ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Nasal continuous positive airway pressure (CPAP) reduces nocturnal gastroesophageal reflux (GER) in obstructive sleep apnea syndrome (OSAS) patients. The primary objectives of our investigation were to determine if CPAP could reduce reflux in non-OSAS patients and, if so, by what mechanism. Esophageal pH was monitored for 48 h in six nocturnal reflux patients. During the first 24 h, basal reflux data were collected; the second night, nasal CPAP was administered (pressure = 8 cm H2O). Esophageal manometry was obtained in six healthy adult volunteers both on and off nasal CPAP (pressure = 8 cm H2O) to ascertain CPAP's effects on esophageal pressure and peristalsis. The six reflux patients experienced less nocturnal GER while on CPAP. The mean percent time esophageal pH < 4 was reduced from 27.7 ± 10.0 to 5.8 ± 2.6 (p < 0.004); the mean reflux duration dropped from 2.1 ± 0.6 to 0.9 ± 0.5 min (p < 0.03); and the mean duration of longest reflux improved from 84.3 ± 32.6 to 13.8 ± 6.9 min (p < 0.01). The CPAP raised the mean resting midesophageal pressure by 4.4 cm H2O (p < 0.01) and the mean resting lower esophageal pressure (LES) by 13.2 cm H2O (p < 0.02) in the healthy volunteers. Nasal CPAP effectively reduced nocturnal GER in six patients with nocturnal reflux. The antireflux activity of CPAP is likely due to passive elevation of intraesophageal pressure and possibly to reflex LES constriction.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Using the manometric method, we studied the progression of esophageal involvement in 17 women with a diagnosis of systemic sclerosis (SSc) and compared the results with those obtained for 14 healthy women. The manometric examination of SSc patients was performed twice, with an interval of 9 to 111 months (median, 40 months). All patients had peristaltic contractions in the proximal esophagus. Eight had peristaltic contractions, and 9 had no contraction in the middle and distal esophagus. The lower esophageal sphincter pressure and the amplitude of contractions in the esophageal body were lower in SSc patients than in controls. The duration of contractions was the same in SSc patients and controls. The velocity of peristaltic contractions did not differ between patients and controls in the distal esophagus, but was higher in SSc patients in the proximal esophagus. In 16 patients, no difference in lower esophageal sphincter (LES) pressure, esophageal contraction amplitude, duration, and velocity was observed between the first and second evaluation. In one patient, the distal esophageal contractions changed from peristaltic to completely absent, and the lower esophageal sphincter pressure changed from 20.2 mm Hg to 5.1 mm Hg. The results suggest that the esophageal involvement of SSc patients was not progressive in all cases.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Pancreatitis as an extraintestinal manifestation of Crohn's disease (CD) is controversial. We review the episodes of acute pancreatitis in patients with CD. Of 852 patients, 12 developed clinically overt pancreatitis, reparesenting a frequency of 1.4% in a follow-up period of 10 years. In 10 patients, common causes of pancreatitis were excluded. In 2 patients, drug-induced disease (azathioprine, sulfasalazine) could not be ruled out. Recurrence of pancreatitis was observed in only 2 patients. Younger patients and those with active disease seemed more at risk for development of pancreatitis. If prednisolone was needed for treatment of active CD, no adverse effect was observed for the pancreatitis. Along with the clinical features, we studied autoantibodies against exocrine pancreas; the incidence of autoantibodies in patients with pancreatitis was the same as in the controls who did not develop pancreatic abnormalities. This does not support the hypothesis that acute pancreatitis in CD is associated with the formation of pancreatic autoantibodies.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

In the last 30 years, many changes have occurred in the epidemiology and natural history of peptic ulcer disease. During the 60 years since Kibbutz Afikim's beginning, 94 members have been diagnosed with duodenal or gastric ulcer. Seventy-one percent were males, 29% died. Ninety-four percent of the patients were diagnosed by barium meal only. Six patients had a gastric ulcer. The incidence rate among adults was 0.6% through the mid-1940s; the rate decreased to 0.3% by the end of the 1970s and to 0.1% in the 1980s. The decrease was noted for both sexes. The prevalence rate among adults since the 1970s has been 7%. In one-fourth of the patients, an ulcer was diagnosed before age 30 and in another fourth after age 50. An average of 3.1 upper gastrointestinal radiographs were done per patient. There was no temporal relationship between the incidence and the stressful effects of arrival in Israel or at the Kibbutz. Twenty-four patients underwent surgery: In the last decade there seemed to be a slight decrease in elective surgery.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The objective of this study was to investigate the possibility of predictive factors of response to treatment with interferon in children with chronic hepatitis B virus infection. We analyzed the influence on the response rate of age, sex, mode of acquisition of infection, severity, and duration of disease in 16 children with chronic hepatitis B treated with 3 MU of recombinant α-interferon 2b three times a week for 6 months. Six months after the end of treatment, eight patients (50%) had cleared HBV DNA, seroconverted to anti-HBe and normalized serum transaminase values. Response was significantly higher in those whose serum transaminase levels were > 100 IU/liter before treatment (70%) and those infected after birth (72%) compared with those with lower serum transaminase levels (16%) and those infected at birth (7%). Our findings indicate that a 6 month course of low dose interferon (3 MU) is highly effective in children with horizontally transmitted chronic hepatitis B virus infection, but noneffective in children infected at birth.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Cutaneous extraintestinal manifestations of Crohn's disease are common. Lesions contiguous with the gastrointestinal tract, such as perianal, peristomal, and perifistular inflammation are characterized by the histologic demonstration of granulomas. Rarely a cutaneous granulomatous lesion occurs that is noncontiguous with the gastrointestinal tract and is separated from it by normal skin. We report axillary “metastatic” Crohn's disease that appeared with exacerbation of the inflammatory bowel disease and responded well to steroid therapy.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Neuroendocrine carcinomas of the colon and rectum are unusual and have in the past been misrepresented as either carcinoid tumors or undifferentiated cancers. Colorectal neuroendocrine tumors comprise a clinicopathologic spectrum that ranges from indolent to highly aggressive. The case discussed illustrates the importance of the right diagnosis because it will affect treatment and may better predict the clinical course.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Teratomas of the liver in adults are rare. We believe this to be only the fifth such case reported, the first with CT correlation and with plain film documentation of the development and slow progression of the lesion from age 44 to 61. A review of the literature regarding hepatic teratomas is appended.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Acute hepatic failure developed after 8-methoxypsoralen and ultraviolet irradiation for psoriasis in a patient with prior methotrexate-induced cirrhosis. Review of the literature and the temporal relationship between 8-methoxypsoralen and hepatic injury in our patient suggests it may be a direct hepatotoxin. In our report, submassive necrosis superimposed on cirrhosis appears to have produced hepatic failure.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID