ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Hyperplastic polyps are regarded as non-neoplastic lesions with no malignant potential. However, several case reports and a clustering phenomenon suggest that they may arise in abnormal colonic that is predisposed to develop neoplastic lesions. The hyperplastic polyp also displays markers associated with colorectal cancer. In addition, several recent articles have addressed the question of hyperplastic polyp in the distal colon as a marker of more proximal adenomatous polyp. Many endoscopists discovering a distal hyperplastic polyp will wish to ensure the absence of a proximal neoplastic lesion.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Gastrointestinal motility disorders constitute a major segment of digestive illness. Therefore, measurement of gut motor activity should be a desired goal. However the practical usefulness of gastrointestinal manometry is controversial. In this report we review the theoretical, technical, and practical problems posed by gastrointestinal manometry in health and in disease. Special emphasis is put on aspects pertaining to the indications and clinical applicability of the technique. New methodological developments that allow measurement of motor functions of the proximal stomach and the antroduodenal junction are also examined. Gastrointestinal manometry is potentially helpful in the diagnostic evaluation of patients presenting with upper gastrointestinal symptoms without demonstrable anatomic alteration as evidenced by conventional diagnostic evaluation. It may help to localize the affected region of the gut as well as to monitor the evolution of the motor disorder and to determine the effect of pharmacological treatment. For a complete evaluation of upper gastrointestinal motility it is important to record gastric activity at the same time as in the intestine, during fasting and also postprandially. Manometry may help to determine the type of abnormal motor pattern that occurs in a given motor disorder. However, at the present time no specific abnormalities for specific diseases have been described. Thus, alterations in upper gut motility due to lesions at different levels of the braingut axis (central nervous system, autonomic nervous system or myenteric plexus) may produce a similarly deranged manometric pattern. Moreover, relations between a particular motor abnormality and the symptoms that the patient complains of may be quite variable. Still, we conclude that measurement of gastrointestinal motility has matured and proven its value to an extent that its application to clinical gastroenterology in carefully selected instances is appropriate and timely.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Helicobacter pyloriinfection has proven to be extraordinarily difficult to eradicate. Antimicrobial monotherapies have been particularly disappointing, with most eradication rates in the range of 0–15%. Clarithromycin has potential advantages over other macrolides to whichH. pyloriis susceptible because of its acid stability and solubility at low pH. We evaluated clarithromycin therapy (250 mg four times daily for 14 days) in 12H. pylori-infected patients. The13C-urea breath test was used to evaluate the effectiveness of therapy. Eradication was defined as a negative urea breath test 4–6 weeks after the end of treatment. Suppression ofH. pyloriwas demonstrated in 11 of 12 patients (92%) by a negative urea breath test 2 days after start of treatment.H. pyloriwas eradicated in five (42%) of 12 patients. Adverse events were intermittent and mild. Clarithromycin is the first antimicrobial agent that appears to offer promise as monotherapy for the eradication ofH. pylori.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We interviewed 1,900 healthy subjects who belonged to one of the three following ethnic groups: (a) Ashkenazi Jews, (b) Sephardi and Oriental Jews, and (c) Arabs (including Druses)-about their bowel habits, laxative use, and beliefs about bowel action. Using stepwise logistic regression, we found that the following variables were significantly and independently related to bowel frequency: (a) sex-male > female (p = 0.0001); (b) age-young > old (p = 0.0001); (c) physical activity-high > little (p = 0.001); (d) body habitus-lean > obese (p = 0.02); (e) marital status-married > single (0 = 0.009); and (f) ethnic group-Arab > Jewish (p = 0.004). Regular use of laxatives was found in 18.4% of women and 10.8% of men (p < 0.0001). This habit was more common among Ashkenazi Jews (17%) than among Sephardi and Oriental Jews (10.7%) and Arabs (4.8%). Laxative intake was higher among the elderly (p = 0.0001) and the obese (p = 0.0004). Concerning the “ideal” bowel frequency, 12.4% of the Ashkenazis, 22.7% of the Sephardis and Oriental Jews, and 26.1% of the Arabs preferred to have at least 9 movements per week. Strikingly, 51.8% of all interviewed believed that constipation was “harmful to health;” women were more concerned than men (56.3% versus 47.5%). Subjects with a high level of education were significantly more concerned about constipation.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

