ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The lower esophageal mucosal ring, or Schatzki's ring, was first described by Templeton. Anatomically, it represents the lower end of the esophagus. Patients classically present with intermittent dysphagia to solids. Diagnosis is made by endoscopy or a barium esophagram. Gastroesophageal reflux disease has been suggested as an etiology. It can usually be treated by passing a large dilator. Further controlled studies are needed to study its cause.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundIn an age of highly competitive sports, whether it be the high school student, the weekend warrior, or the professional athlete, more individuals are using “performance-enhancing” nutritional supplements. Many feel they are gaining a “competitive edge,” without thinking of the potential consequences. Consumers are inundated with claims of strength, weight loss, and improved body definition, but they are rarely given information on the potentially harmful side effects. There are few large, multicenter, randomized trials of these various nutritional supplements that look at the purported claims and potential side effects.StudyWe reviewed the available studies, including case reports, and researched data on five of the most popular performance-enhancing supplements, including androstenedione, creatine, chromium, ephedra, and protein and amino acid supplements.ConclusionsOf the reviewed supplements, only creatine may be marginally beneficial. The potential benefit would probably only be useful to the professional athlete and not the average person. All of the supplements reviewed have potentially harmful side effects; however, certain supplements clearly show harmful effects, and use should strongly be cautioned. In addition, ephedra should be withdrawn from the marketplace. At this time, without better-designed studies, these agents cannot be recommended.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Noncardiac chest pain (NCCP) presents as a frequent diagnostic challenge, with patients tending to use a disproportionate level of health care resources. Gastroesophageal reflux disease (GERD) is the most frequent cause of NCCP.GoalsTo test the efficacy of a potent acid-suppressing agent as a diagnostic test in the evaluation of NCCP and to compare it with three commonly used tests.StudyEighteen men and 24 women, aged 22 to 77 years, who presented with recurrent chest pain complaints of a noncardiac etiology, as determined by rest/stress perfusion imaging with technetium Tc99m sestamibi (MIBI), were enrolled in a prospective, double-blinded, placebo-controlled, crossover trial using high-dose omeprazole. Thirty-seven patients completed both arms of the trial. Findings were compared with those of endoscopy, manometry, and ambulatory 24-hour two-channel esophageal pH monitoring. All patients underwent initial diagnostic upper endoscopy, esophageal manometry, and 24-hour pH monitoring. Patients were then randomly assigned to either placebo or omeprazole (40 mg/d orally twice daily) for 14 days, washed out for 21 days, and then crossed over. Patient's symptoms were determined using a Visual Analogue Scale to measure the severity of chest pain before and after each period.ResultsSeventy-one percent of patients in the omeprazole arm reported improved chest pain, whereas only 18% in the placebo arm did. Abnormal results on manometry (20%), 24-hour pH monitoring (42%), or endoscopy with visual evidence of esophagitis (26%) were found less frequently. Combination of the three tests did not significantly increase their usefulness. In NCCP patients with GERD, as defined by positive results on a 24-hour pH test or presence of esophagitis on endoscopy, omeprazole treatment led to a response in 95% of patients, whereas 90% of GERD-positive patients treated with placebo did not respond. Of NCCP patients determined to be GERD negative, 39% responded to omeprazole.ConclusionsOmeprazole as a first diagnostic tool in the evaluation of MIBI-negative NCCP is sensitive and specific for determining the cause of NCCP. Endoscopy, manometry, and 24-hour pH monitoring were not only less sensitive in diagnosing NCCP, but they were significantly more expensive.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundAlthough no regimen can eradicateHelicobacter pyloriin 100% of patients, factors that may affect the eradication rates have been poorly studied.GoalTo evaluate factors associated withH. pyloritreatment failure.StudyOne hundred patients were treated with pantoprazole plus clarithromycin and furazolidone forH. pylorieradication. Clarithromycin and furazolidone resistance was evaluated by the agar dilution method. Point mutations in 23S rRNA genes related to clarithromycin resistance were investigated by polymerase chain reaction and restriction length fragment polymorphism andcagA by polymerase chain reaction. The data were analyzed by logistic regression.ResultsH. pylorieradication occurred in 85 of 97 patients who completed the treatment (87.6%; 95% CI = 79.0–93.1). AllH. pyloristrains were susceptible to furazolidone, and nine were resistant to clarithromycin (A2142G or A2143G mutation was detected in all of them). The treatment failure was significant and independently associated with clarithromycin resistance (OR = 7.79; 95% CI = 1.73–35.01),cagA-negative status (OR = 4.81; 95% CI = 1.14–20.14), and male gender (OR = 4.20; 95% CI = 1.01–17.78), but not with the type of disease, mean age, smoking, alcohol consumption, and the degree of the antral and oxyntic gastritis.ConclusionResistance to clarithromycin,cagA-negative status, and gender were predictive factors ofH. pylorieradication failure.