ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Patients with familial adenomatous polyposis and Gardner's syndrome frequently have adenomas of the stomach and small intestine. Unlike the colonic adenomas, the upper gastrointestinal lesions seldom cause symptoms or become malignant. Many investigators recommend screening and surveillance upper gastrointestinal endoscopies, although there is no evidence of benefit. The degree of benefit is apt to be small, so many patients will have to be studied. This editorial is a plea for a multicenter study to demonstrate efficacybeforescreening upper gastrointestinal endoscopy is recommended for patients with familial adenomatous polyposis or Gardner's syndrome. Investigators and editors should show restraint in advising endoscopic screening until benefit is shown.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The clinical implications of a diseased papilla at endoscopic retrograde cholangiopancreatography (ERCP) are ambiguous. Is the diseased appearance caused by inflammation or tumor? Is there stenosis? Could papillary disease be the consequence of pathology elsewhere in the biliary–pancreatic tract? What should be the next step? Of 17 patients with a “diseased papilla” among 284 consecutive patients who underwent ERCP for customary indications, 10 had papillitis [inflamed papilla] confirmed. The two major associations of papillitis were common bile duct stones (50%) and biliary or pancreatic surgery (40%). Cholestatic jaundice (60%) and pain (50%) were the major presenting symptoms of papillitis. Six patients had tumor with progressive jaundice (83%). Visually and cholangiographically, it may be difficult to distinguish papillitis from tumor. These concepts will be helpful in the evaluation and management of patients who have a “diseased papilla”. Do they sound like wild tales?

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Patients' accounts of their eating capacity correlate reasonably well with their observed performance, but they do not exactly match each other. This can be attributed to patients' inaccurate estimation of eating ability and the inconstant nature of dysphagia. Therefore, we advocate a combined score in clinical trials. However, for clinical practice, a quantitative assessment of the patient's account is quicker, more convenient, and sufficiently accurate. The advantage of a numerical score is obvious in clinical trials because of its statistical versatility, and may also be desirable in certain cases in clinical practice. We present such a numerical score here.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

One hundred and nine distance runners participated in a questionnaire survey of bowel function related to running. Thirteen (12%) had had fecal incontinence while running. Sixty-eight (62%) had stopped to have a bowel movement while training. Forty-seven (43%) had “nervous” diarrhea before competition and 13 (12%) had stopped during competition for a bowel movement. Fifty-one (47%) had experienced diarrhea after racing or hard runs and 17 (16%) had seen blood in their stool in the same situations. Runners who had nervous diarrhea before competition were more likely to have symptoms of milk intolerance and irregular bowel function when not exercising, and runners who had symptoms of the irritable bowel syndrome often had to stop for a bowel movement during training. Runners with diarrhea after racing or hard runs frequently experienced severe abdominal cramps, nausea and vomiting, and, occasionally, rectal bleeding at the same time. Any form of “runners' diarrhea” was unrelated to age, previous intestinal infection or food poisoning, food allergies, or dietary fiber.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We report two patients with the acquired immune deficiency syndrome and cytomegalovirus associated perianal ulcerations. Both complained of chronic, painful, nonhealing ulcers that required surgical intervention for diagnosis and palliation. One patient developed diffuse cytomegalovirus infection and both had poor response to gancyclovir therapy. We review the pertinent clinical and pathologic findings of this serious manifestation of cytomegalovirus infection.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Ten patients developed apnea or cardiopulmonary arrest during or following endoscopy in more than 10,000 consecutive endoscopies. These complications occurred in patients over the age of 60 years with many associated diseases. Four of the reactions occurred close to the time of giving intravenous medication, the majority after the stimulation of the procedure had ended, usually more than 30 min after the last dose of medication. The initial 7,500 procedures were conducted without automated monitoring, but the most recent 2,500 procedures employed finger pulse oximetry. Monitoring has not prevented apnea and cardiopulmonary arrest, but it provides earlier recognition.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Hypoxia as measured by pulse oximetry is well recognized in patients undergoing colonoscopy. A single trial of supplemental oxygen therapy has been shown to diminish the observed desaturation during colonoscopy. We further defined the role of supplemental oxygen during colonoscopy in a randomized controlled trial. Ninety-four patients undergoing routine colonoscopy were randomized to oxygen (2 L by nasal prongs) or placebo (nasal prongs only) arms. The physician and patients were blinded to which arm they were in. Sixty-four percent of patients in the placebo arm desaturated (

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We report our experience with eight patients with severe persistent pancreatitis associated with peripancreatic fluid collections requiring placement of drainage catheters who subsequently developed pancreatic fistula. The fistulas were diagnosed by endoscopic retrograde cholangiopancreatography, contrast tube study, or Hypaque enema at a mean of 13 weeks after diagnosis of pancreatitis and drain placement. These fistulas involved the duodenum in five patients and colon in three patients. Six patients had fistula resolution with medical therapy (after removal of percutaneous drainage catheters in three and with drain removal in conjunction with transpapillary stenting of a disrupted pancreatic duct in another three). We conclude that in patients with ongoing pancreatitis, pancreaticoenteric fistulas are probably caused by erosion of percutaneous drainage catheters. Such fistulas resolved with conservative treatment in six of eight patients.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In advanced cirrhosis and hepatorenal syndrome, peripheral vasodilation is a prominent feature and may be pathophysiologically relevant. To determine whether the potent vasodilator, calcitonin gene-related peptide (CGRP), circulates at abnormal levels in patients with these disorders, we observed eight patients with alcoholic cirrhosis and hepatorenal syndrome, seven with alcoholic cirrhosis and ascites without hepatorenal syndrome, and 10 healthy controls. Plasma CGRP levels were higher in patients with alcoholic cirrhosis and hepatorenal syndrome (364 ± 166 pg/ml) than in healthy controls (143 ± 54 pg/ml, p < 0.01). In patients with cirrhosis and ascites without hepatorenal syndrome, plasma CGRP levels were less elevated (291 ± 257 pg/ml, NS). The identity of immunoreactive CGRP and synthetic hCGRP was confirmed by high performance liquid chromatography. These results suggest that CGRP may play a role in hepatorenal syndrome. However, to establish whether circulating CGRP contributes to the hemodynamic change in hepatorenal syndrome requires study of a larger number of patients and additional control groups.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID