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Biomedical subjects

M Guelrud

Publications and source records attributed to M Guelrud.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

ERCP in the diagnosis of extrahepatic biliary atresia.

This study assessed the usefulness of ERCP in the diagnosis of biliary atresia. We evaluated 57 infants with prolonged cholestasis with abdominal ultrasound, liver biopsy, and ERCP. Using clinical observations alone, 22 infants were thought to have biliary atresia; whereas 35 children were thought to have neonatal hepatitis. The ERCP was performed with a prototype duodenoscope and was successful in all infants except two with biliary atresia. In 20 infants three types of radiological findings consistent with biliary atresia were seen: type 1, no visualization of biliary tree (35%); type 2, opacification of the distal common duct and gallbladder without visualization of the main hepatic duct (35%); and type 3, opacification of the distal common duct, the gallbladder, and a segment of the main hepatic duct with biliary lakes at the porta hepatis (30%). Twenty-five of 35 infants with suspected neonatal hepatitis were excluded because of a liver biopsy that was diagnostic. In the remaining 10 infants the liver biopsy had some features of extrahepatic biliary atresia and ERCP was performed prior to surgery. A normal extrahepatic biliary tree was obtained in all of them. In conclusion, ERCP permits the visualization of the biliary tree in young infants and is useful in selecting those infants who should be considered for exploratory laparotomy.

Biliary Atresia↗
PubMedDate not supplied

ERCP and endoscopic sphincterotomy in infants and children with jaundice due to common bile duct stones.

ERCP was performed in two infants (29 and 62 days old) and eight children (5 to 12 years old) with jaundice due to common bile duct stones. Seven patients had hemolytic anemia and three patients had a family history of gallstone disease. Successful cannulation of the common bile duct demonstrating stones was accomplished in all patients. Four patients had coexisting gallstones and were treated surgically. Six children who had previously undergone cholecystectomy were treated by endoscopic sphincterotomy and stone extraction without complication. We believe that ERCP should be utilized by expert endoscopists in children with evidence of extra-hepatic cholestasis, and endoscopic sphincterotomy should be the treatment of choice in children who have previously undergone cholecystectomy, and who are jaundiced secondary to common bile duct stones.

Child↗
PubMedDate not supplied

The role of ERCP in the diagnosis and treatment of idiopathic recurrent pancreatitis in children and adolescents.

ERCP was performed in 51 patients, aged 1 to 18 years, as part of diagnostic evaluation for recurrent pancreatitis without obvious cause or as therapeutic intervention. ERCP was successful in 50 patients (98%). Thirty-four patients (68%) had anatomic findings indicating a possible cause of recurrent pancreatitis. Three patients (6%) had findings suggestive of sphincter of Oddi dysfunction. Eighteen of the 37 patients (49%) with ductal abnormalities underwent endoscopic therapy, with a favorable outcome in 15 (83%). Eleven patients were treated surgically, and 8 of these patients (73%) improved symptomatically. Eight patients received no treatment, and 6 of them (67%) had recurrent bouts of clinical pancreatitis. One mild case of pancreatitis (1.9%) occurred after ERCP, and 3 mild cases followed endoscopic therapy. In conclusion, ERCP is a relatively safe technique that produces opacification of the desired ductal system with a high degree of accuracy and provides useful information in the evaluation of children with idiopathic recurrent pancreatitis. These data suggest that endoscopic pancreatic therapy may result in symptomatic improvement, eliminating the need for surgery in selected children. Furthermore, the study demonstrates that manipulation of the pancreatic duct is comparatively safe and less hazardous than formerly believed.

Adolescent↗
PubMedDate not supplied

[Interaction of cimetidine and metoclopramide on the lower esophageal sphincter in man].

The purpose of this study is to evaluate the effect of Cimetidine and Metoclopramide on human lower esophageal sphincter (LES) pressure. Intravenous Metoclopramide in a bolus injection (0.3 mg/Kg or a maximal dose of 20 mg) produced an increase of LES pressure from 20,8 +/- 3,1 mmHg to a peak response of 42,0 +/- 5,0 mmHg. Intravenous Cimetidine in a bolus injection of 300 mg failed to alter basal LES pressure and LES response to Metoclopramide. Cimetidine in continuous infusion (100 mg/h) also failed to alter basal LES pressure and LES response to intravenous Metoclopramide. These studies suggest that: (1) Human LES pressure increases in response to intravenous Metoclopramide; (2) H2-Antagonism with Cimetidine has no effect on the human LES basal pressure; and (3) The H-2 receptors have no apparent role in the human LES response to Metoclopramide.

Adult↗
PubMedDate not supplied

[Double sphincterostomy of pancreatic and choledochal sphincters in the treatment of chronic recurrent pancreatitis].

The treatment of recurrent chronic pancreatitis is controversial. Some patients may have sphincter of Oddi motor abnormalities. Although widely used in the biliary tree, little data is available on endoscopic sphincterotomy of the pancreatic sphincter. This report describes 5 patients with recurrent chronic pancreatitis, who had pancreatic sphincterotomy for hypertensive sphincter of Oddi. Four patients continue long-term follow-up with marked reduction of chronic pain of attacks of recurrent pancreatitis. It is concluded that endoscopic sphincterotomy of the pancreatic sphincter may improve pain in chronic pancreatitis and may obviate the need for surgery.

Adolescent↗
PubMedDate not supplied

[Incidence of Helicobacter pylori in Barrett esophagus].

In Barrett's esophagus the normal squamous epithelium of the mucosa is replaced by columnar epithelium. In this study, we evaluated the incidence of Helicobacter pylori in 28 patients with Barrett's esophagus. In 11 patients (39%) H. Pylori was present and all of them had the bacteria in the gastric antrum. From the 17 patients without H. pylori in the Barrett's mucosa, in 4 (22%) the bacteria was present in the gastric antrum. In conclusion, H. pylori infects the esophagus only when the esophageal mucosa is replaced by the columnar epithelium. The clinical significance of this finding is yet to be determined.

Adult↗
PubMedDate not supplied

[Evaluation and use of polyethylene glycol in constipated patients].

We evaluated the efficiency of polyethylene glycol at low dosage for the treatment of chronic constipation. A prospective, randomized, double blind study was performed in 34 patients (32 female, 2 male) with the following inclusion criteria: age between 20-60 years, history of more than 5 years of constipation and no lower endoscopic findings of infections or malignancies. The solution was administered in a fasting state at the rate of 0.5 liters daily during 8 days. Patients were divided in 2 groups. Group 1 received placebo during the first week and PEG during the 2nd. week. Group 2 received PEG solution during the first week and placebo during the 2nd. A mean of 5.53 bowel movements was observed after placebo and 12.13 after PEG in group 1 (p < 0.005). A mean of 13.56 bowel movements were observed in group 2 after PEG and 7.73 after placebo (p < 0.001). Decreased consistency of the stools was seen after PEG in both groups (p < 0.001). According to our findings, low doses of PEG were useful and safe in the treatment of constipation, with few side effects.

Adult↗
PubMedDate not supplied

[Usefulness of endoscopic retrograde cholangiopancreatography in diagnosis of choledochal cysts in children].

We report 11 infants with choledochal cyst confirmed during surgery. In none of the patients an abdominal mass was palpated during physical examination. In 10 (91%) of the patients, ERCP showed the cyst. Ultrasound was positive in 82% (9/11) of the cases. Two patients had acute relapsing pancreatitis with severe anatomical abnormalities at the pancreatobiliary junction. Multiple biliary lithiasis were seen in four cysts. ERCP is of significant value in establishing the diagnosis, defining anatomic abnormalities and complications. ERCP should be the procedure of choice in patients with suspected choledochal cyst.

Child↗
PubMedDate not supplied

[Comparison of urease test (CLOtest) and histology in the diagnosis of Campylobacter pylori].

Campylobacter pylori has been implicated in the pathogenesis of peptic ulcer, non-ulcer dyspepsia and chronic gastritis. C. pylori produces large amounts of urease which has been used as a biochemical support to identify the microorganism. In this study, we described the use of a rapid urease test (CLOtest) to detect C. pylori. In 46 consecutive patients, biopsy of fundus and antrum were obtained for histology and CLOtest. All specimens showed chronic gastritis. In 22 patients (48%) C. pylori was identified either by histology or CLOtest. In 18 patients (39%) CLOtest was positive and in 16 patients (35%) histology was positive. In 12 patients (26%) C. pylori was identified by both tests. There was no difference in relation to the presence of C. pylori in fundus and antrum. However, in 2 patients (4%) C. pylori was positive in fundus and negative in antrum. In 9 patients (20%) C. pylori was positive in antrum and negative in fundus. CLOtest is a simple, sensitive and rapid test that enables the endoscopist to diagnose C. pylori infection in the endoscopy room.

Adult↗