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Upper Gastrointestinal (upper + gastrointestinal)
Terms modified by Upper Gastrointestinal Selected AbstractsSRS: Upper Gastrointestinal 1,9BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue S1 2000Article first published online: 29 SEP 200 No abstract is available for this article. [source] CLINICAL INVESTIGATION OF UPPER GASTROINTESTINAL HEMORRHAGE AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMYDIGESTIVE ENDOSCOPY, Issue 3 2010Shinji Nishiwaki Background:, Upper gastrointestinal (GI) hemorrhage after percutaneous endoscopic gastrostomy (PEG) is sometimes reported as one of the serious complications. Our purpose was to clarify the cause of upper GI hemorrhage after PEG. Patients and Methods:, We retrospectively investigated the causes of upper GI hemorrhage among a total of 416 patients out of 426 consecutive patients who underwent PEG in our institution, excluding 10 patients who showed upper GI tumors on PEG placement. Results:, Among 17 patients who developed upper GI hemorrhage after PEG, three and four patients showed PEG tube placement and replacement-related hemorrhage, respectively; these lesions were vascular or mucosal tears around the gastrostomy site. Ten patients experienced 12 episodes of upper GI hemorrhage during PEG tube feeding. The lesions showing bleeding were caused by reflux esophagitis (five patients), gastric ulcer (two patients), gastric erosion due to mucosal inclusion in the side hole of the internal bolster (two patients), and duodenal diverticular hemorrhage (one patient). Anticoagulants were administered in six patients, including four patients with replacement-related hemorrhage and one patient each with reflux esophagitis and gastric ulcer. Conclusions:, Reflux esophagitis was the most frequent reason for upper GI hemorrhage after PEG. The interruption of anticoagulants should be considered for the prevention of hemorrhage on the placement as well as replacement of a gastrostomy tube. [source] The Glasgow Blatchford scoring system enables accurate risk stratification of patients with upper gastrointestinal haemorrhageINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2010R. Srirajaskanthan Summary Background:, Upper gastrointestinal (UGI) haemorrhage is a frequent cause of hospital admission. Scoring systems have been devised to identify those at risk of adverse outcomes. We evaluated the Glasgow Blatchford score's (GBS) ability to identify the need for clinical and endoscopic intervention in patients with UGI haemorrhage. Methods:, A retrospective observational study was performed in all patients who attended the A&E department with UGI haemorrhage during a 12-month period. Patients were separated into low and high risk categories. High risk encompassed patients who required blood transfusions, operative or endoscopic interventions, management on high dependency or intensive care units, and those who re-bled, represented with further bleeding, or who died. Results:, A total of 174 patients were seen with UGI bleeding. Eight of them self-discharged and were excluded. Of the remaining 166, 94 had a ,low risk' bleed, and 72 ,high risk'. The GBS was significantly higher in the high risk (median = 10) than in the low risk group (median 1, p < 0.001). To assess the validity of the GBS at separating low and high risk groups, receiver-operator characteristic (ROC) curves were plotted. The GBS had an area under ROC curve of 0.96 (95% CI 0.95,1.00). When a cut-off value of , 3 was used, sensitivity and specificity of GBS for identifying high risk bleeds was 100% and 68%. Thus at a cut-off value of , 2 the GBS is useful for distinguishing those patients with a low risk UGI bleed. Conclusions:, The GBS accurately identifies low risk patients who could be managed safely as outpatients. [source] A decade-long sour-taste sensation successfully treated with a proton-pump inhibitorJOURNAL OF ORAL REHABILITATION, Issue 10 2005N. MANTANI summary We report a case study of a 54-year-old Japanese woman who persistently suffered from a sour-taste sensation in her mouth for 10 years, and was treated with a proton-pump inhibitor (PPI). She found sour-tasting meals irritable, and after eating such meals the sour-taste sensation worsened. She also complained of eructation and regurgitation. Upper gastrointestinal (GI) endoscopy showed duodenal erosion, superficial gastritis, and erosive oesophagitis. After 2 weeks of PPI therapy (lansoprazole, 30 mg day,1) the sour taste subjectively decreased to 70%, and after 6 weeks the symptoms disappeared. In addition to increased sensitivity of the mouth, gastro-oesophageal reflux might have created her obstinate sour-taste sensations. It is suggested that in such cases PPI therapy should be attempted. [source] Review article: hyperammonaemic and catabolic consequences of upper gastrointestinal bleeding in cirrhosisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2009S. W. M. OLDE DAMINK Summary Background, Upper gastrointestinal (UGI) bleeding in patients with cirrhosis of the liver induces hyperammonaemia and leads to a