Subject(s)
Brain Neoplasms/drug therapy , Dacarbazine/analogs & derivatives , Glioblastoma/drug therapy , Hepatitis B/chemically induced , Immunosuppression Therapy/adverse effects , Spinal Neoplasms/secondary , Antineoplastic Agents, Alkylating/adverse effects , DNA, Viral/blood , DNA, Viral/drug effects , Dacarbazine/adverse effects , Hepatitis B/immunology , Hepatitis B/physiopathology , Humans , Immunocompromised Host/immunology , Lamivudine/therapeutic use , Liver/drug effects , Liver/physiopathology , Liver/virology , Male , Middle Aged , Patient Selection , Reverse Transcriptase Inhibitors/therapeutic use , Risk Factors , Spinal Neoplasms/therapy , Temozolomide , Treatment Outcome , Viral Load , Virus Activation/drug effects , Virus Activation/geneticsABSTRACT
Pancreatic enzyme replacement therapy has proved useful in the treatment of malabsorption and persistent pain in patients with chronic pancreatitis. The formulation of pancreatic enzyme preparation varies considerably. Treatment of chronic pain is facilitated by the use of a high-protease enzyme preparation, preferably non-microsphere encoated. Treatment of steatorrhea is optimized by use of high-lipase-containing preparations.
Subject(s)
Gastrointestinal Agents/therapeutic use , Pancreatitis/drug therapy , Pancrelipase/therapeutic use , Abdominal Pain/drug therapy , Abdominal Pain/etiology , Chronic Disease , Humans , Malabsorption Syndromes/drug therapy , Malabsorption Syndromes/etiology , Pancreatitis/complications , Treatment OutcomeSubject(s)
Gastroenterology/trends , Gastrointestinal Diseases/therapy , Acute Disease , Appendicitis/diagnosis , Colorectal Neoplasms/prevention & control , Diarrhea/etiology , Diarrhea/therapy , Gastroesophageal Reflux/physiopathology , Gastroesophageal Reflux/therapy , Humans , Pancreatitis/diagnosis , Pancreatitis/therapy , Peptic Ulcer/etiology , Peptic Ulcer/therapyABSTRACT
The nausea and vomiting that can complicate advanced diabetes is often attributed to impaired gastric motility. Not all patients with diabetic gastropathy show marked abnormality on gastric emptying studies, however. The mechanism remains uncertain, although cases complicated by a bezoar may respond to its removal. Prokinetic drugs may bring a measure of relief, albeit often temporary.
Subject(s)
Diabetes Mellitus, Type 1/complications , Gastroparesis/diagnosis , Gastroparesis/etiology , Nausea/etiology , Vomiting/etiology , Adrenergic alpha-Agonists/therapeutic use , Algorithms , Clonidine/therapeutic use , Diagnosis, Differential , Gastric Emptying , Gastroparesis/drug therapy , Humans , Male , Medical History Taking , Middle Aged , Physical ExaminationSubject(s)
Academic Medical Centers , Research , Allergy and Immunology , Critical Care , Endocrinology , Gastroenterology , Genetics , Hematology , Infections , Kansas , Lung Diseases , Metabolism , RheumatologyABSTRACT
Chronic diarrhea is a common problem facing the practitioner of medicine. Despite impressive advances in diagnostic technology, many patients continue to have chronic diarrhea without a firm diagnosis being established. Most important, the history and physical examination are often perfunctory and the patient undergoes a number of contrast and imaging studies, endoscopic procedures, and laboratory investigations which may still be non-diagnostic. In all patients with chronic diarrhea, which I will arbitrarily define as diarrhea that has persisted over at least 2 months, there is a need for a careful orderly approach to the differential diagnosis. In this paper I will detail a method that I have used in evaluating such patients. The method emphasizes a careful history and physical examination, judicious and sequential use of laboratory investigations, contrast studies, and endoscopic procedures, and calls attention to special situations where more detailed investigations are required. I have found that unless I go through this detailed diagnostic approach, I will miss disorders that can be readily diagnosed and, more importantly, such patients may not be given appropriate treatment.
