ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Balloon dilation of gastric outlet obstruction has evolved over the past 10 years from a technical tour de force to a commonly applied treatment modality complementing or competing with conventional surgical therapy. While not risk-free, current data suggest that 60–80% of patients undergoing such dilation therapy have sustained relief of their obstructive symptoms although long term acid suppression or cessation of nonsteroidal anti-inflammatory drugs may be necessary.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Among the factors involved in the pathogenesis of gastric ulcer, the reduced clearing capacity of the stomach seems to play an important role. On this basis, cisapride, which improves gastrointestinal motility, enhances gastric emptying, and prevents duodenogastric reflux, may be effective in the treatment of the gastric ulcer. We randomly allocated 60 consecutive patients, with uncomplicated antral gastric ulcer (diameter 5–25 mm), into three groups of treatment: cisapride 20 mg b.i.d. (C), ranitidine 150 mg b.i.d. (R), cisapride 20 mg b.i.d. + ranitidine 150 mg b.i.d. (C + R). Endoscopic examination with biopsy specimens was performed on admission, after 4 weeks and (if ulcer not healed) after 8 weeks of therapy. Three patients were lost to follow-up (two in C and one in C + R), and three were withdrawn, due to malignant ulcer (one case in R) or to side effects (one case of diarrhea in C, one case of headache in C + R). Healing rates at 4 weeks were 41.1% in C, 52.6% in R, and 50.0% in C + R; at 8 weeks they were 88.2% in C, 89.4% in R, and 94.4% in C + R. Though the lack of a placebo arm makes final considerations difficult, the results were similar in all three groups, with no evident differences. In conclusion, therapy with cisapride appears as effective as H2-blocker alone or combined treatments in healing benign gastric ulcer.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A dosage of 4 mg/kg/day intravenous cyclosporine as an adjunct to high-dosage hydrocortisone has been recommended to avoid colectomy in acute steroid-resistant ulcerative colitis. In treating eight such patients, four of whom presented with toxic megacolon, we immediately tapered the steroid dosage and infused a lower dosage of only 2 mg/kg cyclosporine for 15 days to fit a therapeutic range of 60–240 ng/ml, as previously designed for a kidney transplant program. Seven of the eight (87.5%), including three with megacolon, went into remission and started the chronic phase of treatment; the eighth patient underwent colectomy. Of the seven, one died on day 3 of the chronic phase because of pulmonary embolism while in clinical remission, and another discontinued treatment. The other five (62.5%) remain in remission on 6 mg/kg oral cyclosporine, or have already switched from cyclosporine to azathioprine. Two episodes of reversible nephrotoxicity appeared in the chronic phase only. These results emphasize the efficacy and safety of cyclosporine in acute ulcerative colitis, but there is still a need for further dose-response and drug association relationship studies.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Severely ill patients with ulcerative colitis are usually treated with parenteral corticoids. Those with signs of systemic toxicity usually receive antibiotics as well. However, the role of antibiotics in patients without high fever, profound leukocytosis, peritoneal signs or mega-colon is not clear. Since 1985, seven patients who were admitted to the hospital with severe ulcerative colitis but without signs of toxicity have received broad spectrum antibiotics. The patients ranged in age from 21 to 65 years: four were male; all were white. Stools for infectious agents were negative. Each patient received intravenous prednisolone at a dose of 60 mg/24 h. After 7 days, each patient continued to have eight to 10 bloody stools per day with low-grade fever and leukocytosis. Institution of broad-spectrum antibiotics was associated with a striking resolution of bloody diarrhea and normalization of temperature. No patient has required co-lectomy in follow-up of 2–9 years. Whether the antibiotics are treating an undetected pathogen or eliminating non-pathogenic bacteria contributing to the inflammatory process is not clear. I suggest that severely ill patients with ulcerative colitis deserve a trial of antibiotics before being considered failures of medical therapy.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Although the etiology of inflammatory bowel disease remains unknown, current evidence favors the interplay of genetic predisposition with environmental factors. Clustering of inflammatory bowel disease in spouses had been described, and supports a role for an environmental agent. We describe three unrelated, unmarried men all attorneys who enjoyed a close, sustained friendship in college, and who within a decade of their contact developed inflammatory bowel disease. We describe the nature of their college contact, the course of their inflammatory bowel disease, and relate our cluster to the scanty literature on clustering in inflammatory bowel disease. Physicians should report similar observations to illuminate the roles of genetics and environment in the development of these illnesses.