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Biomedical subjects

C Rollhauser

Publications and source records attributed to C Rollhauser.

17 recordsLinked to original sources
PubMed2004

Nonvariceal upper gastrointestinal bleeding.

Although the incidence of nonvariceal upper gastrointestinal bleeding (NVUGIB) may be decreasing, the case fatality associated with it remains unchanged. What do the most recent studies tell us about medical and endoscopic therapy? Erythromycin is a potentially useful adjunct to endoscopy, and further data are needed to establish its role in the management of patients with NVUGIB. The use of proton-pump inhibitors in addition to combination endoscopic therapy appears to reduce the rebleeding rate consistently across different studies; the route of administration, dosage, and duration of treatment require further definition. Although two controlled studies suggest improved outcomes with clot removal and endoscopic therapy, the exact role of endoscopic treatment in the setting of overlying clots remains controversial. Hemoclips have not been found, in general, to be superior to the available endoscopic techniques. Currently, other hemostatic techniques such as injection and thermocoagulation - and in particular, combination therapy using both methods - are preferable. No major "breakthrough" endoscopic treatment has emerged. Newer endoscopic therapies such as cryotherapy are interesting, but have not had widespread application. Endoscopic suturing techniques, as used in the treatment of esophageal reflux and obesity, have not been adapted to the management of gastrointestinal bleeding.

Clinical Trials as Topic↗
PubMed2002

Nonvariceal upper gastrointestinal bleeding.

Nonvariceal upper gastrointestinal bleeding (NVUGIB) remains an important cause of morbidity and mortality. The etiological role and the relative risk of nonsteroidal anti-inflammatory drugs (NSAIDs) in association with other clinical factors are the focus of several papers published in the last year. Data from studies that evaluate the interaction of NSAIDs with Helicobacter pylori suggest that there is a clear role for eradication in aspirin-related bleeding. Although the benefit of H. pylori eradication in nonaspirin NSAID-related bleeding is being debated, they should both be eliminated given their relative contribution to the causation of peptic ulcer hemorrhage. The search for reliable and accurate tools to predict outcomes after NVUGIB continues. Recent important contributions in this area of research are the use of a clinical prediction guide to identify patients who are likely to require endoscopic intervention, and the use of Doppler ultrasound examination of the ulcer base to predict rebleeding. The role of antisecretory therapy in the setting of acute NVUGIB has been revisited in two meta-analyses and one randomized, placebo-controlled trial of omeprazole as an adjunct to endoscopic intervention. Until more definitive data are available, it appears that the effect of acid-decreasing medications is more important when endoscopic therapy is not provided than when effective endoscopic intervention is instituted. With regard to therapeutic endoscopy for upper gastrointestinal bleeding, the few randomized trials that have been published in full form in the last year focus on the use of mechanical methods of hemostasis for peptic ulcer bleeding and other etiologies such as Mallory-Weiss tears and Dieulafoy lesions.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

Current status of endoscopic therapy for ulcer bleeding.

This article provides an overview of the therapeutic endoscopic modalities available for the treatment of peptic ulcer bleeding. The benefits of endoscopic haemostasis have been fully demonstrated by three meta-analyses, which included most of the controlled trials published until 1992. In this review, an emphasis is placed on randomized, prospective comparative trials published during the past 20 years. Using an evidence-based medicine approach, the results of meta-analyses are translated into efficacy measures known as relative and absolute risk reductions, and number needed to treat. Single-modality treatments with injection agents such as epinephrine, sclerosants and thrombogenic substances, or with thermal therapies, are efficacious and comparable. Combination therapy involving injection and thermal techniques may offer an advantage over single-method therapy. The differences in the results between clinical trials and routine clinical practice, and among the various randomized studies, are probably related to operators' experience and variations in technique rather than to inconsistency of endoscopic haemostasis.

Acute Disease↗
PubMed1999

Ulcers and nonvariceal bleeding.

This review of nonvariceal upper gastrointestinal bleeding concentrates mainly on peptic ulcer bleeding, and is based on papers published during the last two years. While the focus is on outcome prediction models and therapeutic interventions, brief reference is also made to certain epidemiological aspects, pathological and animal studies, and risk factors for bleeding peptic ulcer.

Duodenal Ulcer↗
PubMed1998

Needle-knife papillotomy: a helpful and safe adjunct to endoscopic retrograde cholangiopancreatography in a selected population.

BACKGROUND AND STUDY AIMS: Needle-knife papillotomy (NKP) has been shown to be a useful alternative when standard techniques fail to provide access during ERCP. A retrospective review was conducted to reevaluate the indications, efficacy, and complications of NKP at a tertiary referral center. PATIENTS AND METHODS: A total of 1205 therapeutic endoscopic retrograde cholangiography procedures (ERCPs) were reviewed. Sixty-eight patients (5.6%) had undergone NKP after an established algorithm of techniques had failed to provide access. The NKP results were analyzed in two periods, including initial experience with 470 ERCPs (group 1, NKP n = 22) and later experience with 735 patients (group 2, NKP n = 46). RESULTS: Immediate free cannulation in group 1 was achieved in 14 of 22 patients (64%), vs. 34 of 46 (74%) in group 2. The delayed cannulation rate was five of eight patients in group 1 (62.5%) vs. 11 of 12 in group 2 (92%). The success rate was 19 of 22 patients in group 1 (86%) vs. 45 of 46 in group 2 (98%). The overall success rate was 64 of 68 (94%). Successful cannulation led to a therapeutic intervention in 94% of these patients. A complication rate of 6%, without mortality, was noted. CONCLUSIONS: NKP is a valuable tool that allows a high success rate for cannulation, with a low complication rate. The success rate increases with operator experience. NKP should be carried out by experienced endoscopists after standard maneuvers fail to provide access, and when cannulation is likely to be followed by a therapeutic intervention.

Adolescent↗
PubMed1996

Case report: a rare case of chylous ascites from Mycobacterium avium intracellulare in a patient with AIDS: review of the literature.

Chylous ascites is a rare complication of acquired immunodeficiency syndrome (AIDS). Although it is most commonly associated with lymphoma, it has been reported in patients with Kaposi's sarcoma. There has been only one case reported of chyloperitoneum occurring in a pediatric patient as a result of Mycobacterium avium intracellulare (MAI). We report the first case of an adult patient with chylous ascites resulting as a complication of MAI. Chylous ascites (chyloperitoneum) is a rare complication of acquired immunodeficiency syndrome (AIDS). Only two cases of chylous ascites associated with AIDS have been reported in the literature (1, 2). In one case, chylous ascites was attributed to extensive abnormal Kaposi's sarcoma (1). In the second case, a 2-year-old child with Mycobacterium avium intracellulare (MAI) developed chylous ascites. (2) We report the first adult case of AIDS which has been complicated by a MAI infection causing mesenteric lymphadenopathy and chylous ascites.

Acquired Immunodeficiency Syndrome↗
PubMed1995

ACTH-producing pituitary carcinoma presenting as the cauda equina syndrome.

A 43-year-old woman presented with incontinence, weakness, and paresthesia, consistent with the cauda equina syndrome, 10 years after having a pituitary tumor surgically removed and 4 years after excision of two "meningiomas" of the cervical cord. The patient was also hypertensive and had a cushingoid habitus. Emergent surgical decompression of the spinal cord revealed intradural metastatic adrenocorticotropic hormone-producing pituitary carcinoma. Pituitary carcinomas are rare. The majority of reported cases of adrenocorticotropic hormone-producing carcinoma have exhibited metastases outside the central nervous system. To our knowledge, this represents the first case of an adrenocorticotropic hormone-producing pituitary carcinoma presenting with the cauda equina syndrome. A review of all reported cases of pituitary carcinoma indicated that central nervous system metastases were more common than metastases to distant sites, and patients with distant metastases experienced a shorter duration of disease than did those with central nervous system metastases.

Adrenocorticotropic Hormone↗
PubMed1992

Sideroblastic anemia. A diagnosis to consider in alcoholic patients.

Alcoholic patients who present with anemia can pose a diagnostic challenge. Although deficiencies of iron, vitamin B12, and folate commonly result in anemia, bone marrow suppression of red blood cell production related to the direct toxic effects of alcohol can cause a form called sideroblastic anemia. This case report describes a patient presenting with acute alcohol intoxication and anemia in whom extensive evaluation revealed a hematologic picture compatible with acquired sideroblastic anemia.

Alcoholism↗