摘要:

The implications of selective liver atrophy in the management of hepatobiliary disease have only recently been recognised and discussed. This editorial focuses on clinical aspects of liver atrophy together with some relevant experimental data.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A re-examination of the anatomic, clinical, and radiologic criteria by which Crohn's disease and ulcerative colitis are currently distinguished suggests that they may be a variant of a single disease, probably with one etiology and differing modes of expression. The many similarities between ulcerative colitis and Crohn's disease and their etiologic and behavioral distinctions from other inflammatory intestinal diseases further support this position.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Information on the occurrence of colon cancer, as with other cancers, has historically been meager. Indeed, accurate information at its current frequency, through cancer registries, has only relatively recently become available. The disease is certainly rare in rural, less developed populations. In urban populations in transition and in developed populations, however, its epidemiology presents many puzzles. In both contexts, some rates are higher and others are lower than would be expected. This points to the existence and operation of as-yet-undefined promotive and inhibiting factors. Uncertainties as to the identity and weight of risk factors thus complicate the task of seeking to prevent or to ameliorate the disease. Apart from genetic influences, it is possible that factors such as the chemistry and microbiology of the gastrointestinal tract, the proportion of resistant starch reaching the large bowel, and the fecal pH of digestra during its traverse are among the determinants.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Following a multicenter, double-blind trial comparing ci-metidine, antacid, and placebo for the treatment of gastric ulcer, patients whose ulcers had healed were followed prospectively to assess the frequency of ulcer relapse. Fifty-eight patients entered the follow-up study. Patients were encouraged to discontinue smoking and excessive ethanol intake, but were not maintained on antiulcer medications. Clinical evaluation was performed at monthly intervals; repeat en-doscopy was performed at the time of symptom recurrence or at 6 to 9 months after ulcer healing. Gastric ulcer recurred in 20 of 58 patients (35%). While 15 (75%) with ulcer recurrence had symptoms, 5 (25%) had asymptomatic recurrences. There were no differences in the incidence of ulcer relapse or symptom recurrences between groups. We conclude that gastric ulcers recur in approximately one-third of patients within 9 months of ulcer healing.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Hypoxemia during esophagogastroduodenoscopy (EGD), or panendoscopy has been generally attributed to sedation. We studied 49 patients ranging in age from 17 to 71 years with normal or nearly normal lung function undergoing EGD to determine the effects of sedation and the effects of the endoscope on arterial oxygen saturation (SaO2). All patients received intravenous diazepam and 41 also received meperidine. EGD was delayed 10.7 ± 7.5 min after intravenous diazepam administration in the 42 group 1 patients. Seven patients underwent EGD within 2 min of receiving intravenous diazepam (group 2). Ventilation decreased after diazepam, recovered, then decreased immediately after endoscope insertion in the group 1 patients. Periods of hypopnea, up to 39 s long, were observed during EGD. The average decrease in SaO2was 4.0% after diazepam (p < 0.0001). SaO2returned to the pre-EGD level, then decreased 2.4% during EGD (p < 0.0005). Maximum SaO2decrease occurred 27 ± 6 s after insertion of the endoscope then rapidly recovered. There was a linear correlation between the duration of hypopnea and maximum SaO2decrease (r = 0.84, p < 0.001). All group 2 patients experienced a period of hypopnea (13.3 ± 9.6 s) and SaO2declined 9.0%. The SaO2decline was significantly greater in the group 2 subjects (p < 0.0001). Our results confirm previous findings that intravenous sedation causes hypoventilation and hypoxemia. Moreover, hypoventilation and further arterial oxygen desaturation are caused by either the mechanical effect of the endoscope or a reflex stimulated by it.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Five patients with patches of gastric fundal type columnar epithelium in the proximal esophagus at the level of the upper esophageal sphincter diagnosed by upper endoscopy underwent99mTc-pertechnetate scintigraphy (TcO-4). In all instances, the patches contained both chief cells and mucus-secreting cells. One patient had dysphagia localized to the area of columnar epithelium. Two cases of heterotopic gastric mucosa in the upper esophagus (HGM-UE) were demonstrated by TcO-4. In both, thyroid uptake was absent due to complete suppression of thyroid function by thyroid hormone supplements. TcO-4accumulated in thyroid glands of the other three patients, causing overlapping activity between the thyroid gland and HGM-UE. TcO-4scintigraphy is suitable for the detection of HGM-UE only in those patients who have had a total thyroidectomy or are on suppressive thyroid therapy.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Some patients with hypergastrinemic achlorhydria may have false-positive secretin provocation as an exaggeration of the normal gastrin response to secretin, presumably related to an increased, or more responsive, antral G-cell mass. To test this hypothesis, we reviewed our experience with secretin provocation in normogastrinemic subjects with presumed normal antral G-cell mass (normal—17, duodenal ulcer—13) and in patients with hypergastrinemia related to changes in antral G-cells (vagotomy—5, hypochlorhydria—7, achlorhydria—10). Basal serum gastrin (mean ± SEM) was progressively higher for each group; normal (42 ± 3 pg/ml), duodenal ulcer (53 ± 4 pg/ml), vagotomy (226 ± 54 pg/ml), hypochlorhydria (346 ± 92 pg/ml), achlorhydria (844 ± 100 pg/ml). On selective analysis of only those with gastrin rises, significant differences (p < 0.05) in peak gastrin change were found between achlorhydria (93 ±21 pg/ml) compared with all other groups and between hypochlorhydria (40 ± 12 pg/ ml) versus normal (6 ± 1 pg/ml). Linear regression in these responders showed a significant correlation (p < 0.001) between basal gastrin and peak gastrin change after secretin. There were no false-positive secretin provocation tests, but four achlorhydric patients had gastrin rises >100 pg/ml, whereas no patient in the other categories had rises above 90 pg/ml. Our results support the concept that patients with hypergastrinemic achlorhydria tend to have greater G-cell responsiveness to secretin provocation, which may account for the false-positive results in some such patients.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We have attempted to elucidate the “natural history” of ulcerative colitis by studying the placebo groups of 11 controlled trials of 185 patients with active disease. Most (182) of the patients were mild to moderately ill, but 3 had severe colitis. They were studied by endoscopic, pathologic, and/or clinical criteria and followed for 15–42 days. Up to 52% improved clinically and 59% sigmoidoscopically. Relapses commonly occurred within 2 months of these “spontaneous” improvements. In another six trials of 174 patients in remission receiving only placebo therapy (134 followed for 6 months and 40 for 12 months), up to 51% remained in remission. Favorable predictive factors for continued remission included a normal rectal mucosa on sigmoidoscopy, limited extent of colitis, and remission recently achieved by active therapy or maintained by therapy for at least 1 year before study entry. Thus, patients can get and stay better with no “specific” therapy. We have clarified advantageous predictive factors.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Morbidity and mortality from malignancies of the large intestine, in Canada, were examined for the periods 1970–1980 and 1941–1985, respectively. Age-standardized morbidity rates for males have increased significantly during the period studied (18.4 to 26.2 new cases per 100,000 population per year; p < 0.0001), with increases in morbidity being most attributable to significant increases in age-specific rates for males aged 45–54, 55–64, 65–74, and 75–84 years (p < 0.015). Standardized rates for females have also increased significantly (21.2 to 23.3 new cases per 100,000 population per year; p = 0.012) as was the case for age-specific rates in women aged 65–74, 75–84, and 85+ years, which have risen sharply (p < 0.015), whereas rates in women aged 25–34 and 35–44 years have declined significantly (p < 0.04). Significant reductions in female age-standardized mortality rates (17.0 to 10.2 deaths per 100,000 population per year; p < 0.0001) are attributable to significant declines in mortality for all of the eight age groups studied (p < 0.013). The significant reduction in male age-standardized mortality rates (14.2 to 13.3 deaths per 100,000 population per year; p = 0.04) is attributable to significant reductions in mortality for five of the eight age groups studied (0–24, 25–34, 35–44, and 45–54 years)—rates for males aged 85+, however, have increased significantly (p < 0.0001).

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Ascitic fluid from nine patients with nonmalignant ascites and nine patients with malignant ascites was subjected to isoamylase analysis. Unusual isoamylase bands that migrate to the anode were demonstrated in seven of eight patients with ovarian carcinoma and in one patient with gastric carcinoma. In no case of nonmalignant ascites was anodic isoamylase found, despite the presence of normal amylase in all samples. This is the first report of anodic isoamylase from ascitic fluid in gastric carcinoma and the first series comparing isoamylase patterns in malignant and nonmalignant ascites. Anodic isoamylase on electrophoresis of ascitic fluid may prove to be useful as a tumor marker in differentiating selected malignancies from nonmalignant ascites.

ISSN:0192-0790    

出版商:OVID    

年代:1989

数据来源: OVID