ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Effective therapy for primary biliary cirrhosis is lacking but not for want of appropriate immunosuppressive, antifibrotic, and cupruretic agents. A consensus as to which agent, if any, to use has not been reached. Recent studies suggest that ursodeoxycholate may be both safe and effective. However, the long-term response to this hydrophilic bile acid is still unknown.

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The records of 79 patients admitted to the hospital from January 1985 through December 1990 for acute esophageal hemorrhage were analyzed to determine the influence of liver disease and/or portal hypertension on the severity of bleeding from Mallory-Weiss syndrome. Forty- two patients had bled from Mallory-Weiss syndrome; 8 had liver disease and nonbleeding esophageal varices, 6 had liver disease without varices, and 28 had no evidence of liver disease. The severity of bleeding was determined by the transfusion requirement for each group. The number of units of blood needed for patients with liver disease was significantly increased (p < 0.005) over the number of units necessary for patients without liver disease. There was no statistically significant difference in the transfusion requirement between liver disease patients with and without varices (i.e., portal hypertension). The transfusion requirement was also unrelated to the Child classification of hepatic functional reserve. We conclude that the severity of bleeding from Mallory-Weiss syndrome is primarily related to the status of liver function and that portal hypertension does not make an additive contribution.

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Four patients with an established diagnosis of Cowden's disease underwent barium meal study, upper gastrointestinal endoscopy, barium enema examination, and colonoscopy. In three, the esophagus was affected by small protrusions, which were diagnosed as glycogenic acanthosis. Numerous hyperplastic polyps were found in the stomach in three patients, and in one an inflammatory fibroid polyp was also detected. Either lymphangiectasia or lymphoid polyps were found in the duodenum in two patients. In all patients, the colon showed polyps that varied in histology and included adenoma, hamartomatous polyp, and ganglioneurofibroma. In addition, jejunal lymphangiomas were found in one of the three patients in whom the small intestine could be precisely evaluated. These findings suggest that the gastrointestinal involvement in Cowden's disease is characterized by various benign lesions, especially esophageal glycogenic acanthosis, numerous gastric hyperplastic polyps, and multiple hamartomatous polyps in the rectosigmoid colon. Detection of these gastrointestinal manifestations may lead to early diagnosis of this potentially malignant disease.

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We evaluated a standardized colonic air insufflation test in patients investigated for abdominal pain; 195 patients were evaluable. Of 164 patients with functional abdominal pain, 100 of the 128 (78%) with irritable bowel syndrome diagnosed on the basis of two or more Manning criteria (group A) had positive tests, compared with 19 of the 36 (53%) with functional abdominal pain not satisfying the diagnostic criteria for irritable bowel syndrome (group B). Eight of the 10 patients (80%) with structural colonic disease had positive tests (group C), and 3 of the 21 patients (14%) with structural noncolonic causes of abdominal pain (group D) had positive tests (group A vs. B, A vs. D, and C vs. D, p < 0.01). The air insufflation test had a sensitivity of 78% for the diagnosis of colonic pain and a specificity of 61%. The positive predictive value was 83% and the negative predictive value 54%. Sequential tests by two independent observers on 26 consecutive patients showed no inter- observer variation. The colonic air insufflation test warrants further evaluation as an adjunct to the Manning criteria in the diagnosis of irritable bowel syndrome. It can also serve as an investigative tool to define a subset of patients with functional abdominal pain who do not fulfill the current criteria for irritable bowel syndrome yet whose pain actually originates from the colon.

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We analyzed retrospectively the characteristics of 87 patients with ulcerative colitis seen in a tertiary care center in north India. Ulcerative colitis was diagnosed on the basis of clinical features, sigmoidoscopy, rectal biopsy, and exclusion of microbiological causes of colitis. Severe clinical disease was seen in 53 (60%) patients that correlated with extensive colonic involvement (p < 0.001), severe changes on sigmoidoscopy (p < 0.001) and histology (p < 0.001), erythrocyte sedimentation rate (ESR) of > 30 mm for the first hour, and serum albumin of < 3 g/dl (p < 0.001). Remission of the disease was maintained on sulfasalazine in 18 (20.7%) patients, whereas 47 (54%) required steroids. Proctocolectomy with il- eoanal anastomosis was done in 22 (25.3%) patients in whom there was poor response to medical treatment. Postoperative complications were seen in seven (31.8%) patients, and death occurred in four (18.1%) patients. Ulcerative colitis thus commonly presents as severe disease, with the majority of patients requiring surgery due to poor response to medical therapy. This pattern of disease as seen in an academic referral hospital in north India is virtually indistinguishable from that seen in similar centers in the West. However, in our setting, proctocolectomy nd ileoanal anastomosis is cost-effective in patients unresponsive to, or unable to afford, drug treatment.

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We retrospectively investigated the annual incidence and prevalence of inflammatory bowel disease (IBD) from 1981 to 1988 in an urban and a rural area of central Spain. Two hundred and eighty-one patients presented with IBD; 193 ulcerative colitis (UC) and 88 Crohn's disease (CD) (prevalence 43.4/100,000 and 19.8/100,000, respectively). Of these patients, 168 were diagnosed for the first time during the study period. One hundred and eleven UC and 57 CD (incidence 3.16/100,000 and 1.61/ 100,000 respectively). Within the urban area, the UC incidence was 3.15/100,000 and the CD 1.87/100,000. In the rural area, the incidence for the UC was 3.25/ 100,000 and 0.86/100,000 for the CD. No sex differences were found. The incidence rates have increased significantly (p < 0.05) for CD in the study period. However, for UC rates did not change. During 1986–1988, the patient's age at the time of diagnosis was significantly lower than that of 1981–1983 (p < 0.05).

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We studied a new enteric-coated pancreatic extract with very high lipase content in 12 patients with Steatorrhea due to chronic pancreatitis. Fecal fat was measured under standard dietary conditions (100 g lipid/day) with no enzyme supplementation and during treatment with 75,000, 150,000, or 225,000 IU of lipase per day. The median fecal fat output (g/day) was significantly (p < 0.005) lower after each increase in dosage: basal, 20.5 (range, 10.3–92.2); 3 cps/day at meals, 13.3 (6.4–38.2); 6 cps/day, 9.9 (4.8–31.4); 9 cps/day, 7.3 (2.6–17.3). For the five patients with a basal fecal fat output of < 15 g/day, Steatorrhea was totally corrected by 3 cps a day. Of the seven patients with more severe Steatorrhea, the fecal fat output of only two was not normalized with the highest dose of 9 cps/day: for one it was reduced to 13.3 g/day from a basal of 92.2 g/day and for the other to 17.3 g/day from 25.4 g/day. This pilot study demonstrates that the tested pancreatic extract very effectively corrects pancreatic Steatorrhea in a simple low-dose regimen. Good compliance can be expected.

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We report on three patients with symptomatic, anicteric, and noncirrhotic primary biliary cirrhosis (Ludwig histological stage III at first liver biopsy) who were treated orally with 600 mg/day of ursodeoxycholic acid (UDCA) for more than 4 years. Follow-up liver biopsy was performed twice (at 1–3 and 4–6 years) during treatment. In all cases, during the whole period of up to 4–6 years of UDCA treatment, transaminase, alkaline phospha- tase, and γ-glutamyltranspeptidase levels improved, remaining at subnormal levels compared with pretreatment levels. Moreover, histological stage did not change throughout the UDCA treatment of up to 6 years. The second liver biopsy (at 1–3 years) revealed decreased lymphocytic infiltration in all cases, and bridging fibrosis was decreased in two cases. However, in the third biopsy at 4–6 years, portal inflammation was increased in one case without fibrotic progression; in the other two cases, bridging fibrosis was slightly worsened without portal inflammatory progression. In summary, these three cases show that liver histology was found to be improved, as were blood chemistry and pruritus, during short-term UDCA treatment, but histology results were slightly worse after long-term treatment despite the sustained improvement in biochemistry and pruritus.

ISSN:0192-0790    

出版商:OVID    

年代:1994

数据来源: OVID