Clinical Manifestations of Hereditary Hemorrhagic Telangiectasia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72156/1/j.1572-0241.1984.tb05137.x.pd

Lethal Pancreatitis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71898/1/j.1572-0241.1983.tb01296.x.pd

Provocation testing in noncardiac chest pain

The ability to reproduce chest pain and to identify the esophagus as the source of this pain are the major reasons why provocation testing has become standard in the evaluation of patients with noncardiac chest pain. Recent studies that challenge the validity of performing provocation tests have polarized experts into two camps: those who would abandon such testing because of its low sensitivity and low specificity, and those who would use testing judiciously because of moderate increases in diagnostic yield. Use of 24-hour pH and pressure testing has shown a high number of chest pain events associated with acid reflux in patients with positive cholinergic stimulation tests and esophageal dysmotility, as well as pain with esophageal dysmotility in patients with positive acid infusion tests. Mechanisms of esophageal chest pain are not known. All provocation agents can decrease coronary flow reserve (i.e., induce microvascular angina), thus raising the question of a cardiac source of pain even in patients with positive presumed esophageal provocation. Acid infusion, cholinergic stimulation, and balloon distention are discussed in light of 24-hour pH and pressure monitoring. Esophageal distention and the role of acid in inducing chest pain are emphasized. The role of stress, the use of defined stressors to induce chest pain, and altered pain perception as a final common pathway for chest pain are examined.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30039/1/0000407.pd

“Giant Colonic Bezoar”: A Medication Bezoar Due to Psyllium Seed Husks

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74894/1/j.1572-0241.1984.tb05167.x.pd

Supraventricular Tachycardia Induced by Swallowing: A Case Report and Review of the Literature

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71974/1/j.1540-8159.1987.tb05933.x.pd

Effect of Naproxen on Gastroesophageal Reflux and Esophageal Function: A Randomized, Double-Blind, Placebo-Controlled Study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75450/1/j.1572-0241.1995.tb09312.x.pd

Gastroduodenal Ulcerations in Patients Receiving Selective Hepatic Artery Infusion Chemotherapy

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72124/1/j.1572-0241.1985.tb02137.x.pd

Prolonged Effect of Omeprazole on the 14 C-Urea Breath Test

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73649/1/j.1572-0241.1996.tb08294.x.pd

Colonic xanthomatosis

We report two additional cases of colonic xanthomatosis associated with persistent rectal symptoms. Disordered colonic motility in the areas of lipid infiltration was documented in one patient. We conclude these lesions may have a pathophysiologic role in the alteration of intestinal motility which appears to be the cause of our patients' symptoms.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44405/1/10620_2005_Article_BF01537008.pd

Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas

Preoperative localization of pancreatic neuroendocrine tumors with traditional imaging fails in 40–60% of patients. Endoscopic ultrasound (EUS) is highly sensitive in the detection of these tumors. Previous reports included relatively few patients or required the collaboration of multiple centers. We report the results of EUS evaluation of 82 patients with pancreatic neuroendocrine tumors. METHODS : We prospectively used EUS early in the diagnostic evaluation of patients with biochemical or clinical evidence of neuroendocrine tumors. Patients had surgical confirmation of tumor localization or clinical follow-up of >1 yr. RESULTS : Eighty-two patients underwent 91 examinations (cases). Thirty patients had multiple endocrine neoplasia syndrome type I. One hundred pancreatic tumors were visualized by EUS in 54 different patients. The remaining 28 patients had no pancreatic tumor or an extrapancreatic tumor. Surgical/pathological confirmation was obtained in 75 patients. The mean tumor diameter was 1.51 cm and 71% of the tumors were ≤2.0 cm in diameter. Of the 54 explorations with surgical confirmation of a pancreatic tumor, EUS correctly localized the tumor in 50 patients (93%). Twenty-nine insulinomas, 18 gastrinomas, as well as one glucagonoma, one carcinoid tumor, and one somatostatinoma were localized. The most common site for tumor localization was the pancreatic head (46 patients). Most tumors were hypoechoic, homogenous, and had distinct margins. EUS of the pancreas was correctly negative in 20 of 21 patients (specificity, 95%). EUS was more accurate than angiography with or without stimulation testing (secretin for gastrinoma, calcium for insulinoma), transcutaneous ultrasound, and CT in those patients undergoing further imaging procedures. EUS was not reliable in localizing extrapancreatic tumors. CONCLUSIONS : In this series, the largest single center experience reported to date, EUS had an overall sensitivity and accuracy of 93% for pancreatic neuroendocrine tumors. Our results support the use of EUS as a primary diagnostic modality in the evaluation and management of patients with neuroendocrine tumors of the pancreas.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75174/1/j.1572-0241.2000.02480.x.pd