ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Our cumulative literature review suggests PEG is a simple, relatively safe, and cost-effective means of establishing enteral access for patients who qualify for long-term nutritional support. Tube placement can be achieved in 98% of patients, usually within 15 to 30 minutes without general anesthesia. The gastrostomy catheter can be easily removed when treatment is ended and conveniently replaced if accidentally dislodged. Complications occur in approximately 17% of patients, but only 3.0% are regarded as serious. No procedure-related deaths have been reported. PEG as the initial choice for feeding tube placement followed by surgical gastrostomy in patients in whom PEG is unsuccessful is a reasonable approach to nutritional management in appropriate patients. PEG for purposes of chronic gastrointestinal decompression and internalization of biliary drainage holds promise but requires further evaluation.

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We reviewed 100 consecutive cases of massive upper gastrointestinal hemorrhage (UGIH). The criteria for inclusion were a decrease in hematocrit ≥ 6%, unstable vital signs, and ≥2 units of blood transfused (16 ± 18 units, mean ± SD). A multiple regression analysis of 96 variables was employed to determine the most accurate predictors of outcome.The overall mortality was 35%. Hospital status (whether the patient was an inpatient or outpatient when the UGIH began) showed a striking association with mortality (70% for inpatients vs. 22% for outpatients,p <0.001). Nonsurvivors also had a greater number of life-threatening diseases than survivors (1.4 ± 1.1 vs. 0.3 ± 0.5,p <0.001) and greater transfusion requirements (27 ± 20 units vs. 10 ± 13 units,p <0.001). Age, the presence of cirrhosis, and recent excessive alcohol intake were not important risk factors.At presentation, the most reliable predictor of a fatal outcome was the brevity of the interval between the onset of bleeding and the initiation of a medical work-up. The primary predictor when considering the entire hospitalization was the number of life-threatening diagnoses.Our data indicate that stratification for hospital status and for other potentially predictive risk factors should be incorporated in future trials of therapy for UGIH.

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We compared the care of all adults admitted directly for acute nonvariceal upper gastrointestinal bleeding in 1981 to three types of hospitals: private (n= 138), health maintenance organization (HMO) (n= 105), and university (n= 72). Some patient characteristics differed, but most indices of blood loss, all final diagnoses, and rates of surgery (<9%) and death (<5%) were similar. Use of intensive care and blood products differed from published guidelines. Health maintenance organization patients had the shortest stays and the fewest transfusions, limited almost completely to packed red cells. Intensive care unit use and duplicate diagnostic testing were greatest for university patients. Rebleeding rates, determined by including readmissions within 1 week of discharge, were <7% and similar at the three institutions. Endoscopic signs of recent hemorrhage from an ulcer were significant signposts to rebleeding. Patients endoscoped early and those without endoscopic signs of recent hemorrhage went home sooner than the others.

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Crohn's disease only rarely affects the esophagus, usually producing strictures and fistulas. Superficial lesions such as erosive esophagitis are infrequent. Histological proof of esophageal Crohn's disease is only exceptionally obtained with endoscopic biopsies. In a 4-year period we have followed 500 patients with Crohn's disease. Esophageal involvement was recognized in nine patients, usually because of painful dysphagia. Esophagoscopy revealed large aphthoid lesions. The clinical picture was characterized by: (a) involvement of multiple segments of the gastrointestinal tract, (b) extraintestinal manifestations, and (c) critical illness of the patients. Esophageal lesions and symptoms disappeared quickly with therapy. Routine histology of esophagoscopic biopsies revealed granulomas in only two patients, but additional sections showed granulomas in another five.

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We describe five patients with lower gastrointestinal bleeding with negative endoscopy who subsequently proved to have sources of bleeding in the rectum close to the anal verge. The failure to identify such sources of bleeding via the endoscope was due to endoscopic geometry within the rectum, limited colonic preparation possible in the massively bleeding bowel, endoscopic inexperience, and a low clinical suspicion for very distal lesions. We discuss appropriate application of the available diagnostic techniques and methods to avoid endoscopic diagnostic failures in low rectal hemorrhage.

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Despite improvements in diagnostic techniques including the use of radionuclide imaging, locating the site of severe rectal bleeding is not always possible. We present two patients in whom a survey film of the abdomen showed a dense accumulation of stool in the transverse colon. Subsequent evaluation confirmed that the source of rectal bleeding was distal to this area. Accordingly, the presence of a fecal impaction in the colon strongly suggests that the site of active bleeding lies more distally. In these circumstances, diagnostic measures should be directed to the segment of the colon distal to the impaction.

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Thirty-five consecutive patients with acute hematochezia, negative gastric aspirates, and negative sigmoidoscopy underwent urgent colonoscopy after Golytely purgation. Mucosal visualization was excellent. Colonic bleeding lesions were identified in 24 of 35 patients, and hemorrhage originating proximal to the ileoceal valve was documented in three of these 35 patients. Therapeutic endoscopic electrocautery, employed in 12 of 35 patients, was effective in 11. The peroral preparation was well tolerated, and there were no complications of the preparation or of colonoscopy. The data suggest that urgent colonoscopy following Golytely purgation is a safe, sensitive, and specific diagnostic procedure that provides an opportunity for early nonoperative treatment of acute colonic hemorrhage.

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID