ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

When Barrett's esophagus is complicated by adenocarcinoma, surgery is indicated in appropriate patients. Until now, high-grade dysplasia in Barrett's esophagus has been managed in a similar fashion. We explore this approach and review reported cases of high-grade dysplasia to suggest guidelines for collection of data to make future clinical decisions more rational.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Amebic colitis can mimick Crohn's disease of the colon and ulcerative colitis. Inflammatory bowel disease (IBD) patients can also be carriers of amebae. Since steroids can provoke amebic activity and even cause a fulminating colitis, it is necessary to determine that amebae do or do not exist. Furthermore, amebae can be easily eliminated by drug therapy but it is hard to eradicate IBD. Despite the above, diagnostic modalities for IBD are as effective as those for amebiasis, particularly for Crohn's disease with ileal involvement. Problems in differential diagnosis arise with IBD grossly limited to the colon. In these cases, false negative stool studies are increased by diarrhea and preparation for examinations, and both stool studies and serologies are compromised by steroids. If the clinical course of IBD is downhill, the clinician is justified in starting steroids even if evaluation for amebiasis is incomplete. If, however, the index of suspicion is high, concomitant treatment with Metronidazole would be reasonable.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Despite the development in the last two decades of new imaging techniques for the detection of pancreatic disease, discrepancies between functional and morphological findings can be remarkable. Pancreatic function tests may aid in the detection of disease at an earlier stage in some patients and can assess the degree of functional damage which is helpful in assessing patients for supplemental therapy. While direct intubation methods are invasive and time consuming, they remain the gold standard against which the other investigations have to be assessed. An indirect test, such as the pancreolaural test, has been shown to be a useful addition to ultrasound for the screening of pancreatic disease. Pancreatic markers and radioisotope methods have failed to live up to early promise, but fecal tests can be used effectively to monitor enzyme replacement. A judicious combination of pancreatic function tests and imaging techniques may be able to rationalize investigation and treatment of pancreatic disease.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In this perspective on the applications of flow cytometry in gastroenterology are described the use of flow cytometry in the study of normal physiology, in normal anatomy, and in premalignant and malignant conditions of the digestive tract. The basic principles and applications for cell counting, sorting, cell cycle analysis, and quantitation of cellular characteristics are addressed to emphasize the great potential and availability of flow cytometry.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We have found only 308 cases of gastric cancer in patients with unoperated duodenal ulcer. We present seven men whose duodenal ulcer disease obscured the diagnosis of gastric cancer. We review the theoretical reasons that those with duodenal ulcer may be protected from gastric cancer, along with the current literature.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A series of 18 patients underwent surgery for upper abdominal symptoms and signs of superior mesenteric artery syndrome (SMAS). The diagnosis was made by simultaneous arteriography and barium meal. Findings at operation confirmed SMAS in every patient, and a duo-denojejunostomy was performed. Duodenal and jejunal wall biopsy from 13 patients revealed normal myenteric and submucous plexuses. A follow-up study of 16 patients was performed after 7 years. At follow-up, the weight loss seen preoperatively had been corrected. However, symptoms were essentially similar to those found at the original examination. Only the frequency of the most distressing symptom, vomiting, was significantly decreased (p < 0.05). The most striking features in the production of the “pincher mechanism” of the duodenum were found to be a short aortomesenteric distance together with sagittal parallelism between aorta and superior mesenteric artery. In conclusion, we recommend a conservative attitude in the treatment of SMAS. Surgical treatment with duodenojejunostomy may be indicated only if vomiting is a predominant symptom and proper conservative treatment has failed.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In a double-blind, randomized trial, we tested the effectiveness of metronidazole (0.6 g/day) against sulfasalazine (2 g/day) in the maintenance of remission in patients with ulcerative colitis. The patients were in remission for 1–11 months at entry to trial, which lasted for 12 months. Forty patients entered the trial and 33 completed it. Metronidazole was found to be slightly more effective than sulfasalazine, a difference statistically significant only at 12 months. Six patients also completed a crossover trial. Remission was maintained for 12 months in 3 patients by metronidazole and in none of the 6 by sulfasalazine. No significant side effects were noted, and in particular, no paresthesias were reported. This trial, as well as our previous one, suggests that metronidazole may be useful in the maintenance of remission in patients with ulcerative colitis, but that it is ineffective in the therapy of the acute attack.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We have followed 11 patients with Crohn's disease and enterovesical fistulas prospectively for up to 21 years. Seven patients underwent resection for complications other than the fistula; the fistula had been present up to 5 years in this group. Four patients have being followed medically for 1–21 years since a fistula was recognized. In no patient of either group has renal impairment developed. We suggest that enterovesical fistula by itself is not an indication for surgical intervention.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We reviewed the course of 500 patients with Crohn's disease to document the incidence, the nature, and the results of management of fistulas to the bladder. Seventeen patients (14 men and three women) had developed enterovesical fistulas; 16 had pneumaturia. The barium radiographs demonstrated the fistula in only 37%. All had received sulfasalazine, and most were treated with corti-costeroids and antibiotics intermittently; two had successful control of their urinary symptoms on this regimen. Eight patients who received 6-mercaptopurine (6-MP) in addition tolerated the urinary fistula well, so that we encourage a trial of 6-MP for this complication of Crohn's disease. Six patients continue on medical therapy alone after a mean of 5.3 years. There were no instances of pyelonephritis during 60 patient years. Eleven patients eventually underwent bowel resection, but in only two was persistence of the enterovesical fistula the primary indication for elective surgery, and in both, it was the patient's choice. Visualization of the fistula on barium enema radiograph or presence of a connection between the sigmoid and the bladder were not associated with adverse outcome. An enterovesical fistula in Crohn's disease rarely leads to serious complications and can often be treated successfully with medical therapy alone; by itself, it need not serve as an indication for surgery.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID