ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A large number of ascitic fluid tests, e.g., fibronectin and cholesterol, have been proposed as helpful in detecting malignancy as the cause of ascites. Unfortunately, these “humoral tests of malignancy” are nonspecific. Although the ascitic fluid concentrations of these proteins or protein-bound substances tend to be quite high in patients with peritoneal carcinomatosis and low in the setting of cirrhotic ascites, the problem is that patients with tuberculous peritonitis, cardiac ascites, pancreatitis ascites, etc. usually have values in the malignancy range, ie., false-positive results. This can lead to an extensive search for a nonexistent tumor, with confusion and anxiety for patient and physician. The cytology is the single best test to order when peritoneal carcinomatosis is suspected; its sensitivity approaches 100%. However, peritoneal carcinomatosis is only one of several mechanisms by which tumors can cause ascites. No one test can be expected to detect tumors as the cause of these diverse mechanisms of ascites formation. The serum-ascites albumin gradient is a helpful test in classifying ascitic fluid specimens into portalhypertension-related and non-portal-hypertension-related categories. An elevated serum α-fetoprotein test can be useful in raising suspicion of hepatocellular carcinoma. Careful analysis of ascitic fluid, without measurement of “humoral tests of malignancy,” combined with information obtained from the history and physical examination, usually lead to an accurate diagnosis of the cause of ascites.

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We reviewed the medical records of 79 patients with primary gastrointestinal lymphoma (GI-NHL), defined according to the criteria of Dawson et al. (without involvement of liver, spleen, peripheral or mediastinal lymph nodes, or bone marrow), observed and treated in our institution between 1973–90. The most common disease site was the stomach (70 patients), followed by the small bowel (five patients) and the large bowel (four patients). The stage was IE in 36 cases and IIE in 43. Radical surgery or surgical debulking was the main therapeutic approach (67 patients); 12 patients received only chemotherapy, eight of whom had tumors considered unresectable at laparotomy. After surgery, most of the patients received chemotherapy; radiotherapy (RT) was given to only four patients. Surgically calculated overall survival (OS) rates at 5 years for the patients treated with surgery plus chemotherapy were 64% (radical surgery) and 46% (surgical debulking with microscopic lymphoma residue). For the 12 patients treated with chemotherapy alone, OS at 5 years was 0%. Our findings, in accordance with most published data, suggest that surgery, together with stage and tumor size, remains an important prognostic factor of survival in primary GI-NHL, especially when it is radical. In patients with negative prognostic factors (bulky disease, high-grade histologic type, microscopic residue, and stage II), postoperative chemotherapy and RT decrease the risk of distant failure and local recurrence.

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

In Crohn's disease, multiple areas of small bowel stenosis are relatively common, but there are only 11 reported cases with stenosis complicated by enterolithiasis. We describe three patients with multiple strictures, enterolithiasis, and refractory iron deficiency anemia. The chronic anemia was severe, requiring multiple transfusions in two patients. One patient developed a perforation, and a second had cancer within one of the saccular dilatations between strictures. Management of this stricture-enterolith–anemia triad requires removal of the enteroliths and correction of the strictures by strictureplasty and/or resection. If the operation of choice is strictureplasty, however, meticulous inspection and biopsy of each proposed site of enteroplasty is essential to rule out carcinoma.

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Despite the increasingly frequent noninvasive detection of central splanchnic venous thrombosis (CSVT), its pathophysiology and clinical significance remain incompletely understood. We reviewed 50 consecutive cases of partially or totally occlusive thrombosis, primarily of the portal (60%) and splenic (40%) veins. Thirty-eight percent of patients had cancer; 26% had portal hypertension or other conditions associated with splanchnic venous stasis; and in 20%, thrombosis developed post-operatively. Angiography (89%), duplex ultrasonography (46%), CT scan (32%), and MRI (16%) were all useful diagnostic modalities. In 58% of cases, CSVT was clinically unsuspected, and 32% of patients were essentially asymptomatic. Variceal hemorrhage occurred in 30% of cases, and abdominal pain was notable in 26%. Whereas 50% of patients died ≤6 months of diagnosis, only one of these deaths was directly attributable to CSVT; the remainder were secondary to underlying disease unrelated to the CSVT itself. CSVT, increasingly detected but often unsuspected clinically, is characterized by a self-limited and nonlethal course in the majority of patients. Death from associated disease is, however, common. The treatment and prognosis of CSVT should therefore be dictated by its clinical manifestations and the setting in which it occurs, rather than by the venous thrombosis itself.

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We have measured serum laminin, a marker of portal hypertension, in 151 patients with nonmalignant liver diseases, to evaluate its utility in cirrhosis and portal hypertension. There were abnormal serum levels in 43.1% of the patients as a whole and in 62.7% of the cirrhotics. Laminin showed a correlation with many laboratory tests, especially those that reflect liver insufficiency and alcohol intake. Cirrhotics had higher laminin levels than noncirrhotics (p < 0.0001); an association was also found with portal hypertension (p < 0.0001), but laminin was also increased in patients without portal hypertension. Our results suggest that liver dysfunction can also lead to abnormal laminin concentrations, probably through slower metabolization rate. Laminin serum concentrations reflect the severity of the liver disease, and are also a marker of alcohol consumption. Determination of laminin serum levels could play an adjunctive role with respect to other liver tests in the evaluation of these patients although the measure does not really provide more useful information.

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Twenty-six patients with liver neoplasm receiving transcatheter arterial chemoembolization (TAE) therapy underwent gastroduodenal endoscopic examinations before and after TAE. The balloon was inflated in the common hepatic artery before chemoembolization if superselective cannulation beyond the gastroduodenal artery could not be done. Sixteen of the 26 patients (61.5%) showed new gastroduodenal lesions, with superficial gastritis in six, one or more erosions in nine, and hemorrhagic gastritis in five. The frequency of lesions detected was no different when the common hepatic artery was obstructed (60.0%) than when superselective embolization was done in more peripheral branch(es) (60.0%). No clinical events indicating upper gastrointestinal bleeding were noticed after TAE. The presence of esophageal and/or gastric varices and session(s) of TAE performed before did not affect the occurrence of gastroduodenal lesion(s). We conclude that TAE produces erosive gastroduodenal lesions that are detected by endoscopic examination but are clinically unimportant; balloon catheter occlusion of the common hepatic artery did not result in more frequent gastroduodenal complications than the ordinary superselective chemoembolization method.

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To evaluate the effect of percutaneous ethanol injection given alone, we studied disease recurrence and prognosis in 37 patients with solitary hepatocellular carcinoma up to 2 cm. The patients were classified as Child's class A, 22; B, 11; and C, 4. During follow-up for periods ranging from 10 to 44 (mean, 26) months, 15 of the 37 patients (40.5%) had disease recurrence. The 1-, 2-, and 3-year recurrence rates were 37, 49, and 53%, respectively (Kaplan-Meier method). Significant risk factors for recurrence included the hypervascularity and the histological differentiation of the tumor (p < 0.01). Of those 15 patients, two had local recurrence, eight had nodular recurrence (fewer than two nodules), and five had widespread multinodular recurrence. The patients with local or nodular recurrence then received repeated injections of ethanol, while those with multinodular recurrence received transarterial embolization or chemolipiodolization therapy as possible. Seven of the 37 patients died during follow-up. The 1-, 2-, and 3-year survival rates were 95, 81, and 70%, respectively (Kaplan–Meier method). No factor was significant in prognosis. We observed a significant relationship between recurrence pattern and prognosis. Patients with a widespread multinodular recurrence had a significantly shorter survival (p < 0.01). In summary, ethanol injections given alone appeared to be effective in treating small and solitary hepatocellular carcinomas. Repeated injection of ethanol of the site of recurrence was useful in prolonging survival.

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Sedation is often justified in patients requiring colonoscopy. We investigated the potential usefulness of hypnotic relaxation in 13 women and 11 men (median age, 43 years; range, 22–67) for whom other forms of anesthesia were not available. Hypnotic relaxation resulted in moderate or deep sedation in 12 patients (nine women; p < 0.05). In the patients in whom hypnosis was successful, pain was less intense than in patients in whom hypnosis was unsuccessful (p < 0.001). In addition, all colonoscopies were completed in the successful group, versus 50% in the unsuccessful group (p < 0.05). The patients in the successful group all agreed to another examination under the same conditions, whereas only 2% in the unsuccessful group agreed (p < 0.001). Our study suggests that, in a subgroup of hypnotizable patients, hypnotic relaxation may be a safe alternative to drug sedation and merits further study.

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Severe iron deficiency was the presenting manifestation in a patient with occult celiac sprue that went unrecognized for a prolonged time. Endoscopic abnormalities and the absence of typical symptoms may contribute to a delay in diagnosis unless a high index of suspicion is maintained.

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID