ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Patient educational programs supervised by non-physicians are becoming popular, but comparison of their effect on outcome with that of physician teaching is limited. We developed a nurse-supervised class for patients with symptomatic gastroesophageal reflux (GER). Primary physicians referred patients to the program. The patients' initial knowledge and the program's excellent cognitive effect were unrelated to demographic and symptom data. One hundred twelve consecutive patients were alternately given appointments either with the class or with a gastroenterologist. Although failed appointments and inappropriate referrals excluded some patients, the remainder of the two groups were similar with regard to demographic and symptom data and their return rate of follow-up questionnaires. They reported equivalent symptomatic improvement and therapeutic compliance after 2 weeks and 2 months. The program's success prompts us to continue this form of patient education.

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Four gastroenterology assistants learned proctosigmoi-doscopy by each performing 200 examinations with a physician. The assistants then examined a total of 7557 patients independently. The quality of their examinations was assessed by reexamination of about every 10th patient by a physician. The data from all examinations were processed for computer tabulation and periodically reviewed.The patients accepted the examination by the gastroenterology assistant in all but three instances. The time spent by the patient for proctosigmoidoscopy, including preparation and examination, averaged 47 minutes before the assistant program and was reduced to an average of 34 minutes by the gastroenterology assistants. Ten patients had polyps (all smaller than 0.4 cm in diameter) undetected by the gastroenterology assistant but discovered by the physician. All 31 cancers and all of 371 polyps 0.5 cm or larger were discovered by the assistants.We conclude that a satisfactory proctosigmoidoscopy examination can be performed by a properly trained gastroenterology assistant, that it will conserve the physician's time, and that it reduces the waiting time of patients.

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Endoscopic retrograde cholangiopancreatography (ERCP), the most advanced of the gastrointestinal endoscopic procedures, provides both specific diagnostic information pertaining to diseases of the biliary tract and pancreas and definitive therapy available only with this modality. ERCP is safe and accurate, establishing a primary diagnosis in 80% of cases and, in experienced hands, cannulation is successful in 98%. In addition to cholangiography, pancre-atography has been a significant achievement providing accurate diagnostic yield through direct cannulation and opacification of the pancreatic duct while permitting collection of secretions for cytological evaluation and chemical analyses. The therapeutic extension of ERCP, endoscopic papillotomy (EPT), is successful in 94% of cases in the treatment of common bile duct stones and papillary stenosis, providing comparable results to surgical procedures while reducing morbidity, mortality and convalescence. Because of the accuracy and safety of these procedures, they should be considered early in suspected diseases of the biliary tract and pancreas so that the clinician can establish a specific diagnosis and provide definitive therapy.

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Carcinoid tumors represent a heterogenous group of widely scattered neoplasms, all of which are probably derived from a common cellular source (amine precursor uptake decarboxylase—APUD). They produce a wide range of bioactive agents, many of which are as yet uncharacterized. Classification of the tumors by ultrastructural appearance or secretory product is more satisfactory than by anatomical location. Many of the protean clinical manifestations cannot be ascribed only to serotonin or bradykinin production. The identification of elevated levels of substance P and motilin in occasional cases suggests the likelihood of other bioactive amines and peptides in the genesis of the syndrome. The trophic effects of enteric polypeptides may be relevant to the known increased incidence of other neoplasms in patients with carcinoid tumors.Diagnosis is primarily made on a clinical basis. Provoked paroxysmal symptoms including flushing, diarrhea and wheezing are most common. The presence of cardiac lesions and metabolic disturbances may often complicate management. Estimation of plasma levels of serotonin or bradykinin can be used to confirm the diagnosis. Elevated urinary 5 hydroxy-indole-acetic acid is the most common and most reliable biochemical test.Resection of the primary tumor is the best method of treatment. Hepatic metastases may be resected or necrosed by embolectomy. Streptozotocin and 5-fluorouracil are reasonably effective as cytotoxic agents in those cases with irresectable tumor. Other combinations such as adriamycin and radioactive tryptophane analogs are promising but await further evaluation. Metabolic antagonists such as methy-sergide, cyproheptadine and parachlorophenylalanine may be useful in controlling symptoms.The 5-year survival rate for resectable tumors is about 60–65% overall. The presence of hepatic metastases significantly decreases this figure to 21%.The identification of the bioactive products of carcinoid tumors is necessary to enable earlier diagnosis and allow specific treatment. Cytotoxic agents effective for particular cell types and specific metabolic antagonists need to be developed for adequate control of metastases and palliation of symptoms.The group colloquation carcinoid should be discarded as the different individual tumors become characterized.

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

A young man with an upper gastrointestinal hemorrhage attributed to esophageal varices had massive splenomegaly, but liver function tests, liver biopsy, and hepatic venous pressure gradient were all normal. Therefore, we did splenic angiography and found a splenic arteriovenous fistula. The fistula was resected and the esophageal varices disappeared. We believe this patient had a congenital arteriovenous fistula of the splenic artery with presinusoidal, extrahepatic portal hypertension.

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The hemolytic-uremic syndrome has varied prodromal symptoms. In a few patients the dominant initial gastrointestinal symptoms have led to a presumptive diagnosis of ulcerative colitis. The colitis tends to be self-limited, to have minimal lesions detected by proctoscopic or roentgeno-graphic studies, and usually to resolve spontaneously without specific therapy. Rarely, more serious colonic involvement can progress to toxic megacolon, rectal prolapse, colonic perforation, intussusception, or colonic stricture.Early hemodialysis will reduce morbidity and mortality in patients with severe renal impairment. The physician should be aware of this entity when young patients present with a picture compatible with ulcerative colitis in order to circumvent delayed or inappropriate management of what would appear to be a primary bowel disorder.

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Light- and electron-microscopic study of concurrent granular cell tumors of the esophagus suggest their neural origin. To our knowledge, 21 cases have previously been reported. Dysphagia and substernal discomfort are most often the predominant symptoms. The radiographic findings suggest benign esophageal lesions. Simple excision appears to be adequate treatment.

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

We report a case of intramural hematoma of the duodenum complicating peroral intestinal biopsy.

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID