ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Children with gastrointestinal motility disorders present with diverse symptoms, and obtaining a detailed history is often impossible. As in adults, evaluation of a suspected motility disorder begins with exclusion of mechanical obstruction or primary inflammatory disorders. Subsequently, coordination of peristaltic function is evaluated in those segments of the gastrointestinal tract that are suspected to be abnormal based on the clinical history. Evaluation of gastrointestinal motility in children is particularly challenging because of frequent lack of patient cooperation and difficulties in adapting the equipment to patient size. This review discusses the indications and approach to the evaluation of motility of each region of the gastrointestinal tract in infants and children.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The porphyrias are a heterogeneous group of metabolic disorders caused by genetic defects of the enzymes involved in heme biosynthesis. The diseases are characterized by excessive accumulation and excretion of porphyrin or porphyrin precursors. The disorders have been classified as cutaneous, hepatic, or neuropsychiatric according to the organ system involved. This review describes the enzymes of the heme biosynthetic pathway along with the clinical features and management of the porphyrias.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Computed tomography (CT) and magnetic resonance (MR) colography (virtual colonoscopy) are new techniques being developed for the purpose of imaging colorectal polyps and cancer. Limited data are available regarding the performance characteristics of either technique, particularly MR. Initial reports suggest that the sensitivity of CT and MR colography for patients with adenomas ≥ 1 cm ranges from 75-90%, and decreases precipitously for smaller polyps. Very early data suggest that the specificity for patient with large adenomas is around 90%, but for patients with adenomas in the 5-9 mm range has been as low as 65%. This review discusses currently available published and abstracted data on CT and MR colography and discusses the real and potential advantages and disadvantages of CT and MR colography compared to current colonic imaging methods. The review discusses problems that must be overcome in order for CT or MR colography to be demonstrated as practical tests, and suggests guidelines for the performance of clinical trials testing the performance characteristics of these methods.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The clinical course and prognosis of ulcerative colitis was studied in a group of 413 Greek patients. The study lasted for 16 years and follow-up was achieved in 95% of the patients. Both sexes were almost equally affected, mainly between the ages of 40-49. Most of the patients lived in cities and had high educational levels. Familial clustering for inflammatory bowel disease was found in 2.7% of the patients. In most of them the disease was confined to the rectosigmoid area or left bowel and was of mild to moderate severity. The disease course included exacerbations-mainly of mild to moderate severity-and remissions. Mortality was absent during first attack, and it was generally low at the completion of the study. Excluding deaths caused by colorectal cancer, most of the deaths were unrelated to the ulcerative colitis itself. Unusual combinations of ulcerative colitis with other diseases, including diseases of autoimmune origin, were noted. There were no differences between men and women in the various clinicoepidemiologic parameters or in the course of the disease. Surgery was performed in 16.7% of patients, whereas surgery at first attack was required in 0.5%. In comparison with the nonoperated group, patients who were operated on were significantly younger at the time of onset of symptoms and had significantly more extensive disease. Factors prognostic of severe attacks and colectomy were extensive disease, young age at onset, and severe recurrences. Evolution to cancer was observed in 1.45%, whereas extraintestinal cancers also appeared in 1.5%. At the completion of the follow-up period, 5.8% of the patients were dead, 16% had only one attack, 2.7% experienced continuous symptoms, whereas in 58.8% of them, the disease course included exacerbations and remissions. On the basis of the outcome of severe attacks and the more favorable short-term prognosis, it could be argued that ulcerative colitis in Greece runs a milder course compared with that of other developed countries in Western Europe and North America.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The relation between inflammatory bowel disease (IBD) and colorectal cancer (CRC) is not clearly defined. Some investigators suggest that patients with extensive colitis have a genetic predisposition to CRC and that long-standing inflammation is not of primary importance in the promotion of cancer. We have assessed any increased risk of colon cancer in the relatives of IBD patients. We studied the prevalence of malignancy in the relatives of 251 IBD patients [198 ulcerative colitis (UC); 53 Crohn's disease of the colon (CDC)] and 251 orthopedic patients (ORTHO) as controls. In all patients (UC, CDC) as well as in controls (ORTHO) the prevalence of colon, extracolic digestive and extradigestive malignant tumors in the first-degree relatives was evaluated. We found no significant difference in the number of colorectal tumors or of tumors of any other kind in the diverse group of relatives of patients with IBD and ORTHO patients. Our data do not point to the existence of hereditary factors linking UC or CDC to CRC.