ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Since the introduction of endoscopic sphincterotomy approximately 15 years ago, the indications for this procedure have expanded. Currently endoscopic sphineterotomy is the procedure of choice for management of retained common bile duct stones following cholecystectomy. It is also being used more frequently for choledocholithiasis with an intact gallbladder in high-risk patients and in some patients with acute gallstone pancreatitis. In patients recovering from an episode of gallstone pancreatitis, standard practice has been subsequent cholecystectomy with possible exploration of the common bile duct. To avoid surgery in high-risk patients, we propose that an elective endoscopic sphincterotomy may be a reasonable therapeutic option regardless of whether common bile duct stones are present at the time of ERCP. A prospective trial is needed to examine this issue since to date there is no literature on endoscopic sphincterotomy in the absence of choledocholthiasis for gallstone pancreatitis in patients with intact gallbladders.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We documented the natural history of esophageal carcioma and its rapid growth by measuring the change in mor diameter radiographically in 10 patients during an bservation period because the diagnosis had been issed. Nine men and one woman (age range, 48–74 ears; mean, 60 years) were included in the study. Eight atients had undergone esophagography for gastrointesnal complaints and had lesions missed on the initial terpretation that were apparent on retrospective review fter the patient had returned with more severe comlaints and undergone repeat studies; two patients had efused treatment. The tumor was squamous-cell carcioma in all. The treatment-free retrospective observation eriod ranged from 4 to 19 months (mean, 12.2 months) nd was shorter for elevated (mean, 9.2 months) than for epressed lesions (mean. 16.8 months). The longitudinal iameter increased from 10–100 mm initially (mean, 0.5 mm) to 32–150 mm (mean, 74.9 mm). No correlation xisted between the increase in size and histologic feares. This documentation of the rapid increase in the size f esophageal carcinoma involving at least the submucosa onfirms clinical impressions of the aggressive nature of is lesion and offers an explanation of why this disease is eldom detected at an early stage and long-term survival so poor after the early stage of disease.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

rimary small-cell carcinoma of the esophagus is an ncommon esophageal malignancy. This report details e clinical and pathologic aspects of 11 cases seen at our stitution over 20 years, as well as 123 other cases ported in the literature. Small-cell carcinomas of the ophagus show considerable histologic heterogeneity, eurosecretory granules can be found in the majority of ses and some show evidence of multidifferentiation. ike primary small-cell cancers of the lung, those in the ophagus are highly aggressive, are usually associated ith spread at the time of diagnosis, and have a dismal ognosis regardless of treatment. The possible origin of is interesting variety of esophageal neoplasm is also scussed.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Although endoscopic laser therapy is effective for symptom palliation in esophageal cancer, few studies have investigated its effect on survival. We previously reported a 300% improvement in survival in 10 patients with squamous-cell carcinoma of the esophagus after endoscopic Nd:YAG laser energy. We now report a study to determine if the survival advantage persisted after treating an additional 26 patients. Thirty-six patients with squamous-cell carcinoma of the esophagus treated with endoscopic laser therapy were compared to 20 controls identified by our hospital Tumor Registry. There was no difference between the groups with respect to age, sex, race, location of tumor, or clinical stage. More control patients (25%) had previously undergone surgery than laser patients (0%) (p < 0.05). Survival analysis demonstrated a significant improvement in overall survival (p < 0.05), with an improvement in median survival from 5.7 to 9.7 months (p < 0.05). One-year survival was 38% in laser patients, compared to 20% in control patients. Our experience continues to demonstrate that endoscopic laser therapy is effective in prolonging life as well as palliating the symptoms of patients with squamous-cell esophageal carcinoma.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Twenty-five patients with bleeding peptic ulcers were ndomized to receive either ranitidine 50 mg 8 hourly i.v. control group) or a continuous nasogastric antacid infuion at the rate of 0.5 ml/min along with an i.v. injection feimetidine 100 mg/h (treatment group). Twelve patients were included in the control group and 13 in the treatment roup. The mean gastric pH on therapy was significantly igher in the treatment group (7.88 ± 0.37) than in the ontrol group (5.00 ± 0.55) (p < 0.001), and the gastric H was noted to be >7 on 95% of the occasions in the treatment group and on 8.6% of the occasions in the control group. An overall control of bleeding was chieved in 92.3% of the patients in the treatment group and 50% of the patients in the control group (p < .05). Thus, the failure of therapy was significantly more common in the control group than in the treatment group (p < .05), and more patients of the control group had to indergo emergency surgery than that in the treatment group. None of the patients in the treatment group, but 6.6% of the patients in the control group, died during the study period in the hospital stay. We conclude that in patients with bleeding peptic ulcer an intensive medical erapy comprising hourly injections of cimetidine (or aresumably of other H2blockers) and continuous nasoastric antacid infusion can achieve sustained achlorhyria, better control of bleeding, and reduce the need for emergency surgery.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We compared the prevalence rates of peptic ulcer (duodenal and gastric) and gastric cancer in 1,796 dyspeptic Peruvian patients with those reported in 2,883 similar patients from developed countries. The prevalence of total peptic ulcer was significantly lower, and that of gastric cancer significantly higher, in the Peruvian patients. The prevalence of gastric ulcer was lower but not significantly so. We deduced that the significantly lower prevalence of total peptic ulcer was directly related to the low prevalence rate of duodenal ulcer. We hypothesize that the reason for these differences was probably a higher prevalence ofHelicobacter pylori-associated chronic atrophic gastritis with hypochlorhydria in the Peruvian patients. Hypochlorhydria decreases the predisposition to peptic ulcer (especially duodenal ulcer), and chronic atrophic gastritis may predispose an individual to gastric cancer.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Enprostil is a synthetic prostaglandin E2analogue with gastric antisecretory and mucosal protective properties. We compared the effects of enprostil and ranitidine on the healing of gastric ulcers and the subsequent relapse rates over 6 months. Patients (N = 156) were recruited for a double-blind study from 12 centers in Europe: 71 were randomly assigned to oral treatment with 35 μg enprostil twice daily and 85 to 150 mg ranitidine twice daily for up to 8 weeks. Both groups were of similar demography; their healing rates were also similar. Cumulative intent-to-treat healing rates were at 4 weeks enprostil 48%, ranitidine 41%: at 6 weeks enprostil 65%, ranitidine 68%; and at 8 weeks enprostil 72%, ranitidine 80%. Of those patients who met all protocol criteria and completed treatment, and were endoscoped at the prescribed times, healing rates were at 4 weeks enprostil 55%, ranitidine 54%, at 6 weeks enprostil 75%, ranitidine 84%; and at 8 weeks enprostil 80%, ranitidine 90%. Relief of pain was rapid and similar in both groups. The incidence of adverse events was low and similar in the two groups. The treatment-free relapse rate at 6 months was enprostil 64%, ranitidine 49%; the median times to relapse were 169 and 203 days, respectively. Enprostil and ranitidine appear to be equally effective in healing gastric ulcers.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

