ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The fear of cancer has evoked calls for intensive surveillance programs in Barrett's esophagus. Two evolving issues are fueling this fire: (a) the rising risk of adenocarcinoma of the esophagus over the past 20 years and (b) the coincidental increase in the recognized prevalence of Barrett's esophagus in the general population. however, these sobering statistics must be carefully weighted against the lack of adverse effects on survival and the cost of an extensive surveillance program for adenocarcinoma in Barrett's esophagus, the latter estimated at between $300 and $1,500 million per year. Barrett's esophagus and its associated cancer risk represent a crisis in gastroenterology. A consensus conference of leading basic and clinical scientists is needed in this area.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A country that once led technological development in health care now leads the charge back to the cave, from which it took mankind 2 million years to emerge. The problems in U.S. health care are not simple. Therefore, there are no simple solutions. True health-care reform can be accomplished only via improved and unbiased public education, identification of the role for primary care, and the need for sub- and sub-subspecialties. Government has an important role, but even more importantly, as a nation, our priorities for rewards require careful reevaluation. Suppliers and consumers must sit down at the same table, realizing that basic health care is not responsive to the usual supply and demand theories proposed by economists. Only then can health care reform be considered a positive change.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

In the last 20 years, patient autonomy has vastly increased and a “well-being” movement has flourished, with great benefits but with definite drawbacks as well. Exaggeration of the individual's potential for prevention and self-healing can foster a crude psychological reductionism that hampers potential for subtle etiologic understanding and may weaken research, as well as creating a tendency to blame the victim. Probing of the health effects of any activity before engaging in it can lead to healthier-than-thouness and a fear of living. The well-being movement tends to ignore social causes of disease in favor of individual ones and therefore to disregard a need for social remedies. Both theory and practice can be contaminated by economic motives: Medicine is expensive, meditation is cheap. The chasm between the “mind-body” school and the dominant medical model may have widened as some holistically minded individuals, finding a haven in the well-being movement, give up on affecting the medical mainstream. Thus, the advance of holistic medicine has aided in conceptualizing the health-illness continuum, in understanding pathogenesis, and in discovering new preventive and therapeutic tools, but its emphasis on internal causes and therapies should not be allowed to detract resources from the equally important ones lying outside the realm of lifestyle.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We report the results of sclerotherapy in 20 patients with bleeding gastric varices due to hepatic schistosomiasis. In an endemic area, patients with hepatic schistosomiasis, and bleeding gastric varices seen on endoscopy to be inferior extension of esophageal varices, were treated with emergency endoscopic injection just proximal to the cardia. Hemostasis was achieved in 17. Obliteration of varices was achieved in all patients with sclerotherapy, combined with surgery. Thirteen patients who had not been operated on in the past and consented to surgery underwent esophagogastric devascularization with splenectomy. Surgery was carried out as an emergency in the three patients who did not respond to sclerotherapy and electively in 10 patients after control of bleeding. After surgery, sclerotherapy was required for remnant varices. One patient with Child-Pugh grade C cirrhosis died of hepatic encephalopathy after control of the bleed. During a median follow-up of 9 months (range, 1-25 months), recurrence of bleeding in one patient and recurrent varices in two others were controlled with sclerotherapy. One patient had a fatal hemorrhage at home. We conclude that sclerotherapy effectively controls acutely bleeding type 1 gastric varices. Combined with esophagogastric devascularization and splenectomy, long-term results may be encouraging in patients with hepatic schistosomiasis.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We studied 47 adults (21 men, 26 women), with biopsy-proven celiac sprue and anti-endomysin antibody (EmA) positivity while untreated, to evaluate the usefulness of both serologic markers of celiac sprue [i.e., immunoglobulin A (IgA)-EmA and total Ig-anti-gliadin (AGA) antibodies] and of a detailed dietary inquiry in predicting the mucosal pattern after gluten withdrawal. A second biopsy was repeated 8-30 months after beginning a gluten-free diet, along with EmA and AGA determinations and the dietary inquiry. Both EmA and AGA were appraised by indirect immunofluorescence on monkey esophagus and rat kidney, respectively. Intestinal biopsy was graded according to Cooke's criteria. After gluten withdrawal, intestinal mucosa reverted to normal in only nine patients. Both EmA and AGA showed high positive but low negative predictive values on intestinal histologic outcome. The positive predictive value of admission of dietary lapses was 100%, whereas the negative predictive value was 39.1%. Neither serologic markers nor dietary inquiries are to be regarded as reliable predictors of intestinal outcome after a gluten-free diet. Biopsy remains the best means of ascertaining mucosal recovery.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