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A multiple choice knowledge questionnaire was developed for patients with inflammatory bowel disease (IBD). Initially, 20 questionnaires were piloted, and then questions of poor discriminatory ability (>75% patients giving a correct response) were eliminated. A second pilot study proved the internal consistency (coefficient alpha = 0.84) and the stability of the questionnaire using a test-retest method (Spearman R = 0.86,p= 0.002). The questionnaire was then completed by 60 randomly selected patients attending colitis clinic. The mean score was 13 of a total of 36 (range 2–29). Eighty percent of patients wished to know more about their disease. Knowledge score was higher in patients who were members of the National Association of Crohn's Disease and Colitis (NACC) (p< 0.005) and in patients with Crohn's disease (CD) rather than ulcerative colitis (UC) (p< 0.005). Knowledge score correlated with the number of years spent in full-time education (R = 0.48,p< 0.001) and inversely with age (R = −0.33,p< 0.02) but did not correlate with disease duration. The study demonstrated some misunderstandings about IBD although most patients would have liked more information. The questionnaire could be used as a tool to evaluate patient education programs.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The objective was to determine ifStreptococcus bovisselectively colonizes colorectal cancer and polyps. Stools were submitted before colonoscopy; fluid and selected tissue biopsies obtained during colonoscopy were cultured forS. bovis.The setting was a large multispecialty clinic. Outpatients undergoing colonoscopy for suspected colorectal cancer and polyps were the participants. Forty studies on 35 patients were performed. One of 35 stools (2.9%) obtained before colonoscopy yieldedS. bovis. S. boviswas cultured from three of 40 fluid aspirations (7.5%), one of 33 adenomas biopsied (3%), none of six adenocarcinomas, none of 14 nonneoplastic polyps, one of 40 (2.5%) biopsies from normal mucosa adjacent to an adenoma, and none of 40 mucosal biopsies remote from any lesion. These data do not support selective colonization of colorectal neoplasms byS. bovis.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We assessed the value of liver biopsy in the diagnosis of fever of unknown origin (FUO) in hospital-based patients by a retrospective analysis of all cases (24 cases) seen at the University of Michigan Medical Center over a 5-year period. Based on the findings of a liver biopsy performed in the course of the evaluation of FUO, patients were divided into two groups: a diagnostic group, in which an abnormal liver biopsy was helpful in determining the cause of the FUO, and a nondiagnostic group, which included those who had either normal biopsy results or abnormal biopsy results that did not lead to a final diagnosis. Four patients (16.7%) had diagnostic liver biopsy results (histoplasmosis in three and tuberculosis in one). Physical findings, such as hepatomegaly, and laboratory data, including routine liver chemistries, were not predictive of a diagnostic liver biopsy. Therefore, despite advances in diagnostic technology since this subject was last reviewed, liver biopsy continues to be useful in the diagnosis of FUO. Furthermore, in endemic or borderline endemic areas, histoplasmosis should be considered in the differential diagnosis of FUO, and liver biopsy can be helpful to confirm this diagnosis.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Hemorrhagic fever with renal syndrome is an acute febrile nephropathy caused by several viruses of the genus Hantavirus of the family Bunyaviridae. During the past 8 years, 32 cases of hemorrhagic fever with renal syndrome have been diagnosed. Nine out of the 32 patients (28%) had raised (twofold upper normal limits) trans-aminases during hospitalization. Four out of the nine patients (44%) died. In contrast, only three out of the 23 patients (13%) without raised transaminases died. Five patients had slightly increased serum alkaline phospha-tase and γ-glutamyl-transpeptidase, whereas six patients had prolonged prothrombin time. Liver histology showed midzonal necrosis in hepatic lobules with extravasation of red cells and mild mononuclear infiltrate. Liver involvement seems to be an ominous prognostic factor in such patients and is correlated with severe renal failure and thrombocytopenia.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID