ISSN:0192-0790    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Intestinal obstruction of the duodenum by entrapment between the aorta and the superior mesenteric artery (SMA) is an uncommon cause of megaduodenum. Despite many case reports, acceptance of the SMA syndrome as a clinical entity has been controversial on account of its confusion with other causes of megaduodenum. We therefore report a case of SMA syndrome which sharply exemplifies its clinical and anatomic features. The clinical findings are proximal duodenal obstruction with an abrupt cutoff and active peristalsis. The anatomic features of this entity are a narrow angle between the aorta and the SMA, together with high fixation of the duodenum by the ligament of Treitz and/or an anomalous SMA crossing directly over the aorta at its intersection with the duodenum. The SMA syndrome may occur as an acute self-limited event due to a reversible precipitating factor, or as a chronic recurring disorder. The acute form subsides with correction of the specific initiating factor; the chronic form responds favorably to simple surgical mobilization of the duodenum.

ISSN:0192-0790    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The treatment of inflammatory bowel disease (IBD) involves words as much as deeds and drugs. IBD is a transfiguring disease with humiliating symptoms, for which there have been few major therapeutic advances in the past 30 years. Pain may have its redeeming qualities, but diarrhea does not. It is important to distinguish objective disease from subjective illness and to remember that by his words and suggestions, the physician can help the illness almost as much as his drugs can help the disease.

ISSN:0192-0790    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Endoscopy was compared in 90 patients with a radiographic diagnosis of peptic esophageal stricture. Retrospectively, 78 strictures were classified as valid diagnoses giving a positive radiographic predictive value of 87%. Endoscopy diagnosed 74 (95%)of the 78 peptic strictures, detecting all 45 strictures under 10 mm in caliber, but failing to detect four (12%) of 33 broader strictures. Nine (75%) of the 12 radiographic false-positive errors involved misinterpretation of muscular or mucosal rings of the lower esophagus. We conclude that endoscopy and radiology are equally effective and complementary methods for evaluating patients with suspected peptic stricture.

ISSN:0192-0790    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Dynamic radionuclide imaging potentially offers a convenient, noninvasive technique for detecting gastroesophageal (GE) reflux disease. Initial studies suggested a high degree of sensitivity, although subsequent reports have been less encouraging. We sought to clarify this controversy by assessing the sensitivity of GE scintigraphy in 15 patients with severe esophagitis at endoscopy and 15 health volunteers. After acid loading, scintigraphy was performed in the basal state and after maneuvers (Valsalva, abdominal compression) which provoke GE reflux. Computer analysis permitted calculation of a reflux index for each maneuver. An index greater than 4% was considered a positive test. We found that the mean reflux index for the patients was significantly greater (p<0.01) than the healthy volunteers; 4.55 ± 1.75% versus 0.42 ± 0.11%, &OV0398; ± S.E.M. Only 30 % of the patients had a reflux greater than 4 %. Using data from our healthy volunteers, we redefined an abnormal reflux index as greater than 1.7 %, but that only improved the test sensitivity to 60% and the specificity to 100%. Scintigraphy for reflux is primarily limited by the short duration of imaging. We cannot recommend GE scintigraphy as a useful screening test for reflux.

ISSN:0192-0790    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

We have studied the accuracy of diagnostic methods in achieving a diagnosis in 75 patients with 81 proven episodes of recurrent ulceration. When the endoscopic findings did not permit an accurate diagnosis, radiology usually provided no additional information. The sensitivity of a combined diagnostic approach was not different from that of endoscopy alone, and so the routine use of upper GI radiographs in addition to endoscopy should, therefore, be abandoned. We also assessed observer variation among endoscopists prospectively in 38 patients investigated for dyspepsia after operation for peptic ulcer. Major observer variation in diagnosing suspected recurrent ulceration occurred in 11% of patients, with a sensitivity and specificity higher than 77 and 94%, respectively. As not all the postoperative gastroduodenojejunal mucosal breaches are peptic, we suggest that acid output and enterogastric reflux assessments are useful diagnostic adjuncts to endoscopy.