catabolic cascade that precipitates life-threatening complications. The haemoglobin molecule is unique because it lacks the essential amino acid isoleucine and contains high amounts of leucine and valine. UGI bleed therefore presents the gut with protein of very low biologic value, which may be the stimulus to induce net catabolism. Aim, To describe the hyperammonaemic and catabolic consequences of UGI bleeding in cirrhosis. Methods, A semi-structured literature search was performed using PubMed and article references. Results, It has recently been proven that (,simulation of,') a UGI bleed in patients with cirrhosis leads to impaired protein synthesis that can be restored by intravenous infusion of isoleucine. This may have therapeutic implications for the function of rapidly dividing cells and short half-life proteins such as clotting factors. Renal and small bowel ammoniagenesis were shown to be the most prominent causes for the hyperammonaemia that resulted from a UGI bleed. This provides an explanation for the therapeutic failure of the current clinical therapies that are aimed at large bowel-derived ammonia production. Isoleucine infusion did not diminish renal ammoniagenesis. Conclusions, New pharmacological therapies to diminish postbleeding hyperammonaemia should target the altered inter-organ ammonia metabolism and promote ammonia excretion and/or increase the excretion of precursors of ammoniagenesis, e.g. l -ornithine,phenylacetate. [source] DEXMEDETOMIDINE FOR SEDATION DURING UPPER GASTROINTESTINAL ENDOSCOPYDIGESTIVE ENDOSCOPY, Issue 4 2008Kazutoshi Hashiguchi Background:, A clinical study was conducted to investigate the safety and efficacy of dexmedetomidine for sedation of patients undergoing routine upper gastrointestinal (GI) endoscopy. Methods:, Forty middle-aged patients who were admitted for medical examination were randomized to receive an initial loading dose infusion of dexmedetomidine 6.0 µg/kg per h over 10 min followed by a maintenance infusion of 0.6 µg/kg per h (group A) or rapid infusion of midazolam 0.05 mg/kg (group B) as sedation for routine endoscopy. Sixty patients did not receive sedative agent (group C). Assessment included measurement of heart rate (HR), blood pressure (BP), oxygen saturation, and endoscopy duration. Results:, There were no statistically significant differences among the groups in baseline characteristics. The level of sedation was similar between groups A and B, and the gag response score was significantly lower in the sedated groups than in group C. Hemodynamic stability was also demonstrated in group A during and after the endoscopic procedure. Increased systolic/diastolic BP was significantly attenuated in group A compared with group C. Interestingly, HR was significantly suppressed in group A than in groups B and C. In groups A and B, SpO2 was decreased compared with group C during and after the procedures; however, there was no significant difference between the two groups. There was no significant difference among the groups with endoscopy duration. Conclusions:, For sedation during upper endoscopy, dexmedetomidine is as safe and effective as midazolam, and it significantly reduces HR and BP during and after the endoscopic procedures. [source] A REVIEW OF CURRENT CLINICAL APPLICATIONS OF UPPER GASTROINTESTINAL ZOOM ENDOSCOPYDIGESTIVE ENDOSCOPY, Issue 2005Kenshi Yao Current clinical applications of upper gastrointestinal (GI) zoom endoscopy were reviewed. The objective of upper GI zoom endoscopy has been the diagnosis of neoplastic lesions as well as the diagnosis of minute inflammatory mucosal change. The target organ and pathology of the neoplastic lesions have been squamous cell carcinoma in the oro- and hypo-pharynx and in the esophagus; intestinal metaplasia, dysplasia, and adenocarcinoma in Barrett's esophagus; and adenocarcinoma in the stomach. For analyzing the magnified endoscopic findings, there were two different basic principles (mucosal microstructural change and subepithelial microvascular changes). Overall diagnostic accuracy for diagnosing a neoplastic lesion was above 80% throughout the upper GI tract. Although the diagnostic accuracy of the zoom endoscopy technique seems to be superior to that of the ordinary endoscopy technique alone, the continuous efforts to establish standardized guidelines and procedures are mandatory in order to lead to the routine use of upper GI zoom endoscopy in clinical practice. [source] Differences in endoscopic views during biopsy through the right and left lower biopsy channels of the upper gastrointestinal endoscopeDIGESTIVE ENDOSCOPY, Issue 3 2004Naoki Mantani Background:, It has not been established as to which side the biopsy (instrument) channel should be placed in the tip of a front-viewing upper gastrointestinal (GI) endoscope to allow an en-face approach to lesions on various aspects of the stomach wall. Methods:, Using a front-viewing two-channel endoscope, we identi,ed a difference in endoscopic views during biopsy between lower-right and lower-left channels. Colored marks were distributed on the lesser curvature (LC), greater