ISSN:0257-2753    

DOI:10.1159/000171337

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Medical treatment of reflux oesophagitis requires life-long medication, does not relieve all patients of their symptoms and may not halt the progression of damage. Antireflux surgery is indicated in refluxing infants who fail to thrive, in disease uncontrolled by medical treatment or when laryngeal and pulmonary symptoms are associated with reflux. A full investigation to establish and quantitate the motility defect and severity of the reflux, nature of the refluxate and pattern of gastric emptying is necessary to plan a correct antireflux procedure which can assure a cure of up to 90% for 10 years.

ISSN:0257-2753    

DOI:10.1159/000171338

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Portal hypertension is characterised by alterations in the splanchnic and systemic circulation associated with the development of portosystemic collateral channels, the most important of which are found in lower oesophagus and stomach. Bleeding from these gastro-oesophageal varices represents the major clinical complication and over the last decade there has been considerable interest in the pharmacological management of this condition. The factors underlying the development and maintenance of portal hypertension and the pathogenesis of variceal rupture are as yet not fully understood. Whilst an increase in portal vascular resistance, as a consequence of liver disease, appears to be the primary event in the majority of cases, increasing attention has focused on the potential importance of enhanced circulating levels of vasoactive compounds coupled with a proposed reduction in vascular sensitivity to endogenous vasoconstrictors. Consequently, portal hypertension is now being more widely considered as a multi-organ disorder associated with changes in blood flow within both systemic and splanchnic vascular beds. This article reviews the factors currently implicated in the development and maintenance of portal hypertension and considers the pathogenesis of variceal bleeding.

ISSN:0257-2753    

DOI:10.1159/000171382

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

There is a changing scene with perforated peptic ulcer. The older age of presentation, the increased association with non-steroidal anti-inflammatory drugs, associated increased debility, and resulting higher mortality in the elderly, are causing a rethink in management protocols. Whereas years ago most discussion was on whether urgent definitive surgery was the most effective therapy, nowadays there is a tendency to less invasive measures. A ‘deliberative’ approach, wherein not all patients require surgery, is detailed, and there may be an increasing role for laparoscopic perforation-sealing techniques in the remainder. Anti-secretory and anti-helicobacter drugs have an important role in post-operative care following lesser procedures than definitive surg

ISSN:0257-2753    

DOI:10.1159/000171339

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Although the mechanism initiating and maintaining variceal hemorrhage is not completely understood, there has been general agreement in recent years on the concept that variceal rupture occurs when the tension on the wall of the varices reaches a critical value (the rupture point) that leads to the leakage of the elastic components of the wall. If this hypothesis is true, the aim of pharmacological treatment should be to reduce variceal wall tension or to prevent any abrupt increase in this parameter. Some vasoconstrictor drugs are currently used in order to achieve these goals and in the attempt to stop the acute bleeding episode. All these agents decrease either portal pressure and azygos blood flow. Vasopressin although effective, has significant cardiac and gastrointestinal adverse effects that discourage its use. Combination with nitroglycerin reduces its adverse effects while maintaining or even enhancing the reduction in portal pressure. Glypressin, which acts as a slow-release preparation of vasopressin, has a longer duration of action and can be administered as single intravenous injections instead of continuous infusion. However, the similarity of effects of these drugs on systemic circulation leads to an overlapping spectrum of untoward effects. Somatostatin and the synthetic octapeptide octreotide display similar pharmacological effects on splanchnic hemodynamics but have a better tolerability profile. Thanks to its longer duration of action and ease of administration, octreotide could become the drug of choice for the early, pre-hospital management of bleeding varices. A different approach to the pharmacological treatment of variceal bleeding may be the use of compounds, like metoclopramide and domperidone, that increase the lower esophageal sphincter pressure (LESP), thereby reducing the inflow of blood flow into the submucous venous plexus of the esophagus and hence into the esophageal varices. However, more studies are needed before these compounds be considered a real alternative to the above established drugs.