ISSN:0192-0790    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

A review of 1,236 patients admitted to The Mount Sinai Hospital with inflammatory bowel disease between 1960 and 1979 yielded 75 cases (6%)with toxic dilatation of the colon. There were 61 cases among 613 patients (10%)with ulcerative colitis (UC), and 14 of 623 (2.3%)with Crohn's disease (CD). Fifty-nine of the 75 patients (79%)underwent surgery during their hospitalization with toxic dilatation. Twelve of the 75 patients (16%)died.Both UC and CD groups had similar mean ages at onset of colitis (32 years and 31 years, respectively) and at development of toxic dilatation (37 years);similar durations of overall disease (4.8 and 5.9 years)and of toxic dilatation prior to surgery(11 days and 13 days);and similar anatomic distributions of disease. Both UC and CD also had similar mortality rates(16% and 14%).Mean duration of presenting attack up to onset of toxic megacolon was longer in CD than in UC (62 days versus 31 days) and in unoperated versus operated cases (64 days versus 37 days),but was not significantly different between survivors and mortalities (43 days versus 39 days).Mortality rates were also unaffected by total duration of inflammatory bowel disease, first attack versus relapse (14% versus 18%),or medical versus surgical therapy (13% versus 17%).Factors which affected mortality included age (30%for patients over 40 years old, versus 5% for those younger than 40), sex (21%in women versus 13%in men), and especially the occurrence of colonic perforation (44%for cases with perforation versus only 2%in those without). Of the 12 patients who died, 11 had suffered colonic perforation. Mortality rates were highest following emergency surgery in patients transferred from other hospitals (30%)and in cases with persistent colitis activity for over a month despite decompression of the colon (40%).By contrast, the mortality rate in cases undergoing relatively elective surgery 6-30 days after admission was only 6%.Among the 57 survivors available for follow-up, eight of 14 treated without operation have required subsequent colectomy,while 40 of 43 initially treated surgically remain entirely well.

ISSN:0192-0790    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Five patients thought to have bleeding angiodysplasia in the distal duodenum and proximal jejunum were treated surgically after conservative measures failed to control hemorrhage. Aspiration through a long oral tube preoperatively and intraoperative endoscopy were most helpful in locating the site of bleeding.

ISSN:0192-0790    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Twelve patients with obstruction of the extrahepatic portal venous system were seen at the Tufts-New England Medical Center between 1970 and 1979; a cause for the portal vein thrombosis was detected in 11. These included pancreatic disease (4); hematologic disorders (2); postoperative complications of laparotomy (3); transhepatic gelfoam embolization of the portal vein (1); and exchange transfusion via the umbilical vein (1). Clinical features included frequent selflimited episodes of bleeding from esophageal or gastric varices; and no characteristic or clinically helpful laboratory findings. The diagnosis was usually made in patients by identifying clots in the portal vein on selective angiography of the celiac and/or superior mesenteric arteries in which the venous phase was examined. Attempts at surgical correction were largely unsuccessful. Further thrombotic episodes occurred in three patients, and led to death in one. Two patients were given chronic anticoagulation with Coumadin and Persantin for 1 and I½ years, respectively without further thrombosis or gastrointestinal bleeding. However, it not yet possible to assess the risks and benefits of such therapy.

ISSN:0192-0790    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Remission in a patient with Menetrier's disease occurred 2 months after presentation with anasarca and marked hypoproteinemia. As such spontaneous remission of Menetrier's disease is unusual, we have analyzed our patient and the only five previously reported cases we could find. In our patient, conservative therapy, depriving the gastrointestinal tract of food, institution of parenteral alimentation, and suppression of gastric secretion appeared to be associated with remission. Such an approach should be tried in other patients with Menetrier's disease.

ISSN:0192-0790    

出版商:OVID    

年代:1985

数据来源: OVID