The American journal of gastroenterology
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Am. J. Gastroenterol. · Dec 1992
The admission serum lipase:amylase ratio differentiates alcoholic from nonalcoholic acute pancreatitis.
To determine whether the lipase:amylase ratio differentiates alcoholic from nonalcoholic pancreatitis, we conducted a retrospective review of charts with the diagnosis of acute pancreatitis at the George Washington University Medical Center between January 1988 and July 1990. A total of 446 charts were reviewed. For a patient to be included in the subsequent analysis, the following criteria were met: 1) the patient had typical symptoms of pancreatitis, 2) serum amylase and lipase were analyzed on admission, and 3) a computerized tomographic (CT) scan or ultrasound of the abdomen was obtained within 72 h of admission. ⋯ Only patients with alcoholic acute pancreatitis had lipase:amylase ratios > 5.0 (sensitivity 31%, specificity 100%). Our data point to the clinical utility of the lipase:amylase ratio in differentiating alcoholic from nonalcoholic acute pancreatitis. Prospective studies will be needed to confirm the clinical utility of this ratio.
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Am. J. Gastroenterol. · Nov 1992
Meta Analysis Comparative StudyOptimal nonsurgical treatment of hemorrhoids: a comparative analysis of infrared coagulation, rubber band ligation, and injection sclerotherapy.
Despite an abundance of nonsurgical hemorrhoid therapies, none has been consistently more efficacious. By combining data from multiple clinical trials in a meta-analysis, the present study compared the efficacy and complications of infrared coagulation, injection sclerotherapy, and rubber band ligation to determine the optimal nonoperative hemorrhoid treatment. All published clinical trials comparing the three methods were identified by computer search and review of appropriate English language journals. ⋯ Although rubber band ligation demonstrated greater long-term efficacy, it was associated with a significantly higher incidence of posttreatment pain. In contrast, infrared coagulation was associated with both fewer and less severe complications. Thus, when all factors are considered, infrared coagulation may in fact be the optimal nonoperative hemorrhoid treatment.
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Am. J. Gastroenterol. · Oct 1992
Preoperative testing for fecal occult blood: a questionable practice.
The benefit of fecal occult blood testing (FOBT) in patients without gastrointestinal symptoms who are hospitalized for an elective surgical procedure is uncertain. To resolve this issue, we analyzed the costs and benefits of preoperative FOBT by the model of a decision tree. In 2- and 3-way sensitivity analyses, the costs of diagnostic and therapeutic procedures and the probabilities of their various outcomes are varied simultaneously so that we might study their joint influence on the outcome of the decision analysis. ⋯ False-positive FOBT leads to expenditures for negative gastrointestinal work-ups, increased procedural costs, and a diminished rate of success for the elective surgical procedure, by delaying it. This outcome of the analysis is insensitive to large variations in the costs and probabilities built into the model. We conclude that screening for fecal occult blood provides no benefit if done routinely in patients who are hospitalized for any major surgical procedure.
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Am. J. Gastroenterol. · Jul 1992
Case ReportsIncreased intracranial pressure and hepatic encephalopathy in chronic liver disease.
Increased intracranial pressure is present in more than 80% of patients with fulminant hepatic failure. However, patients with encephalopathy secondary to chronic liver disease are thought not to develop elevated intracranial pressure. We report two patients with chronic liver disease in hepatic coma with raised intracranial pressure documented by an epidural intracranial pressure monitor. ⋯ The other patient progressively worsened following intravenous sedation administered during upper endoscopy. Both patients had generalized tonic-clonic seizures, and one demonstrated decerebrate posturing and papilledema. Although all metabolic and structural abnormalities should be excluded in patients with hepatic encephalopathy, if the etiology remains in question, the possibility of increased intracranial pressure should be considered in patients with chronic liver disease.