Digestive diseases
-
Ethical and legal implications arise both when seeking a second medical opinion and when providing one. There has been debate as to whether a second opinion for a patient is a right or a concession and whilst today most would consider it to be a patient's right, there are nevertheless some disadvantages associated with seeking a second opinion. ⋯ Finally, the arguments for and against treating patients who are referred for a second opinion are addressed. This paper has been prepared following a round table discussion on this subject, which was addressed during a symposium on Ethics in Gastroenterology and Digestive Endoscopy held in Kos in 2006.
-
Retracted Publication
Irinotecan plus weekly 5-fluorouracil and leucovorin as salvage treatment for patients with metastatic colorectal cancer: a phase II trial.
A phase II study was conducted to evaluate the toxicity and efficacy of irinotecan/5-fluorouracil/leucovorin (CPT-11/5-FU/LV (AIO schedule)) as salvage treatment in patients with metastatic colorectal cancer. ⋯ The combination of weekly CPT-11 and infusional 5-FU/LV is an active and relatively well-tolerated regimen as salvage treatment in MCC.
-
There are few diseases whose incidence varies as greatly worldwide as that of diverticulosis. Its prevalence is largely age-dependent: the disease is uncommon in those under the age of 40, the prevalence of which is estimated at approximately 5%; this increases to 65% in those > or =65 years of age. Of patients with diverticula, 80-85% remain asymptomatic, while, for unknown reasons, only three-fourths of the remaining 15-20% of patients develop symptomatic diverticular disease. ⋯ Predictive factors for severe diverticulitis are sex, obesity, immunodeficiency and old age. Surgery for acute complications of diverticular disease of the sigmoid colon carries significant rates of morbidity and mortality, the latter of which occurs predominantly in cases of severe comorbidity. Postoperative mortality and morbidity are to a large extent driven by patient-related factors.
-
Although the strategy for Helicobacter pylori infection management is well defined and quite well followed in a number of situations, including peptic ulcer disease, the issue of H. pylori screening and eradication in the general population still remains. The following debate attempts to find the answer of whether or not H. pylori screening should be performed in the asymptomatic population for preventing gastric cancer. As yet, there is no final evidence-based consensus about the need to screen for H. pylori in order to decrease the incidence of gastric cancer.
-
Use of opioid analgesics is associated with a number of side effects, especially opioid-induced gastrointestinal dysfunction. The extensive use of these compounds and the significant negative impact of the resulting gastrointestinal dysfunction on patients' quality of life make it an important clinical issue. ⋯ The role of endogenous opioid peptides in certain gastrointestinal diseases is also discussed. A better understanding of the pathophysiological mechanisms of opioid-induced bowel dysfunction should lead to the development of newer opioid analgesics and improved regimens resulting in reduced gastrointestinal adverse effects.