Subject(s)
Diarrhea/diagnosis , Aged , Anti-Bacterial Agents/adverse effects , Bile Acids and Salts/adverse effects , Cathartics/poisoning , Chronic Disease , Clinical Protocols , Colitis, Ulcerative/complications , Diagnostic Imaging , Diarrhea/classification , Diarrhea/physiopathology , Female , Humans , Malabsorption Syndromes/complications , Medical History Taking , Middle Aged , Physical ExaminationABSTRACT
Diagnosis of Clostridium difficile (C. difficile) by its antigen or toxin has improved treatment for patients who have antibiotic-associated diarrhea and opportunistic colonization of the colon with C. difficile. Unfortunately, results from the tissue culture cytotoxicity assay are not available for 48 h. We prospectively compared a latex agglutination test with the tissue culture cytotoxicity assay in 83 patients (15 with antibiotic-associated diarrhea, 23 with non-antibiotic-associated diarrhea, and 45 without diarrhea). In the antibiotic-associated diarrhea group, 43% of patients with pseudomembranes and 25% without pseudomembranes tested positive with both tests. In the non-antibiotic groups 92% with diarrhea and 90% without diarrhea were negative with both tests. The number of discordant results illustrates the value of using two tests to identify C. difficile, since additional patients can be identified by using two tests. We found false positives were rare, and C. difficile toxin or antigen could not be detected in more than half the patients with pseudomembranes. The latex agglutination test for C. difficile is reliable, specific, and faster than the tissue culture cytotoxicity assay. The data suggest that other organisms may also be responsible for pseudomembranous colitis, and that negative tests do not obviate the need for visual evaluation of colonic mucosa in suspected cases of antibiotic-associated diarrhea.
Subject(s)
Cytotoxicity Tests, Immunologic/standards , Diarrhea/diagnosis , Enterocolitis, Pseudomembranous/diagnosis , Latex Fixation Tests/standards , Antigens, Bacterial/analysis , Bacterial Toxins/analysis , Diarrhea/chemically induced , Evaluation Studies as Topic , HumansABSTRACT
The efficacy of 5-aminosalicylic acid enemas in maintaining remission in left-sided ulcerative colitis was studied. Twenty-five patients in remission for at least 2 mo were randomized to receive either 1-g 5-aminosalicylic acid or placebo enemas daily and were followed up for 1 yr. Eleven of 13 patients randomized to placebo relapsed after a mean of 16 wk. Nine of 12 patients randomized to 5-aminosalicylic acid remained in remission for 1 yr, 2 others in remission withdrew by request, and 1 relapsed at 10 wk. The difference between relapse rate on 1-g 5-aminosalicylic acid versus placebo was significant (p less than 0.005). Seven patients entered the blinded trial a second time. Three of 4 patients randomized to 5-aminosalicylic acid remained in remission and 1 relapsed. Three randomized to placebo relapsed at a mean of 14 wk. One-gram 5-aminosalicylic acid enemas are safe and effective in maintaining remission in patients with left-sided ulcerative colitis.
Subject(s)
Aminosalicylic Acids/therapeutic use , Colitis, Ulcerative/drug therapy , Enema , Aminosalicylic Acids/administration & dosage , Clinical Trials as Topic , Double-Blind Method , Female , Follow-Up Studies , Humans , Male , Mesalamine , Random Allocation , Time FactorsABSTRACT
We report results of a prospective study of daily 5-ASA enema therapy in patients with proctocolitis that was unresponsive to conventional therapy. Forty-seven patients with active colonic inflammation distal to the splenic flexure have been followed for three months to three years. Rapid improvement was noted within three months in 41 of 47 (87%) patients, while six failed therapy. Of the 41 patients responding to therapy, 39 achieved complete remission. Nineteen patients have relapsed at least once following discontinuation of 5-ASA, but 23 of 25 (92%) relapse episodes responded to a course of 5-ASA therapy. Complications of 5-ASA therapy were limited to hemorrhoidal irritation and local perianal injury. We conclude that 5-ASA enema is effective in inducing remission in patients with proctocolitis unresponsive to conventional therapy.
Subject(s)
Aminosalicylic Acids/therapeutic use , Colitis/drug therapy , Enema , Proctocolitis/drug therapy , Adult , Aminosalicylic Acids/administration & dosage , Clinical Trials as Topic , Female , Follow-Up Studies , Humans , Male , Mesalamine , Prospective Studies , Time FactorsABSTRACT
A 51-year-old woman with malignant ascites secondary to hepatocellular carcinoma had a peritoneovenous (LeVeen) shunt inserted with effective control of ascites and amelioration of symptoms. The results of 12 recent series evaluating the efficacy of peritoneovenous shunts in the treatment of 198 patients with malignant ascites were reviewed. Peritoneovenous shunts effectively controlled malignant ascites in 77% of patients. Complications occurred in 25%, although the majority of these were related to shunt occlusion and transient congestive heart failure.