Digestive diseases and sciences
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Randomized Controlled Trial
An instrument to predict endoscopy tolerance: a prospective randomized study.
Our purpose in this study was to determine if the use of an instrument developed by our group to direct sedation choice improves patient satisfaction with endoscopy sedation compared to standard sedation practice. After 200 enrollments, data were available for 194 patients who completed the study. There were nine cases of dissatisfaction: five (5%) in the control group and four (4%) in the intervention group (P = 0.78). ⋯ This could have been because the assumption that patients with increased risk of dissatisfaction do better with deeper sedation is incorrect. Another explanation could be the increased awareness of the value of benzodiazepines in endoscopy. Consistent with our findings, nervousness rather than pain predicted dissatisfaction, and the optimal use of anxiolytics with amnesic properties may be comparable to that of propofol.
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Fewer than 10% of patients with major liver trauma have life-threatening bleeding. Laparoscopic operations, endoscopic procedures, and percutaneous interventions such as drainages, vascular or tumor sclerosis, biopsies, and transjugular intrahepatic portocaval shunt (TIPS) have increased the number of iatrogenic vascular and bile duct injuries. Due to its therapeutic success, arterial embolization (AE) has become the standard treatment for late complications of hepatic injury. ⋯ Persistent hemorrhage and rebleeding may be treated with a new AE or an operation. Precise indication and a correctly performed AE are key factors for a successful treatment. Rebleeding episodes are a rare occurrence, which may be treated with AE as well.
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Postoperative ileus (POI) is a major cause of postoperative complications and prolonged hospitalization. Ghrelin, which is the endogenous ligand for the growth hormone secretagogue receptor, has been found to stimulate gastric motility and accelerate gastric emptying. ⋯ The results showed that TZP-101 is equally effective against the delayed gastrointestinal transit induced by surgery, by morphine, or by the combination of both interventions. The prokinetic action of TZP-101 was more pronounced in the stomach compared to the small intestine.