93 research outputs found
Relation of gallbladder function and Helicobacter pylori infection to gastric mucosa inflammation in patients with symptomatic cholecystolithiasis
Background. Inflammatory alterations of the gastric mucosa are commonly caused by Helicobacter pylori (Hp) infection in patients with symptomatic gallstone disease. However, the additional pathogenetic role of an impaired gallbladder function leading to an increased alkaline duodenogastric reflux is controversially discussed. Aim:To investigate the relation of gallbladder function and Hp infection to gastric mucosa inflammation in patients with symptomatic gallstones prior to cholecystectomy. Patients: Seventy-three patients with symptomatic gallstones were studied by endoscopy and Hp testing. Methods: Gastritis classification was performed according to the updated Sydney System and gallbladder function was determined by total lipid concentration of gallbladder bile collected during mainly laparoscopic cholecystectomy. Results: Fifteen patients revealed no, 39 patients mild, and 19 moderate to marked gastritis. No significant differences for bile salts, phospholipids, cholesterol, or total lipids in gallbladder bile were found between these three groups of patients. However, while only 1 out of 54 (< 2%) patients with mild or no gastritis was found histologically positive for Hp, this infection could be detected in 14 (74%) out of 19 patients with moderate to marked gastritis. Conclusion: Moderate to marked gastric mucosa inflammation in gallstone patients is mainly caused by Hp infection, whereas gallbladder function is not related to the degree of gastritis. Thus, an increased alkaline duodenogastric reflux in gallstone patients seems to be of limited pathophysiological relevance. Copyright (c) 2006 S. Karger AG, Basel
Combined sedation with midazolam/propofol for gastrointestinal endoscopy in elderly patients
<p>Abstract</p> <p>Background</p> <p>Although gastrointestinal endoscopy with sedation is increasingly performed in elderly patients, data on combined sedation with midazolam/propofol are very limited for this age group.</p> <p>Methods</p> <p>We retrospectively analyzed 454 endoscopic procedures in 347 hospitalized patients ≥ 70 years who had received combined sedation with midazolam/propofol. 513 endoscopic procedures in 397 hospitalized patients < 70 years during the observation period served as controls. Characteristics of endoscopic procedures, co-morbidity, complications and mortality were compared.</p> <p>Results</p> <p>Elderly patients had a higher level of co-morbidity and needed lower mean propofol doses for sedation. We observed no major complication and no difference in the number of minor complications. The procedure-associated mortality was 0%; the 28-day mortality was significantly higher in the elderly (2.9% vs. 1.0%).</p> <p>Conclusions</p> <p>In this study on elderly patients with high level co-morbidity, a favourable safety profile was observed for a combined sedation with midazolam/propofol with a higher sensitivity to propofol in the elderly.</p
Systematic review for non-surgical interventions for the management of late radiation proctitis
Chronic radiation proctitis produces a range of clinical symptoms for which there is currently no recommended standard management. The aim of this review was to identify the various non-surgical treatment options for the management of late chronic radiation proctitis and evaluate the evidence for their efficacy. Synonyms for radiation therapy and for the spectrum of lower gastrointestinal radiation toxicity were combined in an extensive search strategy and applied to a range of databases. The included studies were those that involved interventions for the non-surgical management of late radiation proctitis. Sixty-three studies were identified that met the inclusion criteria, including six randomised controlled trials that described the effects of anti-inflammatory agents in combination, rectal steroids alone, rectal sucralfate, short chain fatty acid enemas and different types of thermal therapy. However, these studies could not be compared. If the management of late radiation proctitis is to become evidence based, then, in view of its episodic and variable nature, placebo controlled studies need to be conducted to clarify which therapeutic options should be recommended. From the current data, although certain interventions look promising and may be effective, one small or modest sized study, even if well-conducted, is insufficient to implement changes in practice. In order to increase recruitment to trials, a national register of cases with established late radiation toxicity would facilitate multi-centre trials with specific entry criteria, formal baseline and therapeutic assessments providing standardised outcome data
THERAPY OF ACUTE-PANCREATITIS WITH SOMATOSTATIN
Background: The various conservative measures which have been used to
date in the treatment of acute pancreatitis have not proven helpful.
However, somatostatin appears to have a favourable effect on the course
and outcome of this potentially lethal disease. Method and results:
Experiments in animals have shown that somatostatin prevents
experimentally induced acute pancreatitis and lowers the mortality rate
of established pancreatitis. In human acute pancreatitis, somatostatin
reduces gastric and pancreatic secretions; it reduces the local
complication rate and shortens hospitalization. The effect of
somatostatin on the mortality rate of acute pancreatitis has not been
demonstrated in isolated studies, although a meta-analysis of randomized
controlled trials has shown a mortality rate of 6.2% in the
somatostatin-treated group versus 14.0% in the placebo-treated group.
The synthetic analogue of somatostatin, octreotide, is an effective
treatment for established local complication of acute pancreatitis, such
as pancreatic fistulae and pseudocysts. Conclusion: It is suggested that
large-scale, carefully designed multicentre studies of somatostatin are
needed if the beneficial effects of this drug on the course and outcome
of acute pancreatitis are to be evaluated
COMPLEX CARBOHYDRATE MALABSORPTION IN EXOCRINE PANCREATIC INSUFFICIENCY
The magnitude of complex carbohydrate malabsorption in exocrine
pancreatic insufficiency has not been well quantified in the past. The
quantity of carbohydrate malabsorbed after a rice starch (100 g) meal in
20 patients with chronic pancreatitis (n=10) or pancreatic cancer (n=10)
was therefore estimated. Patients had a three day stool fat collection
(80 g/24 hour fat intake), a lactulose (20 g), and a rice flour (100 g)
breath hydrogen test. Normal controls (n=29) had a postprandial H-2
increase less-than-or-equal-to 14 ppm and malabsorbed (mean (SEM)) 1.12
(0.44) (range 0-11.10) g of the 100 g of carbohydrate ingested. Patients
malabsorbed significantly more carbohydrate (11-36 (2-23) (range
8.90-32.60) g, F1,47= 29.92, p<0.001). The number of patients with fat
(>7 g, n=8) or carbohydrate (increase in H-2 greater-than-or-equal-to 20
ppm, n=10) malabsorption was not different (chi2=0.10, p=0.75). There
was a significant correlation between faecal fat and amount of
malabsorbed carbohydrate (r=0.60, F1,17=9.70, p=0.006) and faecal fat
and stool wet weight (r=0.57, Ft,18=8-67, p<0.009), but not between
stool wet weight and amount of malabsorbed carbohydrate (r=0.28,
F1,17=1.45, p=0.25). Although patients with exocrine pancreatic
insufficiency malabsorb 10%-30% of the ingested complex carbohydrate,
the main determinant of stool wet weight could be faecal fat
An introductory course for training in endoscopy
Endoscopy practice must respect the ethical aspects of medicine, and the
principles of humanism must be reinforced when teaching endoscopy. A
well-organized, structured training is essential if we are to ensure
that procedures are performed in a safe and effective manner. The most
difficult period of training is with the novice endoscopist, so we
recommend the introduction of a structured pre-endoscopy training
curriculum. This should ideally include introductory lectures and
courses, the use of didactic videotapes and training in endoscopy on a
computer-based simulator. We also advocate ‘train the trainers’
international courses to encourage a uniform approach to the teaching of
endoscopy. Their aim will be to educate skilled endoscopists in the
principles of teaching, which should be thoroughly grounded in the
ethics of our profession. Copyright (C) 2002 S. Karger AG, Basel
EFFECT OF FORCEPS SIZE AND MODE OF ORIENTATION ON ENDOSCOPIC SMALL-BOWEL BIOPSY EVALUATION
Endoscopy is increasingly being used to obtain duodenal biopsy specimens
in suspected small intestinal malabsorption. We have prospectively
evaluated the effect of standard and jumbo biopsy forceps, as well as
the mode of orientation of the specimens (naked eye or
stereomicroscopy), on duodenal biopsy weight, length, depth, and
orientation in 18 consecutive patients. A pair of biopsy specimens was
obtained from each patient by each type of forceps in random order.
After they had been weighed, one biopsy specimen from each pair was
oriented stereomicroscopically and all four were blindly evaluated by
two pathologists. The biopsy specimens obtained with the jumbo forceps
were significantly larger (15.9 +/- 6.9 mg, mean +/- SD) and longer (0.6
+ 0.2 cm) than those obtained with the standard forceps (8.0 +/- 1.3 mg,
0.4 +/- 0.2 cm, respectively; p < 0.001). Seventy-two percent of the
jumbo biopsy specimens that were oriented with stereomicroscopy included
a minimum of four villi in a row, as compared to 44% of the
eye-oriented jumbo specimens and less than 39% of the standard
specimens, irrespective of the mode of orientation (p = 0.02). These
results indicate that the jumbo forceps is superior to the standard,
because it produces a larger duodenal mucosal specimen, usually suitable
for optimal histologic evaluation when oriented with stereomicroscopy
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