Gut
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A prospective audit of the diagnostic yield and management benefit of laparoscopy was undertaken in 220 consecutive patients. The procedure was performed electively in 180 patients and as an emergency in 40. The indications for laparoscopy in the elective group were suspected hepatic disease, staging of intra-abdominal malignancy, diagnostic problems, and chronic abdominal pain. ⋯ Clinical management was significantly influenced by laparoscopy in 15 of 21 (71%) patients with liver disease, 10 of 30 (33%) with intra-abdominal malignancy, 5 of 19 (26%) with uncertain diagnosis, 32 of 40 (80%) with acute abdominal pain, and 15 of 110 (23%) patients with chronic abdominal pain. A wrong assessment of the nature or stage of the disease was made by laparoscopy in 3 of 220 (1.0%). There was no morbidity or mortality attributed to laparoscopy in the study.
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This study evaluated the effect of the 270 degrees Belsey Mark IV fundoplication on 24 hour ambulatory pH metry variables. Thirty seven patients with confirmed gastro-oesophageal reflux disease who had a Belsey Mark IV antireflux procedure were evaluated preoperatively and three to six months postoperatively including endoscopy, lower oesophageal sphincter manometry, and 24 hour ambulatory pH metry. In 30 of 37 patients the Belsey Mark IV fundoplication was judged successful based on symptom relief and healing of oesophagitis. ⋯ A surgery. A successful 270 degree Belsey Mark IV fundoplication was associated with a significant increase in basal lower oesophageal sphincter pressure, in contrast with the failure group. Restoration of a sufficient lower oesophageal sphincter barrier is an important aim in antireflux surgery.
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There were no data concerning the incidence of inflammatory bowel disease (IBD) in France. The aim of this study was to investigate the incidence of Crohn's disease and ulcerative colitis in northern France. This prospective population based study was realised through the gastroenterologists of the region Nord-Pas de Calais and the Somme Department. ⋯ The highest age specific incidence rate for ulcerative colitis was between 20 and 39 years: 5.5 for women and 6.5 for men. This first French prospective study has shown an incidence rate for Crohn's disease comparable with that seen in north European studies but lower than that seen for ulcerative colitis. These results could be related to the different environmental factors or the genetic background of the population studied, or both.
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A high intragastric PCO2 (iPCO2), determined tonometrically, is the main factor participating in a low gastric intramucosal pH (pHi) and may point to gastric mucosal ischaemia. iPCO2 might also increase, however, after buffering of gastric acid by bicarbonate; the magnitude of this effect and the efficacy of H2 blockers to prevent it are unclear. Ten healthy volunteers (20-24 years) were studied at baseline and after oral ingestion of 500 mg sodium bicarbonate. The same test was carried out one hour after intravenous injection of 100 mg ranitidine. ⋯ The difference between intragastric and blood PCO2 during normal acid secretion probably results from buffering of gastric acid by gastric bicarbonate, rather than by duodenogastric reflux or saliva entering the stomach. During acid secretion suppression, intragastric equals blood PCO2, even after oral ingestion of sodium bicarbonate. Hence, acid secretion inhibition is mandatory for proper assessment of iPCO2 and pHi as specific measures of the adequacy of gastric mucosal blood flow.
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Case Reports
Biliary obstruction resulting from Strongyloides stercoralis infection. Report of a case.
Hepatobiliary manifestations of strongyloidiasis are rare. A case is described of biliary obstruction associated with the presence of Strongyloides stercoralis in the duodenal mucosa and 250 microns rhabditiform larvae in bile. Biliary obstruction resulted from papillary stenosis, which resolved after treatment with thiabendazole. It is proposed that papillary stenosis may be responsible for obstructive jaundice associated with Strongyloides stercoralis infection, and that strongyloidiasis should be added to the causes of papillary stenosis.