ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

One patient's story is recounted. Relatively asymptomatic for 20 years, the patient reflects on factors that contributed to his healing. Psychosocial and spiritual dimensions are described as well as biomedical aspects. The story concludes that dealing with Crohn's disease triggered a spiritual quest which in turn contributed to the patient's healing.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Cold liquid ingestion may precipitate episodes of dysphagia and chest pain in patients with spastic esophageal motility disorders. The effect of hot liquids on esophageal symptoms, esophageal peristalsis, and clearance and any potential therapeutic benefit in such patients has not been examined. Using esophageal scintigraphy and manometry, we have investigated the effects of hot water swallows on dysphagia, chest pain, and esophageal motility and clearance in patients with esophageal motility disorders. We studied 48 men and women with intermittent dysphagia to both solids and liquids, chest pain, and/or regurgitation. All patients underwent upper endoscopy, barium swallow, and esophageal manometry using standard techniques. Esophageal scintigraphy assessed esophageal transit time (ETT) and retrograde intraesophageal movement of bolus at baseline (22°C) and after hot (60°C) water swallows. Esophageal manometry assessed the amplitude and duration of esophageal contractions in response to baseline and hot water swallows. Patients were followed clinically for as long as 6 months to assess symptomatic response. We found that baseline esophageal scintigraphy revealed a mean ETT of 48.5 seconds; after hot water swallow, mean ETT was 27.8 seconds (p < 0.001). The number of secondary peaks at baseline was 3.5; after hot water swallow, it was 2.1 (p < 0.001). Baseline esophageal manometry showed a mean esophageal body contraction amplitude of 188 mm Hg (mean duration, 11.8 seconds) in response to wet swallows and 125 mm Hg (mean duration, 5.7 seconds) with hot water swallows (p < 0.001). Clinically, 28 (58%) of 48 patients noted significant (>50%) improvement of their symptoms and have been ingesting hot water or other hot liquids regularly with their meals. We conclude that hot water accelerates esophageal clearance, decreases the amplitude and duration of esophageal body contractions, and improves symptoms in patients with esophageal motility disorders. Because of its safety and simplicity, it may have an important role in the management of these chronic conditions.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The clinical significance of lung nodules in patients with esophageal carcinoma has received little attention. Therefore, we carried out a retrospective detailed review of 116 consecutive cases of esophageal carcinoma, including 98 squamous cell cancers, seen at the Philadelphia Veterans Affairs Medical Center between 1984 and 1997. Seventy-four percent of our patients were black; it was not surprising therefore that 84% of our patients in this series had squamous cell cancers. Initially, chest radiographs, computed tomography (CT) scans, or thoracotomy showed solitary pulmonary nodules in 22 (19%) patients. A definitive diagnosis was established in 19 patients, including 15 (68%) benign nodules and 4 (18%) new primary lung carcinomas. Three (14%) nodules were indeterminate, but in no case could a solitary lung metastasis be identified. Radiographic evidence of multiple lung metastases was present, however, in 4 (3%) of 116 patients at diagnosis. Autopsies of six patients were later performed, and three showed multiple lung metastases; two of these patients had negative chest radiographs shortly before death. Our experience suggests that for a cohort of mostly squamous cell esophageal cancers, a solitary lung metastasis is rare at diagnosis; a solitary pulmonary nodule at this time likely represents a benign abnormality or primary lung cancer. Multiple pulmonary metastases are also very unusual at diagnosis, probably become increasingly common during the terminal phases of disease, and may be radiographically occult.