curvature (GC), anterior wall (AW), and posterior wall (PW) in the ,stomach' of a dummy for mock-performance of upper GI endoscopy. When biopsy forceps through the different channels touched the marks, an endoscopic photograph was taken. Furthermore, when biopsy specimens were obtained from PW lesions in several patients, endoscopic views were compared between the two biopsy channels. Results:, In the dummy study, no remarkable difference was detected in targeting the marks on AW, LC, or GC of the stomach. The dummy and the patient study showed that the lower-right approach could target PW lesions with a more adequate endoscopic view than from the lower left. The lower-left approach targeted PW lesions on the higher body with a nearly blinded endoscopic view. Specimens from PW of the upper body, which could be precisely obtained under direct visual control through the lower-right channel, were no smaller than those obtained using the channel on the lower left. Conclusion:, The present study suggests that the lower-right channel may be preferable to the lower-left channel in the tip of a front-viewing upper GI endoscope. [source] Factors Related to Helicobacter pylori Prevalence in an Adult Population in BrazilHELICOBACTER, Issue 1 2007Schlioma Zaterka Abstract Background:, The prevalence of Helicobacter pylori is higher in developing countries. Sanitary facilities, crowding and ethnic group are some of the factors related to H. pylori infection. The aim of this study was to investigate in blood donors, free of dyspeptic symptoms, the prevalence and factors influencing H. pylori infection. Materials and Methods:, This study was conducted in Săo Paulo, a city known to have a mixed population coming from all over the country. A total of 1008 blood donors were initially included in the study. After a final revision of all the questionnaires, 993 were included in the final analysis (746 males). H. pylori status was checked by an ELISA test. The following associations to infection were analyzed: sex, age, ethnic group, previous upper gastrointestinal (GI) endoscopy, smoking, alcoholism, drug addiction, type of drinking water, crowding, sanitary facilities, and family income. Results:, Infection was observed in 496 of 746 male (66.5%) and in 156 of 247 female (63.2%) blood donors. Infection prevalence increased according to age group, regardless of sex. Prevalence was lower in White population than in non-White. No relationship was observed between infection and smoking, drug addiction, and alcohol. A positive relation was observed between infection and previous upper GI endoscopy, and type of drinking water, regardless if currently or during childhood. Crowding and lack of toilet in the house during childhood resulted in a higher infection rate. Lower familial income and educational level showed a positive association to infection. Conclusions:, Prevalence of H. pylori is higher in non-White population, independent of gender. A positive association was observed in aging, previous upper GI endoscopy, crowding, type of drinking water, lack of toilet during childhood, lower family income, and lower educational level. [source] Two-Year Results of Once-Weekly Administration of Alendronate 70 mg for the Treatment of Postmenopausal OsteoporosisJOURNAL OF BONE AND MINERAL RESEARCH, Issue 11 2002R Rizzoli Abstract The aim of this study was to provide confirmation that once-weekly dosing with 70 mg of alendronate (seven times the daily oral dose) and twice-weekly dosing with 35 mg is equivalent to the 10-mg once-daily regimen and to gain more extensive safety experience with this new dosing regimen. Twelve hundred fifty-eight postmenopausal women (aged 42,95 years) with osteoporosis (bone mineral density [BMD] of either lumbar spine or femoral neck at least 2.5 SDs below peak young adult mean or prior vertebral or hip fracture) were assigned to receive oral once-weekly alendronate, 70 mg (n = 519); twice-weekly alendronate, 35 mg (n = 369); or daily alendronate 10 mg (n = 370) for a total of 2 years of double-blind experience. Mean BMD increases from baseline (95% CI) at 24 months in the once-weekly, twice-weekly, and daily treatment groups, respectively, were 6.8% (6.4, 7.3), 7.0% (6.6, 7.5), and 7.4% (6.9, 7.8) at the lumbar spine and 4.1% (3.8, 4.5), 4.3% (3.9, 4.7), and 4.3% (3.9, 4.7) at the total hip. These increases in BMD as well as the BMD increases at the femoral neck, trochanter, and total body and the reductions of biochemical markers of bone resorption (urinary cross-linked N-telopeptides of type I collagen [NTx]) and bone formation (serum bone-specific alkaline phosphatase [BSAP]) were similar for the three dosing regimens. All treatment regimens were well tolerated with a similar incidence of upper gastrointestinal (GI) adverse experiences. The incidence rates of clinical fractures, captured as adverse experiences, were similar among the groups. The 2-year results confirm the conclusion reached after 1 year that once-weekly alendronate is therapeutically equivalent to daily dosing, providing patients with a more convenient dosing option that may potentially enhance adherence to therapy. [source] Clinical trial: the incidence of NSAID-associated endoscopic gastric ulcers in patients treated with PN 400 (naproxen plus esomeprazole magnesium) vs. enteric-coated naproxen aloneALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2010J. L. Goldstein Aliment Pharmacol Ther 2010; 32: 401,413 Summary Background, Gastroprotective co-therapy may reduce the risk of nonsteroidal anti-inflammatory drug (NSAID)-associated gastric ulcers, but adherence is suboptimal. Aim, To compare the incidence of gastric ulcers with PN 400 [enteric-coated (EC) naproxen 500 mg and immediate-release esomeprazole 20 mg], or EC naproxen. Methods, Two randomized, double-blind, multicentre studies (PN400-301, PN400-302). Patients [stratified by low-dose aspirin (,325 mg) use] aged ,50 years or 18,49 years with a history of ulcer, received PN 400 BID (301, n = 218; 302, n = 210) or EC naproxen 500 mg BID (301, n = 216; 302, n = 210) for 6 months. The primary endpoint was the cumulative incidence of endoscopic gastric ulcers. Results, The cumulative incidence of gastric ulcers was significantly lower with PN 400 vs. EC naproxen (301: 4.1% vs. 23.1%, P < 0.001; 302: 7.1% vs. 24.3%, P < 0.001). PN 400 was associated with a lower combined incidence of gastric ulcers vs. EC naproxen in low-dose aspirin users (n = 201) (3.0% vs. 28.4%, P < 0.001) and non-users (n = 653) (6.4% vs. 22.2%, P < 0.001). The incidence of, and discontinuations due to, upper gastrointestinal (UGI) AEs was significantly lower with PN 400 relative to EC naproxen (P < 0.01, both studies). Conclusions, PN 400 significantly reduces the incidence of gastric ulcers, regardless of low-dose aspirin use, in at-risk patients, and is associated with improved UGI tolerability relative to EC naproxen (ClinicalTrials.gov, NCT00527782). [source] Implications of eosinophilia in the normal duodenal biopsy , an association with allergy and functional dyspepsiaALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2010M. M. WALKER Aliment Pharmacol Ther,31, 1229,1236 Summary Background, Allergy and functional gastrointestinal disorders have been associated with eosinophilia in duodenal mucosa. Aim, To assess the prevalence of eosinophilia in duodenal biopsies of patients attending for oesophogastroduodenoscopy and delineate associated clinical conditions. Methods, A total of 155 patients (mean age 55 years, 59% women) with normal duodenal biopsies were randomly selected for audit from histopathology files. Eosinophil counts in five high power fields (HPFs) were assessed. Records were analysed for symptoms, diagnosis and medications; patients were divided into five groups based on upper gastrointestinal (UGI) symptom profiles, including a control group of those without predominant UGI symptoms. The prevalence of duodenal eosinophilia (defined as >22/5HPFs a priori) was calculated. Results, In the control group, the mean duodenal eosinophil count was 15/5HPFs; prevalence of duodenal eosinophilia was 22.5%. In postprandial distress syndrome (PDS), both mean eosinophil counts (20.2/5HPF, P < 0.04) and prevalence of duodenal eosinophilia (47.3%, P < 0.04) were significantly higher. Duodenal eosinophilia was significantly associated with allergy (OR 5.04, 95% CI 2.12,11.95, P < 0.001). There was no association with irritable bowel syndrome or medications. Conclusions, Subtle duodenal eosinophilia is relatively common in routine oesophogastroduodenoscopy and previously overlooked; it is associated with allergy and may indicate a hypersensitivity mechanism in some patients with PDS including early satiety. [source] Review article: the modern management of portal vein thrombosisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2009Y. CHAWLA Summary Background, Portal vein thrombosis (PVT) is an important cause of portal hypertension. It may occur as such with or without associated cirrhosis and hepatocellular carcinoma. Information on its management is scanty. Aim, To provide an update on the modern management of portal vein thrombosis. Information on portal vein thrombosis in patients with and without cirrhosis and hepatocellular carcinoma is also updated. Methods, A pubmed search was performed to identify the literature using search items portal vein thrombosis-aetiology and treatment and portal vein thrombosis in cirrhosis and hepatocellular carcinoma. Results, Portal vein thrombosis occurs because of local inflammatory conditions in the abdomen and prothrombotic factors. Acute portal vein thrombosis is usually symptomatic when associated with cirrhosis and/or superior mesenteric vein thrombosis. Anticoagulation should be given for 3,6 months if detected early. If prothrombotic factors are identified, anticoagulation should be given lifelong. Chronic portal vein thrombosis usually presents with well tolerated upper gastrointestinal bleed. It is diagnosed by imaging, which demonstrates a portal cavernoma in place of a portal vein. Anticoagulation does not have a definite role, but bleeds can be treated with endotherapy or shunt surgery. Rarely liver transplantation may be considered. Conclusion, Role of anticoagulation in chronic portal vein thrombosis needs to be further studied. [source] Review article: 5-aminosalicylate formulations for the treatment of ulcerative colitis , methods of comparing release rates and delivery of 5-aminosalicylate to the colonic mucosaALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2008G. R. LICHTENSTEIN Summary Background, Many oral 5-aminosalicylic acid (5-ASA) formulations are designed to maximize 5-ASA release in the colon where it acts topically on the colonic mucosa. Delayed-release formulations and azo-prodrugs minimize 5-ASA absorption in the upper gastrointestinal (GI) tract. Aims, To review methods for assessing 5-ASA release and colonic distribution from oral formulations, and the potential use of this information for guiding clinical decisions. Methods, PubMed and recent conference abstracts were searched for articles describing techniques used to assess 5-ASA release from ulcerative colitis (UC) therapies. Results, In-vitro GI models, although unable to simulate more complex aspects of GI physiology, can provide useful data on 5-ASA release kinetics and bioaccessibility. Gamma-scintigraphy is useful for investigating GI disintegration of different formulations, but may not accurately reflect 5-ASA distribution. Plasma pharmacokinetic studies provide data on systemic exposure, but not on colonic distribution or mucosal uptake. Mucosal biopsies provide direct evidence of colonic distribution and may predict clinical efficacy, but must be interpreted cautiously because of considerable inter-subject variability and other confounding factors. Conclusion, While assessment of 5-ASA release is important, limitations of individual measurement techniques mean that randomized clinical studies in UC patients remain the best guide for dosing and treatment regimen decisions. [source] Social and medical impact, sleep quality and the pharmaceutical costs of heartburn in TaiwanALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2005C.-L. LU Summary Background :,Little is known about the social and medical burdens of heartburn in Asia. Aim :,To assess the impact of heartburn in Taiwan. Methods :,We applied a questionnaire to 2018 apparently healthy adult Chinese receiving a routine health maintenance programme. Costs of heartburn-related prescriptions were obtained from the Bureau of National Health Insurance of Taiwan. Results :,Heartburn prevalence (>1 episode/week) was 7%. Smoking and increased body mass index were associated with heartburn occurrence. Heartburn sufferers reported more atypical gastro-oesophageal reflux disease symptoms, e.g. chest pain, dysphagia and globus. They were more likely to consult physicians, and have an increased frequency and number of days of absenteeism, irrespective of upper gastrointestinal or nongastrointestinal-related illnesses. They experienced sleep disturbances more frequently. The 62 heartburn consulters (48%) were more likely to have co-existing globus, visited physicians more, had more absenteeism, suffered from more sleep disturbances and had higher costs for antacids, proton pump inhibitors, hypnotic/sedatives, tranquilizers and antidepressants than nonconsulters. Conclusions :,Heartburn prevalence in Taiwan is lower than in Western countries. Nevertheless, heartburn in Taiwanese creates a significant burden in terms of social impact, health resource utilization, sleep quality and pharmaceutical costs. The increased costs of psychoactive drugs in consulters suggest that anxiety/depression affects their health-seeking behaviour. [source] Effect of the motilin agonist KC 11458 on gastric emptying in diabetic gastroparesisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2004A. Russo Summary Background :,KC 11458, a motilin agonist without antibiotic properties, accelerates gastric emptying in animals and healthy humans. Aim :,To evaluate the acute effects of KC 11458 on gastric emptying in diabetic gastroparesis. Methods :,Twenty-nine patients (6 type 1 and 23 type 2) with gastroparesis underwent assessments of: (i) gastric emptying of a solid/liquid meal using scintigraphy, (ii) glycaemic control (blood glucose at 0, 30, 60, 90 and 120 min during the gastric emptying measurement) and (iii) upper gastrointestinal and ,meal-related' symptoms (questionnaire), at baseline and after treatment with KC 11458 in a dose of 8 mg t.d.s., or placebo for 8 days. Results :,KC 11458 had no statistically significant or clinically relevant effect on gastric emptying of either the solid intragastric retention at 100 min (T100) (P = 0.87) or liquid 50% emptying time (T50) (P = 0.17) components of the meal. KC 11458 slightly worsened (P = 0.04) upper gastrointestinal symptoms when compared with placebo. The magnitude of the change in solid gastric emptying correlated with the change in the blood glucose concentration (r = 0.49; P < 0.05). Conclusions :,KC 11458, in a dose of 8 mg t.d.s. for 8 days, does not accelerate gastric emptying in patients with diabetic gastroparesis. The absence of efficacy may relate to an effect of hyperglycaemia. [source] Two-stage total hepatectomy and liver transplantation for acute deterioration of chronic liver disease: A new bridge to transplantationLIVER TRANSPLANTATION, Issue 4 2004Michael J. Guirl Two-stage total hepatectomy and liver transplantation has been reported for acute liver disease such as fulminant hepatic failure, primary graft failure, severe hepatic trauma, and spontaneous hepatic rupture secondary to hemolysis, elevated liver function tests, low platelets syndrome, and preeclampsia. This is the first report of patients with cirrhosis to undergo a 2-stage total hepatectomy and liver transplantation. From 1984 to 2002, our institution performed 2008 orthotopic liver transplantations. We identified 4 patients with chronic liver disease who underwent a 2-stage hepatectomy and liver transplantation. This is a retrospective review of these 4 patients and a review of the literature on this procedure. All 4 patients were young men with an age range of 29,31 years and had underlying cirrhosis as well as a previous transjugular intrahepatic portosystemic shunt (TIPS)procedure. Acute decompensation fulfilling Ringes' criteria for toxic liver syndrome secondary to an upper gastrointestinal bleed occurred in all patients. The approximate average time between hepatectomy and liver transplantation was 20 hours (range: 8,42 hours). In all cases, the explanted liver showed histological changes of acute hepatic necrosis within the background of cirrhosis. After hepatectomy, vasopressor requirements were well documented in 2 patients. For 1 patient, there was a clear improvement in their hemodynamic status. The mean hospital stay of the 4 patients was 63 days. All patients were discharged from the hospital and are alive and well with adequate liver function at 6 to 37 months follow-up. Two-stage total hepatectomy and liver transplantation may be a life-saving procedure in highly selected cirrhotic patients with acute hepatic decompensation and multiorgan dysfunction. (Liver Transpl 2004;10:564,570.) [source] Emergency hospital admissions in idiopathic Parkinson's diseaseMOVEMENT DISORDERS, Issue 9 2005Henry Woodford BSc Abstract Little is known about the hospital inpatient care of patients with idiopathic Parkinson's disease (PD). Here, we describe the features of the emergency hospital admissions of a geographically defined population of PD patients over a 4-year period. Patients with PD were identified from a database for a Parkinson's disease service in a district general hospital with a drainage population of approximately 180,000. All admissions of this patient subgroup to local hospitals were found from the computer administration system. Two clinicians experienced in both general medicine and PD then reviewed the notes to identify reasons for admission. Admission sources and discharge destinations were recorded. Data regarding non-PD patients was compared to PD patients on the same elderly care ward over the same time period. The total number of patients exposed to analysis was 367. There was a total exposure of 775.8 years and a mean duration of 2.11 years per patient. There were 246 emergency admissions to the hospital with a total duration of stay of 4,257 days (mean, 17.3 days). These days were accounted for by 129 patients (mean age, 78 years; 48% male). PD was first diagnosed during 12 (4.9%) of the admissions. The most common reasons for admission were as follows: falls (n = 44, 14%), pneumonia (n = 37, 11%), urinary tract infection (n = 28, 9%), reduced mobility (n = 27, 8%), psychiatric (n = 26, 8%), angina (n = 21, 6%), heart failure (n = 20, 6%), fracture (n = 14, 4%), orthostatic hypotension (n = 13, 4%), surgical (n = 13, 4%), upper gastrointestinal bleed (n = 10, 3%), stroke/transient ischemic attack (n = 8, 2%), and myocardial infarction (n = 7, 2%). The mean length of stay for the PD patients on the care of elderly ward specializing in PD care was 21.3 days compared to 17.8 days for non-PD patients. After hospital admission, there was a reduction in those who returned to their own home from 179 to 163 and there was an increase in those requiring nursing home care from 37 to 52. Infections, cardiovascular diseases, falls, reduced mobility, and psychiatric complications accounted for the majority of admissions. By better understanding the way people with PD use hospital services, we may improve quality of care and perhaps prevent some inpatient stays and care-home placements. © 2005 Movement Disorder Society [source] Acotiamide (Z-338) as a possible candidate for the treatment of functional dyspepsiaNEUROGASTROENTEROLOGY & MOTILITY, Issue 6 2010H. Suzuki Abstract Acotiamide hydrochloride is a novel upper gastrointestinal (GI) motility modulator and stress regulator currently being developed for the treatment of functional dyspepsia (FD). The mechanism underlying the enhancement of GI motility by this agent has been proposed to be based on its muscarinic antagonism and inhibitory effects on acetylcholinesterase activity. Pathophysiological studies showed that acotiamide significantly improved both delayed gastric emptying and feeding inhibition in restraint stress-induced model, but did not affect both normal gastric emptying and feeding in intact animals, indicating that acotiamide exerted effects only on the impaired gastric emptying and feeding behavior. According to the clinical pilot study in Europe, acotiamide, at the dose of 100 mg t.i.d., showed to improve the symptoms and quality of life of patients with FD, indicating the need for larger scale symptomatic studies on the efficacy of acotiamide in patients with FD. The recent phase II studies conducted in Japan presented in this issue of the journal also confirmed that acotiamide, at the optimal dose of 100 mg, has potential therapeutic efficacy, especially for meal-related FD symptoms. Although a phase III study is on going, acotiamide is now expected as a novel treatment option for FD. [source] Adverse drug reactions in medical intensive care unit of a tertiary care hospital,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 7 2009Lisha Joshua MBBS Abstract Purpose Patients in the intensive care unit (ICU) have multiorgan dysfunction as well as altered pharmacokinetic parameters. Hence they are susceptible to adverse drug reactions (ADRs). The objective of the study is to assess the characteristics of ADRs among inpatients in the medical ICU and to compare the same with patients who have not experienced ADRs. Methods Prospective, observational study for a period of 1 year in medical ICU of a tertiary care hospital. Relevant data of patients with ADRS were analysed. Characteristics of patients with and without ADRs were compared. Results Of 728 patients admitted in medical ICU, 222 (28.4%) had ADRs. Multiple ADRs (38.7%) implicated by the same drug and serious ADRs (37%) were noticed. Renal/electrolyte system (21%) was most commonly involved. Clinical spectrum included acute renal failure (ARF, 11.4%), hepatic injuries (5.4%), haematological dysfunction (4.2%), seizures (3.3%), upper gastrointestinal bleed (3.3%) and cutaneous ADRs (3.3%). Antimicrobials (27%) were the commonly implicated drug class. The most commonly implicated drug was furosemide (6.8%). Infrequently reported ADRs included azithromycin-induced erythema multiforme, leflunamide-induced erythema multiforme and vasculitis, ceftazidime-induced seizures and ceftriaxone-induced hepatitis. Co-morbidity, polypharmacy and duration of stay were significantly higher in patients with ADRs compared to those who have not experienced ADRs. Three patients died. Conclusion High incidence of serious and multiple ADRs noticed. A wide clinical spectrum of ADRs and infrequently reported ADRs to newer drugs were also observed. Copyright © 2009 John Wiley & Sons, Ltd. [source] Changing work patterns for benign upper gastrointestinal and biliary disease: 1994,2007ANZ JOURNAL OF SURGERY, Issue 7-8 2010Alexander P. M. Jay Abstract Background:, The evolution of surgical technology has impacted on surgical practice. We determined trends in surgical caseload for common benign biliary and uppergastrointestinal conditions in Australia over the last 15 years. Methods:, Using the Medicare Australia web site, the use of Medicare item numbers specific to gall stone, bariatric and anti-reflux procedures were determined nationally and for each Australian state for each year from 1994 to 2007. Rates of operative cholangiography, laparoscopic to open cholecystectomy conversion and bile duct exploration were calculated. Per capita use of bariatric procedures was also determined. Anti-reflux surgery was analysed as total and specific subgroups of anti-reflux procedures. Results:, The use of intra-operative cholangiography has increased over time, and the conversion to open cholecystectomy and application of common bile duct exploration both decreased. A rapid increase in restrictive bariatric procedures has occurred, and this has been followed by a similar increase in revision bariatric surgery and lap band adjustments. The application of anti-reflux surgery has also increased significantly with the repair of large hiatus hernia accounting for most of the increase over the last five years, whereas revision anti-reflux surgery remains uncommon. Conclusions:, These data demonstrate significant increases in the application of some laparoscopic surgical techniques, particularly for morbid obesity. Future health-care planning will need to consider the impact of these changes. [source] Laparoscopic radical prostatectomy: early safety and efficacyANZ JOURNAL OF SURGERY, Issue 12 2004Liam C. Wilson Background: To evaluate the initial results of laparoscopic radical prostatectomy at this institution. Methods: Between January 2000 and September 2003, 30 patients underwent laparoscopic radical prostatectomy. Peri- and postoperative data were accumulated prospectively and maintained in a database. All patients have a minimum of 6 month follow up. Results: There were no conversions to open surgery, and there were no re-operations. Mean operating time was 328 (195,490) min. There was one intraoperative rectal injury which was repaired laparoscopically. Three patients (10%) required blood transfusion. Postoperatively, there were two cases of respiratory depression, one case of haemoptysis and one upper gastrointestinal bleed. Two anastomotic leaks were successfully treated conservatively, one of which was the only readmission to hospital. There was one case of clot retention requiring manual irrigation of the bladder. Mean hospital stay was 2.75 (1,10) days, with six of the last 10 patients being discharged on the first postoperative day. Continence rates at 6 months are 83%. Positive surgical margins occurred in seven patients (23%). At 12 months of follow up, one patient (4.5%) has had biochemical recurrence. Conclusions: Our initial results are comparable to, or better than, the initial series in high volume centres. The procedure is feasible in appropriately selected cases in the Australasian environment. [source] Variability among nonsteroidal antiinflammatory drugs in risk of upper gastrointestinal bleedingARTHRITIS & RHEUMATISM, Issue 6 2010Elvira L. Massó González Objective Traditional nonsteroidal antiinflammatory drugs (NSAIDs) increase the risk of upper gastrointestinal (GI) bleeding/perforation, but the magnitude of this effect for coxibs in the general population and the degree of variability between individual NSAIDs is still under debate. This study was undertaken to assess the risk of upper GI bleeding/perforation among users of individual NSAIDs and to analyze the correlation between this risk and the degree of inhibition of whole blood cyclooxygenase 1 (COX-1) and COX-2 in vitro. Methods We conducted a systematic review of observational studies on NSAIDs and upper GI bleeding/perforation published between 2000 and 2008. We calculated pooled relative risk (RR) estimates of upper GI bleeding/perforation for individual NSAIDs. Additionally, we verified whether the degree of inhibition of whole blood COX-1 and COX-2 in vitro by average circulating concentrations predicted the RR of upper GI bleeding/perforation. Results The RR of upper GI bleeding/perforation was 4.50 (95% confidence interval [95% CI] 3.82,5.31) for traditional NSAIDs and 1.88 (95% CI 0.96,3.71) for coxibs. RRs lower than that for NSAIDs overall were observed for ibuprofen (2.69 [95% CI 2.17,3.33]), rofecoxib (2.12 [95% CI 1.59,2.84]), aceclofenac (1.44 [95% CI 0.65,3.2]), and celecoxib (1.42 [95% CI 0.85,2.37]), while higher RRs were observed for ketorolac (14.54 [95% CI 5.87,36.04]) and piroxicam (9.94 [95% CI 5.99,16.50). Estimated RRs were 5.63 (95% CI 3.83,8.28) for naproxen, 5.57 (95% CI 3.94,7.87) for ketoprofen, 5.40 (95% CI 4.16,7.00) for indomethacin, 4.15 (95% CI 2.59,6.64) for meloxicam, and 3.98 (95% CI 3.36,4.72) for diclofenac. The degree of inhibition of whole blood COX-1 did not significantly correlate with RR of upper GI bleeding/perforation associated with individual NSAIDs (r2 = 0.34, P = 0.058), but a profound and coincident inhibition (>80%) of both COX isozymes was associated with higher risk. NSAIDs with a long plasma half-life and with a slow-release formulation were associated with a greater risk than NSAIDs with a short half-life. Conclusion The results of our analysis demonstrate that risk of upper GI bleeding/perforation varies between individual NSAIDs at the doses commonly used in the general population. Drugs that have a long half-life or slow-release formulation and/or are associated with profound and coincident inhibition of both COX isozymes are associated with a greater risk of upper GI bleeding/perforation. [source] Evaluation of various POSSUM models for predicting mortality in patients undergoing elective oesophagectomy for carcinomaBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2007F. Lai Background: The aim of the study was to validate the use of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM), Portsmouth (P) POSSUM and upper gastrointestinal (O) POSSUM models in patients undergoing elective thoracic oesophagectomy for carcinoma. Methods: The observed in-hospital mortality rates in 545 patients undergoing elective thoracic oesophagectomy for squamous cell carcinoma of the oesophagus in all public hospitals in Hong Kong was compared with rates predicted by POSSUM, P-POSSUM and O-POSSUM. The discriminatory power of these models was assessed using receiver,operator characteristic (ROC) curve analysis. Results: The observed mortality rate was 5·5 per cent, whereas rates predicted by POSSUM, P-POSSUM and O-POSSUM were 15·0, 4·7 and 10·9 per cent respectively. P-POSSUM showed no lack of fit (P = 0·814), but POSSUM (P < 0·001) and O-POSSUM (P = 0·002) showed lack of fit against observed mortality. POSSUM overpredicted mortality across nearly all risk groups, whereas O-POSSUM overpredicted mortality in patients with low physiological scores and in older patients. POSSUM (area under ROC curve 0·776) and P-POSSUM (0·776) showed equally good discriminatory power but O-POSSUM (0·676) was inferior. Conclusion: P-POSSUM provided the most accurate prediction of in-hospital mortality in this group of patients who had elective oesophagectomy. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] | |||||||||||||||||||||||||