ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

As the field of endoscopy continues to expand and assumes an increasingly prominent role in the practice of many gastroenterologists, conflicts arise between technology and traditional clinical care. In this editorial, I address these concerns from the viewpoint of an endoscopy teacher in private practice who is worried about whether the emphasis should be placed in patient care and teaching.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The natural history of Crohn's disease is one of remission and recurrence. Until recently there has been no evidence that medical therapy can alter the pattern of recurrence. Recent large multicenter trials have demonstrated that the aminosalicylates may be effective in maintaining remission. Preliminary studies have also suggested that biochemical investigations may identify patients at high risk for recurrence. Additional studies that combine such predictive models with double-blind, placebo-controlled clinical trials are warranted.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

After defining what is accepted as “organic” and “functional” when digestive problems are classified under these terms, I analyze these terms and classifications. Analysis shows that the generally accepted meaning of the words “organic” and “functional” does not justify the way they are currently used to classify digestive problems. The classification of illnesses into “organic” and “functional” is arbitrary, can lead to incorrect treatment, and can hamper the acquisition of deeper knowledge about many digestive problems. To avoid this, physicians should abandon the “organic” and “functional” categories and try to (a) clarify all the determinant factors of illness possibly present, and (b) eliminate or control the determinant factors found. In this way, patients will receive more complete and efficient treatment for their illnesses.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Abnormalities in esophageal peristaltic function and acid clearance appear to be responsible for prolonged esophigeal acid exposure, a major determinant of the reflux esophagitis and esophageal stricture. We evaluated esophageal motility by manometry in 50 healthy controls and in 35 symptomatic reflux patients before, within 6 months, and 1 year after Nissen fundoplication. Preoperative motility was analyzed in relation to the presence or absence of both nonobstructive dysphagia and erosive esophagitis. We found that (a) preoperative dysphagia was related more to peristaltic dysfunction than to esoph-agitis; (b) peristaltic wave amplitude and duration were significantly lower than control values in patients with efflux, without correlation to degree of esophagitis or power esophageal sphincter hypotension; (c) dysphagia ceased in most patients after antireflux surgery at the same time that normal motility was restored independently of lower esophageal sphincter pressure increments. These results suggest that motility disturbances are an important cause of dysphagia in reflux disease, and that reflux is the cause of, rather than the consequence of, peristaltic dysfunction.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Cocaine is a potent topical vasoconstrictor that causes nasal mucosal and dermal ulceration. Use of the purified eocaine derivative “crack” has reached epidemic proportions in large cities. In 18 months we operated on 24 patients with perforated peptic ulcers. Five of the patients were young (27–38 years) male crack users without prior history of gastric symptoms who presented with a perforated gastric ulcer related to smoking crack. Three had sad symptoms for only 1–5 days before admission. All live were a febrile, had a rigid abdomen, normal leukocyte count, and free intra abdominal air upon radiography. Five other age-matched, non-crack-using patients served as case controls. Their duration of symptoms was 1–24 months, they had elevated leukocyte counts on admission, and, in contrast to the crack users, four of these patients had duodenal perforations. The clinical presentation of the crack smokers and the unusual localization of the perforations imply different pathogenetic mechanisms than are commonly seen in perforated ulcer disease. With increasing abuse of crack, greater numbers of patients with this new complication may be expected to present to emergency services in urban areas.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Two cases of mycobacterium avium-intracellulare (MAI) infection in association with acquired immunodeficiency syndrome (AIDS) are presented to highlight the distinctive upper gastrointestinal endoscopic appearances: 2 × 4 mm diameter, white nodules with intervening erythema and hemorrhagic erosions covered the mucosa of the second part of the duodenum. Histological evaluation of these nodules revealed diffuse expansion of the lamina propria by macrophages that contained numerous intra-cellular and extracellular acid-fast organisms. We conclude that endoscopy with endoscopic biopsy may represent the most rapid and sensitive diagnostic tool available in this disease.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We report four new cases of oral manifestations in Crohn's disease (CD) and evaluate 75 reported cases for morphology and site of oral and intestinal manifestations of CD, clinical manifestation, and treatment. Oral CD was the presenting symptom in 43 of 72 (60%) patients and relapsed in 34 of 60 (57%). Median age at presentation was 22 (range 6–57) years, and males were affected more often (1.85:1, male:female ratio). From a total of 228 oral lesions in 79 patients, lips (57 lesions), gingiva (40 lesions), vestibular sulci (31 lesions), and buccal mucosa (25 lesions) were the sites most frequently affected. Edema (62 lesions), ulcers (57 lesions), and polypoid papulous hyperplastic mucosa (45 lesions) were the most common type of lesions. The rate of granuloma detection was high in oral (67–77%) and intestinal lesions (45–71%). A total of 66 courses of drug therapy in 51 patients were analyzed. Complete remission of oral symptoms was achieved by systemic steroids and/or azathioprine in 13 of 26 (50%) patients, whereas strictly topical treatment with steroids resulted in complete remission of oral symptoms in 7 of 12 (58%). We conclude that oral CD exhibits a characteristic morphologic appearance, as often as not preceding intestinal symptoms in adolescents and young adults. Thus, patients with orofacial granulomatosis CD should be vigorously searched for by complete gastrointestinal endoscopic investigation. Oral CD may cause disabling pain and facial distortion, and results of treatment remain unrewarding. In the absence of data from controlled therapeutic trials, systemic steroids and/or azathioprine are recommended if topical treatment has failed to control symptoms.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Steroid enemas are widely used in distal inflammatory bowel disease (IBD). They are partly absorbed and suppress adrenocortical function. Beclomethasone dipro-pionate (BD) is a topically active steroid that undergoes rapid first-pass inactivation in the liver and is practically devoid of systemic side effects. We treated 32 consecutive patients with active distal ulcerative colitis (40 attacks) with 0.5 mg BD and/or 5 mg betamethasone phosphate (BP) enemas for 28 days. Clinical, laboratory, sigmoidoscopic, and histologic data were recorded before, during, and after the trial. The clinical efficacy of both treatments was similar. Betamethasone was slightly more effective in relation to the histologic improvement and disappearance of blood from the stools. Clinical signs of steroid overdosage were noted in patients on BP but not in patients on BD. Mean fasting plasma cortisol at the end of the trial was 2.9 μg/dl in the BP group and 15.3 μg/dl in the BD group. The adrenocorticotropin test was markedly suppressed in the BP group but not in the BD group. The absence of systemic steroid side effects makes BD enemas a useful addition in the therapy of IBD. Its oral administration should also be considered.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Low-dose oral cyclosporine was used to maintain remission in patients with Crohn's disease. In seven patients, cyclosporine was used as a steroid-sparing agent; in 14 it was given for refractory active disease as an adjunct to conventional treatment, and then continued as maintenance treatment. Cyclosporine was given at an initial dose of 5 mg/kg reduced by 1 mg/kg at 2-month intervals until a maintenance dose of 2 mg/kg was reached. Of the seven patients in whom cyclosporine was used as a steroid-sparing agent, six had a relapse. Remission was achieved in seven of the refractory active group, but cyclosporine was withdrawn because of side effects in six of the patients in this group. Of the seven patients who had achieved remission, six subsequently had a relapse. Therefore, 12 of 14 patients (86%) in remission had a relapse despite cyclosporine maintenance. Ten of these (83%) had a relapse at a cyclosporine dose of 2 or 3 mg/kg. Cyclosporine levels at relapse (median, 74 ng/ml) were lower than the mean levels over the first 6 weeks of treatment (median, 130 ng/ml; p = 0.02). Our data do not support the use of cyclosporine to maintain remission in Crohn's disease.

ISSN:0192-0790    

出版商:OVID    

年代:1991

数据来源: OVID