Pseudomonas aeruginosa bacteremia associated with sphincter of Oddi manometry.
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Ampulla of Vater↗
Biomedical subjects
T T Schubert
Publications and source records attributed to T T Schubert.
A US multicenter study of enprostil 35 micrograms twice daily for treatment of prepyloric, pyloric channel, and duodenal bulb ulcers. Enprostil Study Group.
One hundred twenty-seven patients with endoscopically diagnosed active duodenal, pyloric, or prepyloric ulcers participated in this multicenter, double-blind, randomized, controlled trial comparing placebo with enprostil 35 micrograms twice daily for up to four weeks. Cumulative endoscopic healing for the enprostil and placebo treatment groups, respectively, was 25% (15 of 59) and 12% (7 of 60) at two weeks (P = 0.060) and 59% (34 of 58) and 33% (19 of 57) at four weeks (P = 0.005). Excluding prepyloric ulcers, cumulative healing for the enprostil and placebo groups, respectively, was 22% (9 of 41) and 7% (3 of 44) at two weeks (P = 0.104) and 56% (23 of 41) and 24% (10 of 42) at four weeks (P = 0.002). A greater percentage of prepyloric ulcers healed on enprostil than placebo, but the difference was not significant. Mean antacid use in both groups was identical, averaging only two or less tablets per day in each group throughout the study. Daytime pain was relieved more quickly in the enprostil group, while median time to relief of nighttime pain was essentially identical in both groups. The most common side effect in the enprostil treatment group, diarrhea, was mostly mild to moderate in intensity and was generally self-limiting, requiring no specific therapy; no patient withdrew because of this complaint. Other symptoms and laboratory profiles were similar in the two groups. These results indicate that enprostil 35 micrograms taken twice daily for four weeks is effective and safe for the treatment of prepyloric, pyloric channel, and duodenal ulcers.
Adult↗
Surgical therapy of diabetic gastroparesis.
Diabetic gastroparesis is a complication of diabetes mellitus that usually responds to medical management. We report a patient in whom medical management failed, and a gastrostomy, pyloroplasty, and jejunostomy were done to insure nutrition and to decompress the stomach. We also review the surgical management of this condition.
Adult↗
Chronic Epstein-Barr virus infection: a cause of granulomatous hepatitis?
A 37-year-old man had fever, weight loss, malaise, right upper quadrant pain, lymphadenopathy, and a twofold elevation of serum alkaline phosphatase, transaminases, and gamma glutamyl transpeptidase. Granulomas were found on liver biopsy after 2 1/2 months of illness. Treatment with isoniazid and rifampin for 2 months did not lead to improvement in fever or symptoms, but prednisone caused a prompt resolution. Positive IgM antibodies to the viral capsule antigen followed by marked elevation of the IgG fraction suggest chronic Epstein-Barr virus infection to be the etiology. The patient was asymptomatic without treatment 14 months after onset of the illness.
Adult↗
Papillary cystadenocarcinoma of the bile ducts resulting in hemobilia.
Cystadenocarcinoma is a rare tumor of the intrahepatic and a very rare tumor of the extrahepatic biliary system. In the reported cases, abdominal swelling is the most common presenting symptom, followed by right upper quadrant mass. Melena was the initial presenting symptom in the present case. Bleeding into the second part of the duodenum was observed only during the third diagnostic esophagogastroduodenoscopy. Hemobilia was suspected because of abnormal liver enzymes and a mass in the left lobe of the liver on computerized tomography. At laparotomy, we suspected that the mass was a hemangioma. Cystadenocarcinoma diagnosis was made only by histopathological examination.
Aged↗
Prevalence of Campylobacter pylori in patients undergoing upper endoscopy.
From August 1987 through July 1988, we evaluated antral biopsy specimens for Campylobacter pylori (CP) in 212 patients undergoing upper endoscopy. For those patients who had multiple endoscopies, the first endoscopy in which a urease test, histology, and culture were done was used to determine CP status. A patient was regarded as CP-positive if the culture was positive or if both a urease test and the histology were positive. Blacks had an increased CP positivity (61.2%) compared to whites (31.5%). Among non-ulcer patients, CP positivity was 52% in black patients and 18% in white patients. Age and gender were unrelated to CP positivity among controls and those without ulcers. There was increased CP positivity in patients with duodenal ulcers (85%), compared with those without ulcers (37%), and a trend toward increased positivity in those with gastric ulcer (53%) and duodenitis (50%). There was no increased CP positivity in patients with gastroesophageal reflux disease (28%), gastritis (29%), non-ulcer dyspepsia (43%), or the control patients with no gastroduodenal mucosal abnormalities (40%). CP-negative DU patients were older (average 71 yr) than CP-positive DU patients (43 yr), and female DU patients had a lower CP positivity (71%) than males (94%).
Adult↗
Usefulness of culture, histology, and urease testing in the detection of Campylobacter pylori.
Several tests have been described which detect the presence of Campylobacter pylori (CP) in the human upper gastrointestinal tract. Antral biopsies from 160 endoscopies were evaluated for the presence of CP; four tests readily available to the practicing endoscopist were used: two urease tests [CLOtest and microtiter biopsy urease test (MBUT)], hematoxylin and eosin staining, and culture. Sensitivity and specificity of each was evaluated and found to be near 90%, except for culture, which was less sensitive. The presence of peptic disease on endoscopy, and age greater than 50 yr, did play a small role in the sensitivity and specificity of the tests. With the advantage of lower cost, ease, and rapidity of performance, either the CLOtest or MBUT is recommended for the standard endoscopic evaluation for CP.
Age Factors↗
Delta hepatitis: first two cases identified in Kansas City.
Hepatitis delta virus (HDV) was identified in 1977 and has since been found to be a worldwide disease. Prevalence in North America is highest among drug abusers. We present two IV drug abusers from the city hospital in Kansas City as the first two cases identified in the city, one with apparent superinfection and the other with a chronic HDV infection. We review the various manifestations and diagnosis of HDV, and advocate prevention of spread of HDV infection by hepatitis B vaccination and use of single donor blood products in high-risk patients.
Acute Disease↗
Polystyrene bezoar in a patient with polystyrenomania.
A 35-yr-old man with hematemesis, epigastric pain, and no predisposing factors to delayed gastric emptying was found to have a gastric bezoar. Surgical removal was required. Pathological and biochemical examination revealed a mass composed of polystyrene. This represents an unusual composition and a newly recognized predisposing factor to bezoar formation, "polystyrenomania" from ingestion of styrofoam cups.
Adult↗
Inorganic lead poisoning in an adult.
Lead poisoning is uncommon in the adult population, but must be considered in the differential diagnosis of patients with abdominal pain of obscure etiology. In this paper we present a 38-yr-old male with abdominal pain, a history of alcohol abuse, and exposure to the virus responsible for acquired immunodeficiency syndrome. The cause of pain was elusive until his occupation as a housepainter was appreciated. The diagnosis of lead poisoning then was considered and confirmed by an elevated blood lead level and symptomatic response to therapy. With the increase in renovation of old buildings, it is likely that the incidence of lead poisoning will become more common.
Adult↗
Talc liver.
Talc in the liver is highly suggestive of intravenous drug abuse. We report three patients in whom finding talc or talc granuloma on liver biopsy led to the diagnosis of unsuspected i.v. drug abuse. There follows a discussion of the pathogenesis, laboratory and clinical features, and liver pathology of talc liver.
Adult↗
Aortogastric fistula from hiatal hernia ulcer. A cause of massive upper gastrointestinal bleeding.
An 83-year-old woman with no history of vascular surgery presented with a fatal upper gastrointestinal bleed from an aortogastric fistula secondary to a penetrating gastric ulcer. The fistula was between the thoracic aorta and the gastric ulcer in a hiatus hernia. On autopsy, a discrete 1-cm ulcer had perforated into the otherwise normal thoracic aorta. Aortogastric fistula involving the thoracic aorta and a gastric ulcer is rare in the absence of vascular graft surgery or aneurysm. We review the pertinent literature.
Aged↗
Hepatobiliary system in sickle cell disease.
This paper reviews the literature reports concerning sickle cell disease and the hepatobiliary system. Sickle cell disease can cause progressive injury to the liver with significant fibrosis, often cirrhosis, and decreased liver function by adulthood. Asymptomatic patients commonly have hepatomegaly and elevated liver enzyme levels. The presence of sickle cell disease obscures features otherwise useful in differential diagnosis. Acute episodes of the disease selectively affect the liver in 10% of patients, causing hepatic crisis with abdominal pain, nausea, fever, jaundice, and transaminase elevation. Viral hepatitis is often clinically indistinguishable from hepatic crisis, but in viral hepatitis the abdominal pain is usually less, the jaundice tends to be more severe, and the transaminase elevation more prolonged. The two can be distinguished by serology and liver biopsy. Furthermore, acute cholecystitis or choledocholithiasis may have clinical and laboratory features similar to sickle cell hepatic crisis or viral hepatitis. By adulthood, 50%-70% of sickle cell patients have gallstones. Elective cholecystectomy is indicated for those who are symptomatic, but, because of operative mortality, there is disagreement concerning surgery for asymptomatic patients. The literature contains nine well-documented cases of acute hepatic failure related to sickle cell disease. The mechanism is unclear; however, as the necrosis is often not severe, a metabolic problem is suggested.
Acute Disease↗
Screening and detection of colon cancer.
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Colonic Neoplasms↗
Gastric cancer in a young adult.
We report a case of gastric adenocarcinoma in a 23-yr-old white man. Since only 1% of gastric cancers occur in patients under 35 yr or age, the diagnosis is often overlooked. The presence of persistent pain, weight loss, early satiety, anemia, and vomiting are clues to the underlying disorder. Endoscopy is the best means of diagnosis. All ulcers or other suspicious lesions should be biopsied. Prognosis is poor, related to the failure to suspect the diagnosis and to the aggressive nature of the disease. This case points out the importance of the thorough investigation of all patients with suggestive findings regardless of the patient's age.
Adenocarcinoma↗
Update in treatment of peptic ulcer disease.
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Adult↗
Hemoperitoneum from a ruptured varix in cirrhosis. Case report and literature review.
A cirrhotic patient with hemoperitoneum is presented. The diagnosis of ruptured retroperitoneal varices was made at laparotomy and the patient becomes the second reported case to survive hospitalization for bleeding intra-abdominal varices. The formation of varices as a consequence of portal hypertension is discussed; the differential diagnosis and evaluation of hemoperitoneum is considered and the seven previously reported cases of intra-abdominal variceal hemorrhage are reviewed.
Hemoperitoneum↗
Phycomycosis of the gastrointestinal tract.
A case of gastrointestinal phycomycosis, a highly lethal fungal infection, is presented. Radiographic, operative and histopathologic features are discussed. Pathogenesis of the disease and the importance of underlying illness, malnutrition, immunosuppression and antibiotic therapy are considered. The literature is reviewed and current approaches to diagnosis and management are summarized. Greater awareness of the clinical setting in which gastrointestinal phycomycosis may develop and earlier consideration of the diagnosis are prerequisite to improved survival.
Female↗