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundEndoscopic ultrasound (EUS) is the standard modality in local preoperative staging of gastric cancers and is reputedly able to detect ascites. However, the association between ascites detected by EUS and local tumor staging, peritoneal carcinomatosis, or survival after surgery is not well documented.GoalsTo assess the accuracy, sensitivity, and specificity of EUS in the preoperative staging and detection of ascites in gastric cancers. We also try to correlate ascites with histologic staging, tumor differentiation, and survival rate of gastric carcinoma after surgery.StudyThe retrospective analysis was made in 57 consecutive patients with histologically confirmed gastric adenocarcinomas that underwent EUS before surgery. The accuracy of EUS was compared with the final surgical-pathologic findings. We estimated the prognostic usefulness by analyzing the clinicopathologic features of gastric adenocarcinomas and following up their survival rates.ResultsThe overall T staging was 88% accurate by EUS. The accuracy for T staging was as follows: T1, 100%; T2, 33%; T3, 93%; and T4, 100%. About 50% of T2 cases were overstaged. The overall accuracy, sensitivity, and specificity of detecting lymph node metastasis by EUS were 79%, 79%, and 80%, respectively. One of the seven T1 cancers had regional lymph node metastasis, and it was missed by EUS, although the T classification was precisely staged based on finding submucosal invasion. A total of 22 patients (39%) had ascites detected by EUS; both the sensitivity and specificity of EUS in demonstrating ascites were 100% in our study. Ascites was significantly correlated with the depth of tumor invasion (p= 0.036), lymph node metastasis (p= 0.008), and poor cellular differentiation (p= 0.007), but it was not significantly correlated with macroscopic peritoneal carcinomatosis. The survival rate after surgical treatment was poor in those with gastric cancers with lymph node metastasis, ascites, or poorly differentiated tumors (p< 0.05). However, multivariate analysis showed that lymph node metastasis was the only significant prognostic predictor (p= 0.004).ConclusionsEndoscopic ultrasound is a valuable diagnostic tool in the local staging of gastric cancers and demonstration of ascites. Although the surgical treatment of gastric cancers with lymph node metastasis, ascites, or poor differentiation had poorer survival rate, only lymph node metastasis was proved to be a significant prognostic predictor in multivariate analysis.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundSevere ulcerative colitis is conventionally treated with parenteral corticosteroids followed by oral corticosteroids. Regular use of corticosteroids is associated with side effects. Corticosteroid pulse therapy, i.e., use of supraphysiologic dose followed by complete withdrawal, which is likely to have fewer side effects, was tried in the current study.StudyDexamethasone pulse therapy, i.e., 100-mg/d infusion in 5% dextrose, was used for 3 consecutive days in 14 patients with severe ulcerative colitis. Ulcerative colitis disease activity was assessed on days 7, 15, 30, and 60. The primary end point was defined as the number of patients who achieved clinical remission and an activity index less than 150 at day 15. The second end point was the number of patients who remained in remission and had an activity index less than 150 at 30 and 60 days. None of the patients enrolled got subsequent oral corticosteroids after their 3 days of megadose corticosteroid infusion.ResultsClinical remission was achieved in 93% patients (13 of 14 patients) by day 15. Two of these 13 patients suffered relapse during follow-up, and hence, the clinical remission was sustained in 79% patients at 30 and 60 days.ConclusionsDexamethasone pulse therapy is highly effective in inducing remission in patients with ulcerative colitis, but randomized controlled trials are needed to compare dexamethasone pulse therapy with standard oral continuous corticosteroid regimens.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Collision tumors of the stomach are uncommon. To the best of our knowledge, this is the first case report of gastric collision tumor composed of gastrointestinal stromal tumor (GIST) intermixed with primary adenocarcinoma in the English literature. The adenocarcinoma was determined to be the primary tumor based on histologic features. The tumor cells of the GIST were diffusely and strongly positive for CD34 and CD117, weakly positive for smooth muscle actin (5% of cells), and negative for desmin, S-100 protein, synaptophysin, and cytokeratin. There was no transition between the different components. We hypothesized that the stomach was influenced by the same unknown carcinogen, resulting in a simultaneous proliferation of different cell lines (epithelial and stromal cell). This case represents an example of two independent tumors in a unique one-on-another pattern, namely growth of adenocarcinoma on GIST.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID