustment for serum pepsinogen, sex, or cigarette smoking. Anxiety inhibits the healing of duodenal ulcers treated with adequate antisecretory therapy.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The aim of our study was to demonstrate the effect ofHelicobacter pylorieradication on basal and stimulated serum gastrin levels and gastric acid output 5 months after therapy of patients with duodenal ulcer. Thirty-two patients (24 men and eight women with a mean age of 45 years) who had had endoscopy and were diagnosed as having duodenal ulcer entered the study. In all patients three biopsy specimens were taken from the duodenal bulb, gastric antrum, body, and fundus. These specimens were then sent for microbiological and histological examination. Triple therapy consisting of bismuth, metronidazole, and tetracycline was administered. Endoscopy was repeated 1 and 5 months after therapy, and biopsy specimens were again taken from the gastric antrum and body. Before treatment, serum samples were taken to measure basal and stimulated (90 min) gastrin levels after ingestion of two beef cubes, and basal and stimulated acid outputs (after pentagastrin) were studied. Measurements of gastrin and gastric acid output were repeated 5 months after therapy.H. pyloriwas eradicated in 26 patients (81.3%). Basal gastrin levels (mean ± SD) at diagnosis and after eradication were 44 ± 12 and 35.8 ± 2 pg/ml, respectively (p < 0.05). Similarly, stimulated gastrin levels (integrated values) decreased from 5,303 ± 1,526 pg/ml/min before therapy to 3,779 ± 1,204 pg/ml/min after eradication (p < 0.001). However, basal (4.9 ± 4 mEq/h) and stimulated (28.5 ± 10 mEq/h) acid output did not vary after eradication (3.9 ± 4 mEq/h and 26.2 ± 12 mEq/h, respectively). We conclude that basal and stimulated gastric acid output are not changed byH. pylorieradication in duodenal ulcer patients 5 months after therapy, in spite of its association with a significant decrease in basal and stimulated gastrin levels.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The purpose of this research was to look for a possible mechanism whereby NSAIDs, and particularly ASA, might cause gastrointestinal bleeding. A total of 34 hospitalized GI bleeders and 29 age- and sex-matched controls were studied. Skin bleeding time (SBT) was measured within 6 h of coming to hospital and before any blood products were given. All patients and controls were questioned regarding current NSAID use. This history was supplemented by estimation of serum salicylate and of platelet cyclooxygenase activity to detect unreported current aspirin (ASA) use. Various aspects of platelet function were also tested by lumiaggregation in 28 controls and, after recovery, in 27 of the bleeders. Of 34 bleeders, 26 bled from the upper GI tract, (13 from peptic ulcer) and eight from the lower GI tract, 30 (88%) had a current intake of NSAIDs and of these 22 (73%) used ASA, some in combination with other NSAIDs, whereas 12 of 29 controls were using NSAID's, 11 of which were ASA. SBT in the bleeders was 9.0 ± 1.02 min versus 4.8 ± 0.42 min in the controls (p<0.001). SBT measured 6.6 days later in 28 bleeders was 4.7 ± 0.22 min (p<0.0006), and of those tested after recovery all but one had fallen to 6.5 min or less. None had any residual constitutional platelet abnormalities as tested by lumiaggregation. By logistic regression, NSAID intake was strongly associated with prolonged SBT to >6 min (odds ratio [OR], 16.7; p < 0.0002), whereas NSAID intake (OR 14.6; p < 0.0003) and SBT >6 min (OR 1.8; p < 0.005) contributed to a bleeding outcome. Almost 90% of GI bleeders had recently consumed NSAIDs, mostly ASA, on an average 15 h before onset of bleeding. Although most of the nonbleeders who had used NSAIDs did not have a prolonged SBT, most of the bleeders who used NSAIDs had an abnormal elevation of SBT, suggesting a possible mechanism for GI bleeding. Retesting ≈7 days after recovery from bleeding showed normalization of the SBT, indicating that the defect was transient and spontaneously reversible.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We describe three cases of watermelon stomach in which the endoscopic appearance suggested the diagnosis, which was confirmed by histologic examination. The diagnosis was further substantiated by endoscopic ultrasound imaging.