ISSN:0192-0790    

出版商:OVID    

年代:1981

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1981

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

In the past decade, C.Difficilehas been implicated as the putative organism in antibiotic-associated pseudomembranous colitis. The natural history, clinical features, and pathologic features have been better defined. Vancomycin is the current drug of choice in treating this illness, but other therapies as well as exciting epidemiologic areas need to be explored. The role of C.Difficiletoxin in chronic inflammatory bowel disease is another area which also must be evaluated.

ISSN:0192-0790    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Why a substantial proportion of peptic ulcers fails to heal in clinical trials of drugs remains uncertain. We therefore made a prospective study of biological and social factors which might influence healing. 160 patients who were treated with cimetidine for various types of peptic ulceration were grouped into successes or failures by serial endoscopic review. There were 80 patients in each group.Significant differences between the two groups emerged. The mean age and mean age of onset of symptoms were lower in the failure group. The proportion of manual workers and artisans, the frequency of a family history of peptic ulcer, the proportion of smokers, alcohol users, analgesic takers, and the frequency of acid hypersecretion were all higher in the failure group. The “degree” of abuse of smoking, alcohol, and analgesics was also greater in the failures than in the successes. The proportional reduction of maximal acid output after a dose of cimetidine was not different between the groups.

ISSN:0192-0790    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The mortality in patients with upper gastrointestinal bleeding has not changed in the past quarter century in spite of the introduction of new modes of therapy and treatment. In this review we address the possible reasons for a lack of change in mortality and the implications raised for the use of new techniques. We review the factors that affect the mortality of acute upper gastrointestinal hemorrhage and the diagnostic accuracy of upper gastrointestinal endoscopy. Based on this information, we present guidelines for the therapy of the major causes of upper gastrointestinal bleeding. These guidelines should be useful until new therapies have been assessed and become generally available.

ISSN:0192-0790    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

We studied the pancreatic function, alcohol history, and ERCP findings in 26 patients with painless and 34 patients with painful alcohol-induced calcific pancreatitis (AICP). About 50% of patients in both the painless and painful groups continued to take alcohol, the incidence of duct stricture or obstruction was of the order of 62% in both groups, and the proportion of patients with duct stricture or obstruction and continued alcohol intake was comparable.In all instances the patients in the painless category had significantly greater pancreatic insufficiency, or more impaired function, than patients with pain. This applied to those patients who continued to take alcohol, to those with an obstruction or stricture on ERCP, and to the subgroup with both duct narrowing and continued alcohol intake. We conclude that grossly impaired pancreatic function confers a degree of freedom from painful attacks in AICP in those patients who continue to drink even in the presence of duct obstruction or stricture on ERCP; and that patients with AICP become free of pancreatic pain once gross pancreatic insufficiency supervenes.

ISSN:0192-0790    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Intestinal pseudo-obstruction (IP) is an uncommon disorder of gut motility which must be differentiated from mechanical intestinal obstruction. We have seen 11 such patients over the last 5 years. Characteristic symptoms, shared by mechanical obstruction, include abdominal distention and pain, nausea, and vomiting. Radiologic studies reveal dilated loops of bowel with air fluid levels. In most patients a major differentiating feature from obstruction may be the presence of diarrhea rather than obstipation. Steatorrhea is secondary to an overgrowth of anaerobic bacteria in the motionless dilated loops of bowel. IP has been associated with various disorders: in our series two patients had scleroderma, one multiple small bowel diverticula, one systemic amyloidosis, one celiac disease, and one spinal cord injury; in only two patients was the disorder considered “idiopathic.” Three patients had previously undergone a jejuno-ileal bypass for morbid obesity. During the acute episode, the patients were treated symptomatically with decompression by nasogastric or rectal tube with fluid and electrolyte replacement. Malabsorption treated with broad spectrum antibiotics reversing the steatorrhea but not episodes of pseudo-obstruction. Magnesium deficiency was present in seven patients and its correction resulted in amelioration of the symptom complex. In two patients episodes of pseudo-obstruction were markedly reduced by metoclopramide which was not effective in two others.

ISSN:0192-0790    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

We analyzed 186 secretin provocation tests performed in our laboratory over a 5 year period. Positive tests, i.e., an increase in serum gastrin of more than 100 pg/ml, were found in 3 of 136 normogastrinemic and in 30 of 50 hypergastrinemic subjects. In all 16 patients with positive tests who were operated upon the diagnosis of gastrinoma was confirmed. In the 17 nonoperated patients the diagnosis of gastrinoma was supported by the demonstration of gastric acid hypersecretion. Two normogastrinemic patients with questionable gastrinoma had increases in serum gastrin of 72 and 73 pg/ml, respectively. Five patients with combined hypergastrinemia and basal hyperchlorhydria had negative secretin provocation tests: three had hypergastrinemia of antral origin, one had a gastrin-producing ovarian cystadenocarcinoma, and one had a pancreatic gastrinoma with liver metastases. We conclude that the secretin provocation test is helpful in the diagnosis of gastrinoma.

ISSN:0192-0790    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

We have seen 13 patients with sclerosing cholangitis diagnosed mainly by ERCP. An elevated alkaline phosphatase is frequently the first manifestation. ERCP is adequate for diagnosis, and an operation is usually not necessary. Radiologic findings include diffuse and irregular areas of stenosis, dilation, beading, and extensive involvement of both the extrahepatic and intrahepatic biliary radicles. There was an association with long-standing ulcerative colitis, but no relationship with activity of this disease or its complications. Liver biopsy in 10 of 11 patients demonstrated very little progression of disease, and evidence of secondary biliary cirrhosis was found in only one case. Corticosteroid therapy was used in 10 patients without clinical evidence that this altered their course. Prognosis appears to be reasonably good and unrelated to the course of ulcerative colitis.

ISSN:0192-0790    

出版商:OVID    

年代:1981

数据来源: OVID