The American journal of medicine
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Although flexible sigmoidoscopy is recommended in patients over age 40 to complement fecal occult blood screening for colorectal neoplasia, the yield of this procedure in asymptomatic, average-risk subjects has varied between studies. In addition, the efficacy of flexible sigmoidoscopy in detecting early curable carcinoma has been the subject of debate. We therefore undertook this study to assess the efficacy, safety, and cost of the procedure for early detection of colorectal neoplasia in asymptomatic subjects. ⋯ In conclusion, 60-cm flexible sigmoidoscopy is a safe, high-yield procedure for the initial screening of colorectal neoplasia in asymptomatic, average-risk subjects over the age of 50. Because the carcinomas detected were still in an early stage, such screening may improve survival.
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Cocaine abuse has recently emerged as a major problem among young adults, and is increasingly associated with a variety of medical complications. In view of recent reports demonstrating that illicit cocaine use may cause rhabdomyolysis, we reviewed the collective experience of a university-affiliated medical center to identify patients with cocaine-induced rhabdomyolysis. ⋯ Rhabdomyolysis must be added to the every-growing list of medical complications associated with the illicit use of cocaine. Skeletal muscle injury may be a more common complication of cocaine abuse than has previously been appreciated, escaping medical attention when the clinical manifestations are relatively mild. The importance of recognizing this clinical entity lies in the potential confusion with myocardial ischemia. This point is illustrated by the fact that each of our patients was hospitalized to exclude the possibility of cocaine-induced myocardial infarction. Cardiac ischemia could not be differentiated from skeletal muscle injury solely on the basis of clinical assessment.
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Reports of biliary tract abnormalities in patients with acquired immunodeficiency syndrome (AIDS) are infrequent. Nine patients with features of papillary stenosis and sclerosing cholangitis and one patient with primary bile duct lymphoma were previously described. Since those reports, an additional 16 AIDS patients with clinical and laboratory features suggestive of biliary tract disease have been evaluated. The findings in these 26 patients form the basis of this study. ⋯ Clinicians should be aware that profound biliary tract abnormalities may develop in a large number of human immunodeficiency virus-infected patients. Confirmation of the anatomic abnormalities, determination of correct etiology, and effective therapy may depend upon early endoscopic cholangiography.
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The effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on the gastric mucosa are well documented. The complex mechanisms of gastric damage, however, are not fully understood. This review examines current knowledge about the normal function of the gastric mucosal barrier; the role of prostaglandins in cytoprotection and repair; the mechanisms by which aspirin and other weak organic acids are absorbed by the stomach; and the subsequent cascade of events--including ion trapping and back diffusion of hydrogen ions--that leads to gastric erosion and bleeding. A hypothesis describing NSAIDs' dual insult on the stomach is advanced.