ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

In this symposium we chose endoscopic sclerosis of esophageal varices as the prototype of emerging technology for which controls are needed. Experts on clinical studies, institutional review boards, the Food and Drug Administration, legal issues, and ethical issues all comment on the problems raised by such “small-ticket” items that seldom receive much attention from third-party payers or others concerned with cost control. It is clear that many emerging technologies fall through the regulatory mesh and that no one is in charge of overseeing such technology.

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Sudden esophageal obstruction after eating poorly chewed meat has been called the Steakhouse syndrome. Some cases have demonstrable esophageal narrowing above which food impacts, but in many patients with identical symptoms no underlying obstruction is demonstrated. We report four patients with acute dysphagia who were unable to swallow liquids or solids for as long as 72–96 h. Onset occurred after eating meat in three patients and after taking psyllium in one. All had a structurally normal esophagus demonstrated by x-ray and endoscopy, but motor disorders were denned by manometry in three. We hypothesize that an underlying motor abnormality led to food impaction and call this presumed spastic variant “Steakhouse spasm.” We suspect that this is a common but frequently unrecognized manifestation of esophageal dysmotility.

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Many claim that upper gastrointestinal hemorrhage in patients with varices is frequently not of variceal origin. Such teaching is contrary to our experience. We therefore reviewed the records of 127 consecutive patients with 165 episodes of acute upper gastrointestinal bleeding who were found to have esophageal varices by endoscopy. Varices were the only potential site of the index bleed in 101 of the 127 patients (79.5%). In addition to varices, other potential sites of bleeding were gastric ulcer in 9 (7%), Mallory-Weiss tear in 4 (3.1%), duodenal ulcer in 3 (2.3%), and multiple gastroduodenal erosions in 10 (7.8%). We used the characteristics of the clinical presentation (e.g., varix seen bleeding) and the known natural course of the variceal bleeding to attempt to define the site of bleeding in the group with more than one potential site. In 15 we could make a judgment as to the likely source: In 9 it was variceal and in 6 nonvariceal. When varices are seen at endoscopy in a patient with a major hemorrhage, they are responsible for the bleeding in >80% of cases.

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Epistaxis was diagnosed in 10 patients with apparent upper gastrointestinal bleeding, comprising a 0.55% incidence of hematemesis and melena in the population studied. A sufficient amount of blood can be swallowed during epistaxis to cause hematemesis and melena. Recent facial trauma or epistaxis, absence of a history of chronic dyspepsia, and impairment of blood coagulation emerge as strong indicators of the diagnosis and should lead to a careful examination of the nose and nasopharynx for the source of bleeding.

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Our experience and review of the literature suggests that perforation follows fiberoptic sclerotherapy at an incidence of 1–6% per patient. Perforation is delayed for 2–14 days after the procedure and is due to chemical necrosis of the esophageal wall. The risk of perforation is higher in Child's class C patients. The use of large volumes or high concentrations of sclerosant may increase the risk of perforation. To reduce this risk, we suggest a cautious approach to Child's class C patients, with no more than two sclerosis sessions during the first 2 weeks of treatment using ≤10 ml of 1.5% sodium tetradecyl sulfate per session.

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Our experience with endoprosthesis placement in 400 patients with obstructing esophagogastric or pulmonary malignancy includes patients with bronchoesophageal fistulas, carcinoma of the cardia, tumor recurrence after Billroth I and Billroth II surgery, tumor recurrence after proximal and total gastric resection, and patients with total involvement of the stomach. We employed an introducer and tubes that were designed and adapted to solve specific problems of dilatation and intubation. Adequate tube functioning was obtained in 95% of the patients, despite the fact that we treated some who had been previously considered to be unsuitable candidates. Complications were severe bleeding (1%), perforation (7%), early migration (15%), late migration (8%), obstruction (6%), and pressure necrosis (3%). The mortality rate due to the procedure was 4%. In general, marked improvement of the quality of life was obtained. Mean survival time was 113 days.

ISSN:0192-0790    

出版商:OVID    

年代:1987

数据来源: OVID