ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The hypertensive peristaltic (nutcracker) esophagus represents a motility disorder characterized clinically by squeezing restrosternal chest pain and manometrically by high amplitude esophageal peristaltic contractions. This study was designed to examine whether the nutcracker esophagus is: (a) a distinct entity, (b) a member of the spectrum of primary esophageal dysmotilities (e.g., diffuse esophageal spasm and achalasia), or (c) is secondary to reflux-induced acid sensitivity. Thirteen patients with a nutcracker esophagus by baseline manometry were subsequently studied after acid perfusion and bethanechol stimulation (0.08 mg/kg). Records were analyzed for symptomatic response and motility changes. Eight of 13 (62%) experienced chest pain during acid perfusion, but none had significant motility changes documented during this period. After bethanechol injection, chest pain occurred in six of 12 (50%) patients; two had burning pain and in the other four (33%) their squeezing chest pain was reproduced. Changes in the motility tracing with evidence of disordered motility suggestive of diffuse esophageal spasm were seen after bethanechol in seven of the 12 tracings analyzed (58%), including all six patients who developed chest pain. We conclude that patients with nutcracker esophagus on baseline manometry may develop motility patterns consistent with diffuse esophageal spasm after provocation with bethanechol. We take this to suggest that the nutcracker esophagus is part of the continuum of primary motility disorders and may actually be a precursor of diffuse esophageal spasm.

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We prospectively evaluated 22 patients with manometrically proven “nutcracker esophagus” (high amplitude peristaltic contractions). All patients were symptomatic with angina-like chest pain, dysphagia, or both. Patients underwent barium esophagram with video-recording of the images. Video tapes were reviewed independently by a gastrointestinal radiologist who was unaware of the patients' manometric diagnoses. The video-esophagram was normal in 12 of 22 (55%) patients. Eight of 22 (36%) had dysmotility: either diffuse spasm (9%) or tertiary contractions (27%) (Fig. 2). A hiatal hernia was the only abnormality in two patients. Although the presence of diffuse spasm or tertiary contractions may suggest the presence of the underlying motor disorder in patients with nutcracker esophagus, we conclude that the “barium swallow” lacks sufficient sensitivity to screen adequately for this disorder in patients with atypical angina or dysphagia.

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A postal questionnaire was sent to 800 members of the Motor Neurone Disease Association about difficulties experienced in eating and swallowing foods and liquids. Replies were received from 310 patients or their relatives. In 45 cases the reply was from the relative of a patient who had died recently. Seventy-three percent of patients had difficulty in chewing or swallowing and this was most marked in patients who had died. Most problems were encountered with solid food rather than liquids. Aspiration was a common problem and may have contributed to some patients' death. Surprisingly, swallowing was often painful.

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The risk of gastroesophageal bleeding in cirrhotic patients with massive spontaneous portosystemic shunt (SPSS) has been evaluated variously in the literature. We undertook a retrospective study in a large group of cirrhotic patients admitted to our surgical department to evaluate the incidence of large SPSS and the correlation with current or previous episodes of gastroesophageal hemorrhage. Of 456 patients submitted to splenoportography or celiac-mesenteric an-giography, 20 showed evidence on the roentgenograms of large self-established SPSS. They were classified into three groups: (a) splenorenal shunts (three patients); (b) mesenteric-caval shunts (two patients), and (c) large patent umbilical vein (15 patients). Twelve of these 20 patients had one or more episodes of gastrointestinal bleeding, and seven of them were submitted to surgical treatment to prevent recurrent bleeding. No correlation was found between the risk of esophageal hemorrhage and the type of SPSS. We concluded that, despite the presence of massive SPSS, cirrhotic patients have an unpredictable risk of bleeding and they often require surgical treatment to prevent recurrent episodes.

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Advances in therapeutic endoscopy have brought to the gastroenterologist a host of new devices capable of controlling hemorrhage. Variations of cautery including monopolar and bipolar units and the heater probe, provide a choice in current therapy. Use of the laser in gastrointestinal hemorrhage may be eclipsed by these small, portable, reasonably priced instruments. Microwave tissue coagulation represents an application to clinical medicine of an energy source found in many kitchens. I review the current status of these devices to help practitioners to determine which to purchase and choose for the treatment of gastrointestinal hemorrhage.

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Some laboratory investigations are abnormal during the course of Crohn's disease (CD). We investigated the trend of some of these laboratory tests in a group of patients with CD to study the relationships between an activity index made up of such laboratory parameters only (LCDAI) and the usual Crohn's disease activity index (CDAI).One hundred thirty-one examinations of 63 patients were evaluated. At each investigation, besides calculation of the CDAI, 10 laboratory investigations were carried out. Three gastroenterologists independently gave an overall evaluation of the laboratory activity for each of the 131 examinations on the basis of the results of the blood tests alone. The sum of the evaluations was used as an independent variable on which a laboratory index was developed by multiple regression analysis. C reactive protein, red cell sedimentation rate, acid alpha1-glycoprotein, alpha1-antitrypsin, and white blood cells had an important share in the development of this laboratory index.The evaluation of the relationships existing between LCDAI and CDAI showed that in patients with moderate to severe clinical disease activity, LCDAI was constantly altered. The same happened in 55% of cases in clinical remission, which suggests an inflammatory activity that is not clinically evident. These results point to the advisability of supplementing a predominantly clinical index, such as CDAI, with a laboratory index such as LCDAI in the evaluation of CD.

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Surveillance has become an established concept to find dysplasia as a premalignant lesion in ulcerative colitis. Since the advent of colonoscopy and the access of the entire colon to biopsy, utilization of the rigid sigmoidoscope and rectal biopsies has been markedly reduced. We have reviewed 940 rectal biopsies obtained from 360 patients with ulcerative colitis of various extent and duration to determine the yield of dysplasia and assess the value of this procedure. The rectal biopsies had been performed for a variety of reasons in the course of clinical management of ulcerative colitis in addition to surveillance. Dysplasia was found in 10.8% of the patients—higher than has been demonstrated by colonoscopy. In four of the 39 patients with dysplasia a carcinoma coexisted (2) or developed subsequently (2). In no instance did dysplasia serve to warrant the colectomy that disclosed the carcinoma, but earlier discovery of the dysplasia or more intense surveillance once it had been found might have led to earlier discovery of the carcinoma. The yield of dysplasia was greater in those with onset of ulcerative colitis in childhood. In more than half, including 71% of patients with onset in childhood, the dysplasia was found before they had the disease for 9 years. Surveillance, therefore, should begin earlier in young patients with ulcerative colitis. Sigmoidoscopic biopsies do not substitute for colonoscopic biopsies in a surveillance program. Nevertheless, the ease of obtaining rectal biopsies, the relatively large yield of dysplasia, and the need for frequent sigmoidoscopy in the clinical management of ulcerative colitis all warrant a high priority role for rectal biopsies to supplement that of colonoscopic biopsies.

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Diseased resected portions of intestine from patients with inflammatory bowel disease were examined by chicken embryo inoculation for the presence of chlamydia and histolog-ically for the presence of chlamydia, intracellular campylo-bacters, Tyzzer's bacilli, and cryptosporidia. Chlamydia were not isolated from any of the seven colon specimens tested and chlamydia, intracellular campylobacters, Tyzzer's bacilli, and cryptosporidia were not demonstrated in 39 sections of colon and ileum from 16 IBD patients.

ISSN:0192-0790    

出版商:OVID    

年代:1986

数据来源: OVID