ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Abdominal pain, excruciating and recurrent, is the dominant feature of chronic pancreatitis that initially brings most of the patients to the physician's attention. The pathogenesis of pancreatic pain is often multifactorial and explains why not all patients respond to the same mode of therapy. Increased intraductal pressure as a result of ductal stricture and/or calculi is the most frequent cause for pain in the large majority of patients with large duct disease. Interstitial hypertension, ongoing pancreatic ischemia, neuronal inflammation, and extra pancreatic complications may be the sole or additional factors in the pathogenesis of pain.The management of pain is difficult and requires a team approach. Internist, gastroenterologist, radiologist, surgeon, and a psychiatrist may have to work together to achieve maximum success. Drug and alcohol dependency needs vigorous management by a psychiatrist. Supportive therapy with a low-fat diet and antioxidant supplementation are helpful. When analgesic therapy fails, surgery may have to be considered much before a narcotic dependency develops. If at all of use, oral pancreatic enzyme therapy is suitable only in a selected group of patients-women with idiopathic pancreatitis. Endoscopic papillotomy, stent placement, and stone removal, although becoming popular, are under trial only and appear to be suitable in those with obstructive disease mostly localized to the head of the pancreas without much proximal disease. A patient with a dilated duct system is a good candidate for Puestow's pancreatico-jejunal anastamosis, which appears to be the best surgical procedure. Those with small duct discases are difficult to be managed. Resective procedures and celiac ganglion blocking are suggested but not of much help.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Fecal incontinence is the impaired ability to control gas or stool. It is a disabling and distressing condition. Its exact incidence and prevalence are unknown. It is a disorder about which patients are frequently reluctant to discuss, even with their physician. However, it is a common condition especially in older individuals, where the prevalence has been reported to approach 60%. In women, incontinence reaches 54% as a result of childbirth. Of the patients surgically treated, the female-to-male ratio is 4 to 1. In an epidemiological study to identify its community-based prevalence, the University of Illinois determined fecal incontinence existed in 2.2% of the general population.There is available treatment for fecal incontinence. Many patients improve with conservative treatment (constipating agents, antidiarrheal medications, dietary changes) or with biofeedback. For patients where conservative treatment has failed, surgical treatment (direct-apposition sphincter repair, overlapping sphincteroplasty, postanal repair, neosphincter procedures) may be successful.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Colonic ischemia encompasses a wide clinical spectrum from mild, reversible disease to severe, irreversible injury. It is a frequent disorder of the large bowel in the elderly, and can mimic certain diseases such as inflammatory bowel disease and neoplasms. The clinical course is variable, but often includes crampy, lower abdominal pain and the passage of red or maroon blood mixed with stool. In most cases, management is expectant, with supportive care and attention for signs of complicated disease. Prognosis typically is favorable, with a majority of patients completely resolving their illness; a minority go on to develop irreversible injury including strictures and chronic segmental colitis. Successful management of a patient with ischemic colitis requires a high degree of clinical suspicion, early diagnosis, careful follow-up, and prompt recognition of persistent disease.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We compare the clinicopathological features of 98 Crohn's disease (CD) patients with initial symptoms at 40 years of age or older (elderly; male n = 56, female n = 42) with those of 347 CD patients with onset of symptoms between the age of 16 and 40 years (young adults; male n = 166, female n = 181). The frequency of presenting symptoms, such as diarrhea, rectal blood loss, and weight loss were comparable in both groups, except for abdominal pain/cramps, which occurred somewhat less frequently in the elderly (59% vs. 71%, p < 0.05). The mean lag time between onset of symptoms and first visit to a general practitioner (GP) was considerably shorter in the elderly than in the young adults(0.2 years vs. 0.6 years, p < 0.001), as was the lag time between GP and referral to a specialist (0.6 years vs. 1.0 years, p < 0.07). Overall, this resulted in a significantly (p < 0.01) shorter time to establish the diagnosis in the elderly(1.8 years vs. 2.7 years). Crohn's disease as correct initial diagnosis was in the elderly less frequently observed than in the young adults (49% vs. 61%, p < 0.05), in contrast to diverticulitis (7.1% vs. 0%) and malignancy (6.1% vs. 0.9%), which were more frequently encountered as incorrect preliminary diagnosis in the elderly(both p < 0.005). The percentage of patients who underwent an abdominal operation was similar in both groups (83% vs. 77%), but the diagnosis CD was in the elderly more frequently established at first operation than in young adults (25% and 12%, p < 0.005). The elderly were found to undergo a bowel operation or resection earlier after onset of symptoms. The development of recurrence after bowel resection, although occurring in a lower percentage of patients, was significantly shorter than in the young adults (3.7 years vs. 5.8 years, p < 0.02). Arthritic extraintestinal manifestations were equally frequent in both groups, but elderly patients had significantly less relatives in the first or second degree affected by CD (3.1% vs. 12%, p < 0.02).We conclude that the diagnosis Crohn's disease is more readily established in elderly patients. Moreover, these patients less frequently have abdominal pain/cramps as a presenting symptom, a shorter time interval between onset of symptoms and first resection, and subsequent recurrence of the disease. In addition, elderly CD patients have less relatives affected by the same disease. Thus, CD in the elderly appears to be characterized by a more rapid development.