To define the characteristics of colorectal cancer with regard to site distribution, age, and sex, due to the significantly increased incidence of colorectal cancer in Japan, we investigated 1,205 Japanese patients with colorectal cancer between 1975 and 1994. When we compared site distribution for age and sex in the entire 20-year period, tumors in the proximal colon were more frequent in elderly patients than in young ones (p < 0.05); this tendency was true only for females (p<0.01), but not for males. The increased incidence of proximal colon cancer in elderly patients was also found in the second 10-year period (p < 0.05). Because elderly patients are characterized by an increasingly high incidence of proximal colon cancer in recent years, more concerted efforts for the early detection of proximal colon cancer, particularly in the elderly, are called for.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Primary pancreatic lymphomas are rare. We reviewed our experience at King Faisal Specialist Hospital and Research Center; the hospital tumor registry identified five patients with primary pancreatic lymphoma among the 1,212 adult non-Hodgkin's (NHL) cases referred to this institute during 1987-1994. The histology was diffuse large cell in all cases. According to the Ann Arbor classification, four patients had stage IE and one patient stage IIE disease. The diagnosis was established by laparotomy in three and ultrasound or CT-guided biopsy in two patients. All patients received chemotherapy. Radiotherapy was used in two cases; in one patient the pancreatic bed was irradiated, whereas in the other radiation was given for obstructive jaundice. Four patients are alive with no evidence of disease at 84, 26, 24, and 21 months follow-up. One patient relapsed at 12 months following chemotherapy and is alive with disease at 23 months follow-up. The clinical and radiological findings in primary pancreatic NHL are not pathognomonic, and the diagnosis is only established on histopathological examination. The management should be nonsurgical as the response to chemotherapy and radiation appears to be no different from NHL at other sites.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The diagnosis of hemochromatosis requires liver biopsy and the quantification of hepatic iron. Magnetic resonance imaging (MRI) of the liver shows a characteristic decrease in tissue signal intensity in iron overload states, but its role in the diagnosis of hemochromatosis has not been fully delineated. Forty-three patients (31 men and 12 women) were referred for the evaluation of hemochromatosis based upon a fasting transferrin saturation >55% and/or a serum ferritin >400 ng/ml in males or >300 ng/ml in females. Each patient prospectively underwent MRI of the liver prior to percutaneous liver biopsy and quantitative hepatic iron determination. Homozygous hemochromatosis was diagnosed in 10 patients based upon an hepatic iron/age index ≥2. MRI was performed with a 1.5 Tesla system using standard spin-echo sequences (TI; TR = 300-500 ms, TE = 13-17 ms, PD; TR = 2,000-2,600 ms, TE = 30 ms). Signal intensity values were blindly determined for regions of interest in liver and skeletal muscle at T1 and proton density. Ratios of liver to muscle (LM) for T1 and proton density (PD) calculated from these values showed a significant correlation with quantitative iron by multiple regression analysis. The LMPD ratio provided the best correlation with hepatic iron (r= -0.6946; p < 0.001). Linear regression analysis also provides an equation that can be used to predict hepatic iron based upon the LMPD ratio; μg/g of hepatic iron = (-5,174 × LMPD) + 9,932. All patients with LMPD ratios of >0.5 had hepatic iron/age indices of <2.0, thereby excluding homozygous hemochromatosis. These results suggest that LMPD ratios derived from MRI of the liver can accurately predict hepatic iron content. These ratios can be clinically useful in the evaluation of hemochromatosis among patients who either refuse or have contraindications to liver biopsy.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Esophagocutaneous fistula due to tuberculosis is a distinctly rare entity, with only two cases reported over the past 25 years. We report this unusual complication in an 85-year-old, human immunodeficiency virus-negative man and review the relevant literature.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID