ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Chronic pancreatitis is characterized by progressive and irreversible loss of pancreatic exocrine and endocrine function. In the majority of cases, particularly in Western populations, the disease is associated with alcohol abuse. The major complications of chronic pancreatitis include abdominal pain, malabsorption, and diabetes. Of these, pain is the most difficult to treat and is therefore the most frustrating symptom for both the patient and the physician. While analgesics form the cornerstone of pain therapy, a number of other treatment modalities (inhibition of pancreatic secretion, antioxidants, and surgery) have also been described. Unfortunately, the efficacy of these modalities is difficult to assess, principally because of the lack of properly controlled clinical trials. Replacement of pancreatic enzymes (particularly lipase) in the gut is the mainstay of treatment for malabsorption; the recent discovery of a bacterial lipase (with high lipolytic activity and resistance to degradation in gastric and duodenal juice) represents an important advance that may significantly increase the efficacy of enzyme replacement therapy by replacing the easily degradable porcine lipase found in existing enzyme preparations. Diabetes secondary to chronic pancreatitis is difficult to control and its course is often complicated by hypoglycaemic attacks. Therefore, it is essential that caution is exercised when treating this condition with insulin. This paper reviews recent research and prevailing concepts regarding the three major complications of chronic pancreatitis noted above. A comprehensive discussion of current opinion on clinical issues relating to the other known complications of chronic pancreatitis such as pseudocysts, venous thromboses, biliary and duodenal obstruction, biliary cirrhosis, and pancreatic cancer is also presented.

ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Diverticular disease of the colon is quite common in developed countries, and its prevalence increases with age. Although present in perhaps two thirds of the elderly population, the large majority of patients will remain entirely asymptomatic. Nonetheless, an estimated 20% of those affected may manifest clinical illness, mainly diverticulitis, with its potential complications of abscesses, fistulas, and obstruction, as well as lower intestinal hemorrhage. The purpose of this report is to review our understanding of the epidemiology, pathophysiology, clinical presentation, and treatment options for this disorder.

ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

In the United States and Western Europe, primary hepatocellular carcinoma is an uncommon malignancy. Even though many well-defined associations have been reported, paraneoplastic manifestations are rare in North American patients. We describe an adolescent with complaints of weight loss, weakness, and a sensation of “fullness in the upper abdomen.” On initial laboratory workup a lactescent serum was found, with the following abnormalities: serum cholesterol level of 573 mg/dl (normal 120-260), triglycerides of 1,761 mg/dl(normal 10-190), and serum thyroxine level of 21 ng/dl (normal 5.5-12.3). Serum albumin, calcium, and thyroid-stimulating hormone levels were also minimally elevated. Liver biopsy confirmed hepatocellular carcinoma. This is a rare hepatoma, which in our case manifested with multiple paraneoplastic phenomena, including, Hypertriglyceridemia hypertriglyceridemia, and hypertriglyceridemia. We review the pertinent literature.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Ambulatory surgery centers, both single- and multispecialty, have flourished in a decade that has witnessed a phenomenal shift of medical services from the inpatient to the outpatient setting. The survival of single-specialty endoscopic ambulatory surgery centers (EASCs) will depend on their ability to meet the demands of a rapidly changing healthcare marketplace. EASCs are particularly well adapted to thrive under the dominant forces and trends that will drive the foreseeable future of healthcare: consumer expectations, cost containment, consistency of care (quality), and consolidation. Those EASCs that anticipate and adapt to the conditions of the healthcare market environment will thrive as vital components of the new millennium's healthcare industry.

ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

It has been reported that the serum uric acid levels in patients with cirrhosis were decreased compared with healthy subjects. These studies suggested that the lower serum uric acid levels in cirrhotic patients were attributed mainly to an increased effective vascular volume, and consequently to an excessive renal clearance of uric acid. However, the previous observations are challenged by a recent hypothesis for the pathogenesis of hyperdynamic circulation and formation of ascites in cirrhosis. The current study was undertaken to reevaluate serum uric acid levels in patients with cirrhosis. Ninety-eight cirrhotic patients with normal renal functions were included in this study. All biochemical and hemodynamic data were utilized for analysis. The mean serum uric acid level (mean, 6.1 ± 1.2 mg/dL; range, 2.7-9.1 mg/dL) was higher than that of the age- and sex-matched healthy control subjects (mean, 5.5 ± 1.3 mg/dL; range, 2.9-8.1 mg/dL;p= 0.018). Using multiple regression analysis it was determined that the serum uric acid level was not related to the severity of liver disease, cardiac index, systemic vascular resistance, and hepatic venous pressure gradient but was related closely to age (r= 0.210,p= 0.026) and effective renal plasma flow (r= −0.677,p< 0.0001). Compared with cirrhotic patients without ascites, those with ascites had a significantly higher serum uric acid level (6.7 ± 1.6 mg/dL vs. 5.6 ± 1.7 mg/dL,p< 0.05) and lower effective renal plasma flow (396 ± 125 mL/min vs. 445 ± 149 mL/min,p< 0.05). In conclusion, for cirrhotic patients with normal serum creatinine levels, the current study shows that the mean serum uric acid level is higher than that of healthy control subjects. It is not related to the severity of liver failure and systemic and portal hemodynamics, but is related closely to renal functions, especially the renal plasma flow.

ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The frequency of reported cases of primary gastric mucosa-associated lymphoid tissue (MALT)-lymphoma is increasing worldwide.Helicobacter pyloriplays a preponderant role in its pathogenesis. Gastric MALT-lymphoma arises from nonrecirculating centrocytelike cells located at the periphery of reactive lymphoid follicles, which are common in patients infected with this microorganism. Histopathologic features other than lymphoid follicles have not been well described. In this study the authors describe the morphologic changes in the gastric mucosa adjacent to MALT-lymphomas. From the files of the departments of pathology at the Instituto Nacional de Cancerologia and the Instituto Nacional de la Nutricion in Mexico City, primary gastric MALT-lymphomas were retrieved. Patients with hematoxylin-eosin-stained histologic sections, including the overt neoplasia and the neighboring gastric mucosa, were selected. Lymphoid follicles as well as intestinal metaplasia, atrophy, and eosinophils were evaluated as present or absent and graded as proposed by the Updated Sydney System for gastritis. Fifty-one patients were eligible for analysis. There were 35 low-grade and 16 high-grade primary MALT-lymphomas. Forty-seven patients (92.6%) showed reactive lymphoid follicles in the neighboring mucosa, 32 patients (69.5%) had intestinal metaplasia, and 26 patients (54.1%) demonstrated atrophy. In 41 patients (73.8%) there was an increased number of eosinophils. Our findings suggest that lymphoid follicles, intestinal metaplasia, atrophy, and eosinophils in an endoscopic biopsy are markers of both gastric lymphoma and carcinoma.

ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The aim of this study was to evaluate the effects of the prolonged duration of total parenteral nutrition (TPN) on the clinical, laboratory, and nutritional parameters and short-term outcome in acute attacks of ulcerative colitis and Crohn's colitis, and the difference in the response to TPN between the two diseases. Twenty-two patients with severely and moderately active ulcerative colitis (8 severe and 14 moderate) and 12 patients with Crohn's colitis were analyzed retrospectively. Eleven of 22 patients with ulcerative colitis were treated with TPN and corticosteroids (TPN group). The remaining 11 patients were treated with corticosteroids alone and hospital meals (oral diet group). Both groups were matched regarding disease severity at pretreatment. The clinical characteristics, and the initial and total dosages of corticosteroids for 3 weeks were similar between the two groups. The authors compared the changes in the clinical, inflammatory, and nutritional parameters and short-term outcome between the TPN and the oral diet groups with ulcerative colitis. The same evaluations were also made for 12 patients with Crohn's colitis who received TPN (CD group). The TPN group did not show any significant improvement in the clinical parameter, inflammatory signs, or nutritional state compared with the oral diet group with ulcerative colitis. The remission rate after 3 weeks of therapy and a colectomy rate also showed no significant difference between the two groups. In contrast, TPN resulted in a disappearance of clinical symptoms and an improvement in both the inflammatory and nutritional parameters in the CD group. Only one of the 12 patients with Crohn's colitis underwent colectomy. TPN induced no additional benefit in corticosteroid therapy in an acute attack of ulcerative colitis. In contrast, TPN may have primary effects on Crohn's colitis.

ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID