Comparative trial of three different schedules for endoscopic esophageal variceal sclerotherapy.

We analyzed our experience in 125 patients with variceal bleeding to compare the efficacy and complications of various schedules of endoscopic variceal sclerotherapy. The schedules for the first three injections were as follows: (A) 3-5 ml of aqueous phenol injected at intervals of three weeks (Group I, n = 28), one week (Group II, n = 30) and three days (Group IIIa, n = 33), and (B) 2-3 ml of phenol at each site at intervals of 3 days (Group IIIb, n = 34). Subsequent injections were given at four week intervals for all groups. Varices could be obliterated significantly earlier (p less than 0.001) in patients injected at 3-day intervals (mean +/- SD 9.12 +/- 5.95 weeks) as compared with those injected at 1-week (13.50 +/- 10.28 weeks) and 3-week (20.55 +/- 7.77 weeks) intervals. The rebleeding rate was not significantly less in the 3-day interval group (Group IIIa--16.66% and Group IIIb--17.64%) as compared with the 1-week (23.3%) and 3-week (28.5%) groups. However the mortality due to rebleed was significantly less (p less than 0.05) in patients injected at 3-day interval (nil), as compared with those injected at 1-week (13.3%) and 3-week (10.7%) intervals. Mucosal ulcerations and stricture formation were observed significantly (p less than 0.001) more frequently in patients undergoing sclerotherapy at 3-day intervals (Group IIIa--51.5% and 18.18%) with 3-5 ml of phenol as compared with those injected similar volume at 1-week (16.66% and 3.3%) and 3-week (7.1% and 3.5%) intervals respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptative changes in terminal ileum after total colectomy, mucosal proctectomy and straight ileo-anal anastomosis in chronic ulcerative colitis.

Total colectomy, mucosal proctectomy and straight ileo-anal anastomosis was performed in four adult patients with chronic ulcerative colitis (three males, one female; mean age 27.4 years). During a follow-up period of one to five years, all patients were continent, had spontaneous bowel evacuation (average 4-5 per day), and had normal bladder and sexual function. Sequential per rectal ileoscopies revealed loss of ileal folds and gradual transformation to a colonic type of mucosa. On barium studies, the anastomosed terminal ileum showed progressive ballooning and assumed a rectosigmoid appearance with complete disappearance of ileal characteristics. The histology showed a progressive transformation from ileal to colonic type of mucosa, with blunting and ultimate disappearance of villi, increasing goblet cell population, and increase in mononuclear cells in the lamina propria. Histochemical studies (high iron diamine and alcian blue stains) revealed a change from small intestinal to colonic mucin, progressing proximally from just above the anastomotic site. Two patients had a single recurrence with ileal histology resembling that of active ulcerative colitis; both responded to short term steroid therapy. The results of straight ileo-anal anastomosis compare well with Western reports of ileal reservoirs. Adaptative changes of 'colonisation' can be consistently demonstrated in the anastomosed ileum on follow-up; these start just above the anastomotic site and ascend proximally. The colonised ileum appears to be susceptible to the ulcerative disease.

Sucralfate in the short-term treatment of duodenal ulcer. A double-blind comparison with cimetidine and placebo.

A phase III randomised, double-blind, placebo controlled study was conducted to compare the efficacy and adverse effects of sucralfate and cimetidine in the short-term management of active duodenal ulcer. Standard therapeutic doses were used. Antacids were permitted on an ad lib basis. Eighty patients with endoscopically proven DU were treated for 4 weeks with sucralfate (SUC) (n = 40), cimetidine (CIM) (n = 20) and placebo (PLA) (n = 20), of whom 60 patients--SUC (32), CIM (14) and PLA (14) completed the trial. Baseline clinical and endoscopic data were comparable amongst the 3 groups. The patients were reexamined clinically at 1, 2 and 4 weeks and endoscopically at 2 and 4 weeks. The data comprising pain and non-pain symptom scores, and ulcer size before and after the trial were analysed using the Mann-Whitney test. There were no significant differences in the rate of ulcer healing between SUC and CIM at 4 weeks. 71.8% of the SUC group had complete healing, as compared with 71.4% in the CIM group and 35% in the PLA group. Both SUC and CIM were superior to PLA. (p less than .05) Non-pain symptom scores at the end of 1 week were significantly lower with CIM (p less than 0.001), but levelled at 4 weeks when compared with SUC. Both SUC and CIM were superior to placebo (p less than .001). Day-time pain relief was significantly better with both SUC and CIM as compared to placebo (p less than 0.1). There was no significant difference in night-pain relief between the 3 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Diarrhea associated with metastasis from medullary carcinoma of thyroid.

Watery diarrhea is a prominent symptom in medullary carcinoma of the thyroid (MCT) and may occur as the initial symptom and/or during the course of metastatic malignant disease. Death is generally the result of widespread dissemination of the tumour. We report a case with MCT and metastatic disease manifesting with diarrhea and dying due to widespread metastatic disease.

Modified sham feeding and Congo red test in determining completeness of vagotomy.

Gastric acid response to modified sham feeding was evaluated in 14 patients with duodenal ulcer prior to vagotomy and in 18 patients after vagotomy. Nine patients in the latter group had recurrent ulcer, suggesting inadequate vagotomy. Based on values in the 32 tests (14 pre and 18 postoperative), cut-off levels of six secretory indices were selected to provide a specificity of 1.00 for the presence of ulcer. When applied separately to the 18 postoperative patients and to the 13 patients who underwent the endoscopic congo red test, observed volume of 75 ml/h and peak volume of 90 ml/h following sham feeding gave specificity, sensitivity and efficiency of 1.00 each in determining inadequate vagotomy. The endoscopic congo red test done in 13 post-vagotomy cases showed a sensitivity of 1.00, and high specificity (0.89) and efficiency (0.92). Measurement of crude gastric juice response to modified sham feeding is a convenient bedside test to confirm inadequate vagotomy. The endoscopic congo red test is also useful, especially as a screening test, and has the added advantage that it can be used intra-operatively.