Effect of dietary cholesterol on biliary lipids in patients with gallstones and normal subjects.

The purpose of this study was to determine the effect of dietary cholesterol on biliary lipids in subjects with and without gallstones. Twelve patients with asymptomatic gallstones (six men, six women) were assigned diets containing 500, 750, and 1000 mg cholesterol daily for 3-wk periods in random sequence. Seven healthy women similarly were assigned diets containing 500 and 1000 mg cholesterol daily. With increasing dietary cholesterol in patients with gallstones, biliary saturation indices and molar percents of cholesterol and phospholipids increased significantly while molar percent of biliary bile acids decreased significantly. With increasing dietary cholesterol in healthy women, the biliary saturation index and molar percent of cholesterol increased significantly; the mean saturation index exceeded unity on the diet containing 1000 mg cholesterol daily. In conclusion, augmented dietary cholesterol for brief periods increased biliary cholesterol saturation in subjects with and without gallstones.

Use of verapamil for the symptomatic treatment of microscopic colitis.

BACKGROUND: The initial use of verapamil for the symptomatic treatment of microscopic colitis is reported. STUDY: Four patients diagnosed with microscopic colitis who failed to respond to conventional therapy are presented. RESULTS: Verapamil was instituted, resulting in prompt and sustained resolution of symptoms. CONCLUSIONS: This therapy was convenient and well tolerated.

Fistula to the pancreatic duct from a peptic ulcer. Case report and literature review.

We report a case of pancreatic duodenal fistula as a complication of peptic ulcer disease. Complete healing of the ulcer and fistula was achieved with intensive medical therapy. No surgical intervention was required. The unique radiographic and endoscopic features of the case are presented and pertinent literature is reviewed.

Endoscopic neodymium-YAG laser treatment of nonresectable gastrointestinal tract cancer.

Five patients with advanced gastrointestinal tract cancers were treated endoscopically with the neodymium-YAG infrared laser. Palliative ablation of an obstructing or hemorrhaging intraluminal malignant lesion was safely achieved in all patients.

Cytomegalovirus colitis. Report of the clinical, endoscopic, and pathologic findings in two patients with the acquired immune deficiency syndrome.

We report 2 homosexual patients with the acquired immune deficiency syndrome and histopathologic evidence for cytomegalovirus colitis. In each case, the initial endoscopic impression was Kaposi's sarcoma but the appropriate diagnosis was made by histologic demonstration of a cytomegalovirus vasculitis. Clinical manifestations may include diarrhea, abdominal pain, and hematochezia. Fulminant progression to gangrenous bowel was documented in 1 patient and was associated with histologic evidence of severe cytomegalovirus vasculitis. The pertinent clinical, endoscopic, and pathologic findings are reviewed.

Crohn's disease of the duodenum complicated by adenocarcinoma.

Patients with Crohn's disease of the small bowel or the colon are at risk for development of cancer within their chronically inflamed intestinal loops. We present here the first reported case of malignant degeneration of duodenal mucosa involved by Crohn's disease. The clinical observations as well as radiographic and endoscopic features of this unusual complication are described.

Endoscopic neodymium-YAG laser palliation of nonresectable esophageal malignancy.

Seven men and five women with nonresectable esophageal carcinoma were treated endoscopically with the neodymium-YAG (yttrium-aluminum-garnet) infrared laser. Before laser fulguration, tumors were dilated directly with metal olive dilators. Before treatment, mean tumor length was 5 cm with luminal occlusion averaging more than 80%. After a mean of 3.3 treatment sessions spanning 18.5 days, all patients had substantial immediate palliation. Continued symptomatic relief was noted during follow-up (mean, 83 days; range, 8 to 206 days).

Campylobacter pylori gastritis in the acquired immunodeficiency syndrome.

Campylobacter pylori has been associated with gastritis, duodenitis, and duodenal ulceration in the immunocompetent individual. It has been described within the superficial mucus layer, in interepithelial junctions, and occasionally in the microcanaliculi of epithelial cells, but never in the lamina propria. We describe a case of invasive C. pylori in a patient with the acquired immunodeficiency syndrome and discuss its clinical presentation and histopathological findings.

Bilateral adrenal hemorrhage as a complication of intravenous ACTH infusion in two patients with inflammatory bowel disease.

We report two patients with inflammatory bowel disease in whom intravenous corticotropin therapy was complicated by bilateral adrenal hemorrhage. In one, the initial presentation was acute and unilateral, simulating colonic perforation and/or abscess. The diagnosis was made only at exploratory laparotomy. In the second patient, the presentation was subacute; multiple episodes of adrenal hemorrhage occurred subsequent to the course of corticotropin, and ultimately, hypoadrenalinism developed. Pertinent clinical and computed tomographic findings are reviewed.

Technique and complications of reconstruction of the pelvic floor with polyglactin mesh.

A polyglactin mesh sling was used to reconstruct the pelvis in eight patients after colorectal or urologic resections in preparation for postoperative radiation therapy. There were three perioperative complications--a pelvic abscess requiring percutaneous drainage, a wound dehiscence and a herniation of the small intestine between the pelvic sidewall and mesh requiring small intestinal resection. There were two delayed complications, both partial small intestinal obstructions. One occurred just after the conclusion of radiation treatment and the other occurred five months after the conclusion of radiation therapy. Both obstructions responded to conservative management. None of the common acute radiation effects occurred during radiotherapy. One patient with delayed partial small intestinal obstruction had possible late radiation effects. The median follow-up period after radiation therapy was 12.5 months. Despite the complications described in this report, the use of a polyglactin mesh sling as an adjunct to resection of carcinoma of the pelvis has merit and should be studied further.