To investigate the effect of aerobic exercise on total gastrointestinal and segmental colon transit, 16 male health care workers with a sedentary life-style were studied during 1 week of rest and 1 week of exercise. The exercise phase consisted of walking 4.5 km on a level treadmill for 1 h on each of 3 days. Total gastrointestinal and segmental colon transit times were measured using radiopaque markers ingested on each of 3 consecutive days with an abdominal radiograph obtained on the fourth day. With exercise, total gastrointestinal transit time decreased in 5, increased in 6, and did not change in 5 subjects. Using a paired t test, total transit did not show a significant change from rest (24.5 ± 21.8 h) to exercise (20.9 ± 16.8 h),p= 0.50. These observations support our previous findings that physical activity to the extent that average people consider routine exercise does not necessarily improve gastrointestinal transit. Therefore, the role of such exercise in the management of chronic constipation can be seriously questioned.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Why anorectal pain is relieved by sitting in a warm-water bath was investigated in 18 healthy volunteers and 28 patients with painful anorectal disease (18 patients with fissures and 10 with hemorrhoids). Investigations consisted of measuring rectal and interstitial sphincter temperature, rectal and rectal neck pressures, and electromyographic activity of both the external and internal anal sphincters before and after the subjects sat in a warm-water bath at temperatures of 40, 45, and 50°C for 10 min each time. Pain relief was more evident and lasted longer at higher bath temperatures. The rectal and interstitial sphincter temperatures were unchanged before and after bath in both the healthy volunteers and patients. The rectal neck pressure and internal anal sphincter electromyographic activity dropped significantly in the bath, but increased gradually to pretest levels 25–70 min after exiting the bath. The higher the bath temperature, the greater the drop in rectal neck pressure and internal sphincter EMG activity, and the longer the time needed to return to pretest levels. Pain relief after Sitz bath seems to be the result of internal anal-sphincter relaxation with a resulting diminution of the rectal neck pressure. The relaxation of the internal sphincter following the warm bath postulates a relationship, but direct action was ruled out. A neural pathway through a “thermosphincteric reflex” seems most likely.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

After we encountered one case of cystic duct carcinoma out of 110 cases of gallbladder carcinoma treated from 1976 to 1991, we reviewed the 14 treated Japanese cases, including our own, as well as the 18 Western cases hitherto reported in order to examine the clinical features of carcinoma of the cystic duct and to evaluate the various options for treatment. The patients' ages were similarly distributed between the Japanese and Western patients with a mean age of 62 years. Males were predominantly affected in the western countries with a ratio of male to female of 3.5:1; the ratio was similar in Japan. Gallstones were present in six of 18 Western cases and in two of 14 Japanese cases; both groups had a much lower rate of accompanying gallstones than did gallbladder carcinoma patients. Despite the depth of invasion, the prognosis of carcinoma of the cystic duct was relatively good, mainly owing to the absence of either lymph node metastases or distant metastasis. Although the lymph nodes and bile duct are not usually involved in carcinoma of the cystic duct, cholecystectomy, either with or without lymph node dissection, usually produced an unsatisfactory outcome, possibly due to bile duct invasion and perineural invasion. Thus, combined resection of the gallbladder and bile duct with lymph node dissection is the choice of treatment for carcinoma of the cystic duct.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

An epiphrenic diverticulum is usually accompanied by esophageal motor disorders, diaphragmatic hernia, or esophagitis. Symptoms are rarely attributable to the diverticulum except very rarely when no other explanation for dysphagia or chest pain is demonstrated. We describe acute esophageal obstruction from food accumulating in an epiphrenic diverticulum and compressing the gastroesophageal junction, and we confirm the mechanism with an artificial balloon.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

In an adult patient with untreated celiac sprue, mesenteric lymphadenopathy was detected by computerized tomography (CT). Although malignant lymphoma was suspected, the nodes disappeared after treatment with a gluten-free diet, as was documented by CT follow-up. This report demonstrates that mesenteric lymphadenopathy in celiac sprue might be benign. With the increased use of CT investigation, findings like these may be encountered more often.

ISSN:0192-0790    

出版商:OVID    

年代:1993

数据来源: OVID