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Our objective in this study was to use high resolution endoluminal sonography to compare the size of esophageal varices within 5 cm of and at the esophageal high pressure zone. We carried out the study in 36 patients with endoscopically proven esophageal varices. A 20-MHz 6.2F ultrasound catheter was passed through a 34F endoscope and used to image esophageal varices as it was slowly withdrawn through the high pressure zone (the level at which the diaphragm was imaged) and into the body of the esophagus approximately 5 cm above the high pressure zone. All images were captured on videotape and reviewed by one of the investigators. The mean, total, and percent cross-sectional surface areas occupied by varices were calculated and then compared within 5 cm and at the esophageal high pressure zone. Six of 36 (17%) patients had no varices imaged at the high pressure zone but did have varices imaged in the distal esophagus. The mean cross-sectional surface area per varix at the high pressure zone (0.036 ± 0.006 cm2) was significantly less (p ≤ 0.0001) than the mean cross-sectional area per varix 5 cm above the high pressure zone (0.142 ± 0.018 cm2). The average total cross-sectional surface area occupied by varices at the high pressure zone (0.137 ± 0.034 cm2) was significantly less (p < 0.0001) than the average cross-sectional surface area occupied by varices 5 cm above the high pressure zone (0.672 ± 0.080 cm2). The mean percent esophageal wall cross-sectional surface area occupied by varices at the high pressure zone (16%) was significantly less (p ≤ 0.0001) than 5 cm above the high pressure zone (49%). We conclude that the mean, total, and percent cross-sectional surface areas of esophageal varices at the high pressure zone are significantly less than those 5 cm above the high pressure zone.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Doctors are optimistic in their perception of how acceptable endoscopy is for patients. We analyzed elements that contribute to a poor experience for the patient and the agreement between the perceptions of endoscopists and patients. Eighty-four outpatients who had undergone gastroscopy completed questionnaires (response rate of 73%) 48 to 96 hours after the procedure. The endoscopist completed a similar questionnaire. Questions concerned overall tolerance, swallowing, retching and vomiting, sedation, duration, diagnosis, age, and sex. Data from both doctor and patient were available in 84 cases. The type of sedation, administration of hyoscine or Xylocaine (Astra Pharmaceuticals Ltd., Kings Langley, UK), diagnosis, and expression of need for more sedation were not statistically significantly related to the overall patient score. The largest contribution to a poor overall tolerance score arose from difficulty in swallowing the endoscope, followed by the duration of the procedure. A total of 8.3% of patients reported some overall difficulty which was not recognized by the endoscopist. In relation to retching and vomiting, 11.9% of patients had difficulty with retching and vomiting, which went unrecognized by the doctor, and 18% had difficulty in swallowing the endoscope. There was fair agreement between the assessments of overall acceptability of both endoscopists and patients. Difficulty in intubation, however, is the major contributor to a poor tolerance of gastroscopy and also the issue on which doctors and patients disagreed the most.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

With hopes of alleviating discomfort and improving the tolerance of patients undergoing endoscopy, we have assessed the influence of various background conditions in the endoscopy room. Two hundred twenty-one candidates for upper endoscopy were randomly allocated to four groups, each with one of the following conditions in the endoscopy room: background music and conversation related to the patient's complaints (n = 50); background music and conversation unrelated to the patient (n = 53); background music only, with the staff maintaining silence (n = 49); and complete silence (n = 47). Before endoscopy patients answered a 26-item questionnaire that included an evaluation of their degree of anxiety before the examination. Conscious sedation was induced by using 3 mg midazolam. After complete recovery from sedation, patients answered another set of questions. Patients in all four groups felt quite comfortable with the atmosphere in which gastroscopy was performed. Neither music, conversation, nor silence had a great effect on patients as far as improving tolerance or diminishing anxiety. Therefore, endoscopists and nurses may have a free hand in choosing the prevailing conditions during the examination. This conclusion may be valid for both patients and the staff involved in other invasive procedures performed under light sedation.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Infection by viral or bacterial pathogens has been suspected in playing a role in the development of autoimmune thyroid disease. BecauseHelicobacter pylorimight be involved in the development of nongastrointestinal conditions such as rosacea, ischemic heart disease, and diabetes mellitus, we evaluated the prevalence ofH. pyloriinfection in patients with autoimmune thyroid disease. Fifty-nine patients with autoimmune thyroid disease were included: autoimmune atrophic thyroiditis (n = 21), Hashimoto's thyroiditis (n = 18), and Graves' disease (n = 20). Twenty patients with nontoxic multinodular goiter served as controls for nonautoimmune thyroid disease, and 11 patients with Addison's disease served as controls for nonthyroid endocrine autoimmune disease. The levels of anti-H. pyloriimmunoglobulin G (IgG) were determined, and a radiolabeled urea breath test were performed. The prevalence ofH. pyloriinfection was markedly increased in the patients with autoimmune atrophic thyroiditis (85.7%), compared with the controls with nontoxic multinodular goiter (40%) and Addison's disease (45.4%). Infection byH. pyloriresulted in increased levels of gastrin, pepsinogen I, and pepsinogen II in theH. pylori-positive groups, compared with theH. pylori-negative groups. A positive linear regression was found between the levels of microsomal autoantibodies and those of anti-H. pyloriIgG in patients with autoimmune atrophic thyroiditis (n = 21; r = 0.79; p < 0.01). Finally, and although the overall prevalence ofH. pyloriinfection was not increased, the anti-H. pyloriIgG levels and the results from the breath test were higher in the patients with Graves' disease and Hashimoto's thyroiditis patients than in the controls. Clearly, the prevalence ofH. pyloriinfection is increased in autoimmune atrophic thyroiditis and results in abnormalities of gastric secretory function. The strong relation between the levels of anti-H. pyloriIgG and the levels of microsomal antibodies suggests thatH. pyloriantigens might be involved in the development of autoimmune atrophic thyroiditis or that autoimmune function in autoimmune atrophic thyroiditis may increase the likelihood ofH. pyloriinfection.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Helicobacter pylori,one of the most prevalent human pathogens, is associated with chronic gastritis, peptic ulcer disease, and possibly gastric cancer and primary gastric lymphoma. The need to treat these patients has necessitated the development of improved methods to diagnoseH. pyloriinfection. We present the preliminary assessment of a13C-urea breath test (UBT) in which the expired13CO2is detected in a rapid, simple, inexpensive way by the LARA (Laser Assisted Ratio Analyzer) System (Alimenterics, Inc., Morris Plains, NJ). Eighty-seven consecutive patients, examined for upper gastrointestinal symptoms, underwent endoscopy.H. pyloriinfection was established by antral biopsies and a rapid urease test (CLOtest). The UBT was performed between 2 and 24 hours after endoscopy. Of the 84 analyzable patients, 70 were found to beH. pylori-positive either by histology or by CLOtest. All 70 were positive by the LARA UBT, yielding a sensitivity of 100%. Fourteen patients were negative forH. pyloriby histology and the CLOtest. Of these, 12 were negative by the LARA UBT and 2 were positive, yielding a specificity of 85.7%; because of the limitations ofH. pyloridetection by histology or urease assays, however, the specificity of the UBT may have been underestimated. Our study demonstrates the feasibility of a non-radioactive, rapid UBT based on the LARA system and suggests the need for its more detailed evaluation.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Rapid urease tests are used for quick identification ofHelicobacter pyloriduring upper gastrointestinal endoscopy. Rapid urease test solutions contain urea, which in the presence ofH. pyloriurease, generates ammonia, which changes the test medium color to indicate a positive result. Theoretically, Xylocaine spray (ASTRA, Södertalje, Sweden), which has a basic pH value, could cause a similar positive reaction in the test medium. To determine whether patients premedicated with Xylocaine spray have a higher rate of false positive urease tests, we compared the results of a rapid urease test and histologic stains in 107 patients, 54 premedicated with Xylocaine spray and 53 premedicated with intravenous midazolam but not Xylocaine spray. There were no significant differences in test sensitivity, specificity, or predictive values between the study groups. We conclude that patients can be premedicated with Xylocaine spray without concern that the false positive rate of rapid urease tests will increase.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID