Applied virtual reality for simulation of endoscopic retrograde cholangio-pancreatography (ERCP).

Researchers from the Georgia Institute of Technology and the Medical College of Georgia (GIT/MCG) have developed an interactive computer simulation of Endoscopic Retrograde Cholangio-Pancreatography (ERCP). ERCP is a minimally invasive technique for evaluating and treating pathologic conditions of the biliary and pancreatic ducts. While ERCP provides the patient with substantial advantages over traditional methods, ERCP requires advanced skills and extensive experience to minimize the risk of complications. Computer simulation offers many advantages for efficiently and safely training physicians in ERCP. The GIT/MCG proof of concept simulation provides realistic training with both visual and force feedback while an endoscopist practices the ERCP procedure.

Non-steroidal anti-inflammatory drug-induced gastroduodenal injury: therapeutic recommendations.

Non-steroidal anti-inflammatory drug (NSAID) use is associated with gastro-duodenal erosions and ulcers. Bleeding and perforation are reported complications in NSAID users. Therapeutic recommendations for NSAID-induced gastroduodenal injury are necessary because of our rapidly growing geriatric population, a steady increase in prescriptions for NSAIDs, and the widespread use of over-the-counter NSAIDs. Studies seem to indicate that there is no relationship between acute NSAID-induced mucosal injury and potential damage from chronic NSAID ingestion. Ranitidine (150 mg) b.d. effectively reduces the incidence of duodenal ulcer in NSAID users, but the same dose does not reduce the incidence of gastric ulcer. Misoprostol is effective in reducing the incidence of gastric ulcer in NSAID users, although confirmatory data on its effectiveness in preventing NSAID-induced duodenal ulcer are lacking. In addition to anti-ulcer therapy, treatment of NSAID-induced ulcers includes discontinuing the drug, reducing the dose, or switching to a less potent NSAID. Longer courses of anti-ulcer treatment may be required to achieve expected healing rates when NSAIDs are not discontinued. Results of treatment of NSAID-related ulcers with currently available anti-ulcer medications vary. Several studies have shown that 150 mg ranitidine b.d heals both gastric and duodenal NSAID-induced ulcers. Sucralfate has also been shown to heal NSAID-induced duodenal ulcers. Misoprostol treatment of NSAID-induced ulcers is not well documented, although there are placebo-controlled data that substantiate its benefit in gastric ulcer patients not taking NSAIDs.

Recovery from hepatic vein thrombosis (Budd-Chiari syndrome) complicating ulcerative colitis.

A 22-year-old female with active ulcerative colitis developed massive ascites, hypoalbuminemia, and hepatomegaly compatible with thrombosis of the hepatic veins. The diagnosis of Budd-Chiari syndrome was confirmed by ultrasonography, computed tomography, and by liver biopsy. A search of the literature disclosed only three previous reports of Budd-Chiari syndrome occurring in patients with ulcerative colitis. All patients have been young females with active colitis and no other known risk factor for the development of hepatic vein thrombosis. Our patient, unlike the previously reported patients who died, recovered sufficiently to be discharged from the hospital.

Diarrhea in the intensive care unit: the role of hypoalbuminemia and the response to a chemically defined diet (case reports and review of the literature).

We describe five patients who developed acute kwashiorkor-like hypoalbuminemia during their hospitalization in the intensive care unit. With the initiation of enteral alimentation, diarrhea ensued and continued for at least 48 hours. Routine evaluation for the cause of diarrhea including stool culture for enteric pathogens, white blood cells, ova and parasites, Clostridium difficile cytotoxin, and flexible sigmoidoscopy was negative. When a peptide based formula (Vital HN, Ross Laboratories, Columbus, OH) was initiated, there was a significant reduction in stool output within 24 hours. In three of the five cases, hypoalbuminemia corrected within 2 weeks. Four of the five patients were discharged from the hospital. Although several reports have acknowledged the association between hypoalbuminemia and impaired gastrointestinal absorption, no previous enteral formula has been tolerated in these acutely ill patients until serum albumin levels had improved. Further studies will be required to confirm the better gastrointestinal tolerance of this peptide based formula in patients with severe hypoalbuminemia.