The American journal of gastroenterology
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Am. J. Gastroenterol. · Aug 2003
Nurse-administered propofol sedation without anesthesia specialists in 9152 endoscopic cases in an ambulatory surgery center.
Narcotics and benzodiazepines are commonly used for sedation for endoscopy in the United States. Propofol has certain advantages over narcotics and benzodiazepines, but its use is often controlled by anesthesia specialists. This report describes our experience with dosage, safety, patient satisfaction, and discharge time with nurse-administered propofol sedation in 9152 endoscopic cases. ⋯ Gastroenterologists strongly preferred propofol. The mean time from completion of procedures to discharge in a sample of 100 patients was 18 min. Nurse-administered propofol sedation in an ambulatory surgery center was safe and resulted in high levels of patient satisfaction and rapid postprocedure recovery and discharge.
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Am. J. Gastroenterol. · Aug 2003
Risk factors for symptomatic gallstones in patients with liver cirrhosis: a case-control study.
Liver cirrhosis is a well-documented risk factor for the formation of gallstones. In cirrhotic patients, gallstones are almost always "silent," and surgery is rarely required. When indicated (symptoms or complications), cholecystectomy implies a high morbidity risk in these patients, especially in the advanced stages of cirrhosis. The aim of this study was to estimate the risk factors for symptom development in cirrhotic patients with gallstones to identify the subgroup of patients at risk of undergoing surgery. ⋯ The risk of gallstones becoming symptomatic is significantly lower in men and in alcoholic cirrhosis. In cirrhotic women, and especially in the presence of a positive family history and of advanced age, the risk of developing symptoms and undergoing surgery was significantly greater.
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Am. J. Gastroenterol. · Jun 2003
Role of fresh frozen plasma infusion in correction of coagulopathy of chronic liver disease: a dual phase study.
Fresh frozen plasma infusions are commonly used to correct the prolonged prothrombin time in patients with advanced chronic liver disease. The aim of this study was to establish how frequently this treatment is effective in correcting this coagulopathy. ⋯ Our results reiterate previous observations made more than 45 yr ago, that fresh frozen plasma infusions using the number of units commonly employed in clinical practice infrequently correct the coagulopathy of patients with chronic liver disease. Higher volumes (6 or more units) may be more effective but are rarely employed.
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Am. J. Gastroenterol. · Jun 2003
Brain responses to visceral and somatic stimuli in patients with irritable bowel syndrome with and without fibromyalgia.
Symptoms of irritable bowel syndrome (IBS) and fibromyalgia (FM) commonly coexist. We hypothesized that one of the mechanisms underlying this comorbidity is increased activation of brain regions concerned with the processing and modulation of visceral and somatic afferent information, in particular subregions of the anterior cingulate cortex (ACC). ⋯ Chronic stimulus-specific enhancement of ACC responses to sensory stimuli in both syndromes may be associated with cognitive enhancement of either visceral (IBS) or somatic (IBS + FM) sensory input and may play a key pathophysiologic role in these chronic pain syndromes.