Journal of clinical gastroenterology
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J. Clin. Gastroenterol. · Sep 2001
Case ReportsClinical characteristics of acute hemorrhagic rectal ulcer.
Acute hemorrhagic rectal ulcer (AHRU) occurs suddenly with painless, massive, fresh rectal bleeding in elderly, bed-ridden patients who have a serious primary disease. There have been several reports on AHRU in Japan, but in Western countries, there have been none. We examined the clinical characteristics of four cases, and we report on AHRU in Western countries. ⋯ When painless, massive, fresh rectal bleeding occurs in elderly and bed-ridden patients, it is important to carefully examine the lower rectum, as there is a strong possibility of AHRU.
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J. Clin. Gastroenterol. · Jul 2001
ReviewShould indirect calorimetry be used as part of nutritional assessment?
The use of indirect calorimetry in the design of nutritional support regimens is poorly appreciated by clinicians, who fail to recognize the importance of providing a sufficient volume of enteral feeding to critically ill patients. In contrast to the overfeeding that routinely occurred in the past with the provision of total parenteral nutrition, patients placed on the enteral route of support tend to be underfed because of problems with intolerance and frequent cessation. Clearly identifying and coming as close as possible to the caloric goal may be required to achieve the therapeutic endpoints of enteral tube feeding (which include maintenance of gut integrity, attenuation of the stress response, prophylaxis against stress-induced gastropathy, and stimulation of immune function). Indirect calorimetry is a convenient, accessible, and highly accurate instrument for the measurement of caloric requirements and is a valuable tool for the optimization of nutritional support in the intensive care unit.
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Celiac plexus neurolysis is an established technique for relieving pain in cancers of the upper abdomen. This article reviews the novel technique of endoscopic ultrasound (EUS)-guided neurolytic celiac plexus block. This recently described procedure is a therapeutic extension of curvilinear array endosonographic fine needle aspiration. ⋯ We believe that where the expertise is available, this procedure can be integrated into the diagnostic EUS of patients with inoperable upper abdominal malignancy. As such, this would be the safest and most cost-effective approach for celiac plexus neurolysis in these patients. The role of EUS-guided celiac plexus block in patients with chronic pancreatitis may be emerging and needs further study.
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J. Clin. Gastroenterol. · Apr 2001
Case ReportsOrnithine transcarbamylase deficiency unmasked because of gastrointestinal bleeding.
Ornithine transcarbamylase (OTC) is a mitochondrial-matrix enzyme that catalyzes conversion of ornithine and carbamyl phosphate to citrulline, the second step in the urea cycle. The urea cycle is the most important pathway to detoxification of ammonia in human beings. ⋯ Women with OTCD have a variable expression of their disease, the variability being determined by lyonization (random inactivation) of the X chromosome. We report a case of a 28-year-old woman who presented with hyperammonemic encephalopathy that was precipitated by a gastrointestinal bleed unmasking OTCD.
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J. Clin. Gastroenterol. · Mar 2001
Case ReportsAutoimmune hemolytic anemia in treatment-naïve chronic hepatitis C infection.
Extrahepatic immunologic abnormalities have been shown to occur in patients with chronic hepatitis C virus (HCV) infection. Induction of autoimmune hemolytic anemia has been reported, either during or after interferon treatment of HCV infection. I report a 48-year-old patient with HCV infection who developed Coombs-positive autoimmune hemolytic anemia in the absence of treatment with interferon, with a review of the available literature. ⋯ There was resolution of the hemolytic anemia and the prednisone was tapered gradually. No deterioration of the underlying HCV liver disease was evident even though an increase in HCV viremia was noted. Coombs-positive autoimmune hemolytic anemia can occur as an extrahepatic immunologic abnormality in treatment-naïve patients with chronic HCV infection.