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BACKGROUND: Chronic gastrointestinal ischemia is still a difficult diagnosis to establish. The diagnosis depends on a high degree of clinical suspicion as well as selective angiography. Duplex sonography may serve as a screening tool, providing information on splanchnic vessel patency and flow patterns. GET is a minimally invasive test that can be used for diagnosis in patients with chronic gastrointestinal ischemia, and can differentiate between symptomatic and asymptomatic splanchnic artery stenosis. In the present study, we compared four different diagnostic approaches. METHODS: Between 1997 and 2000, 84 patients were evaluated for suspected chronic gastrointestinal ischemia. All underwent splanchnic arterial angiography, duplex sonography, and GET. For the presence or absence of stenosis, angiography was used as the gold standard. For diagnosing ischemia, we relied on a panel decision. The diagnostic approaches studied were: (a) angiography, only in patients with classic abdominal angina; (b) screening with duplex sonography, angiography if sonography abnormal or unreliable; (c) screening with gastric tonometry and angiography if tonometry not normal; (d) both gastric tonometry exercise and duplex sonography, angiography if one of both screening tests not normal. RESULTS: In 28 patients, chronic gastrointestinal ischemia was diagnosed. Using clinical suspicion only, 16 patients (57%) would have been missed. Screening by duplex sonography or gastric tonometry only would have missed 4 or 6 patients, respectively. Screening with combined gastric tonometry and duplex sonography would not have missed patients with symptomatic ischemia, while 21% of angiographies would have been avoided. CONCLUSION: Screening by combined GET and duplex sonography has excellent diagnostic accuracy. Currently, this approach represents the best diagnostic workup strategy in patients with suspected chronic gastrointestinal ischemia.  相似文献   

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Harper A 《Lancet》2003,361(9371):1831-1832
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ObjectiveTo compare initial clinical/laboratory parameters and outcomes of mortality/rebleeding of endoscopy performed <12 h(early UGIE) versus endoscopy performed after 12–24h(late UGIE) of ED admission in children with acute upper gastrointestinal bleeding(AUGIB) due to portal hypertension.MethodsThis is a retrospective cohort study. From January 2010 to July 2017, medical records of all children admitted to a tertiary care hospital with AUGIB due to portal hypertension were reviewed until 60 days after ED admission.ResultsA total of 98 ED admissions occurred from 73 patients. Rebleeding was identified in 8/98(8%) episodes, and 9 deaths were observed. UGIE was performed in 92(94%) episodes, and 53(58%) of them occurred within 12 h of ED admission. Episodes with early UGIE and late UGIE were similar in terms of history/complaints/laboratory data at admission, chronic liver disease associated, AUGIB duration, and initial management. No statistically significant associations were found between early UGIE and the outcomes of death/rebleeding and prevalence of endoscopic hemostatic treatment (band ligation or sclerotherapy) compared to late UGIE.In the multivariable logistic regression model, the endoscopic hemostatic treatment showed a negative association with early UGIE(OR=0.33;95%CI=0.1–0.9;p = 0.04).ConclusionsThis study suggests that in pediatric patients with AUGIB and portal hypertension, UGIE may be performed after 12–24 h without harm to the patient, facilitating better initial clinical stabilization/treatment and optimization of resources.  相似文献   

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Worldwide, along with the increasing prevalence of obesity, the number of people with prediabetes is increasing. The diagnostic criteria for prediabetes include impaired fasting glucose, impaired glucose tolerance, and metabolic syndrome. The presence of two or more of these three criteria renders a person at high risk for future diabetes. The treatment goal of prediabetes is to prevent future development of type 2 diabetes and diabetes-related cardiovascular complications. The treatment approach is twofold: glycemic control and control of cardiovascular risk factors, mainly hypertension and hyperlipidemia. Intensive lifestyle modification is the mainstay of treatment in low-risk patients. When lifestyle modification fails and in high-risk patients, medications such as metformin and/or acarbose are recommended. For high-risk patients and those who progress despite intensive lifestyle modification, thiazolidinediones are also recommended. The goals for cardiovascular risk factor control are similar to those for patients with diabetes.  相似文献   

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Smale S  Bjarnason I  Forgacs I  Prasad P  Mukhood M  Wong M  Ng A  Mulcahy HE 《Gut》2003,52(8):1090-1094
BACKGROUND: Previous researchers have shown that non-medical endoscopists can perform lower gastrointestinal endoscopy as safely and effectively as medical staff. However, it is not known if upper gastrointestinal endoscopy performed by medical and non-medical endoscopists in clinical practice yields similar results in terms of performance, patient discomfort, and satisfaction. AIM: To determine differences in the yield of diagnosis for significant disease during upper gastrointestinal endoscopy performed by nurse and medical endoscopists and to measure patient discomfort, satisfaction, and attitudes towards future endoscopy. PATIENTS: This two part study included 3009 patients in a retrospective analysis and 480 in a prospective study. METHODS: The first part of the study assessed indications for endoscopy, diagnoses, and procedures performed by medical and nurse endoscopists. In a second prospective study, 480 patients were included to determine the association between endoscopist type and sedation, patient anxiety, discomfort, satisfaction, and attitudes towards future sedation. RESULTS: No patient refused endoscopy by either a nurse or medical endoscopist and there were no complications in either group. Nurses performed 1487 procedures and reported fewer endoscopies as "normal" than medical staff (p=0.006). Multivariate analysis showed that male sex, older age, inpatient status, dysphagia, and gastrointestinal bleeding, but not endoscopist type, were all associated with significant disease. In relation to discomfort and satisfaction, a similar proportion of patients received sedation in both groups (p=0.81). There were no differences in pre-procedure anxiety (p=0.61), discomfort during intubation (p=0.97), discomfort during examination (p=0.90), or post-procedure examination rating (p=0.79) in patients examined by medical or nurse endoscopists. CONCLUSION: Experienced nurses perform routine diagnostic gastroscopy safely in everyday clinical practice and with as little discomfort and as much patient satisfaction as medical staff.  相似文献   

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What is the most effective way to communicate results after endoscopy?   总被引:1,自引:0,他引:1  
BACKGROUND: The growing demand for endoscopy associated with colorectal cancer screening has resulted in busier endoscopy units and an increase in the practice of open-access endoscopy, in which patients are referred for procedures without prior consultation by the gastroenterologist, all of which may result in less-informed patients. OBJECTIVE: We sought to determine whether providing patients with a written copy of their standard endoscopy report at the conclusion of their procedure enhanced recall of the findings and recommendations. DESIGN: Eighty consecutive outpatients who presented to 3 endoscopists were randomized to receive the results of their upper or lower endoscopy via standard verbal report (VR) or by standard VR followed by receipt of a computer-generated endoscopy report (VR+WR) from the Olympus ImageManager report generator. The endoscopist communicated the VR after a standard postprocedure recovery period of 30 to 60 minutes and routinely discussed all findings and recommendations as mentioned in the WR. The endoscopist was blinded as to whether the patient subsequently received the WR. Recall of the endoscopic procedure was assessed by using a piloted 11-question survey instrument to be filled out 3 days after the procedure. Results were calculated by using the Fisher exact and Wilcoxon rank sum tests. PATIENTS: Referral for endoscopy from University of Chicago physicians. RESULTS: Seventy-eight of 80 patients (98%) approached about the study agreed to participate. The response rate was 77%. Patients in the VR+WR group overall had a greater composite score than patients in the VR group (8.9/10 vs 7.7/10, P<.01). Patients in the VR+WR group were also significantly more likely to recall the recommendations for therapy or follow-up (72% vs 42%, P<.01) and the name of the endoscopist (97% vs 74%, P<.05). LIMITATIONS: Patients with an education beyond the 10th-grade level were not formally accessed in this study. Because of this, we could not evaluate whether differences in educational attainment affected patient understanding of endoscopy procedure details and findings. CONCLUSIONS: A computer-generated endoscopy report (WR) significantly improved patient recall of endoscopic procedure information compared with a VR alone. Despite this, patients were unable to recall 28% of recommendations. Additional study to determine if such enhanced physician-patient communication improves patient satisfaction or follow-up, and whether more specific patient-directed results further improve recall needs to occur.  相似文献   

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We report two cases of mitral stenosis after Duran ring annuloplasty for myxomatous mitral regurgitation. Simple explantation of the ring provided relief of mitral stenosis.  相似文献   

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Epidemiologic studies suggest that postprandial hyperglycemia is more strongly linked to an increased risk for cardiovascular events than fasting or preprandial glucose levels. Although the results of prospective randomized studies proving causation of this finding are mixed, clinicians have given increased attention to target therapy to postprandial glucose than in the past. Rapid-acting insulin analogues, glucagon-like peptide-1 agonists, dipeptidyl peptidase-4 inhibitors, and acarbose all target the postprandial glucose levels. This wide range of therapies allows the clinician to mix and match agents of different classes to target the fasting, preprandial, and postprandial glucose to optimize the daily glucose pattern and reduce the risk of diabetic complications.  相似文献   

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Treatment of early rheumatoid arthritis has to be started very early, when the diagnosis is made, preferentially before 6 months of symptoms. Combination therapy with conventional disease-modifying anti-rheumatic drugs (DMARDs) with low-dose, oral glucocorticoids in the induction phase from the start gives the best results. The patient should be monitored systematically, at start between 1 and 3 months, and the patient should have access to additional visits if a flare or arthritis or adverse event occurs. The treatment should aim to remission (no tender and swollen joints, no signs of inflammatory activity), which can be reached by 60–80% of the patients. Intra-articular glucocorticoid injections as part of the treatment strategy increase the suppression of arthritis and retard joint destruction. Biological drugs are reserved for patients who have consistent active disease and who do not respond to conventional combinations.  相似文献   

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