The American journal of gastroenterology
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Am. J. Gastroenterol. · Jun 2009
Comparative Study Clinical TrialNovel removable internally fully covered self-expanding metal esophageal stent: feasibility, technique of removal, and tissue response in humans.
Internally fully covered self-expandable metal stents (FCSEMSs) have recently become available offering the possibility of removal. However, to our knowledge, the feasibility, techniques for endoscopic removal, and tissue reaction to FCSEMS have not been reported in humans. Our aims are (1) to report reasons for and success of FCSEMS removal in consecutive patients, (2) to describe methods of esophageal stent retrieval, and (3) to describe stent reactions induced by FCSEMS in humans. ⋯ FCSEMSs palliate dysphagia from both benign and malignant conditions and seal postoperative tracheoesophageal fistulas and mediastinal leaks. Tissue reaction to the stents was common but remained clinically insignificant in the majority of patients. Close follow-up of patients with FCSEMS is required and repeat endoscopy with stent retrieval might be necessary with the development of new symptoms or complications from the stent.
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Am. J. Gastroenterol. · Jun 2009
ReviewMost doctors win: what to do if sued for medical malpractice.
All gastroenterologists are at risk of being accused of medical malpractice; few have received much training about what to do should a lawsuit occur. This article details what one can expect in a typical medical malpractice negligence claim and reviews basic relevant legal terminology. The timeline of a lawsuit is described, particularly noting the physician's role in discovery and trial. Cautions and suggestions for successful navigation of this unfamiliar and uncomfortable world are dispensed.
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Am. J. Gastroenterol. · Jun 2009
Comparative StudyRisk of arterial thrombotic events in inflammatory bowel disease.
Patients with inflammatory bowel disease (IBD) have an increased risk of venous thrombotic events. The risk of arterial thrombotic events in IBD, however, has been less well characterized. We explored whether Crohn's disease (CD) and ulcerative colitis (UC) are associated with a higher risk for thrombotic events involving the mesenteric, cardiac, or cerebral arteries. ⋯ Patients with IBD have a markedly increased risk of acute mesenteric ischemia. Subgroup analysis reveals that women over the age of 40 years with IBD are at increased risk of myocardial infarction, whereas those below the age of 40 years exhibit a two-fold higher risk for stroke. In contrast, men with IBD did not share these same risks for arterial thrombotic events.
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Am. J. Gastroenterol. · Jun 2009
Editorial CommentHyponatremia in hepatic encephalopathy: an accomplice or innocent bystander?
Hyponatremia, a common complication inpatients with advanced liver disease and impaired free water clearance, has been shown to be an important predictor of short-term mortality. Hepatic encephalopathy, also a late complication of end-stage liver disease, has been associated with low-grade cerebral edema as a result of swelling of astrocytes. Guevara et al. hypothesized that hyponatremia and the resultant depletion of organic osmolytes (e.g.,myo-inositol) from brain cells contribute to brain edema, playing an important role in the pathogenesis of hepatic encephalopathy. ⋯ Their magnetic resonance spectroscopy data correlated low brain concentrations of myoinositol with hepatic encephalopathy. As both hyponatremia and encephalopathy occur in patients with advanced liver disease, it has been difficult to implicate hyponatremia independently in the pathogenesis of hepatic encephalopathy. Guevara's data do suggest that hyponatremia is more likely an accomplice than an innocent bystander.