Management of Gastric Varices

Upper gastrointestinal bleeding is one of the emergency conditions in the field of gastroenterology and variceal bleeding is the most common cause of it. Gastric varices accounts only 5% to 10% of all causes of upper gastrointestinal bleeding respectively, but it could be fatal and difficult to control despite provision of adequate therapy. Early diagnosis and appropriate management may decrease the morbidity and mortality of gastric variceal bleeding

Approach for Diagnostic and Treatment of Achalasia

Achalasia is a rare motor disorder of the esophagus and lower esophageal sphincter. The incidence is approximately 1/100,000 per year and the prevalence rate is 10/100,000. Achalasia is quite difficult to establishbecause the symptoms might be insidious and therefore not many people come to seek medical attention until it deteriorates to final stage of the disease. There are several modalities that can be used as diagnostic toolssuch as manometry, barium esophagogram, esophagoduodenoscopy, esophageal CT-scan, until the recent one, high-resolution manometry that can classify achalasia into three different types. The treatment options are the pharmacologic intervention, endoscopic treatment, minimal invasive surgery, and radical surgery.We reported a case of 20 year old female with achalasia who came with dysphagia symptom since three years before. The diagnosis was made by historytaking, physical examination and barium meal and esophagogastroduodenoscopy. The patient underwent pneumatic dilatation and since then the symptom was relieved

Management of Constipation

Constipation is the most ignored complaint by doctors and unfortunately, it requires urgent management due to the decreased quality of life. Most cases are functional constipation but there is also a great number of constipation due to organic abnormalities. In an attempt to manage the patient properly, we should put our emphasis on excellent knowledge of pathophysiology of constipation.By using the colonic transit time test, we could determine the type of constipation, which would have an effect on therapy. In most cases, constipation has a good response to high fiber diet and additional laxative medication and surgical therapy is seldom required unless complications have occurred. There is also a suggestion for preventing constipation may be caused by opioid USAge

Antibiotic Associated Diarrhea in Hospitalized Adult Patients

Background: Antibiotic associated diarrhea (AAD) occurs from the first initiation until 2 months of the end of antibiotic treatment. The aims of this study were to know the incidence of AAD, Clostridium difficile infection and other gastrointestinal symptoms in hospitalized adult patients.Method: The study is a cross sectional study. We studied the antibiotic associated diarrhea (AAD), Clostridium difficile infection and other gastrointestinal symptoms in patients who were admited in Cipto Mangunkusumo Hospital. Inclusion were male or female, age 18-75 years old, Patients started receiving antibiotics maximal 2 x 24 hours prior to hospitalization, gave written informed consent.Results: The incidence of AAD was 11.5%. The incidence of Clostridium difficile infection was 15.4%. The Upper gastrointestinal symptom was present on 20 (38.5%) patients. Lower abdominal symptom was present on 10 (19.2%) patients.Conclusion: The Incidence of AAD and Clostridium difficile infection were 11.5% and 15.4% respectively. The clinical manifestations of AAD were diarrhea, other upper and lower abdominal symptoms

Gamma-gamma directional correlation measurements in the decay of Ba133

The gamma rays following the electron capture decay of Ba133 have been studied using coincidence and directional correlation techniques. The existence of gamma rays with energies of 162 keV and 222 keV has been ascertained. The correlation functions for the 356 keV-82 kev, 302keV-82 keV, 80 keV-82 keV and 276 keV-162 keV cascades are found to be, respectively: W([theta]) = 1+(0.0331+/-0.0017)P2(cos [theta])+(0.0045+/-0.0033)P4(cos [theta]), W([theta]) = 1-(0.0238+/-0.0060)P2(cos [theta])+(0.0061+/-0.0089)P4(cos [theta]), W([theta]) = 1+(0.0319)+/-0.0045)P2(cos [theta])+(0.005+/-0.009)P4(cos [theta]), W([theta]) = 1-(0.328+/-0.009)P2(cos [theta])-(0.067+/-0.016)P4(cos [theta]).These results support the spin sequence of , for the ground state, 82, 162, 384 and 438 keV levels of Cs133. The measured mixing ratios of the following gamma rays are: 80 keV:(63+/-9)% E2+(37+/-9)% M1; 82keV: (97.6+/-0.1)% M1+(2.4+/-0.1)% E2; 162 keV: (95.1+/-0.6)% E2+(4.9+/-0.6)% M1; 276 keV: pure E2; 302 keV: (99.7+/-0.1)% M1+(0.3+/-0.1)% E2; 356 keV: pure E2.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32122/1/0000175.pd

Precision energy measurements of high energy gamma rays occuring in the decays of 46Sc, 82Br, 99Mo and 110Agm

Curved-crystal spectrometers have been utilized to determine the energies of 21 gamma rays following the decays of . Seventeen of these gamma ray have energies in the range between 550 keV and 1121 keV and thus provide a number of calibration standards which supplement the earlier standards published by Raeside and others.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34006/1/0000279.pd

Clinical Profile and Outcome of Non-Variceal Upper Gastrointestinal Bleeding in Relation to Timing of Endoscopic Procedure in Patients Undergoing Elective Endoscopy

Background: Endoscopy is the most accurate method for diagnosing the source of upper gastrointestinal bleeding. This study was aimed to evaluate the correlation between the timing of elective endoscopy and the length of hospital stay, the amount of transfusion given and incidence of recurrent bleeding or patient mortality. Method: A retrospective study was conducted in all patients with non-variceal upper gastrointestinal bleeding who had experienced elective endoscopy at Cipto Mangunkusumo Hospital between January 2007 and August 2008. Identification of clinical risk using clinical Rockall score was performed at the emergency room. Persistent bleeding, recurrent bleeding, surgical treatment and death were the outcome variables. Statistical analysis was performed using Chi-square/fisher exact test and linear regression. Results: There were 40 eligible cases with mean age of 53 ± 13 years; the greatest occurrence was at the age group of 50-59 years (12%), male (52.5%) and those who had clinical symptom of melena (52.5%). Twenty seven (67.5%) patients had Rockall score of 1-3 points and 13 (32.5%) had 4-6 points. There was only one patient who had adherent clots (Forrest grade II B). Endoscopy results revealed that the most common cause of bleeding was gastric ulcer, which occurred in 12 (30%) patients. There was no correlation between the timing of endoscopic procedures and outcome variable; however the length of hospital stay had a significant correlation with timing of endoscopic procedures. Conclusion: Elective endoscopy does not affect the variables of mortality and recurrent bleeding; however, it affects the length of hospital stay. Further prospective studies are required to find causal relation between them

Esophageal Varices Bleeding in Portal Hypertension Due to Portal Vein and Splenic Vein Obstruction

Based on its relation to the liver sinusoid, increased pressure of portal vein can occur at three levels: presinusoid, sinusoid ,and postsinusoid. Obstruction of the presinusoid veins can be caused by extra- hepatic condition such as venous thrombosis. We reported a case of portal hypertension with esophageal varices bleeding was a result of obstruction due to thrombosis of the splenic vein and portal vein under hypercoagulant conditions due to thrombocytosis. The management of esophageal varices was sclerotherapy while for overcome the thrombosis the patient was given hydroxy urea