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Biomedical subjects

Q Q Contractor

Publications and source records attributed to Q Q Contractor.

At least 19 recordsLinked to original sources
PubMed2001

Endoscopic therapy after laparoscopic cholecystectomy.

The role of endoscopic therapy after laparoscopic cholecystectomy (LC) was assessed in 62 patients referred for endoscopic retrograde cholangiopancreatography (ERCP). Patients were referred because of persistent biliary pain, jaundice, abnormal liver function tests, elevated serum amylase, abnormal ultrasound of the biliary system, or abnormal laparoscopic cholangiogram. Diagnostic imaging of the biliary system was abnormal in 47 of 62 (76%) cases. Sonographic abnormalities were seen in 33 of 57 (58%) patients: common bile duct (CBD) stones were present in 10 of 58 (17%); CBD >7 mm, in 22 of 58 (38%); and subhepatic fluid collection, in 10 of 58 (17%). Laparoscopic cholangiogram was done in nine cases, and CBD calculi were detected in eight. Magnetic resonance cholangiogram was abnormal in six of seven patients: CBD stones were seen in two cases; subhepatic fluid collection, in two; and clip-on CBD, in two. Endoscopic therapy was carried out in 46 of 62 (74%) patients: 40 of 47 (85%) had abnormal imaging (p = 0.0003); 29 of 33 (88%), abnormal sonography (p = 0.002); 10 of 10 (100%), CBD stones on sonography (p = 0.03); and 31 of 46 (67%), abnormal liver function tests before ERCP (p = 0.04). Twenty-five patients had a CBD stone extracted at ERCP. Bile leaks were treated successfully with papillotomy alone in 12 of 13 cases; a stent was necessary in 1 case. Endoscopic papillotomy was done in two patients with biliary pancreatitis, in one patient with recurrent idiopathic pancreatitis, and in five with suspected biliary dyskinesia. Surgery was necessary in four patients with a CBD transection. We conclude that most patients referred for ERCP after LC need endoscopic intervention. Abnormal imaging correlates best with the need for endoscopic therapy.

Adult↗
PubMed1999

Endoscopic esophagitis and gastroesophageal flap valve.

The authors studied the relationship of endoscopic esophagitis and gastroesophageal flap valve (GEFV) in patients with symptomatic gastroesophageal reflux (GER). On endoscopy, the GEFV was graded as I to IV in 138 patients with acid regurgitation and heartburn relieved by antacids, and in 54 control subjects without symptoms suggestive of GER. Grade of GEFV was correlated with the grade of esophagitis, response to medical treatment, duration of symptoms, obesity, smoking, sex, and age of the patient. Abnormal GEFV (grades III and IV) was more frequent in patients with symptomatic GER, both with and without esophagitis, compared with control subjects (p = 0.000001. p = 0.03). Abnormal GEFV was significantly more common in patients with GER with esophagitis compared with those without (p < 0.00001). There was no significant difference in the distribution of normal and abnormal GEFV in patients with grade I esophagitis. However, grade 2 and grade 3 esophagitis were associated more commonly with an abnormal GEFV (p < 0.00001, p < 0.02 respectively). Hiatal hernia is always associated with an abnormal GEFV. Abnormal GEFV correlated significantly with age (more frequent when older than 40 years). Sex, duration of symptoms (>3 years), response to medical therapy, smoking, and obesity (body mass index > 30 kg/m2) did not correlate significantly with abnormal GEFV. We conclude that endoscopic esophagitis is usually associated with abnormal GEFV. It is more frequent in grades 2 and 3 but not grade 1 esophagitis. It is also encountered more commonly after the age of 40 years.

Adult↗
PubMed1997

Abnormal common bile duct sonography. The best predictor of choledocholithiasis before laparoscopic cholecystectomy.

We conducted a prospective study to determine the most reliable indicator of common bile duct stones before laparoscopic cholecystectomy. One hundred thirty-seven patients were referred for endoscopic retrograde cholangiography before laparoscopic cholecystectomy for suspected choledocholithiasis due to one or more of the following abnormalities: (a) altered liver function tests, (b) increased serum amylase levels, or (c) a dilated common bile duct (> 7 mm) with or without evidence of stones on sonography. Sensitivity, specificity, positive and negative predictive values, and the likelihood of the presence or absence of morbidity were calculated for 25 different variables. Common bile duct stones were detected in 63 (46%) patients. Abnormal result of sonography of the common bile duct was the best predictor of choledocholithiasis (p < 0.0001). Abnormalities of the combined liver function tests were statistically significant predictors only when combined with abnormal sonographic results. Improving liver function tests before endoscopy had a significant negative predictive value (p = 0.01). Stepwise logistic regression analysis showed that abnormal ultrasound and the presence of common bile duct stones on ultrasound were significant (p = 0.009 and p = 0.049, respectively). Abnormal result of sonography of the common bile duct is the best predictor of choledocholithiasis before laparoscopic cholecystectomy.

Adult↗
PubMed1996

Sclerotherapy in bleeding gastric varices of hepatic schistosomiasis.

We report the results of sclerotherapy in 20 patients with bleeding gastric varices due to hepatic schistosomiasis. In an endemic area, patients with hepatic schistosomiasis, and bleeding gastric varices seen on endoscopy to be inferior extension of esophageal varices, were treated with emergency endoscopic injection just proximal to the cardia. Hemostasis was achieved in 17. Obliteration of varices was achieved in all patients with sclerotherapy, combined with surgery. Thirteen patients who had not been operated on in the past and consented to surgery underwent esophagogastric devascularization with splenectomy. Surgery was carried out as an emergency in the three patients who did not respond to sclerotherapy and electively in 10 patients after control of bleeding. After surgery, sclerotherapy was required for remnant varices. One patient with Child-Pugh grade C cirrhosis died of hepatic encephalopathy after control of the bleed. During a median follow-up of 9 months (range, 1-25 months), recurrence of bleeding in one patient and recurrent varices in two others were controlled with sclerotherapy. One patient had a fatal hemorrhage at home. We conclude that sclerotherapy effectively controls acutely bleeding type 1 gastric varices. Combined with esophagogastric devascularization and splenectomy, long-term results may be encouraging in patients with hepatic schistosomiasis.

Adolescent↗
PubMed1996

Thrombolysis of acute portal vein thrombus.

We report a middle-aged woman who presented with postpartum acute severe central abdominal pain. Portal vein, thrombosis was diagnosed by ultrasonography and confirmed by splenoportogram. She received thrombolytic therapy with symptomatic improvement and gradual disappearance of the thrombus on ultrasound. Early thrombolytic therapy seems to be effective in the treatment of acute portal vein thrombosis.

Adult↗
PubMed1995

Traumatic solitary rectal ulcer in Saudi Arabia. A distinct entity?

Solitary rectal ulcer syndrome is a perplexing condition with a complex multifactorial pathophysiology. Inappropriate contraction of the puborectalis muscle and rectal mucosal prolapse have been commonly implicated, although self-induced trauma has been suspected in some cases. Eight patients who presented with rectal bleeding with excessive mucus were found to have an isolated rectal ulcer on proctosigmoidoscopy. Constipation, straining at stools, and pain in the anal region were present in seven of eight cases. All of them confessed to rectal digitation. Most of them had consulted more than two physicians and half of them had had barium enema and colonoscopy in the past. An ulcer was present on the anterior wall at 6-8 cm from the anal verge in seven of eight patients and none of them had either external or internal rectal prolapse. Rectal biopsy performed in six of eight showed histological findings consistent with the diagnosis of solitary rectal ulcer. Patients were convinced to stop finger evacuation and were given psyllium supplements. There was endoscopic healing with symptomatic improvement in the six patients who followed up for an average period of 38 weeks. We conclude that traumatic solitary rectal ulcer due to rectal digitation is a distinct entity and response to avoidance of this habit is good.

Adolescent↗
PubMed1994

Mutagenic activity of gastric fluid from chewers of tobacco with lime.

Although tobacco chewing is strongly associated with a high risk of oral and upper alimentary tract cancers, the nature of mutagenic exposure among users has not been clearly defined. In this study, tobacco-specific and mutagenic exposure of chewers of tobacco with lime was evaluated by analysis of gastric fluid (GF). The pH, nitrite and cotinine levels of GF samples from chewers and non-chewers were determined and the samples were tested for mutagenicity in the Ames Salmonella/microsome assay using Salmonella typhimurium strains TA98, TA100 and TA102. Cotinine was not detected in GF from non-chewers while the levels ranged between 0.4-13.64 micrograms/ml in samples from chewers; however, the mean pH values (3.8 +/- 0.4 versus 2.8 +/- 0.3) and nitrite levels (29.40 +/- 1.51 versus 27.39 +/- 0.83 microM) were similar in both groups. While all GF samples from non-chewers were non-mutagenic, samples from chewers were directly mutagenic or upon nitrosation to all the three tester strains and to TA102 strain in the presence of S9. Experiments using scavengers of reactive oxygen species (ROS) showed that mannitol and benzoate abolished the mutagenic response of TA102, indicating that ROS are principally responsible for oxidative damage. The findings provide specific information regarding the mutagenic exposure among tobacco chewers and suggest that tobacco chewing may be an important risk factor in the development of gastric cancer.

Calcium Compounds↗
PubMed1994

Electron microscopic observations in gastric mucosa of habitual tobacco chewers.

Clinical evaluation, upper gastrointestinal endoscopy and electron microscopy of mucosal biopsies from antrum, body and fundus of stomach were performed in three control subjects and 17 habitual tobacco chewers. Electron microscopic abnormalities such as discontinuous, fragmented basement membrane with reduction in hemidesmosomes, and widened intercellular spaces filled with clusters of desmosomes were found in the gastric mucosa of habitual tobacco chewers; these were similar to those reported in experimental carcinogenesis and leukoplakia. It is concluded that habitual chewing of tobacco produces electron microscopic alterations in the human gastric mucosa which may be important precursors for gastric malignancy.

Adult↗
PubMed1993

Gastric mucosa in acute viral hepatitis.

In acute viral hepatitis, gastric biopsy and augmented histamine test were performed in 63 patients. Gastric histology was abnormal in 12 of 63 (19%) patients; 3 with superficial and 9 with atrophic gastritis. Maximal acid output was less than 10 mEq/h in 35 of 63 (55.5%) patients. Acid load tests were performed in 23 patients measuring H+, K+, Na+ fluxes; the results showed increased loss of acid from lumen to mucosa in 16 of 23 (69.6%) patients, indicating damage to the gastric mucosal barrier.

Acute Disease↗
PubMed1993

Ultrastructural changes in esophageal mucosa of chronic tobacco chewers.

Seventeen chronic tobacco chewers and three control subjects underwent clinical evaluation, upper gastrointestinal endoscopy and esophageal mucosal biopsies. The esophageal biopsies were processed and examined under the electron microscope. A large number of ultrastructural abnormalities such as discontinuous, fragmented basement membrane, with reduction in hemidesmosomes, widened intercellular spaces were found in the esophageal mucosa of chronic tobacco chewers which resembled the ultrastructural features of experimental carcinogenesis and leukoplakia. It is concluded that chronic chewing of tobacco produces ultrastructural abnormalities in the esophageal mucosa which could be important precursors for esophageal malignancy.

Basement Membrane↗
PubMed1990

Laparoscopic appearance of the liver in Schistosoma mansoni infection.

In an area endemic for Schistosoma mansoni infection laparoscopy was performed in 45 patients with liver disease. Hepatic schistosomiasis was diagnosed by histology in 20 cases. The only complication encountered was unusual bleeding from the biopsy site in one patient. Liver lobe size was variable. Mild uniform irregularity of the liver surface was seen in most of the patients. Other changes noted were macronodularity, lumpy surface, tiny white tubercles, white patchy discoloration, and thick and thin adhesions. Characteristic features of the liver surface in Schistosoma mansoni infection as seen on laparoscopy are thus described.

Adult↗
PubMed1988

Duodenal involvement in Schistosoma mansoni infection.

Intestinal involvement in Schistosoma mansoni infection is usually confined to the ileum and colon. Duodenal infestation was diagnosed in a patient with recurrent schistosomiasis despite treatment who presented with a postoperative small bowel fistula. Duodenal schistosomiasis can be suspected on endoscopy, but must always be confirmed by biopsy.

Adult↗