ISSN:0192-0790    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Crohn's disease (CD) is now accepted as a systemic illness. The importance of extraintestinal manifestations is underlined by the fact that such “complications” can be more prominent and even more difficult to control than the intestinal disease itself. Lately, evidence for more than accidental association of pancreatitis and exocirine pancreatic insufficiency with CD is growing. This might have a significant impact on the treatment of abdominal pain and diarrhea in CD, symptoms which have so far been attributed exclusively to the intestinal rather than the extraintestinal manifestations of the disease.

ISSN:0192-0790    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Abnormalities in oncogenes, which are broadly classified into viral and cellular oncogenes, and suppressor genes appear critical for the development of colon cancer. Cellular oncogenes contribute to malignant transformation when they become activated by point mutation, translocation, amplification, or loss of regulator sequences. The properties of the oncoproteins, the proteins encoded by oncogenes which are essential for carcinogenesis, are unclear. Suppressor genes normally suppress the tumorigenic phenotype by keeping the growth of cells in check; it is their inactivation that contributes to malignant transformation. Development of colon cancer appears to take place by stepwise accumulation of multiple genetic alterations during the progression from normal colon to adenoma and carcinoma. Activation ofras,an early event in this sequence, is found in 50% of colon cancers; overexpression of c-mycis found in >80%. Inactivation of suppressor genes, which occurs during later stages, is noted in <70% of tumors. A current model of colonic tumorigenesis is presented.

ISSN:0192-0790    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

We wanted to know if the blood urea nitrogen to creatinine (BUN/Cr) ratio could help distinguish upper from lower gastrointestinal bleeding. We analyzed retrospectively patients admitted to our hospital for gastrointestinal bleeding over the past 5 years. A total of 126 patients represented 74 upper bleeds and 52 lower bleeds. The mean BUN/Cr ratio was significantly higher in upper than lower bleeders, 34.8 and 17.8 respectively (p > 0.001). No lower bleeder had a ratio of ≥ 36, whereas 38% of upper bleeders had a ratio of ≥ 36. The BUN/Cr ratio may be an easy, cheap method of distinguishing upper from lower gastrointestinal bleeding in some cases. A BUN/Cr ratio of ≥ 36 suggests upper gastrointestinal bleeding, whereas a ratio of >36 is not helpful in locating the source of bleeding.

ISSN:0192-0790    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

We retrospectively reviewed the records of 60 patients who had been referred for gastrointestinal manometry because of stasis after gastric surgery. Nausea, vomiting, bloating, abdominal pain, and weight loss were the most common symptoms. Two thirds of these patients had a well-documented history of peptic ulcer before their initial operations; in other, surgery was performed for other reasons, such as obesity (5%) or reflux esophagitis (8%). Twelve patients had undergone truncal vagotomy and a “drainage operation” and 48 had received a partial gastrectomy with a gastroenterostomy: Billroth I (n = 8), Billroth II (n = 11), Roux-en-Y (n = 29). All patients had recordings of gastrointestinal manometry; 16 also had a scintigraphic measurement of gastric empyting. Measurements were compared with data from healthy controls. Gastric manometry, which could be assessed only in the group with an intact antrum, was characterized by antral hypomotility (p > 0.05). Gastric emptying studies showed rapid early emptying of liquids and delayed emptying of solids (both p > 0.05). In the whole group, fasting jejunal motility was characterized by absence of phase II in 13, presence of bursts of phasic activity in 18, and abnormal propagation of phase III in 8. A significantly increased frequency of phase III of MMC was noted in the patients after Billroth II and Roux-en-Y operations. Postprandially, 19 patients failed to develop a “fed pattern.” In 11 of 35 patients, the fed pattern was of shorter duration than in healthy controls; in others, there were postprandial MMC-like complexes that did not interrupt the fed pattern. Motor disturbances, which occur frequently in patients symptomatic after gastric surgery, are associated with the development of gastric stasis. These physiologic abnormalities may represent a persistence or aggravation of a preoperative psychophysiologic status, or they may be a bonafide motility disorder, such as antral hypomotility. Some of these abnormalities may have been present preoperatively and may have been the cause of the upper gut symptoms before operation, particularly in those without documented peptic ulcer disease. The lack of enteric continuity following Billroth II and Roux-en-Y gastrectomy may predispose to the manometric abnormalities we observed. We discuss the therapeutic implications of these pathophysiological findings.

ISSN:0192-0790    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Although rosacea was formerly believed to be associated with gastrointestinal upsets, no one any longer finds a significant association between rosacea and the intestinal tract. We describe four patients with a combination of ulcerative colitis and rosacea. In all four, ulcerative colitis preceded the onset of severe papulopustular rosacea, and we therefore feel that the severity of rosacea could have been due to the associated bowel disorder. In one, the severity and poor initial response of rosacea to treatment was clearly related to the activity of the ulcerative colitis, and the rosacea improved only after proctocolectomy. While it is possible that this purported association is fortuitous, we report these cases in the hope that others may have seen this combination of diseases, to our knowledge previously unreported.

ISSN:0192-0790    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The current treatment of inflammatory bowel disease (IBD), though improved over earlier therapies, remains variable rather than consistent and supportive rather than curative. The similar management of ulcerative colitis (UC) and Crohn's disease (CD), which are thought to be differing though related disorders, suggests that therapy is nonspecific. The variation in therapeutic practices results from the fact that the etiologies of the diseases are obscure, from limited knoledge of the biological and pharmacological actions of drugs commonly prescribed (sulfasalazine, 5-ASA compounds, steroids, 6-MP and azathioprine), from an inadequate understanding of genetic differences influencing drug metabolism, from insufficient awreness of the factors influencing drug efficiency (concurrent use of anti-motility drugs, cigarette smoking, food combinations), from the variability of the patient groups studied (extent and severity of disease), and from incomplete documentation of the clinicla status of patients at the time of therapeutic trial. Future advances in treatment will depend on gaining new information about the nature of IBD and of drug pharmacology and bioavailability, derived from collaborative studies by clincians, clinical investigators, and basic scientists. Important areas for IBD research include the biology of intestinal epithelium, the nature of the IBD inflammatory reaction and of gut mucosal immune regulation (via the application of new biotechonologies) and more representative experimental animal models. Decisive multicenter therapeutic studies require agreement on definitions of ulcerative colitis and Crohn's disease, accurate characterization of patient groups, acceptable objective criteria of IBD severity and activity, and reliable indicators of therapeutic response. Since evaluations based on trials of four to six weeks reflect early, often transient effects, trials should extend for at least one year. These approaches, taken under the guidance of a national IBD clinical and research committee, would faciliate the acquisition of comparable data and more definitive therapeutic evaluations, which would accelarate the understanding of inflammatory bowel disease.

ISSN:0192-0790    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

We examined the frequency of isolation ofBlastocystis hominisfrom stools of patients seen in an indigent-care teaching hospital. Over a 2-year period, 2,744 stool specimens were examined prospectively.B. hominiswas found in 262 stools (9.5% of all stool specimens and 53.5% of the positive specimens). Clinical data were obtained from 80 patients with stools positive forB. hominis. B. hominiswas the only parasite isolated in 39 of 47 (83%) of the adults, compared with 17 of 33 (52%) of the children (p = 0.006). All but 2 of 52 patients without concomitant parasitic infection or bacterial pathogens in stool had gastrointestinal sysmptoms (41 abdominal pain, 26 diarrhea, and 5 vomiting), but no association was seen with fever, peripheral leukocytosis, stool occult blood, fecal leukocytes, or endoscopic or radiologic evidence of colitis. Therefore,B. hominiswas frequently recovered from stools eamined in a hospital clinical parasitology laboratoty. The clinical presentations of patients in our series did not suggest thatB. hominiswas invasive. Most patients withB. hominisprobably do not require treatment since they will either have spontaneous resolution of symptoms or will be found to have an alternative explanation for their problem.

ISSN:0192-0790    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Generally, the results of liver transplantation for metastic liver disease have not been favorable. One exception has been the unique group of neuroendocrine tumors, the slow growth of which allows liver transplantation to effectively palliate and control symptoms. We report two cases: (a) A 51-year-old man who underwent orthotopic liver transplantation and resection of the pancreatic primary tumor for a nonfunctioning malignant neuroendocrine tumor with features of both carcinoid and islet-cell glucagonoma remains symptom-free and without evidence of tumor recurrence at 13 months follow-up. (b) A 47-year-old man who underwent orthotopic liver transplantation and Whipple resection fo a metastatic isletcell tumor in the head of the pancreas is fully recovered at 5 months follow-up.

ISSN:0192-0790    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

There is general agreement that the prevalence of gallstones in cirrhotics is high (at least twice that in the general population), but the pathogenetic link between cirrhosis and cholelithiasis is still uncertain. The influence of cholelithiasis on survival in cirrhotics is also unknown. During an 8-year period, we observed 90 patients affected by decompensated cirrhosis: 36 of them (40%) turned out by cholecystographic/cholangiographic or ultrasonographic examination to have cholelithiasis. We were not able to demonstrate any correlation between cholelithiasis and sex, age of patients, etiology of cirrhosis severity of the illness, degree of portal hypertension, previous gastrointestinal bleeding, number of pregnancies, or levels of serum cholesterol, bilirubin, and triglycerides. During the follow-up observation, (range, 1–91 months), 30 patients died. Survival curves analyzed by the log-rank test did not show any difference between patients with or without gallstones. We therefore confirm that cirrhosis is a lithogenic condition, but we were not able to explain the reasons for the close relationship between cholelithiasis and cirrhosis. Gallstones, however, did not affect the survival of these patients.

ISSN:0192-0790    

出版商:OVID    

年代:1990

数据来源: OVID