Journal of clinical gastroenterology
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J. Clin. Gastroenterol. · Oct 2000
Review Case ReportsAngioedema of the small bowel due to an angiotensin-converting enzyme inhibitor.
We describe a case of a 72-year-old woman who presented with two episodes of abdominal pain, vomiting, and diarrhea. Abdominal computed tomographic scans done during each episode demonstrated edema of the small bowel. Review of the patient's history revealed that she had been started on a treatment of lisinopril for hypertension 1 month before the first episode and had her prescribed dose increased 24 hours before each presentation. ⋯ All cases, including ours, occurred in women. Angioedema of the small bowel associated with ACE inhibitors is rare and often is not recognized before surgical exploration. Angioedema of the gastrointestinal tract should be considered in symptomatic patients taking ACE inhibitors.
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J. Clin. Gastroenterol. · Oct 2000
Comparative StudyRandomized comparative study of indocyanine green and India ink for colonic tattooing: an animal survival study.
Indocyanine green has been reported previously as a useful agent for colonic tattooing, but its durability, ease of use, cost, and safety have not been compared with India ink. Eight pigs were randomized to colonic tattooing using sterile indocyanine green or India ink injected through tandem filters. The animals were recovered and killed after 2 weeks and were examined. ⋯ Although indocyanine green was slightly more expensive, it was easier to handle compared with India ink. Both indocyanine green and India ink tattoos cause only mild histologic reaction in the swine colon when examined 2 weeks after injection. India ink is superior to indocyanine green, when used for colonic tattooing.
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A Sengstaken-Blakemore (SB) tube, when used approximately, still has a place in the management of acute variceal bleeding. Due to a number of reported complications from the misplacement of this tube, an x-ray localization before full inflation of the gastric balloon is recommended as the standard of care. ⋯ This technique is easy, accurate, and can be performed in any unit where a patient with variceal bleeding can be managed. Because it cuts down on the need for an x-ray or ultrasound confirmation, this technique may well become the "standard of care" among the practicing gastroenterologists.
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J. Clin. Gastroenterol. · Apr 2000
Comparative Study Clinical Trial Controlled Clinical TrialRespective value of alkaline phosphatase, gamma-glutamyl transpeptidase and 5' nucleotidase serum activity in the diagnosis of cholestasis: a prospective study of 80 patients.
We studied the value of alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), and 5'-nucleotidase (5'-NU) activities in the diagnosis of intrahepatic (IHC) versus extra-hepatic cholestasis (EHC). Eighty patients were included prospectively. All presented with cholestasis as defined by a concomitant increase in at least two of three cholestatic enzymes (AP, GGT, 5'-NU), a low cytolytic ratio (alanine aminotransferase/AP [xN/xN] < or = 5), and no evidence for associated liver tumor. ⋯ In IHC, the ratio GGT/5'-NU (xN/xN) was significantly lower than in EHC (2.8 [0.7-7.2] vs. 3.7 [1.8-10.5]: p < 0.006). A threshold of GGT/5'-NU < 1.9 had a sensitivity of 40% and a specificity of 100% for the diagnosis of IHC. Although such hepatobiliary enzymes cannot be regarded as diagnostic, they can provide useful information to orientate the clinician in the diagnosis of cholestasis.
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J. Clin. Gastroenterol. · Apr 2000
Comparative Study Clinical TrialTriage of patients with acute gastrointestinal bleeding for intensive care unit admission based on risk factors for poor outcome.
This study's aim was to determine the prognostic factors and to develop a triage system for intensive care unit (ICU) admission of patients with gastrointestinal bleeding (GIB). This prospective, observational study included 411 adults consecutively hospitalized for GIB. Each patient's selected clinical findings and laboratory values at presentation were obtained. ⋯ End-organ dysfunction, active bleeding, hepatic cirrhosis, and high APACHE II scores were independent predictors of poor outcome with odds ratios of 3:1, 3:1, 2:3, and 1:1, respectively. The ICU admission rate was 37%. High APACHE II score, active bleeding, end-organ dysfunction, and hepatic cirrhosis are independent predictors of poor outcome in patients with GIB and can be used in the triage of these patients for ICU admission.