ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Acute pancreatitis is a disorder that has numerous causes and an obscure pathogenesis. Bile duct stones and alcohol abuse together account for about 80% of acute pancreatitis. Most episodes of biliary pancreatitis are associated with transient impaction of the stone in the ampulla (that causes obstruction of the pancreatic duct, with ductal hypertension) or passage of the stone though and into the duodenum. Other causes of acute pancreatitis are various toxins, drugs, other obstructive causes (such as malignancy or fibrotic sphincter of Oddi), metabolic abnormalities, trauma, ischemia, infection, autoimmune diseases, etc. In 10% of cases of acute pancreatitis, no underlying cause can be identified; this is idiopathic pancreatitis. Occult biliary microlithiasis may be the cause of two thirds of the cases of "idiopathic" acute pancreatitis. Intra-acinar activation of trypsinogen plays a central role in the pathogenesis of acute pancreatitis, resulting in subsequent activation of other proteases causing the subsequent cell damage. Ischemia/reperfusion injury is increasingly recognized as a common and important mechanism in the pathogenesis of acute pancreatitis and especially in the progression from mild edematous to severe necrotizing form. Increased intracellular calcium concentration also mediates acinar cell damage. Oxygen-derived free radicals and many cytokines (e.g., interleukin [IL]-1, IL-6, IL-8, tumor necrosis factor-α, platelet activating factor) are considered to be principal mediators in the transformation of acute pancreatitis from a local inflammatory process into a multiorgan illness.

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Adenocarcinoma of the exocrine pancreas is one of the most refractory neoplasms to medical treatment. Although of marginal value, 5-fluorouracil (5-FU) alone or in combination with other agents or modalities has been the standard surgical adjuvant approach to localized unresectable tumor as well as the standard treatment for disseminated pancreatic cancer. Recently, a new chemotherapeutic agent, gemcitabine, has been shown to be somewhat more effective than 5-FU against metastatic pancreatic cancer. Treatment with gemcitabine usually results in a greater likelihood of objective response and better symptom control than treatment with 5-FU or drug combinations that include 5-FU. However, treatment with gemcitabine does not improve overall survival of patients with disseminated neoplasm. Newer promising agents such as 9-nitrocamptothecin have recently entered clinical trials, and novel modalities (e.g., gene therapy) are nearing full-scale clinical trial. There are reasons to believe that these and other new initiatives may soon significantly improve the medical management of adenocarcinoma of the exocrine pancreas.

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Despite a marked decline in the incidence of gastric carcinoma in Western countries, the majority of patients presents with advanced inoperable tumors. In this setting, usually the aim of therapy is palliation, with the exception of chemotherapy administered in the attempt to downstage the tumor and to facilitate potentially curative surgery in patients with locally advanced nonmetastatic disease. This review will focus on the use of chemotherapy for advanced gastric cancer and after curative surgery, providing an overview of future directions for clinical research: preoperative (neoadjuvant) systemic chemotherapy, intraperitoneal treatment, and newer drugs.

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Older people are growing in prevalence and their nutrition-related concerns adversely impact upon health, function, and life quality. Changes in body composition and organ system function alter nutrient requirements. The purpose of this review is to examine changes in nutritional requirements with aging and to highlight practical approaches to nutritional screening, assessment, and intervention. A multidisciplinary approach with individualized care is recommended. Health care providers who work with older people must be attentive to nutrition, because appreciable comorbidity and unfavorable outcomes may accompany either under- or overnutrition.

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Free radicals (FRs) play an important role in the pathogenesis of gastroduodenal mucosal inflammation, peptic ulcer disease, and probably even gastric cancer. Various micronutrients protect the gastric mucosa by scavenging FRs. Only limited data is available regarding the concentration of micronutrients in the gastric mucosa in patients with gastritis and peptic ulcer disease. Our aim was to analyze micronutrient antioxidant concentrations in the antral mucosa in patients with gastritis and gastric ulcer and to determine the influence ofHelicobacter pyloriinfection on gastric mucosal antioxidants in patients with gastritis and gastric ulcer. Patients who underwent upper endoscopy for evaluation of dyspepsia were included in the study. Ascorbic acid, α-tocopherol, α-carotene, β-carotene, total carotenoids, lutein, cryptoxanthin, and lycopene levels were measured in the sera and antral mucosal biopsies in these patients. The diagnosis ofH. pyloriwas confirmed by histology, urease test (CLO) and serology. Patients with negative endoscopic findings and normal histology and noH. pyloriinfection served as controls. In patients with gastritis, α-tocopherol levels were reduced in serum and mucosa irrespective ofH. pyloristatus, whereas carotenoids and ascorbic acid levels were similar to controls. However, in patients with gastric ulcer, serum and mucosal levels of all micronutrient antioxidants were markedly decreased compared with both controls and patients with gastritis. The degree of depletion of antioxidants was similar in patients with eitherH. pylori-induced or nonsteroidal antiinflammatory drug (NSAID)-induced ulcers. Patients with gastric ulcer have very low gastric antioxidant concentrations compared to patients with gastritis and normal mucosa. This depletion in antioxidants seems to be a nonspecific response and was not related toH. pyloriinfection.

