ISSN:0257-2753    

DOI:10.1159/000171576

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Subclinical hepatic encephalopathy (SHE) – cognitive deficits in the absence of overt encephalopathy – is frequently present in patients with cirrhosis. In the absence of biological correlates, diagnosis of SHE relies on psychometric tests. Attentional and motor abnormalities are the most common neurocognitive deficits. Sleep disturbances – a frequent complaint in cirrhosis – may be part of the spectrum of SHE. The impact of SHE on daily activities is controversial as patients may adapt their lives to cognitive limitations. Demanding activities, such as driving motor vehicles, may be impaired, though a blanket restriction appears premature. The benefit of treating SHE is not established. Antiencephalopathic drugs may be effective and can be considered in certain indi

ISSN:0257-2753    

DOI:10.1159/000171577

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

There is currently controversy regarding the use of serum carcinoembryonic antigen (CEA) in the follow-up of colorectal cancer. This article reviews the most recent clinical data regarding CEA and discusses the rationales for its use in the follow-up of colorectal cancer. The patterns of colorectal cancer recurrence and their variable association with CEA elevation are presented. The contributions of the new imaging modalities, including radiolabeled antibodies, are reviewed end information on the prognosis following resection of recurrences is provided. A practical approach to colorectal cancer recurrences is suggested in two algorithms.

ISSN:0257-2753    

DOI:10.1159/000171535

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Hepatic encephalopathy (HE) is a frequent complication of portosystemic shunts with an incidence of about 25%. In side-to-side shunts, such as the transjugular intrahepatic portosystemic shunt (TIPS), there is relation between the incidence of postshunt HE and the diameter of the shunt. A smaller shunt with a diameter of < 8 mm has a lower risk of HE by maintaining some prograde portal perfusion in most patients and preventing arterioportal blood flow which may be of disadvantage in most conditions. On the other hand, a smaller shunt diameter limits the reduction in the portal-systemic pressure gradient and, therefore, may have a higher risk of rebleeding. The size of the shunt must be based on these risks which may be estimated by factors such as age, Child class, previous episodes of HE, size of varices and severity of previous bleedings. In retrospect, the decision for a specific diameter, i.e. pressure reduction, was right if the patient’s liver function remained stable after TIPS, no HE occurred, and the varices disappeared. If this is not the case, the shunt diameter needs fine tuning with reduction in case of HE or functional deterioration, or enlargement if rebleeding occurred or the varices show a higher risk of such an event. This potential of fine tuning at any time is the major advantage of TIPS over the surgical shunting procedure

ISSN:0257-2753    

DOI:10.1159/000171579

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The development of laparoscopic interventional surgery has brought about a revolution in general surgery over the past 5 years. Laparoscopic cholecystectomy has now become the treatment of choice for symptomatic cholelithiasis because of a reduction in access trauma, resulting in less postoperative pain and a faster recovery. Laparoscopic fundoplication for gastroeosophageal reflux also looks to be a promising procedure which will probably become generally accepted. Laparoscopic hernia repair, although widely practised, has raised question marks because of doubt about recurrence rates and major complications such as intestinal obstruction. Laparoscopic colectomy has similarly raised concerns about complication rates and tumour recurrence rates. Laparoscopic appendicectomy offers marginal benefits over open appendicectomy. Virtually every other intra-abdominal procedure has been performed laparoscopically, but most require further evaluation.

ISSN:0257-2753    

DOI:10.1159/000171536

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Attempting to forecast future trends in research is difficult enough in any area but is well nigh impossible with the volatile field of hepatic encephalopathy (HE). Undaunted in this review it is suggested that more frequent use of intact animal models of HE to probe the pathogenesis of HE will occur with newly developed pharmacological agents. This process would be greatly facilitated by wide acceptance of a discrete number of reproducible animal models of this syndrome. Brief comments are made on the current status on some of the current hypotheses. Greater utilization of patients with subclinical HE for clinical studies will occur. Continuing interest in nuclear magnetic resonance imaging and spectroscopy findings peculiar to HE will be seen over the next decade.

ISSN:0257-2753    

DOI:10.1159/000171580

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

I am presenting my view on how to approach the difficult subject of dyspepsia, based on my personal experience and the writings and teachings of Howard M. Spiro. Symptoms arising from the esophagus, and called esophageal dyspepsia, are separated from symptoms arising from the stomach, designated as gastroduodenal dyspepsia. The holistic approach to patients with dyspepsia, and designated Spiro syndrome, is the main purpose of this report. I am introducing a newly defined classification, and criteria, using an intechangeable, standardized nomenclature, to be used by the clinician, endoscopist, and pathologist for diagnosing and managing the causes of gastroduodenal dyspepsia. There are five clinical/endoscopic/histological categories to be considered as possible causes of gastroduodenal dyspepsia. Often these entities are found to be asymptomatic, or a combination may cause symptoms: (1) idiopathic dyspepsia – normal endoscopy and histology; (2) congestive gastropathy/duodenopathy; (3) gastritis/duodenitis; (4) peptic ulcer crater; and (5) gastric cancer. I believe this holistic, unifying approach to diagnosis and management of dyspepsia will enhance the communication between physicians and help standardize the terminology for clinical investigatio

ISSN:0257-2753    

DOI:10.1159/000171537

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Human hepatic encephalopathy (HE) is identified by a new noninvasive test, proton magnetic resonance spectroscopy (1H MRS) applied to the brain in a few minutes. Chemical changes identified by 1Η MRS are elevated glutamine, decreased choline and decreased myoinositol. The specific association with HE is proven by clinical studies in patients with cirrhosis, overt and subclinical HE, by the appearance of the same changes after transjugular intrahepatic portasystemic shunt, and by their complete reversal by liver transplantation. The importance of the new marker, myoinositol, may lie in its role as an osmolyte regulating cell volume in the astrocytes. Other roles are also postulated. Progress in the management of both HE and subclinical hepatic encephalopathy may depend upon finding means, short of liver transplantation, which will restore cerebral choline and myoinositol. The finding of identical changes in experimental animals simplifies the search

ISSN:0257-2753    

DOI:10.1159/000171581

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The treatment of hepatic encephalopathy is predominantly an empirical approach because the process pathogenesis of this syndrome is uncertain. Many treatment trials have been published, but few fullfil the usually accepted criteria for optimum study design. Lack of placebo controls, inadequate sample size and the difficulty in assessing the severity of encephalopathy are noteworthy examples. Treatments based on reducing ammoniagenic factors in the intestinal tract and promoting urinary waste nitrogen elimination are discussed. Other forms of therapy based on the false neurotransmitter and γ-aminobutyric hypotheses are reviewed before outlining a practical approach to treatment of hepatic encephalopathy in clinical practice

ISSN:0257-2753    

DOI:10.1159/000171582

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

There have been many conflicting reports about the benefits of dietary fiber. Dietary fiber has been touted to provide remarkable benefits: from the control of functional bowel disease to the prevention of cancer. We have reviewed all prominent studies on the benefits of dietary fiber and examined the nature of their conflicting results. Recommendations for dietary fiber intake are also discussed.

ISSN:0257-2753    

DOI:10.1159/000171538

出版商:S. Karger AG    

年代:1996

数据来源: Karger