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Individuals with inflammatory bowel disease (IBD) are known to have an increased incidence of thromboembolic disease. Activated protein C resistance (APCR) has been identified as one of several inherited disorders of coagulation that predispose individuals to thromboembolic problems. This resistance results from a single point mutation in the factor V gene, called factor V Leiden. It has been suggested that many patients with IBD have APCR, as tested by a clotting assay.We have evaluated a series of 49 patients with IBD, none of whom had a history of thromboembolic disease. We assayed for the factor V Leiden mutation by polymerase chain reaction and found only one heterozygote. Seventeen of the 49 patients were negative for APCR by the clotting assay.Factor V Leiden mutation is not more common in patients with IBD than in the general population. We were unable to confirm a prior report indicating that patients with IBD have a higher prevalence of resistance to activated protein C.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Disease of the terminal ileum can be diagnosed by ileocolonoscopy or barium radiography. We compared the diagnostic accuracy in the terminal ileum of ileocolonoscopy and small-bowel meal with pneumocolon.Consecutive patients during an 18-month period who had both ileocolonoscopy and small bowel meal with pneumocolon were identified and their colonoscopy reports, radiographs, and ileal biopsies reviewed blindly by paired gastroenterologists, radiologists, and pathologists, respectively. A gold-standard diagnosis was determined for each patient by consensus.Of 48 study subjects, 14 (29.2%) had Crohn's disease, 5 (10.4%) had lymphoid nodular hyperplasia, and 29 (60.4%) were normal. The sensitivity for a diagnosis of Crohn's ileitis was 92.9% for ileocolonoscopy and 100% for small-bowel meal, while their specificities were 100% and 97.1% respectively. The gold standard diagnosis confirmed ileocolonoscopic findings in 45 patients (93.8%) and radiographic findings in 42 patients (87.5%). Agreement between ileocolonoscopy and small bowel meal occurred in 39 cases (81.2%). By combining histology with ileocolonoscopy, the sensitivity and specificity could be increased to 100% for all diagnoses.Ileocolonoscopy and small-bowel meal with pneumocolon are complementary techniques for imaging the terminal ileum. A prospective comparative trial is now needed to more objectively assess their accuracy, cost effectiveness, and adverse effects.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We have evaluated the association between gallstones and abdominal symptoms, comparing two different study designs. We asked questions on abdominal pain, dyspeptic symptoms, and food intolerance in (1) surgery patients referred for conditions unrelated to gallstones, screened by ultrasound (screening study, n = 892, 63 with gallstones); and in (2) symptomatic patients referred for gallbladder ultrasound (clinical study, n = 336, 71 with gallstones). Gallstones were associated with mid upper abdominal pain in the screening study, and with mid upper abdominal pain, biliary pain, and colic (each independently) in the clinical study. When these symptoms were absent (and only dyspeptic symptoms or food intolerance was present), gallstones were not more common than expected from the general population prevalence (estimated from the screening study). When upper abdominal pain symptoms are accounted for, other symptoms (dyspeptic; food intolerance; pain related to food intake) have no additional diagnostic value. The results are discussed, contrasting different types of studies.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

No medical therapy exists for subjects with hepatopulmonary syndrome (HPS). A patient with HPS was reported to have improvement in arterial oxygenation while self-administering garlic. Our goal was to determine whether a standardized garlic powder improves arterial oxygenation and dyspnea in subjects with HPS. A prospective, open label uncontrolled pilot study in 15 subjects with HPS were administered garlic powder capsules daily for a minimum of 6 months. Arterial blood gases were determined every 4-8 weeks, in the same position on room air, and a subjective dyspnea transition index was reported. Six of 15 subjects (40%, confidence interval: 0.15-65) had at least a 10 mmHg increase in the Po2or decrease in the alveolar-arterial gradient. The mean pre- and postarterial difference in these patients were: Po2(14 ± 4 mmHg) and alveolar-arterial gradient (18 ± 5 mmHg). All 6 subjects who responded to garlic had less dyspnea on exertion. Garlic improved arterial oxygenation in younger subjects (mean 40 versus 56 years old;p= 0.021) or those with lower macroaggregated albumin shunt fractions (mean 21 versus 44%,p= 0.058). Garlic may improve arterial oxygenation and symptoms in patients with hepatopulmonary syndrome and warrants further investigation.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID