ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The role of specific pathological findings in the upper gastrointestinal tract in chronic renal failure remains uncertain. Most of the studies were conducted in the West, and the number of subjects was small. We have tried to look at that problem in Taiwan. Endoscopy to evaluate the source of upper gastrointestinal hemorrhage was performed in 698 patients over a 37-month period; that represents 4.4% of all patients undergoing upper gastrointestinal endoscopy for miscellaneous reasons in that time span. Fifty-eight patients (8.3%) who had been hemodialyzed for chronic renal failure were selected, as were 640 control patients who did not have renal failure. Patients with renal transplant were not included. Endoscopic diagnoses, contributing factors of bleeding, and the course and outcome of the hospitalization were analyzed. χ2Test with or without Yates' correction and Student'sttest were used as appropriate. Erosive gastritis was the most frequent source of bleeding in patients with chronic renal failure. Erosive gastritis (p < 0.005), erosive esophagitis (p < 0.001), and esophageal ulcer (p < 0.005) were significantly more common causes of bleeding in the renal failure population than in the group without renal failure. The two groups did not differ significantly (p > 0.05) in smoking, heavy alcohol intake, or use of ulcerogenic medications. The age was older (64.1 ± 11.4 vs. 55.7 ± 16.2 years) and the mortality rate higher (13% vs. 2%) in patients with renal failure than in those without. The differential diagnoses of upper gastrointestinal bleeding sites differ in patients with and without chronic renal failure; they are divers. However, erosive gastritis, rather than gastric ulcer or doudenal ulcer, is the most common cause in the patients with renal failure. The mortality rate is significantly higher in these patients than in the general population.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Acute segmental enteritis, also called “enteritis necroticans” is characterized by nonocclusive intestinal ischemia in the absence of any precipitating cause. We studied 30 such patients over a 5.5-year period. All patients had acute abdominal symptoms requiring emergency laparotomy, and in only 30% was a preoperative diagnosis of segmental enteritis proposed. The jejunum alone (63.3%), or with the ileum (26.7%), was the most common site of necrotic patches (86.7%), frank gangrene (50.0%), free perforation (36.7%), and circumferential dusky lesions (30.0%). Twenty-eight patients required resection of the affected bowel. Specimen angiography in two cases showed normal mesenteric vasculature. In 12 patients, a detailed microbiological profile from peritoneal fluid, intestinal contents, and intestinal wall was performed, butClostridium welchiiwas isolated from none. The resected intestinal specimens showed mucosal ulceration, submucosal edema, mixed inflammatory infiltrate, and patchy necrosis of the muscularis propria. The intramural vessels were patent in all cases. Wound-related complications occurred in 14, pulmonary complications in 14, renal failure in eight, and fecal fistulas in five; 23.3% died.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Chronic diarrhea is a common clinical problem. To determine the possible causes in North India, we studied prospectively 71 patients with chronic diarrhea of the large bowel type. A definite diagnosis could be established in 70 patients. Ulcerative colitis was found in 18 patients, colorectal malignancies in three, colonic polyps in three, and irritable bowel syndrome in 32. In addition, seven patients with seronegative polyarthritis and chronic diarrhea were found to have chronic inflammation of the colon on histology. Two patients had pseudodiarrhea, and no diagnosis could be established in one patient. The remaining five patients with chronic diarrhea showed histologic evidence of chronic colonic inflammation with predominantly mononuclear cell infiltration of the lamina propria and increased intraepithelial lymphocytes, but results of their radiologic and endoscopic studies were normal. These five patients were classified as having microscopic (lymphocytic) colitis. We conclude that the causes of chronic diarrhea in North Indian patients are similar to a large extent to those seen in Western populations. Microscopic (lymphocytic) colitis is a definite clinicopathologic entity that should be considered in the differential diagnosis of chronic diarrhea.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Hereditary pancreatitis is characterized by an autosomaldominant mode of inheritance with incomplete penetrance, onset of symptoms in childhood or early adolescence (mean age of onset ≈ 13 years), and an approximately equal sex incidence. Pancreas divisum is a congenital variant of pancreatic ductal anatomy in which the ventral and dorsal pancreatic ductal systems fail to fuse, so that two functional papillae drain the exocrine secretions of the pancreas. In recent years, several reports of pancreatitis associated with pancreas divisum in children have appeared. We now report a family in which the mother, son, and daughter all had presented with recurrent pancreatitis from an early age. Both the mother and son have endoscopic retrograde cholangiopancreatography-documented pancreas divisum, whereas the daughter has a stricture in her distal pancreatic duct. To our knowledge, this is the first such report of “familial” pancreas divisum. The implications of these findings in the setting of hereditary pancreatitis highlight the controversial issues of the clinical significance of pancreas divisum and the appropriateness of surgical therapy.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Thirty patients ≥80 years of age (mean 86) underwent diagnostic and/or therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The low mortality (6.6%) and complication (6.6%) rates lead us to believe that ERCP in octogenarians provides an acceptable route for diagnosis and treatment of biliary and pancreatic disorders.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Dietary intake and plasma lipids were estimated in 200 patients with gallstones and 98 control subjects from a hospital in Northern India and were matched for age, sex, and social class. The intake of total calories and carbohydrates and the plasma triglyceride values were higher in all gallstone patients as compared with controls (p < 0.05 and p < 0.01, respectively). The dietary intake of refined carbohydrates was higher than in controls, but only in the female patients with gallstones (35.6 ± 32.9 g/day compared with 24.5 ± 11.8 g/day; p < 0.001). By contrast, the male patients with gallstones had an increased intake of fat (patients 79.0 ± 38.1 g/day vs. controls 60.2 ± 24.3 g/day; p < 0.05) and had increased plasma cholesterol values (patients 166.4 ± 54.2 mg/dl vs. controls 140.3 ± 32.8 mg/dl; p < 0.01). Such sex differences in the dietary intake and plasma lipid values may form a special feature of gallstone disease in Northern India and should be studied further.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Splenomegaly is obvious in portal hypertension, but controversy still exists over the relationship between splenic size or size of esophageal varices. Previous methods to assess spleen size are less accurate than ultrasonic estimation of spleen size by splenic volumetric index (SVI). In a prospective study, we evaluated 101 consecutive patients with portal hypertension for spleen size measured ultrasonically by SVI, presence and size of esophageal varices, and etiology of portal hypertension. A total of 219 age-matched controls were evaluated ultrasonically to define a normal SVI. Splenomegaly defined by 1 or 2 standard deviations of normal SVI had high accuracy in predicting portal hypertension, presence of esophageal varices, and provided a clue to the etiology of portal hypertension. However, there was no correlation between spleen size and size of esophageal varices.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The pathophysiology of ascites in patients with cirrhosis is complex and includes increases in hepatic sinusoidal pressure, the formation of hepatic and splanchnic lymph, renal sodium retention, and hypoalbuminemia. However, the role of hypoalbuminemia in ascites formation is controversial. Evaluating ascites in hypoalbuminemic patients with nephrotic syndrome could add to our understanding of the role of hypoalbuminemia in ascites development. We conducted a retrospective analysis of 52 adults and 21 children with nephrotic syndrome who were hospitalized in the Hadassah University Hospital on Mount Scopus during 1981-1994. There was a significant difference in the prevalence of ascites between pediatric (52%) and adult patients (23%) (p = 0.024). Pediatric patients had lower serum albumin levels than adults (1.70 ± 0.08 g/dl vs. 2.10 ± 0.07 g/dl, p = 0.001). Adult patients with ascites had lower serum albumin levels than adult patients without ascites (1.80 ± 0.13 g/dl vs. 2.20 ± 0.07 g/dl, p = 0.01). This difference was not found in pediatric patients. Temporary fluctuations in liver enzymes (up to four times the upper limit of normal for transaminases) were evident in five patients from the pediatric group with ascites, whereas all pediatric patients without ascites had completely normal liver enzymes (p = 0.035). Among the 12 adult patients with ascites, seven had liver disease (three with cirrhosis and four with amyloidosis), and two had right-sided congestive heart failure. Among the 40 adult patients without ascites, only four had liver disease (amyloidosis). The plasma albumin levels of the patients with amyloidosis without ascites were higher than patients with amyloidosis with ascites (1.90 ± 0.10 g/dl vs. 1.50 ± 0.07 g/dl, p = 0.03). Two patients with nephrotic syndrome and ascites (one without liver disease) had episodes of spontaneous bacterial peritonitis. Ascites in nephrotic syndrome is more common in children than in adults. Although in most pediatric patients ascites formation is probably a common manifestation of the general fluid retention, in most adult patients with nephrotic syndrome ascites can be attributed to both hypoalbuminemia and the presence of liver disease or congestive heart failure, with increased hepatic sinusoidal pressure.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Esophageal papillomas are rare. Both local irritation as by gastroesophageal reflux and infections with human papillomavirus (HPV) have been implicated as etiological factors. We here describe a 28-year-old female patient with massive esophageal papillomatosis. The clinical course has been mild, with signs of regression after a 3½-year observation period. An extensive evaluation showed no predisposing diseases, and test results for HPV using sensitive methods were negative despite histological features suggesting virus infection and concomitant pharyngeal papillomas that are known to be caused by HPV. This case underlines the incomplete understanding of the etiology of this disease.

ISSN:0192-0790    

出版商:OVID    

年代:1996

数据来源: OVID