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Ulcerative colitis (UC) is prevalent among Jews around the world, as well as in Israel. We evaluated the incidence rates of the disease in one of the northern districts of Israel (Kinneret) by religion and by type of settlement. The population in this district is composed of Jews who have immigrated to Israel in the last century from various countries all over the world, and from Arabs. The study population included all residents of Kinneret district diagnosed with UC between 1965 and 1994.The mean annual incidence rate of UC in the 30 years covered in this survey (1965-1994) proved to be 3.5/100,000. A trend of increase in the incidence rate was observed until 1989. It was most prominent among the Jewish rural settlements. Since 1989, the rates have been declining. Prevalence rates were 87/100,000 among the Jewish population, and 27/100,000 among the Arab population. Both prevalence and incidence rates were 2.5 times higher among Jews than among Arabs.We include that (1) UC morbidity had been increasing until 1989 and has been decreasing moderately ever since; (2) the lowest morbidity was found in the Arab population; and (3) the highest morbidity was found among the Jewish rural population.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

It has been suggested that profound acid inhibition by proton pump inhibitors affects the accuracy ofH. pyloridetection. This report aims to evaluateH. pyloristatus during treatment with four different invasive detection methods and to investigate if histopathological alterations during treatment can be used as an early marker forH. pylorieradication.Twenty-eightH. pylori-positive patients were studied randomized into two treatment groups: 14 patients received omeprazole, 20 mg plus amoxicillin 1,000 mg b.i.d (OA), and 14 patients received omeprazole, 20 mg and placebo b.i.d (OP) for 14 days.Biopsies from antrum and corpus of the stomach were collected on days 0, 10 and 42.H. pyloristatus was based on rapid urease test, cultivation, histology, and polymerase chain reaction (PCR). The biopsies were also graded according to the Sidney classification.In the OP and the OA group, 17% (2/12) and 92% (12/13) of the patients wereH. pylorinegative when tested during treatment (day 10). Four weeks after treatment none of the patients(0%) in the OP group and 61% (8/13) in the OA group had theirH. pyloriinfection eradicated. PCR was up to 34% more sensitive than the other tests to detectH. pyloriduring treatment. There was a decrease in histological inflammation and activity in the antrum already during treatment in the OA group, but the decrease did not discriminate for successful treatment.During treatment with omeprazole alone or in combination with amoxicillin,H. pyloridetection is impaired regardless of the detection method used. However, PCR appears to be more sensitive than other tests. Early changes in the histological appearance of the gastric mucosa do not predictH. pyloritreatment outcome.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Gallbladder (GB) abnormalities are rarely reported in children, but involvement of the GB has been demonstrated in various inflammatory disorders. Thirty-nine children hospitalized with hepatitis A virus infection were evaluated by ultrasound. Pseudosurgical gallbladder wall of 10 mm or more with striation was found in 10.Pathological echographic findings were found in the pancreas of three patients, one with frank pancreatitis. Ascitic fluid was noted in eight. Pediatricians and pediatric surgeons alike should be familiar with this gallbladder and pancreatic involvement, which might avoid unnecessary procedures or surgery.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Acalculous acute cholecystitis(AAC) is a well-known complication in critically ill patients. However, there is no satisfactory data regarding this complication in leukemic patients. We reviewed the medical records of 426 patients with acute or chronic leukemia retrospectively to investigate the incidence, possible pathogenetic mechanisms, and clinical course of AAC in leukemia. Six cases of AAC were identified. The incidence was 1.65% (5/302) for acute leukemias. Three out of 6 patients underwent cholecystectomy, and two recovered completely. Percutaneous cholecystostomy was performed in another patient successfully. Careful histological examinations of the surgical specimens did not reveal any specific etiopathogenetic finding. However, clinical data suggested that infectious agents and visceral ischemia may contribute to the pathogenesis of AAC in leukemia.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The serum ascites albumin gradient(SAAG) is widely used to help determine the cause of ascites formation. A serum ascites albumin gradient of ≥1.1 g/dL reliably distinguishes portal hypertension-related ascites from other causes. To date, there are no published data on the impact of portal decompression on this gradient. The recent development of transjugular intrahepatic portosystemic shunt (TIPS) allows for nonsurgical decompression of portal hypertension by radiologically creating a portosystemic shunt. This study examines the short-term impact of portal decompression on the serum ascites albumin gradient (SAAG) in patients with portal hypertension-related ascites undergoing transjugular intrahepatic portosystemic shunt. Portal pressure measurements were obtained before and after TIPS placement. Serum ascites albumin gradient was determined before and at 6 and 24 hours post-TIPS placement. Fifteen patients were enrolled in the study. The mean portosystemic gradient(PSG) before TIPS was 21.0 ± 9.2 mmHg, whereas the post-TIPS mean PSG was reduced to 11.0 ± 6.3 mmHg, consistent with portal decompression (p = 0.005). The mean pre-TIPS serum ascites albumin gradient was 1.9 ± 0.5 g/dL and was reduced to 1.7 ± 0.5 g/dL at 6 hours (p = 0.003) and 1.4 ± 0.4 g/dL at 24 hours (p = 0.002) after TIPS placement. These findings further solidify the association between the SAAG and portal hypertension.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID