Journal of clinical gastroenterology
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Eighty-two consecutive patients with oral mucosal disorders were screened for celiac sprue with serum immunoglobulin A (IgA)-class endomysial and gliadin antibodies. In positive cases the diagnosis of celiac sprue was established by duodenal biopsy. Four patients were positive for endomysial antibodies and 22 for gliadin antibodies. ⋯ Sixteen of 22 patients positive for gliadin antibodies underwent small bowel biopsy, and 15 had normal mucosa. Patients with chronic oral mucosal disorders and a positive endomysial antibody test may suffer from celiac sprue. By contrast, gliadin antibodies were very prevalent even in the absence of celiac sprue.
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Although fluid analysis usually is the first step toward identifying the cause of pleural effusion in patients with cirrhosis and ascites, there are no available data on the reliability of this approach, therefore, we retrospectively evaluated hematologic and biochemical parameters from pleural fluid analysis in 21 patients with hepatic hydrothorax (with proven peritoneal-pleural communication) and 6 patients with primary pleural disease (2 with tuberculosis, 3 with parapneumonic effusion, and 1 with empyema). The criteria developed by Light were diagnostic of pleural "exudate" in only one of six patients with primary pleural disease, concentrations of leukocytes, total protein (TP), albumin, and lactic dehydrogenase (LDH) in both fluids were measured and pleural fluid-to-ascites ratios of these measurements were calculated. ⋯ We conclude that pleural fluid analysis has limited diagnostic efficacy in the patient with cirrhosis. Data collected by other methods--clinical and radiologic--should assist in arriving at the correct diagnosis.
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J. Clin. Gastroenterol. · Sep 1997
Colonic disease associated with a positive assay for Clostridium difficile toxin: a retrospective study.
In this retrospective review of colonic tissue from 21 patients with a positive stool assay for Clostridium difficile toxin, four groups of patients were identified by pathologic examination. Classic pseudomembranous colitis was identified in 38% of patients in colon biopsies, resections, and at postmortem examination. ⋯ In 19% of patients, no acute or chronic colitis or pseudomembranous colitis was noted. This report reminds gastroenterologists that C. difficile infection is associated with a range of pathologic changes similar to the well known clinical spectrum of disease.
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J. Clin. Gastroenterol. · Jun 1997
Electrogastrography and gastric emptying scintigraphy are complementary for assessment of dyspepsia.
We have tried to correlate abnormalities in electrogastrography (EGG) and gastric emptying (GE) with symptom severity in patients with functional dyspepsia. Seventy-two patients with functional dyspepsia underwent EGG, GE, and symptom severity quantitation. EGGs were assessed for dominant frequency (DF), percentage of time of DF in the 2 to 4 cpm range, and postprandial-fasting DF power ratio. ⋯ We conclude that EGG abnormalities are more common in dyspeptic patients with delayed GE. Patients with both delayed GE and abnormal EGG have more severe symptoms. Our results suggest that EGG and GE complement each other in correlating symptoms to gastric dysmotility.