this retrospective analysis we searched for a constelation of signs or symptoms attributable to childhood mphonodular hyperplasia (LNH). Of 147 children with ocumented LNH reviewed, 43% had lesions in the small owel, and 57% in the large bowel. Children in this study presented with complaints of abdominal pain (58%) and light red blood per rectum (32%). Physical examination evealed little except right lower quadrant (RLQ) abdommal tenderness and “fullness” in 35%. The pain was eriumbilical, dull-cramping, rarely acute, and nonradiating. The hematochezia was most commonly streaky red mucoid strands adhering to the stools, with no associated tenesmus. Three clinical patterns emerged: (a) Unler 1 year of age most patients were male, with painless leeding and pancolonic LNH. (b) Between 2 and 6 years, though the LNH was predominantly colonic, pain and leeding occurred equally. (c) From 7 years old on, the ain symptom was abdominal pain, but LNH distribution has nearly equal between the small bowel and the colon. o date, our long-term follow-up of the children with olated LNH has revealed no sequelae.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

nce the published incidence of tube feeding-associated arrhea varies widely between 2.3 and 68%, and because commonly used definitions of diarrhea are subjective and precise, we determined the actual fecal output of alnourished patients during the first 6 days of tube eding. Nine patients on the same isoosmolar formula ere evaluated for diarrhea. Patients were interviewed ily as to whether they thought diarrhea was present or sent. Frequency of defecation was recorded, and stool as collected daily for weight. When assessed subjectvely, the incidence of diarrhea rose from 11% on day 1, 25% on day 4, and to 43% by day 6. The group (n = 4) mplaining of diarrhea averaged 3.0 bowel movements r day, whereas those denying diarrhea (n = 5) averaged wer than 0.2 bowel movements per day (p < 0.01). ool weight, however, plateaued for all patients by day 6 52.7 ± 35.7 g of stool per day. No patient produced in cess of 250 g of stool per day. We suggest that aditional subjective measures for assessing diarrheaay be flawed and should not be relied upon when valuating and treating tube feeding-associated diarrhea.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID