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Biomedical subjects

S Bank

Publications and source records attributed to S Bank.

At least 55 records · Page 3Linked to original sources
PubMed1991

Pneumatic dilation in patients with achalasia with a modified Gruntzig dilator (Levine) under direct endoscopic control: results after 5 years.

From 1985 to 1990, 62 patients have undergone pneumatic dilatation with the modified Gruntzig (Levine) dilator in the treatment of achalasia. A single dilatation with a 30-mm balloon dilator was successful in 85% of the patients. Nine patients required additional procedures. One elected for operative surgical repair, and eight patients underwent a second dilatation with a 35-mm balloon dilator. One patient required a third procedure with a 40-mm dilator. Two patients developed dysphagia for solids after pneumatic dilatation, and did not demonstrate delay or obstruction to the passage of technetium on follow up study. We have described this syndrome as dysfunctional dysphagia, and believe that it is related to the rapid ingestion of a food bolus, and is relieved by eating smaller portions at a slower rate. This is to be differentiated from reflux esophagitis and/or stricture secondary to reflux. One patient required bougie dilatation of a stricture, and three other patients were treated with omeprazole, ranitidine, or antacids with relief of reflux symptoms. The safety and efficacy of the procedure of pneumatic dilatation under direct endoscopic control with the modified Gruntzig dilator has been demonstrated in patients from 8 to 93 yr old, and in patients who have had prior Heller myotomy.

Adolescent↗
PubMed1990

Adenocarcinoma of the pancreas producing pancreatitis and pancreatic abscess.

Pancreatic abscess is a severe complication of pancreatitis usually caused by alcohol, gallstones, abdominal trauma, or prior operative procedures. Pancreatic cancer is a rare cause of acute pancreatitis and an extremely rare cause of pancreatic abscess. We report three patients with pancreatic abscess caused by cancer who experienced a prolonged, complicated course with delay in diagnosis and substantial morbidity.

Abscess↗
PubMed1990

The prevalence of Helicobacter pylori in nonulcer dyspepsia. Importance of stratification according to age.

Helicobacter pylori (formerly Campylobacter pylori) is causally related to active antral gastritis and is highly associated with duodenal and gastric ulcers. However, the relationship of H pylori to nonulcer dyspepsia is less clear. We determined the presence of H pylori in unselected patients who were undergoing upper gastrointestinal tract endoscopy, and we found a prevalence of 37% in 110 patients with nonulcer dyspepsia that was similar to previous data. Patients with nonulcer dyspepsia who had H pylori were found to be significantly older than patients with nonulcer dyspepsia who did not have H pylori. In addition, when stratified according to age, we detected an increased prevalence of H pylori in patients with nonulcer dyspepsia with increasing age, similar to that reported for asymptomatic control populations. This finding casts doubt as to the causal role of H pylori for most patients with nonulcer dyspepsia and stresses the importance of considering epidemiologic factors, such as age, when evaluating the role of H pylori in specific disease states.

Age Factors↗
PubMed1989

Sandwich enzyme-linked immunosorbent assays for the quantification of the C4 isotypes (C4A and C4B) in human plasma.

Sandwich enzyme-linked immunosorbent assays were developed to determine the concentration of the isotypes of the fourth component of human complement (C4A and C4B) in human plasma. In the case of C4A a monoclonal antibody against a common determinant of the alpha chain was used to capture the protein. The bound antigen was then detected with a biotinylated monoclonal antibody reacting exclusively with the C4A isotype, followed by peroxidase labeled avidin. For the quantification of C4B, C4B-specific monoclonal antibodies were coated onto a microtitration plate in order to capture the protein. Bound antigen was then detected with a biotinylated monoclonal antibody directed against C4 followed by peroxidase labeled avidin. The assays, which were rapid, selective and specific for C4A and C4B, respectively, provide an alternative to gel electrophoresis and blot procedures for the study of unexpressed alleles ('null alleles') at each of the C4 loci.

Antibodies, Monoclonal↗
PubMed1989

Safety of endoscopy in the immediate postoperative period following gastric anastomosis.

The safety of gastrointestinal endoscopy in the immediate postoperative period following partial gastrectomy was assessed in ten dogs. Endoscopy was performed preoperatively and at 1, 2, 3, and 7 days postoperatively. The mean pressures required to perform an adequate endoscopy varied from 17 to 20 mm Hg. Following partial gastrectomy, the abdominal wall was closed with a zipper to facilitate inspection of the gastric anastomosis. No leakage of air or intra-abdominal abscesses were seen following endoscopy. The results of this study suggest that endoscopy can be safely performed in the immediate postgastrectomy period.

Animals↗
PubMed1989

Role of reactive oxygen metabolites in early cardiopulmonary changes of acute hemorrhagic pancreatitis.

The role of reactive oxygen metabolites in extrapancreatic organ dysfunction associated with acute hemorrhagic pancreatitis was studied in dogs. Experimental pancreatitis was induced by the intraductal infusion of activated trypsin and taurocholate. Cardiac output, pulmonary and systemic blood pressure, pulmonary wedge pressure, central venous pressure, heart rate, blood gases and serum amylase were measured. Cardiac index, pulmonary and systemic vascular resistance, and the right and left stroke work were calculated. Systemic arterial and venous blood pressure and cardiac index gradually declined over 6 hr, while pulmonary mean blood pressure and pulmonary vascular resistance increased. Pretreatment of pancreatitis with catalase and superoxide dismutase prevented the rise in mean pulmonary blood pressure, moderated the rise in pulmonary vascular resistance, and decreased the rate and extent of the fall in cardiac index. These data suggest that reactive oxygen metabolites may play some role in the extraabdominal organ manifestations of acute pancreatitis.

Acute Disease↗
PubMed1989

Effects of the cholecystokinin receptor antagonist L-364,718 on experimental pancreatitis in mice.

The effects of the cholecystokinin receptor antagonist L-364,718 was studied in a model of mild pancreatitis induced in mice by repeated injections of the secretagogue caerulein and in a lethal form of pancreatitis induced by feeding mice an ethionine-supplemented choline-deficient diet. L-364,718 prevented the caerulein-induced rise in serum amylase and pancreatic weight in a dose-dependent manner, the most effective dose being 0.1 mg/kg body wt. L-364,718 also prevented the caerulein-induced pancreatic inflammation as seen by light microscopy. L-364,718 offered no protective effects as determined by changes in serum amylase, pancreatic weight, histology, or mortality in the ethionine-supplemented choline-deficient diet model.

Amylases↗
PubMed1989

Resolution of intestinal cryptosporidiosis after treatment of AIDS with AZT.

Intestinal cryptosporidiosis commonly results in severe protracted diarrhea that contributes significantly toward morbidity and mortality in patients with acquired immunodeficiency syndrome. No satisfactory therapy for cryptosporidiosis currently exists. We describe a patient with severe secretory diarrhea and malabsorption who had clinical, microbiologic, and histologic resolution of cryptosporidiosis after therapy with zidovudine.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Unusual anodic migrating isoamylase differentiates selected malignant from nonmalignant ascites.

Ascitic fluid from nine patients with nonmalignant ascites and nine patients with malignant ascites was subjected to isoamylase analysis. Unusual isoamylase bands that migrate to the anode were demonstrated in seven of eight patients with ovarian carcinoma and in one patient with gastric carcinoma. In no case of nonmalignant ascites was anodic isoamylase found, despite the presence of normal amylase in all samples. This is the first report of anodic isoamylase from ascitic fluid in gastric carcinoma and the first series comparing isoamylase patterns in malignant and nonmalignant ascites. Anodic isoamylase on electrophoresis of ascitic fluid may prove to be useful as a tumor marker in differentiating selected malignancies from nonmalignant ascites.

Amylases↗
PubMed1989

Gastroenterology, diagnosis-related groups, and age.

Hospitals are now being reimbursed by a prospective Diagnosis-Related Group (DRG) classification system. There have been no major changes in the Federal Medicare DRG classification system since its inception 5 years ago. In this project, we analyzed all gastrointestinal (GI) medicine admissions by age and resource utilization at a large academic medical center. Total hospital costs for the 3,598 GI patients (January 1, 1985, through December 31, 1987) were $18,460,604. Although DRG reimbursement for all patients for the 3-year period would have generated an aggregate profit of $957,760, four out of five age categories of patients 65 years of age and above would have generated losses; the highest loss was for patients 85 years and over, at $2,235 per patient. Older GI patients (i.e., 65 years and over) had higher hospital costs, longer lengths of stay, more diagnoses and procedures per patient, and a higher mortality rate than younger patients. Both intensive care unit (ICU) and blood utilization rose with age. Thus, older GI patients consumed a disproportionately larger share of hospital resources. Our study suggests that the current DRG reimbursement scheme may be inequitable relative to the older GI medicine patient; financial disincentives from DRGs may affect elderly patients' access to and quality of care in the future.

Academic Medical Centers↗
PubMed1989

Acute necrotizing gastritis in a patient with peptic ulcer disease.

Gangrene of the stomach is a rare, often fatal disease which may be due to vascular, chemical, mechanical, or infectious etiologies. The infectious type, acute necrotizing gastritis, is thought to be a variant of phlegmonous gastritis, which has been associated with recent large intake of alcohol, "gastritis," and upper respiratory tract infections. Our patient, who had a history of peptic ulcer disease and gastric outlet obstruction, presented with abdominal pain, hypotension, and pneumomediastinum.

Acute Disease↗
PubMed1989

Nutritional deficiencies in chronic pancreatitis.

Marked weight loss is the major nutritional defect in chronic pancreatitis. Inadequate food intake owing to recurrent or near continuous pain usually accounts for the initial 10 to 20 per cent of loss of body weight, which decreases again with the onset of diabetes and is often precipitous with the development of steatorrhea. Treatment of pain, control of diabetes, and intensive pancreatic replacement therapy for steatorrhea usually causes weight gain, but seldom to ideal weight. It appears that the patient's body weight gets set at a new "weight-stat." Although isolated abnormalities of small bowel function tests can be elicited and deficiencies of fat-soluble vitamins, calcium, zinc, selenium, and so forth may be demonstrated, these rarely lead to clinical syndromes, as with demonstrable low B12 uptake in some 10 to 15 per cent of patients. In the late stage of the disease and particularly in NATP, extreme protein-calorie malnutrition may occur, which may not be correctable even by hyperalimentation. Although the mortality of the disease was reportedly higher in areas of socioeconomic deprivation, it appears from recent studies in Switzerland and other developed countries that mortality during a 12-year period may be in the region of 50 per cent worldwide.

Avitaminosis↗
PubMed1988

Hyperamylasemia in inflammatory bowel disease.

We determined the prevalance and significance of hyperamylasemia in 180 patients with idiopathic inflammatory bowel disease (IBD) (83 with ulcerative colitis, and 97 with Crohn's disease). Serum total amylase and pancreatic and salivary isoamylase activity were measured in all patients. In all patients with hyperamylasemia, we measured isoamylase activity by cellulose acetate electrophoresis and lipase activity, assayed for the presence of macroamylase, and carried out pancreatic ultrasound examination and barium studies of the upper gastrointestinal tract. Eight of 97 patients with Crohn's disease (8%) had hyperamylasemia; 4 of them had an elevated pancreatic isoamylase and 2 a raised lipase activity. All patients with hyperamylasemia had normal ultrasonographic scans of the pancreas and no evidence of duodenal involvement on barium meal. None had macroamylasemia. We found no relationship of hyperamylasemia to disease site, activity, and duration or therapy and no patient developed clinical evidence of pancreatitis. We conclude that a small but important number of patients with Crohn's disease have hyperamylasemia not associated with overt pancreatitis. In the absence of appropriate indications, it requires no investigation.

Amylases↗
PubMed1988

Acetate production from hydrogen and [13C]carbon dioxide by the microflora of human feces.

Fecal suspensions from humans were incubated with 13CO2 and H2. The suspensions were from subjects who harbored 10(8) and 10(10) methanogens per g (dry weight) of feces, respectively, and from a subject who did not harbor methanogens. Quantitative nuclear magnetic resonance spectroscopy showed that acetate labeled in both the methyl and carboxyl groups was formed by suspensions from the subject without methanogens and the subject with the lower concentrations of methanogens. The amounts of labeled acetate formed were in agreement with the amounts expected based on measurements of H2 utilization. No labeled acetate was formed by suspensions from the subject with the higher concentrations of methanogens, and essentially all of the H2 used was accounted for by CH4 production. Suspensions from the subject with lower concentrations of methanogens produced both methane and acetate from H2 and CO2. The results indicate that reduction of CO2 to acetate may be a major pathway for microbial production of acetate in the human colon except when very high concentrations of methanogens (ca. 10(10) per g [dry weight] of feces) are present. Double-labeled acetate was also formed from H2 and 13CO2 by fecal suspensions from nonmethanogenic and moderately methanogenic rats.

Acetates↗
PubMed1988

Percutaneous sonographic needle aspiration biopsy of endoscopically negative gastric carcinoma.

We report here the use of ultrasound-guided percutaneous fine needle aspiration gastric biopsies in three patients with endoscopically negative biopsies. Two men, ages 60 and 64, and one woman, age 64, with signs and symptoms of weight loss, abdominal pain, and early satiety, had barium contrast studies suggestive of thickened gastric walls of the antrum and cardia, yet multiple endoscopic biopsies were negative for malignancy. Using real time sector B-scan ultrasonography, percutaneous fine needle aspiration biopsy retrieved signet cell carcinomatous cytologic material in all three patients. No complications were noted. In patients with clinical and radiographic findings compatible with an infiltrative process but negative endoscopic biopsies, in whom sonography can identify a thickened stomach wall, we suggest that percutaneous fine needle aspiration biopsy be attempted.

Adenocarcinoma, Mucinous↗
PubMed1988

Hospital costs, resource characteristics, and the dynamics of death for hospitalized gastroenterology patients.

The federal Medicare diagnosis-related group (DRG) hospital payment system has been on-line for 5 yr with no major adverse effects on either access or quality of care. The hospital industry contends that DRGs are underpaying for hospital care, especially for certain types of patients. Analysis of 2,500 gastroenterology patients by outcome (i.e., survivors vs mortalities) demonstrated that the 122 mortalities had a much greater intensity of hospital resource utilization, and generated substantial financial risk under DRG pricing schemes, compared with the 2,378 survivors. Only mortalities that occurred within 1 wk of admission to the hospital were profitable under DRGs. A long hospital length of stay (LOS) for mortalities was very unprofitable (mortalities with more than a 60-day LOS generated $20,210 loss per patient). Emergency gastroenterology admissions who died had greater financial risk under DRGs, compared to nonemergency mortalities. Those mortalities referred to gastroenterology from other clinical services tended to have greater resource utilization and financial risk under DRGs, compared with nonreferred mortalities. These data suggest significant inequities in the current DRG prospective payment system vis-a-vis gastrotenterology mortalities. Predictive variables of greater hospital resource utilization for gastroenterology mortalities include longer hospital lengths of stay, emergency admission, and referral from another clinical service. If equity of DRG payment is not improved by the federal government, certain groups of patients likely to be mortalities may suffer a decline in access and/or the quality of medical care in the future.

Adult↗