Cortical blindness and acute myocardial infarction following injection of bleeding gastric varices with cyanoacrylate glue.
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Biomedical subjects
Publications and source records attributed to G Zubaidi.
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OBJECTIVE: Inflammatory bowel disease has been reported to have varying frequencies in different parts of the world, and there seem to be significant differences in the disease pattern and clinical course in cases of ulcerative colitis (UC). The aim of the present study was to assess the incidence and disease pattern of UC in Oman. METHOD: A prospective study, over a period of 8 years (1987-1994), was performed to study 108 patients found to have UC. RESULTS: The annual incidence of UC was 1.35/100,000. The disease was mainly seen in the middle and upper middle class group, and the majority were nonsmokers or exsmokers. There was no significant difference in the incidence of the disease between nationalities or sexes. Total colitis was seen in 18%, and a significant number had disease extending up to the splenic flexure. Proctitis was seen in 8%. Although, the extent of the disease was similar to reports from the West, these patients had fewer hospital admissions, blood transfusions and none of them suffered local complications such as toxic dilatation, perforation or severe bleeding. Sclerosing cholangitis occurred in 2 patients. Patients were followed up for a maximum period of up to 7 years after diagnosis and none developed dysplasia or cancer. Three patients had surgery mainly for failure of medical treatment. CONCLUSIONS: From this report it seems that UC occurs in Oman at a lower frequency compared to the West. Although, the extent of the disease was similar to Europeans, these patients had less severe disease with fewer complications.
Under basal conditions serum gastrin concentration was compared with lower oesophageal sphincter pressure (pull-through perfusion manometry) and gastrooesophageal reflux (continuous pH measurements) in 72 patients. Between patients with low, middle and high basal gastrin level no differences were obtained for mean sphincter pressure. Mean reflux frequency and total reflux duration were increased significantly in patients with high gastrin level compared with patients with low gastrin level. Mean basal gastrin level was found to be higher in patients with symptoms of reflux than in patients without symptoms.
The deep duodenoscopy serves for the endoscopico-bioptic clarification of radiologically unclear findings distally from the bulb (niches, sockets, stenoses) and of the positional relations between diverticulum and papilla. As a rule, it is connected with an endoscopic retrograde cholangiopancreaticography (ERCP). The endoscopic retrograde pancreaticography is indicated in relapsing chronic pancreatitis for proving or excluding of changes needing operation which are taken into consideration as partial factors of the relapsing course as well as in suspicion to a local pancreatitis complication and carcinoma of the pancreas. The endoscopic retrograde cholangiography is a decisive aid for the differentiation of the cholostatic icterus. It improves the diagnostics of complaints after operative interventions at the system of the biliary ducts, facilitates the diagnosis of the papillary stenosis and is indicated in insufficient conventional contrasting the biliary ducts. The complications (pancreatitis, cholangitis, cystic infection) have become rare with increasing experience. Contraindications are the florid pancreatitis and cholangitis.
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A survey is given on indications, results and complications of the deep duodenoscopy and endoscopic retrograde cholangiopancreaticography. The endoscopic retrograde pancreatography is indicated in the chronic forms of pancreatitis, in suspicion to cysts of the pancreas or tumours. Its results have a decisive influence on the indication to surgical procedure and on the planning of the intervention. The endoscopic retrograde cholangiography is of greatest practical significance for the differential diagnosis of the cholestatic icterus: non-obstructed bile ducts exclude an extrahepatic icterus and render a laparotomy useless. Furthermore, the endoscopic retrograde cholangiography is indicated when the demonstration of the duct is intravenously insufficient, when papillary or prepapillary narrowings are present and in the etiologically unclear syndrome of postcholecystectomy. The most dangerous complications of the endoscopic retrograde pancreatography are the acute pancreatitis and the infection of cysts. Cholangitides and septicaemias appear after the endoscopic retrograde cholangiography only in such cases when obstructions of the drainage are present.
An own case of lipodystrophia intestinalis (Whipple's disease) of a male patient who was 41 years old at the time of the first admission is reported and discussed using literature. The biopsy of the small intestine is of decisive importance for the establishment of the diagnosis as well as for the long-term therapy with antibiotics (1 g oxytetracycline a day).
For the immunological diagnostics of the chronic pancreatitis preliminary results on the proof of specifically sensibilized lymphocytes are demonstrated by means of a lymphocyte transformation test. The in-vitro-stimulation is successful in such a case, when no in-vivo-stimulation preceded, i.e. beyond an acute attack.
Specific lymphocyte sensitization was found in vitro using a lymphocyte transformation test with human pancreatic antigens. It should be possible to develop an immunological diagnostic test for chronic pancreatitis.
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