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A splice variant of CD44 (exon V4-V7) confers metastatic behavior in a rat carcinoma model; aberrant expression of splice variants has been detected on a variety of human tumor cell lines as well as primary and metastatic human tumors, including lymphomas, carcinomas (colon, thyroid, mamma, bladder), and glioma. We used enzyme-linked immunosorbent assay to determine the concentration of soluble CD44 in the serum samples of 10 normal individuals and 41 patients with various stages of gastric cancer. Soluble CD44S and its isoforms, V5 and V6, were present in the serum of normal individuals (288.53 ± 18.33, 25.49 ± 1.70, and 148.32 ± 3.15 ng/ml, respectively). The concentrations of soluble CD44 V5 and V6 were elevated in patients with advanced gastric carcinoma (69.39 ± 6.06 and 216.62 ± 32.98 ng/ml, respectively). Serum CD44 V5 concentrations correlated with the extent of tumor invasion (T), the status of lymph node involvement (N), and distant metastasis (M) (TNM staging) (p < 0.05), whereas CD44S did not. These results suggest that detection of abnormal regulation of CD44 splicing could be helpful in gastric cancer diagnosis and disease evaluation.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Pressure pain over the abdominal aorta is a clinical sign of undetermined significance. Ultrasonographic criteria were used to define and further evaluate this variety of epigastric tenderness. The incidence of aortic pressure pain, aortic characteristics, and gastrointestinal symptoms were scored in 250 consecutive patients. The incidence was ≈ 7%. All the patients with aortic pressure pain had gastrointestinal symptoms, with a significantly higher mean symptom score. The occurrence of pressure pain was independent of any of the examined aortic characteristics, age, or body mass index. We further compared the incidence of aortic pressure pain between 25 patients with irritable bowel syndrome and 25 patients without apparent functional gastrointestinal disease. It was present in ≈50% of the patients with irritable bowel syndrome. We found pressure pain over the abdominal aorta to be associated with significant gastrointestinal discomfort. A causal relationship is possible but not proven. Aortic pressure pain can be provoked in a significant subgroup of patients with the irritable bowel syndrome.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

To compare the time course of clinical recurrences and reoperations following primary resections for fistulization versus fibrostenotic obstruction in ileal Crohn's disease, we performed a retrospective cohort study of 71 patients undergoing their first resection at The Mount Sinai Hospital between 1961 and 1984. Among these 71 patients, 35 were classified as fistulizing and 36 as fibrostenotic. Follow-up was 93% complete through 1990, with a median follow-up of 73 months to reoperation and 105 months to last contact. The fistulizing and fibrostenotic patients experienced virtually identical numbers of clinical recurrences: 25 from the former group and 24 from the latter. The recurrences appeared very slightly earlier among the fistulizing than among the fibrostenotic group, but the difference did not approach statistical significance. Only 18 patients came to reoperation during follow-up: 12 from the fistulizing and 6 from the fibrostenotic group. The earliest reoperation in the fistulizing group occurred at 14 months and in the fibrostenotic group at 44 months. There was a trend for earlier reoperation in the fistulizing group, but the difference was not statistically significant. Different clinical patterns of Crohn's disease have yet to be correlated with distinctive subclinical biologic markers.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The synthesis of prostaglandin E2(PGE2) and leukotriene B4(LTB4) in colonic mucosal cells was investigated in 7 patients and 10 controls. Biopsies obtained from the descending colon were isolated biochemically by a special technique and the suspension of isolated colonic cells was incubated during 45 min. Compared with healthy subjects, patients with an inflammatory bowel disease showed a significantly increased PGE2production. The LTB4synthesis was enhanced as well, but this change was not statistical. We conclude that PGE2is the dominant eicosanoid during less severe inflammatory bowel disease. Age and gender did not influence PGE2or LTB4synthesis.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We describe the pathological findings of 50 biopsies of Mexican (Mestizo, or mixed race, usually Indian and white heritage) patients with hepatitis C infection confirmed by a second generation test. Although half of the patients were asymptomatic, the histological examination revealed advanced stages of disease. Chronic active hepatitis was found in 26 cases, cirrhosis in 23, and acute hepatitis in one case. Common histological changes included steatosis, lymphoid aggregates, and apoptotic bodies, whereas indisputable bile duct damage was observed in only four cases. Comparison with other series in which different types of populations were analyzed revealed a wide morphological spectrum with respect to some histological changes and the type of hepatitis reported. The apparently contradictory results found in the literature indicate the need to apply universal histological criteria in biopsies of patients with hepatitis C.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID