ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Despite remarkable progress in the treatment of chronic peptic ulcer disease, acute gastroduodenal ulcer hemorrhage remains a therapeutic challenge. Numerous trials of H-2 receptor antagonists have not consistently shown a significant benefit in such patients. Proton-pump inhibitors, which more profoundly suppress gastric acid, are being increasingly evaluated. We have performed a qualitative systematic review to analyze the results of these trials to determine if a reasonable consensus can be reached. We searched for all published, randomized, controlled studies that evaluated proton-pump inhibitors in patients with acute peptic ulcer hemorrhage. The primary outcomes evaluated were: (A) persistent or recurrent bleeding; (B) need for surgery; and (C) mortality. Sixteen trials were evaluated, enrolling 3154 patients. Four of the sixteen studies showed a statistically significant decrease in overall rebleeding rate, and two described specific benefit in patients with Type IIa and IIb endoscopic stigmata. Four studies also showed a significantly decreased surgery rate, but none demonstrated a significant mortality reduction. Proton-pump inhibitors may improve outcome in acute peptic ulcer bleeding, but the available clinical data remain inconsistent. Further study is necessary to define the optimal dosage, route of administration, duration of therapy, and subsets of patients most likely to benefit.

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Since the introduction of transjugular intrahepatic portosystemic shunt (TIPS) 10 years ago, it has been used increasingly in the management of portal hypertension and its complications. TIPS is now considered the procedure of choice for management of refractory variceal bleeding. Its role in the management of refractory ascites, hepatic hydrothorax, hepatorenal syndrome, and hepatopulmonary syndrome still awaits further prospective studies. The two main complications of TIPS are hepatic encephalopathy and shunt malfunction. Generally, TIPS stenosis or occlusion is a major drawback requiring routine surveillance of TIPS with doppler ultrasound. Venography with balloon dilation of the stent or placement of serial or parallel stents may be required in some cases. Promising modalities of preventing TIPS malfunction (e.g., brachytherapy, covered stents, or anti-platelet derived growth factor) are currently being investigated.

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Reduced serum vitamin B12(cobalamin) levels have been documented occasionally during long-term treatment with a proton pump inhibitor (PPI) in selected groups of patients. This has largely been confined to patients being treated for Zollinger-Ellison syndrome who have sustained drug-induced achlorhydria, which does not ordinarily occur during treatment with a PPI. An appreciation of normal cobalamin metabolism and the pharmacological action of the PPIs adequately explain the mechanism for this reduction. PPIs do not promote the development of pernicious anemia.

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Pediatric feeding disorders are common: 25% of children are reported to present with some form of feeding disorder. This number increases to 80% in developmentally delayed children. Consequences of feeding disorders can be severe, including growth failure, susceptibility to chronic illness, and even death. Feeding disorders occur in children who are healthy, who have gastrointestinal disorders, and in those with special needs. Most feeding disorders have underlying organic causes. However, overwhelming evidence indicates that abnormal feeding patterns are not solely due to organic impairment. As such, feeding disorders should be conceptualized on a continuum between psycho-social and organic factors. Disordered feeding in a child is seldom limited to the child alone; it also is a family problem. Assessment and treatment are best conducted by an interdisciplinary team of professionals. At minimum, the team should include a gastroenterologist, nutritionist, behavioral psychologist, and occupational and/or speech therapist. Intervention should be comprehensive and include treatment of the medical condition, behavioral modification to alter the child's inappropriate learned feeding patterns, and parent education and training in appropriate parenting and feeding skills. A majority of feeding problems can be resolved or greatly improved through medical, oromotor, and behavioral therapy. Behavioral feeding strategies have been applied successfully even in organically mediated feeding disorders. To avoid iatrogenic feeding problems, initial attempts to achieve nutritional goals in malnourished children should be via the oral route. The need for exclusive tube feedings should be minimized

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Endogenously formed nitrogen and oxygen free radicals are believed to be involved in human cancer etiology. Plasma nitrate/nitrite originates from endogenous nitric oxide production in fasting humans, decrease in superoxide scavenger activity (SSA), and free sulfhydryl groups (SH) reflects the amount of superoxide anion generated, and nitrotyrosine is believed to be formed by the interaction of tyrosine and peroxynitrite in vivo. The aim of the current study was to measure plasma nitrate/nitrite, SSA, and SH in 69 patients (mean age ± standard deviation, 66 ± 11 years) with colorectal carcinoma. Nitrotyrosine was measured from both the plasma and tumor tissues in 32 patients. All patients had adenocarcinoma of the colon or rectum. Twenty-five patients were classified as stage B according to Dukes classification as modified by Astler-Coller, 13 were classified as stage C, and 31 patients were classified as stage D. To determine whether the changes are specific for colorectal cancer, 20 patients with active inflammatory bowel disease (IBD; mean age, 52 ± 18 years) and 30 healthy volunteers, who served as control subjects (mean age, 48 ± 11 years), were studied. Plasma nitrate/nitrite was measured by the modified Griess method, SSA was measured by an electron/spin resonance spin trapping method, free SH was measured by Ellman's method, and the presence of nitrotyrosine in the plasma and tumor tissue was detected by high performance liquid chromatography (HPLC) using C-18-derivatized silica (5 μm) column (C18S, Crestpaque, New York, NY, USA) and at a wavelength of 274 nm. Patients with colorectal carcinoma and with active IBD had a significantly higher plasma nitrate/nitrite level (51.2 ± 26.2 μm and 56.0 ± 14.6 μm versus. 29.6 ± 6.3 μm;p< 0.01), and a lower SSA level (39 ± 11.5 U/g protein and 52.0 ± 18.9 U/g protein versus. 88 ± 25.1 U/g protein;p< 0.05) and SH level (7.7 ± 3.89 μm protein and 6.4 ± 2.1 μm protein versus. 10.9 ± 4.14 μm/mg protein;p< 0.01) than control subjects. A nitrotyrosine peak could be detected in 7 of 32 specimens of cancer tissue but not in biopsy samples obtained from patients with IBD, nor in the plasma. There was no difference in nitrate/nitrite, SSA, or SH levels between subgroups of cancer patients when sex, disease duration, tumor location, or therapy were considered. The elevated plasma nitrate/nitrite with lower plasma SSA and SH levels suggest a concomitant increase in nitrogen and oxygen free radical formation in cancer patients. This change is likely not specific for tumor formation because it can also be observed in other inflammatory conditions such as IBD. The presence of nitrotyrosine in the tumor tissue is the first evidence for the in vivo formation of peroxynitrite in colorectal carcinoma.

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Forty-five patients with systemic lupus erythematosus (SLE) underwent a cross-sectional study to evaluate intestinal secretory immunity. Peroral jejunal biopsy with histologic and immunohistochemical assessment of the mucosa were carried out in the patients and in 12 healthy volunteers. It was observed that an altered pattern of immunoglobulin-bearing plasma cells distributed in the lamina propria and complementary components were invariably present, mainly in the patients with active disease. The basement membrane of the intestinal crypt epithelium exhibited immunoglobulin and complementary deposits, similar to the lupus band test. None of the immunologic findings correlated with the medical treatment and with the peripheral blood analysis. The local changes in humoral immunity in patients with SLE did not correlate with gastrointestinal symptoms and may reflect the systemic effects of the disease.

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

To reconfirm that the duration of symptoms is not associated with esophageal motility in patients with gastroesophageal reflux disease (GERD), esophageal manometric data from 768 patients with GERD were retrospectively analyzed with relation to the duration of symptoms. GERD was defined by positive acid reflux test results monitored by ambulatory 24-hour pH monitoring. Correlation of the duration of symptoms with esophageal body pressures, the presence of dysmotility determined by simultaneous waves, average resting pressure of the lower esophageal sphincter (LES), and abdominal and overall lengths of the LES were statistically analyzed. The median duration of the symptoms was 60 months (range, 1-600). Duration of symptoms was not associated with contraction pressures of the esophageal body at 3 and 8 cm above the LES (r= −0.070 and −0.063, respectively). There was no correlation between LES pressures, LES lengths, or the percentage of simultaneous waves and duration of symptoms. Stricture formation is related to decreased distal esophageal function in GERD patients. In conclusion, the duration of GERD has little influence on esophageal body and LES function.

ISSN:0192-0790    

出版商:OVID    

年代:2000

数据来源: OVID