ISSN:0257-2753    

DOI:10.1159/000171384

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The identification of the early events occuring in ulcerative colitis may lead to a better understanding of the etiology of this disease. Many observations have now indicated that colonic epithelial abnormalities occur independently of the presence of mucosal inflammation and have suggested that early events are more likely to involve the epithelium than immuno-inflammatory mechanisms. Although a large number of candidate luminal and mucosal mechanisms for injuring the epithelium or modulating its function can be identified, the real reasons why the epithelium is abnormal remain unclear. Mucosal inflammation may well be a secondary phenomenon due to influx into the lamina propria of luminal macromolecules with toxic, antigenic, immunoadjuvant and chemoattractant properties. This pathogenic model offers new areas of focus for research and the potential for novel therapeutic approaches.

ISSN:0257-2753    

DOI:10.1159/000171340

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Cystic fibrosis (CF) is the commonest, fatal, autosomal recessive disorder and is associated with lung sepsis, pancreatic failure and elevated sweat electrolytes. The CF gene on chromosome 7 encodes a protein identified as CF transmembrane conductance regulator (CFTR) which regulates chloride ion transport in epithelial cell membranes. Almost 100 mutations have been identified in this gene which cause defective chloride-channel control. Recently, this abnormality has been reversed in affected CF cells in vitro by retrovirus-mediated transfer of a normal gene. Fifty years ago, most cases died in childhood, but now up to 80% reach adulthood. Chronic lung sepsis is the principal cause of death, and intensive antibiotic therapy with chest physiotherapy is used to control this. Advanced lung disease can be successfully treated by heart-lung transplantation. Nebulised recombinant DNase and antineutrophil elastase agents such as alpha-1-antitrypsin and secretory leucoprotease inhibitor are potentially promising new therapies. Pancreatic insufficiency is managed by high-calorie diets and enteric coated enzyme supplements. Other prominent gastrointestinal complications include meconium ileus equivalent, biliary cirrhosis and cholelithiasis. Specially dedicated CF centres have led to improved survival rates and allow experienced staff to treat the many complications of CF while promoting research in this multisystem disorder.

ISSN:0257-2753    

DOI:10.1159/000171341

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Vasoactive drug therapy is the only therapy that can be administered immediately to patients with suspected variceal bleeding. The optimal agent is not yet available, but somatostatin or octreotide, glypressin and vasopressin and nitroglycerin are the best candidates. Somatostatin and octreotide have the best therapeutic index as they have very few side effects. They compare well to the other agents in comparative randomized trials. In addition to being used prior to sclerotherapy, vasoactive agents may show benefit when used in combination with endoscopic methods and in the immediate interval thereafter in order to prevent early re-bleeding. This remains to be tested in clinical trials.

ISSN:0257-2753    

DOI:10.1159/000171385

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Chronic alcohol intake interferes especially with the two main pathways regulating exocrine pancreatic secretion: the cholinergic and the pancreozymin pathway. Recently, a new theory of the pathogenesis of alcoholic pancreatitis was proposed emphasizing disordered agonist-receptor interaction at the level of pancreatic acinar cells. Accordingly, alcohol-induced alterations in the control of exocrine pancreatic secretion result in hyperstimulation of pancreatic acinar cells and their muscarinic receptors, mimicing the mechanism of acute pancreatitis caused by scorpion sting, intoxication with an anti-acetylcholinesterase-containing insecticide or supramaximal doses of secretagogues. The present review emphasizes the role of these alcohol-induced secretory alterations in the pathogenesis of alcoholic pancreatitis.

ISSN:0257-2753    

DOI:10.1159/000171342

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Maternal-infant transmission of hepatitis B virus (HBV) infection is estimated to account for 40-50% of HBV carriers in Chinese populations, but is uncommon among other ethnic groups. The high frequency of maternal-infant transmission among Chinese populations is related to the high prevalence of carrier mothers with replicative HBV infection. The natural course of perinatally acquired HBV infection consists of three phases: an initial phase of immune tolerance followed by a phase of immune clearance and then a non-replicative phase. The initial phase of immune tolerance which may last for several decades contributes to the poor response to interferon therapy. The high prevalence of carrier mothers with replicative infection mandates a combination of passive and active prophylaxis for the newborns.

ISSN:0257-2753    

DOI:10.1159/000171343

出版商:S. Karger AG    

年代:1992

数据来源: Karger