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Biomedical subjects

E Scapa

Publications and source records attributed to E Scapa.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Stromal uterine sarcoma arising from intestinal endometriosis after abdominal hysterectomy and salpingo-oophorectomy].

The incidence of ectopic endometriosis is 4% to 18%. The intestinal type is quite common with the rectosigmoid the most likely part of the bowel to be involved due to its pelvic location. A 43-year-old woman, whose symptoms, X-ray and endoscopic findings suggested malignancy of the rectosigmoid, is presented. Primary malignancy of the bowel was excluded by endoscopic biopsies. Histological examination at operation showed stromal sarcoma of the uterus with foci of endometriosis. There is no report in the English literature of transformation of intestinal endometriosis into malignancy, such as stromal sarcoma of the uterus, which imitates a primary malignancy with obstruction of the rectosigmoid.

Adult↗
PubMed1997

The role of endoscopic retrograde cholangiopancreatography in management of patients recovering from acute biliary pancreatitis in the laparoscopic era.

BACKGROUND: Traditionally an episode of acute biliary pancreatitis (ABP) is an indication for direct imaging of the biliary tree. The optimal approach may vary according to local expertise, and endoscopic retrograde cholangiopancreatography (ERCP) is the most common. The fact that the incidence of choledocholithiasis in patients recovering from ABP varies between 3 and 33% raises a question about the necessity of visualizing the biliary tree in all patients recovering from ABP. METHODS: In order to evaluate this policy, we reviewed 48 ERCPs performed on patients recovering from ABP who were scheduled for laparoscopic cholecystectomy (LC). We checked the correlations between ERCP findings and the severity of pancreatitis, biochemistry values (which were sampled during the acute phase), and ultrasonographic (US) findings. RESULTS: The ERCP demonstrated common bile duct (CBD) stones in 11 (22.9%) patients. US finding of a dilated CBD and maximal aspartate transaminase (AST) values higher than 90 units/l were significantly correlated with CBD stones (a relative risk [RR] of 2.95 with a 95% confidence interval [CI] for a dilated CBD and RR of 3.89 with a 95% CI of 1.18-12.80 for an AST value higher than 90 units/l). No other parameters were significantly correlated with CBD stones. CONCLUSION: We, therefore, recommend performing a preoperative ERCP only on patients who present with an ultrasonographic finding of CBD dilatation. The correlation to high AST is still to be proven.

Acute Disease↗
PubMed1997

Treating gastrointestinal bleeding with endoscopic hemoclips.

Seventeen patients were treated with endoscopic hemoclip placement in order to arrest or prevent active bleeding. Eight patients were investigated for lower gastrointestinal problems, and 9 patients for upper gastrointestinal indications. Success rate was 100%. Application was relatively easy. Comparative studies with other modes of endoscopic hemostasis are needed.

Adult↗
PubMed1997

Esophagogastric mucosal junction (EGMJ): its location as measured by endoscopy.

The "esophageal" length, i.e., incisors-esophagogastric mucosal junction distance, was measured endoscopically in 758 patients, retrospectively. Two hundred twenty-five additional patients were evaluated prospectively and their height and weight were measured. All patients were analyzed according to their age and sex, indication for the procedure, and its endoscopic diagnosis. "Esophageal" length was found to be significantly longer in male patients. Fifty-three percent of the examined population had "esophageal" length shorter than 38 cm, whereas 99% of patients with normal endoscopy had "esophageal" length of 38-40 cm. Linear correlation was found between "esophageal" length and height, but not with weight. Patients with dyspepsia and esophagitis had a "shorter" esophagus, whereas those with tumors of the upper gastrointestinal tract and those with duodenal ulcer had a "longer" esophagus.

Adolescent↗
PubMed1997

The effect of colonoscopy on tumor markers.

As preoperative elevated serum levels of carcinoembryonic antigen (CEA) and CA19.9 are markers for bad prognosis in colorectal cancer patients, it is important to decide whether preoperative total colonoscopy would make a significant change in their serum levels. CEA and CA 19.9 were evaluated in three groups of patients before and after colonoscopy. The groups comprised the following: Group A, 20 patients with colorectal cancer; Group B, 17 patients with colorectal polyp of > or = 1-cm diameter; Group C, 16 patients with no colorectal pathology. CEA serum levels were found to be significantly lower after colonoscopy in all groups. CA19.9 was found to be significantly lower after colonoscopy only in Group B; it did not reach significance in Group A and was found not to be significantly higher in Group C.

Adult↗
PubMed1996

[Percutaneous choledochoscopic electrohydraulic lithotripsy].

Treatment of biliary stones impacted in the distal, common bile duct is a technical challenge. We report 2 consecutive patients, a woman aged 80 years and a man aged 64, in whom all operative attempts failed. In both, the stone was removed by percutaneous, choledochoscopic, electrohydraulic lithotripsy in a single session. To the best of our knowledge these are the first such cases reported in Israel.

Aged↗
PubMed1996

Endoscopic retrograde cholangiopancreatography in octogenarians.

Thirty patients > or = 80 years of age (mean 86) underwent diagnostic and/or therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The low mortality (6.6%) and complication (6.6%) rates lead us to believe that ERCP in octogenarians provides an acceptable route for diagnosis and treatment of biliary and pancreatic disorders.

Aged↗
PubMed1996

Superoxide dismutase activity in Helicobacter pylori-positive antral gastritis in children.

Reactive oxygen metabolites have been implicated in gastric mucosal injuries. Superoxide dismutase, a scavenger of superoxide radical, is a key enzyme in gastric mucosal protection against several damaging factors. This study was aimed at investigating the relationship of superoxide dismutase activity to Helicobacter pylori-induced antral gastritis in children. Two groups of 11 children each, one positive and the other negative for Helicobacter pylori, were studied. Biopsies from the antrum and corpus were obtained for evaluation of Helicobacter pylori by CLOtest and histology as well as for superoxide dismutase activity (cytochrome c method). Erythrocytic and serum superoxide dismutase levels were determined as well. Superoxide dismutase activity was significantly higher only in the antrum of children with Helicobacter pylori-induced antral gastritis. There was no significant difference in superoxide dismutase activity in the corpus, erythrocytes, or serum of both groups. These findings may suggest a pathogenic relationship between the presence of Helicobacter pylori and oxygen radicals in inducing antral mucosal injury.

Adolescent↗
PubMed1996

Superoxide dismutase activity in duodenal ulcer patients.

OBJECTIVE: To investigate whether duodenal ulcer (DU) is associated with increased free radical generation at the site of ulceration and to attempt, indirectly, to confirm the hypothesis by determining activity of free radical scavengers such as superoxide dismutase (SOD). STUDY DESIGN: Prospective study comparing SOD activity in biopsies taken from the ulcer edge, and antrum in DU patients before and after one month of treatment to SOD activity in biopsies from the duodenal bulb and antrum in a control population. SETTING: Institute of Gastroenterology of a university hospital. STUDY POPULATION: Twenty-five patients with DU. The diagnosis was confirmed by endoscopy. MEASUREMENTS: SOD activity in biopsy specimen, red blood cells (RBC) and serum was measured using the cytochrome c method by spectrophotometry and expressed as U SOD/mg protein. Helicobacter pylori was diagnosed by the rapid urease test (CLO test) from antral biopsies. RESULTS: SOD activity was markedly depleted in the ulcer edge (2.78 +/- 0.9 U SOD/mg protein) as compared to the same patients after one month of treatment (4.59 +/- 2.2 U SOD/mg protein) (P = 0.05) and to biopsies from the duodenal bulb in control population (6.7 +/- 2.4 U.SOD/mg protein) (P = 0.05). SOD activity in the antrum of both groups was similar. There was no difference in SOD activity in RBC and serum of both groups. CONCLUSION: Products of free radical reactions are implicated in the pathogenesis of DU disease. SOD, which is a key enzyme in gastric mucosal protection, is depleted significantly in the ulcer edge compared with controls and increases after healing. However, it is not clear whether this abnormality in oxygen free radical metabolism reflects, rather than causes, the condition which characterizes DU.

Biopsy↗
PubMed1996

Helicobacter pylori infection and blood groups.

OBJECTIVES: Bacterial attachment is a prerequisite for colonization of the gastric epithelial surface. Recently, it was demonstrated that the receptor for Helicobacter pylori is the blood group antigen Lewis b, which is exposed only in blood group O. We prospectively examined the prevalence of blood groups in H. pylori-positive and -negative patients. To avoid a genetic bias, we compared blood group prevalence of our patients with the general population of Israel. METHODS: In the 187 consecutive patients we studied, in addition to regular upper endoscopy, H. pylori status and blood group. Exposure to H. pylori was diagnosed when the results of two or more of three methods were found to be positive. RESULTS: Exposure was found in 123 patients and 64 negative. The groups were similar in average age and origin, and no significant difference was demonstrated for blood group. Blood group distribution between any given origin was not significantly different in our patients and in a sample of 182,701 blood donors. CONCLUSIONS: Positivity for H. pylori was not associated with blood group O. Our observation does not support the conclusion that the receptor for H. pylori in the gastric mucosa is the blood group antigen Lewis b.

Adolescent↗
PubMed1995

Gastric Mucosal Changes following Gastroplasty: A Comparative Study Between Vertical Banded Gastroplasty and Silastic Ring Vertical Gastroplasty.

BACKGROUND: Long-term changes of gastric mucosa following surgery for morbid obesity have never been studied, to the best of our knowledge. As 31 patients in our series presented with various gastrointestinal complaints following surgery, we used this opportunity to study mucosal changes. METHODS: Thirty-seven gastroscopies were performed on 31 patients, 20 patients following Vertical Banded Gastroplasty (VBG) and 11 patients following Silastic Ring Vertical Gastroplasty (SRVG) with various gastrointestinal complaints. Macroscopic appearance of the gastric mucosa was examined and biopsies taken from the proximal gastric pouch, the transitional zone and distal stomach. RESULTS: In most patients, macroscopic appearance of the proximal and distal pouches was normal. Pathological findings were mainly located in the transitional zone and were found mainly in the VBG group. CONCLUSIONS: This study indicates that damage to the gastric mucosa is related to the surgical technique, and mainly to the strip of mesh used in the VBG patients. Since hyperplasia and metaplasia were among the microscopic findings, a question is raised about the possibility of malignant transformation. We suggest that routine post-operative gastroscopies be considered, especially following VBG.

Journal Article↗
PubMed1995

Gastrointestinal patients in the emergency room.

Of 4,839 patients who visited the Emergency Room (ER) of a 650-bed general hospital (serving a regional population of 220,000) over a period of 28 consecutive days, 436 were suffering from gastrointestinal (GI) problems. The patients, together with their 140 ER doctors, were interviewed by 40 trained interviewers and information concerning demographic data, tests performed, diagnosis, treatment and hospitalization was collected and evaluated. Most of the GI patients (39.9%) were aged 16 years or younger, were Israeli born and were suffering from infections of the GI system. Twenty percent of all GI patients were hospitalized. Most came to the ER on working days although their symptoms began at home. A total of 77.9% of the GI group expected to be treated in the ER and sent home without being hospitalized. The ER, which is open for 24 hours a day, is considered by the population as a kind of an outpatient clinic.

Abdominal Pain↗
PubMed1995

To do or not to do an endoscopic retrograde cholangiopancreatography in acute biliary pancreatitis?

In 16 patients with acute biliary pancreatitis, we performed endoscopic retrograde cholangiopancreatography (ERCP) 10 to 14 days after onset of the attack. All patients had mild pancreatitis. In 10 patients with normal-appearing common bile duct (CBD) on ultrasonography, ERCP was normal also. In two patients with dilated CBD on ultrasonography, stones were found in the CBD on ERCP, sphincterotomy was performed, and the stones were extracted endoscopically. We think there is no need for preoperative ERCP in patients with mild attacks of biliary pancreatitis if the CBD appears undilated on ultrasonography.

Acute Disease↗
PubMed1994

Are elevated liver enzymes and bilirubin levels significant after laparoscopic cholecystectomy in the absence of bile duct injury?

OBJECTIVE: Increased aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin levels were noted incidentally after a laparoscopic cholecystectomy. The percentage in which such elevation occurs and its clinical significance in the absence of bile duct injury were investigated. SUMMARY BACKGROUND DATA: Bile duct injury is the most feared complication of laparoscopic cholecystectomy. Some laboratory tests may be indicative of this complication, such as increases in liver enzyme (AST, ALT, and alkaline phosphatase [ALP]) and bilirubin. These parameters have not been investigated in patients who had laparoscopic cholecystectomy and in whom no damage to the bile duct was noted. METHODS: Sixty-seven patients with normal results of preoperative liver function test were entered into the study. Blood was collected 24 hours after laparoscopic cholecystectomy, and AST, ALT, ALP, and bilirubin levels were measured. RESULTS: A mean 1.8-fold increase in AST occurred in 73% of patients; 82% showed a 2.2-fold increase in ALT. A statistically nonsignificant increase was noted in 53% of patients (ALP remained within normal limits), and in 14% of patients bilirubin levels were increased (they were primarily of the unconjugated type). CONCLUSIONS: In many patients a significant increase in AST and ALT levels occurred after laparoscopic cholecystectomy, but they returned to normal values within 72 hours. The cause of this is unclear, and these elevations appear to have no clinical significance.

Adult↗
PubMed1994

"Rendez-vous" procedure (RVP) for obstructive jaundice.

Seven patients with obstructive jaundice were palliatively treated with the "rendez-vous" procedure, which combines a percutaneous and an endoscopic approach to stent insertion into the biliary system. In six cases, pretreatment papillotomy was not needed. Endoscopy was also not really necessary for stenting in one patient. This procedure should be restricted for use in cases of endoscopic failure.

Aged↗