The American journal of gastroenterology
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Am. J. Gastroenterol. · Mar 2000
Review Case ReportsCompletion of upper endoscopic procedures despite paradoxical reaction to midazolam: a role for flumazenil?
Paradoxical excitation after benzodiazepine administration is well described. Although it is relatively uncommon, its occurrence can severely impede or even prevent the performance of upper endoscopy. We describe three cases in which paradoxical reactions to midazolam responded so well to flumazenil administration that the procedure was successfully completed in each instance. We review the limited literature on this topic and suggest that flumazenil may have greater utility in the management of this particular problem than is considered at present.
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Am. J. Gastroenterol. · Feb 1999
ReviewAmylase normal, lipase elevated: is it pancreatitis? A case series and review of the literature.
This study was undertaken to identify clinical scenarios in which the lipase is significantly elevated (three times above the upper limit of normal) but the amylase is normal, and to examine whether or not pancreatitis is the likely cause for this seemingly unusual constellation of laboratory results. ⋯ 1. An elevated lipase should not be equated with evidence for pancreatitis if the amylase is normal. 2. A simultaneous determination of both amylase and lipase is recommended for the evaluation of patients with abdominal pain.
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Am. J. Gastroenterol. · Sep 1997
Review Case ReportsPerforated diverticulum of the transverse colon.
We report a case of perforated diverticulitis of the transverse colon. The preoperative diagnosis of perforated appendicitis was made on the basis of findings of both ultrasonography and CT. ⋯ Diverticulitis of the transverse colon is rare, and there have been few reports in the English-language medical literature. This report describes a true diverticulum of the transverse colon that presented as acute diverticulitis.
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Am. J. Gastroenterol. · Jul 1997
Review Case ReportsSplenic rupture: an unusual complication of colonoscopy.
Splenic rupture is an uncommon complication of colonoscopy. A high index of suspicion is a crucial factor in the prompt diagnosis of this rare but potentially fatal complication. We report a case of splenic rupture diagnosed 3 days after a colonoscopy and requiring splenectomy. ⋯ The factors mandating further evaluation of persistent abdominal pain after colonoscopy are hemodynamic instability, clinical features of acute abdomen, leukocytosis, and/or acute anemia. The onset of abdominal pain associated with one or more of these critical factors is usually within 24 h after colonoscopy. An emergent CT scan of the abdomen is the modality of choice to further evaluate these clinical features, but intestinal perforation and external bleeding must first be excluded.
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Am. J. Gastroenterol. · Jul 1997
Review Practice Guideline GuidelineDiagnosis and treatment of gastrointestinal bleeding secondary to portal hypertension. American College of Gastroenterology Practice Parameters Committee.
Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When data are not available that will withstand objective scrutiny, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care, which are inflexible and rarely violated. Given the wide range of choices in any health care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its practice parameters committee. These guidelines are also approved by the governing boards of American College of Gastroenterology and Practice Parameters Committee. Expert opinion is solicited from the outset for the document. Guidelines are reviewed in depth by the committee, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time. The following guidelines are intended for adults and not for pediatric patients. ⋯ Once esophageal varices have been established by endoscopy as the site of bleeding, either sclerotherapy or endoscopic variceal ligation should be performed to control the bleeding episodes. Concomitant use of vasoactive drugs lowers portal pressure, potentially offers the endoscopist a clearer field in which to work, and is the only noninvasive treatment for nonesophagogastric variceal sites of bleeding related to portal hypertension. For patients failing medical therapy, the transjugular intrahepatic portasystemic shunt procedure is a reasonable alternative to an emergency surgically created shunt. Nonselective beta-adrenergic blockers are the only proven therapy for prevention of first variceal hemorrhage. Both nonselective beta-adrenergic blockers and endoscopic variceal ligation (which has replaced sclerotherapy for this indication) are effective in reducing the risk of recurrent variceal bleeding. For patients failing these approaches, selective or total shunts or, in selected patients, liver transplantation are appropriate rescue procedures.