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

At present, there is no study that simultaneously addresses the apparent differences between bacterial and host factors in patients with bleeding and nonbleedingHelicobacter pylori-related ulcer diseases. Therefore, we designed this prospective study to evaluate whether there are identifiable differences between the two groups of patients whoseH. pylori-related peptic ulcer diseases present with bleeding or dyspepsia. From July 1996 to November 1996, consecutive patients presenting with upper gastrointestinal bleeding or dyspepsia were enrolled ifH. pylori-related ulcer diseases were confirmed. Fifteen clinical, endoscopic, histologic, and serologic factors were tested for association with ulcer bleeding by a logistic regression analysis. In the study period, bleeding occurred in 39 out of 119 patients withH. pylori-related peptic ulcer diseases. Multivariate analysis showed that ingestion of nonsteroidal antiinflammatory drugs (NSAIDs;p= 0.0156; odds ratio = 5:4), ulcer size ≥ 1 cm (p= 0.0033; odds ratio = 4:2), and low bacterial density (p= 0.0030; odds ratio = 4:1) were independent factors associated with the risk of bleeding. There were no associations between ulcer bleeding and age, sex, smoking, alcohol consumption, the histologic grade of gastritis, location and number of ulcers, and the cytotoxin-associated gene (CagA) status ofH. pyloristrain. Therefore, we concluded thatH. pylori-related ulcer patients who use NSAIDs or have large ulcers are more likely to present with upper gastrointestinal bleeding; that the CagA-bearing strains are not associated with the development of bleeding complication in patients with peptic ulcer diseases; and that the exact reason concerning the association between low bacterial density and ulcer bleeding merits further investigation.

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Advanced age and comorbidity as well as gastrointestinal (GI) disease contribute to the increased mortality after upper GI endoscopy in inpatients when compared to outpatients. The aim of this study was to measure comorbidity in inpatients undergoing endoscopy using the Acute Physiology and Chronic Health Evaluation (APACHE) II severity of disease classification and to assess the usefulness of the APACHE II system in predicting outcome. During a 10-week period, 155 consecutive inpatients undergoing upper GI endoscopy were prospectively scored using APACHE II. They were followed up for 30 days, the measured endpoint being death. Of these, 92 (59%) inpatients were admitted with GI hemorrhage, 14 (9%) were admitted for other reasons but subsequently bled, and 49 (32%) were endoscoped for reasons other than bleeding. The mean (SEM) APACHE II score in patients with GI bleeding was 8.0 (0.5), and in patients without bleeding was 6.5 (0.6;p= 0.07). Eighteen patients (12%) died within 30 days of endoscopy. APACHE scores were higher at 10.5 (1.2) in patients who died, compared to 7.1 (0.4) in those who lived (p< 0.01). Increased acute physiology scores led to this difference. Age and chronic health scores were similar in both groups. In the 18 patients who died, 9 had GI bleeding and their mean APACHE score was 13.8 (1.5); 9 had been endoscoped for other reasons and had a lower score of 7.2 (1.3;p< 0.01). These latter 9 deaths amounted to a 18% mortality in the nonbleeding group, which was greater than expected. APACHE II scores can help predict poor outcome in inpatients referred for endoscopy. However, the APACHE II system has limitations and failed to identify (by means of a high score) some patients without GI bleeding who subsequently died. A tool to measure comorbidity, such as the APACHE II system, is necessary when comparing groups of patients in different settings.

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The diagnosis of gastrointestinal tuberculosis (GITB) is often delayed, increasing the morbidity associated with this treatable condition. In this case series, the clinical presentations and outcomes of 18 patients with GITB are reviewed. Our aim was to elucidate the presenting signs and symptoms of GITB so as to help physicians improve their ability to make this diagnosis. Cases were gathered retrospectively over an 8-year period from Santa Clara Valley Medical Center, San Jose, California. Sources of information included patient records from our TB clinic and our hospital from 1989 to 1997. Of the 18 patients, 16 had a definitive diagnosis of GITB made from histology and/or culture from an abdominal source. In the remaining two patients, a presumptive diagnosis of GITB was made based on the co-occurence of abdominal signs and symptoms, response to antituberculous therapy, andMycobacterium tuberculosisidentified at a nonabdominal site. The most common clinical presentation was a triad of abdominal pain, fever, and weight loss. This triad was present in 8 of 18 patients. Seven patients presented with two of these signs and symptoms, two had abdominal pain alone, and one presented with other symptomatology. Time to diagnosis ranged from 2 days to 11 months, with a mean time to diagnosis of 50 days. These findings suggest that the diagnosis of GI and hepatic TB is often delayed. Possible reasons for delay include nonspecific signs and symptoms and failure to consider TB in the initial differential diagnosis. Once diagnosed, the outcome of GITB in this series was favorable.

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The aim of this study was to evaluate fat absorption in HIV-positive (HIV+) patients in different phases of HIV infection using a14C-triolein breath test. We distributed 47 HIV+ patients according to the 1993 Centers for Disease Control Revised Classification: 20 in Group 2 (A1 or A2) and 27 in Group 3 (B1, B2, A3, B3, or C). Ten HIV-negative healthy subjects comprised the control group (Group 1). All individuals underwent a14C-triolein breath test. Parasitic infection was evaluated through three stool exams, includingCryptosporidiumandIsosporainvestigation. The median value of cumulative 6 hours'14C excretion expressed as percentage of the14C given as triolein was significantly higher in Group 1 (8.4%) than Group 2 (5.5%) or Group 3 (3.4%),p= 0.04 andp≪ 0.01, respectively. Fat malabsorption was found in 25% of Group 2 individuals, 52.6% of those without diarrhea in Group 3, and was correlated with CD4+ lymphocyte counts (p≪ 0.01). Fat malabsorption is a common feature in advanced stages of HIV infection, even in the absence of diarrhea and is also present in asymptomatic HIV+ patients. These findings suggest that malabsorption is an early event in HIV-infected individuals and is correlated with the degree of immunosuppression.

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID