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Biomedical subjects

G F Longstreth

Publications and source records attributed to G F Longstreth.

At least 37 records · Page 2Linked to original sources
PubMed1995

Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study.

OBJECTIVES: To obtain epidemiological data on hospitalization for acute upper gastrointestinal hemorrhage (AUGIH) in a demographically defined population. METHODS: Adults hospitalized in 1991 with AUGIH [from a San Diego health maintenance organization (270,699 adult members)] were identified from discharge codes in the International Classification of Diseases, 9th Revision, Clinical Modifications, and their records were reviewed. RESULTS: There were 276 hospitalizations among 258 patients, an annual incidence rate of 102.0 hospitalizations per 100,000. Patient analysis, including the first admission of 15 patients with multiple hospitalizations, revealed rates of 128.3 in males and 65.8 in females. The rate increased with age in males (p = 0.008) and females (p = 0.001) more than 30-fold between the 3rd and 9th decades of life. AUGIH started before admission in 242 (93.8%) patients and after admission for other disorders in 16 (6.2%) patients. Endoscopy was performed in 241 (93.4%) patients. Diagnoses were: peptic ulcer, 159 (61.6%); mucosal erosive disease, 37 (14.3%); varices, 16 (6.2%); miscellaneous, 25 (9.7%); and unknown, 21 (8.1%). Peptic ulcer patients were similar to other patients (mean +/- SE) in age [60.6 +/- 1.2 vs. 60.7 +/- 1.5 yr] and gender [104 (65.4%) vs. 60 (60.6%) males], but were more often nonsteroidal anti-inflammatory drug (NSAID)-users [87 (54.7%) vs. 34 (34.3%) (p = 0.002)]. Older age, female gender, and NSAID use independently predicted gastric ulcer (p < or = 0.03). The severity of bleeding was similar in patients with peptic ulcers and in those with mucosal erosive disease and was not related to NSAID use in peptic ulcer patients. Patients whose AUGIH started after admission were older than those whose AUGIH began before admission [70.4 +/- 2.9 vs. 60.0 +/- 1.0 yr (p = 0.002)], and they had a higher mortality rate [4 (25%) vs. 9 (3.7%) (p = 0.005)]. CONCLUSIONS: 1) The annual incidence of hospitalization for AUGIH was 102.0 per 100,000, increased markedly with age, and was twice as high in males as in females. 2) Peptic ulcer was the most common cause. 3) Gastric ulcer was associated with older age, female gender, and NSAID use. 4) Mortality rates were high when AUGIH started after hospitalization for another disorder.

Acute Disease↗
PubMed1994

Megaesophagus and hereditary nervous system degeneration.

A patient with a progressive, inherited disease of the CNS developed remarkable esophageal dilatation without the lower esophageal sphincter dysfunction characteristic of achalasia. Postmortem examination included neuropathologic study of the CNS and evaluation of esophageal myenteric plexus histology, but the pathogenesis of the megaesophagus remains unknown.

Aged↗
PubMed1994

Hospital care of acute nonvariceal upper gastrointestinal bleeding: 1991 versus 1981.

Developments important to the care of upper gastrointestinal (UGI) bleeding occurred in the 1980s. We compared the features, care, and outcome of patients hospitalized with acute nonvariceal UGI bleeding in 1991 (n = 216) and 1981 (n = 105). Most patient characteristics and the hemoglobin values were similar. Final diagnoses differed, mainly because there were more peptic ulcers and fewer unknown diagnoses in 1991. More patients had endoscopy in 1991 (94%); 92% of endoscoped patients had the procedure within 24 h of admission. The hospital stay of patients without surgery or comorbidity in 1991 was 2.8 +/- 0.1 days, significantly shorter than that in 1981. In 1991 only one half of patients received blood transfusion. The hemoglobin values before transfusion (7.2 +/- 0.1 g%) and at discharge (9.8 +/- 0.1 g%) were lower in 1991; transfused patients received similar amounts of blood in the 2 years. Endoscopic hemostatic therapy was used in 25% of patients with ulcers in 1991 and in none in 1981. Rates of rebleeding (including patients readmitted for recurrent bleeding within 1 week of discharge) and surgery were similar. Mortality was 2.8% in 1991, similar to the 1981 death rate. Because of the excellent 1991 patient outcome, we continue to care for most patients with acute nonvariceal UGI bleeding with urgent endoscopy and short hospitalization.

Acute Disease↗
PubMed1994

Irritable bowel syndrome and chronic pelvic pain.

The irritable bowel syndrome (IBS) is a common functional bowel disorder diagnosed by characteristic symptoms. It is often associated with gynecologic symptoms, especially chronic pelvic pain (CPP). IBS symptoms worsen during menstruation and are correlated with increased levels of various perimenstrual symptoms. Psychosocial factors including depression, somatization, substance abuse, and childhood abuse are similar in IBS and CPP. IBS predisposes women to undergo hysterectomy and negatively influences pain improvement postoperatively. Therefore, IBS should be considered in the differential diagnosis of CPP. Collaboration between gynecologists and gastroenterologists is needed in the care of women with CPP and IBS as well as in the conduct of additional research on the relationship of these two disorders.

Chronic Disease↗
PubMed1993

Irritable bowel-type symptoms in HMO examinees. Prevalence, demographics, and clinical correlates.

A study of irritable bowel-type symptoms in 1264 health examinees using a self-administered questionnaire and psychological tests revealed they are common throughout adulthood. Of affected subjects 68% were female, and those with the more severe type (> or = 3 Manning criteria) were predominantly female (80%). Fewer Asians than other racial/ethnic groups had these symptoms. Nongastrointestinal symptoms, physician visits, incontinence, laxative use, a stress effect on bowel pattern and abdominal pain, abdominal surgery, hysterectomy, childhood abuse, use of mind-altering drugs, depression, and anxiety were correlated with irritable bowel-type symptoms. Regression analysis found some of the clinical correlates were independent markers for irritable bowel-type symptoms and that sexual abuse was related to nongastrointestinal symptoms and abdominal surgery independent of irritable bowel-type symptoms. More severe irritable bowel-type symptoms were especially associated with nongastrointestinal symptoms, stress effects, sexual abuse, use of sedatives and oral narcotics, and a past alcohol problem. There are important demographic and clinical correlates with irritable bowel-type symptoms.

Abdomen↗
PubMed1993

Bowel patterns and anxiety. Demographic factors.

In a survey of bowel patterns and anxiety on 1264 health maintenance organization (HMO) members undergoing health assessment, I found (a) Stool frequency increased with age (p = 0.001), was greater in men than women (p < 0.00001), and was greater in whites than blacks (p = 0.07); (b) Fecal incontinence increased with age in women (p < 0.001) but was not age-related in men (p > 0.10); (c) Laxative use was greater in women than men at all ages (p < 0.01), and there was an age effect on use in women (p < 0.025) but not in men (p > 0.20); (d) Bowel pattern change and abdominal pain were frequently caused by stress, and both effects declined with age in each gender (p < 0.05); (e) More women than men at all ages reported stress effects (p < 0.001), and subjects who reported either stress effect scored higher on both parts of the State-Trait Anxiety Inventory (p < 0.00001) than other people. Bowel patterns and their relation to anxiety have demographic characteristics.

Adolescent↗
PubMed1990

Irritable bowel syndrome in women having diagnostic laparoscopy or hysterectomy. Relation to gynecologic features and outcome.

We identified irritable bowel syndrome (IBS) in 47.7% of 86 women having diagnostic laparoscopy for chronic pelvic pain, 39.5% of 172 women having elective hysterectomy, and 32.0% of 172 controls age-matched for the hysterectomy group (P = NS). Constipation and pain subtype IBS were more common in hysterectomy patients than controls (P less than 0.05). In laparoscopy patients, dyspareunia was more common in those with IBS than in those without it (P less than 0.05). In the hysterectomy group, more IBS patients had chronic pelvic pain (P less than 0.005), and abnormal menses (P less than 0.01). Chronic pelvic pain was more frequently the only prehysterectomy diagnosis in IBS patients (P less than 0.05), and IBS was present more often when pain was a reason for hysterectomy (P less than 0.01). One year after laparoscopy, IBS patients gave lower overall status ratings (P less than 0.01) and lower pain improvement ratings (P less than 0.05) than non-IBS patients. In women who had a hysterectomy for pain, there was less pain improvement one year later in those with the pain subtype of IBS than in non-IBS patients (P less than 0.05). IBS is associated with gynecologic symptoms and affects the symptomatic outcome of diagnostic laparoscopy and hysterectomy.

Adult↗
PubMed1989

Cyclophosphamide therapy of idiopathic hepatic granulomatosis.

A 50-year-old woman presented with idiopathic hepatic granulomatosis and autoimmune hemolytic anemia. Splenectomy corrected the anemia, and the liver disorder responded to prednisone. However, her liver disease relapsed on four occasions when prednisone was tapered, including three episodes when hepatic granulomatosis was proven by biopsy. Cyclophosphamide therapy allowed prednisone withdrawal, and she has remained in clinical and biochemical remission for two years on a low dose of the drug.

Anemia, Hemolytic, Autoimmune↗
PubMed1988

Checking for "the occult" with a finger. A procedure of little value.

The performance of an occult blood test on normal-appearing feces obtained by rectal examination probably yields such high rates of false positive and false negative reactions that it is of little value in the detection of colorectal neoplasia. In acute gastrointestinal bleeding, it helps to know what the stool looks like; nevertheless, many physicians merely describe it as "heme positive" and neglect to record its gross appearance. Both of these practices should be discouraged.

Colonic Neoplasms↗
PubMed1987

Detecting colorectal neoplasms. Assessment based on hypothetical cases.

Because of the controversy surrounding the detection of colorectal neoplasia, I used 10 hypothetical, typical patients to assess the testing attitudes of 33 experienced colonoscopists. There was great disagreement on the type and frequency of the advised diagnostic investigation in some cases. The magnitude of interphysician variation in testing attitudes has major implications concerning cost and risk. This is particularly applicable to the interval between follow-up colonoscopies after polypectomy and cancer surgery, and the evaluation of patients with a positive fecal occult blood test. I reviewed the recent literature most pertinent to the patients. Although I could not derive firm guidelines for most of the cases from my review, consideration of the case management decisions, in light of available information, suggests that some gastroenterologists are testing many patients more than necessary, especially with colonoscopy.

Adenocarcinoma↗
PubMed1986

Acute nonvariceal upper gastrointestinal bleeding. Care in three different San Diego practice settings.

We compared the care of all adults admitted directly for acute nonvariceal upper gastrointestinal bleeding in 1981 to three types of hospitals: private (n = 138), health maintenance organization (HMO) (n = 105), and university (n = 72). Some patient characteristics differed, but most indices of blood loss, all final diagnoses, and rates of surgery (less than 9%) and death (less than 5%) were similar. Use of intensive care and blood products differed from published guidelines. Health maintenance organization patients had the shortest stays and the fewest transfusions, limited almost completely to packed red cells. Intensive care unit use and duplicate diagnostic testing were greatest for university patients. Rebleeding rates, determined by including readmissions within 1 week of discharge, were less than 7% and similar at the three institutions. Endoscopic signs of recent hemorrhage from an ulcer were significant signposts to rebleeding. Patients endoscoped early and those without endoscopic signs of recent hemorrhage went home sooner than the others.

Aged↗