ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Submucosal edema and lymphectasia have traditionally been considered the earliest recognizable alterations in Crohn's disease. However, a characteristic pattern of ulceration grossly resembling the oral lesions of aphthous stomatitis is believed by others to be the earliest macroscopic lesion. We have studied 50 consecutively accessioned surgical specimens with Crohn's disease in an effort to define more thoroughly the frequency, distribution, and morphology of these “aphthoid” ulcers. The scanning electron microscope (SEM) was used in the study because an understanding of the morphology and evolution of these lesions requires an appreciation of their three-dimensional configuration.Typical “aphthoid” ulcers were identified in 35 of the 50 specimens studied. Grossly the typical ulcerative lesion varies from barely visible up to 3 mm in diameter. They have a characteristic light-microscopic appearance consisting of focal ulceration usually overlying an aggregate of lymphoid tissue. The SEM was helpful in identifying the smallest of these lesions and was especially useful in defining a variety of villous abnormalities in the small bowel mucosa adjacent to the ulcers.

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

One hundred symptomatic patients were evaluated independently with upper gastrointestinal radiography and fiberoptic endoscopy, and the results were compared. Of the two endoscopists sequentially examining the same patient, one was informed of available clinical and radiographic details and the other was not. Knowledge of the x-ray examination by the informed endoscopist did not improve his accuracy. Each endoscopist made four errors of interpretation. The endoscopic and x-ray findings agreed in 46 of the 100 patients, most often (68%) in the eophagus, least often (29%) in the stomach and half the time (45%) in the duodenum. Ulcer craters seen endoscopically were detected radio-graphically in 36% of patients. We conclude that: 1) knowledge of results of prior upper gastrointestinal radiography did not alter endoscopic results; 2) experienced endoscopists are accurate but make mistakes; and 3) endoscopic findings would have been unaltered had radiography not been performed.

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

One hundred twenty-five patients were prospectively evaluated with upper gastrointestinal “skinny” endoscopy and radiology. Seventy-five patients underwent endoscopic examination before barium studies, whereas 50 patients underwent radiologic examination before endoscopy. If superficial mucosal erosions are eliminated, the areas of greatest disagreement occurred in the postoperative stomach, the deformed antrum, and the deformed duodenal bulb. We conclude that 1) a barium meal is not a prerequisite to a complete endoscopic examination by a trained endoscopist, 2) a barium meal following an adequate endoscopic examination usually adds little new information, and 3) “skinny” endoscopic examination can be utilized as the initial and usually the only diagnostic test in most patients with upper gastrointestinal symptoms.

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

To evaluate the impact of panendoscopy on diagnosis and management, we asked several gastroenterologists to state their diagnoses, management plans, and confidence in these plans before performing endoscopy in patients with chronic abdominal or thoracic pain; and to repeat the same decisions after endoscopy. To evaluate acceptance of the procedure, patients were later interviewed about their discomfort during its performance.To check the way that changes in diagnosis may have affected patient management, we formed six diagnostic groups that roughly correspond to differing treatments. The postendoscopic diagnostic groupings revealed two unsuspected cancers and disagreed with the original classification in 38 (45%) of 84 patients. Dramatic or substantial changes in management occurred in 37 (44%) patients, but often did not correspond to changes in diagnosis. Conversely, management was often unchanged despite alterations in diagnosis. Patients expressed about equal preferences for barium meal as for panendoscopy, and 75% would have agreed to a repeat endoscopy without hesitation.Although the ultimate benefits of postendoscopy management changes were not ascertained, we believe that these results support the use of panendoscopy in patients with persistent and unexplained symptoms.

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The phase II/III U.S. clinical drug trials for cimetidine (Tagamet) in duodenal ulcer were examined for their potential application to cost-benefit analysis. Data on “time lost from work” were obtained from a special protocol added to these short-term, double-blind trials of cimetidine. Sixty-four outpatients from the clinical trials remained from an original pool of 217 after exclusion of those subjects who were either retired, unemployed, or of uncertain employment status. Cimetidine was significantly more effective than placebo in reducing “time lost from work” during ulcer disease. The patients' “time lost from work” occurred as a strikingly all-or-nothing phenomenon. We conclude that a prospective clinical trial is appropriate for gathering economic data.

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Four patients had a characteristic cholestatic syndrome intermediate between primary biliary cirrhosis (PBC) and sclerosing cholangitis (SC). These patients with atypical biliary cirrhosis (ABC) differ from patients with PBC in that they donothave either antimitochondrial antibodies or elevated IgM, are younger, and three of the four are men. Patients with ABC differ from those with SC in that the common duct, hepatic duct, the right and left hepatic ducts and their immediate tributaries show none of the changes characteristic and diagnostic of SC. The findings in ABC which are similar to PBC are: 1) the earliest biopsy finding of the disease is confined to the interlobular duct and is indistinguishable from PBC; 2) late changes on cboiangiogram are similar to those in a proportion of patients with PBC; and 3) the incidence of gallstones is increased. ABC has no similarity to SC except that the small intrahepatic ducts are affected by both diseases. The histologic features in fully established ABC suggest extrahepatic bile duct obstruction because of the predominantly PMN leukocytic portal inflammation. The cholangiograms show no evidence of bile duct obstruction, but there is rapid attenuation and narrowing of the smaller intrahepatic bile ducts. Cholecystec-tomy does not improve the clinical course of ABC.

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

We have studied five long-term survivors of allogeneic bone marrow transplantation. All exhibited prolonged serum biochemical evidence of hepatic dysfunction during 2− to S-year periods of follow-up. Two patients developed chronic cholestasis without pruritus. The serum of a third patient became chronically positive for HBsAg. A fourth patient developed an acute hepatitic syndrome and high titers of antibody to cytomegalovirus. Nuclear, mitochondrial, and smooth muscle antibodies were not detected. Seven liver biopsies, obtained from three of the patients, all revealed a hepatocellular necroinflammatory lesion suggestive of chronic active hepatitis, a paucity of interlobular bile ducts, and intrahepatic cholestasis. Possible etiologies for these hepatic changes include reactivation of chronic non-A, non-B hepatitis and chronic graft-versus-host disease perse. Our study emphasizes the diagnostic problems posed by hepatic dysfunction occurring in an immunosuppressed multiply-transfused patient after bone marrow transplantation.

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

We prospectively investigated the possibility that type B hepatitis might be transmitted during fiberoptic endoscopy from hepatitis B surface antigen (HBsAg)-positive patients to others subsequently endoscoped. All 186 patients having upper gastrointestinal endoscopy during a 6-month period at the Washington, D.C., Veterans Administration Medical Center had a blood sample obtained at the time of the procedure. Three patients were found to be HBsAg-positive and 45 others to have either antibody to HBsAg (anti-HBs) or antibody to hepatitis B core antigen (anti-HBc). Follow-up evaluation for evidence of type B hepatitis and hepatitis B virus infection was possible in only 76% of patients. One patient developed type B hepatitis. This patient's endoscopy did not follow endoscopy of any known HBsAg-positive individual, but he had received five units of blood 5 months before hepatitis developed. No other patient showed clinical, biochemical, or serologic evidence of hepatitis during the follow-up period. These data suggest that transmission of type B hepatitis during fiberoptic endoscopy is rare, if it occurs at all, and support the current policy of not sterilizing the fiberoptic endoscope between procedures and of not routinely screening patients for HBsAg.

ISSN:0192-0790    

出版商:OVID    

年代:1980

数据来源: OVID