The American journal of gastroenterology
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Am. J. Gastroenterol. · Sep 1996
ReviewSplanchnic ischemia and gut mucosal injury in sepsis and the multiple organ dysfunction syndrome.
The incidence of multiple organ failure syndrome (MOFS) has increased dramatically in most intensive care units (ICU) in the United States and is now the leading cause of death after sepsis, trauma, and burns (1). Despite advances in resuscitation, availability of potent antibiotics, and modern techniques of organ support (2), the survival of critically ill patients with MOFS has not significantly improved since the syndrome was first described over 2 decades ago (3). In the ICU, the monitoring and management of critically ill patients with MOFS has relied, in large part, on readily available measurements of global hemodynamics and oxygen transport. ⋯ The role of gastric tonometry in the monitoring of splanchnic oxygenation and its utility in critically ill patients is then analyzed. In addition, the effects and clinical implications of commonly used vasoactive agents on intestinal oxygenation are discussed. Finally, novel therapeutic strategies based on the "gut-origin hypothesis" of MOFS are reviewed.
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Am. J. Gastroenterol. · Jun 1996
Review Case ReportsPylephlebitis: a case report and review of outcome in the antibiotic era.
Pylephlebitis or septic thrombophlebitis of the portal vein, a precursor of hepatic abscesses, is an extremely rare and frequently fatal complication of diverticulitis. The following report describes a patient presenting with pylephlebitis and complicated diverticulitis. Diagnosis was confirmed by computed tomography. The patient had a favorable outcome with medical and surgical therapy, prompting us to evaluate historical treatment of pylephlebitis.
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Am. J. Gastroenterol. · Jun 1996
Review Case ReportsSevere dysphagia, dysmotility, and unusual saccular dilation (diverticulum) of the esophagus following excision of an asymptomatic congenital cyst.
Iatrogenic dysmotility syndromes, particularly achalasia-like conditions, occasionally complicate esophageal and paraesophageal surgery. We describe a patient who developed a very unusual (and as far as we know unreported) syndrome characterized by severe dysphagia, esophageal dysmotility (segmental simultaneous contractions of the distal esophagus), and very large saccular outpouching (diverticulum) involving the right wall of the distal half of the esophagus as a consequence of excision of an asymptomatic congenital cyst. The cyst had been discovered as an incidental finding on a preemployment chest x-ray. Our patient's dysphagia did not improve with nonsurgical treatments that are usually successful for idiopathic and iatrogenic achalasia.
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Am. J. Gastroenterol. · Mar 1996
Review Case ReportsBleeding from polypoid colonic arteriovenous malformations.
The endoscopic appearance of vascular ectasias has been well characterized. We present two cases of bleeding polypoid colonic arteriovenous malformations.
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Am. J. Gastroenterol. · Oct 1995
Review Case ReportsHemosuccus pancreaticus as a source of obscure upper gastrointestinal bleeding: three cases and literature review.
We report three patients with chronic pancreatitis and recurrent episodes of severe upper gastrointestinal bleeding caused by hemosuccus pancreaticus. No bleeding source could be identified despite repeated endoscopies. ⋯ No rebleeding occurred after operation. In cases of obscure upper gastrointestinal hemorrhage, the pancreas should be considered as a bleeding source, especially in patients with chronic pancreatitis.