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Biomedical subjects

D Wengrower

Publications and source records attributed to D Wengrower.

At least 37 records · Page 2Linked to original sources
PubMed1993

A new self-expandable and removable metal stent for biliary obstruction--a preliminary report.

We report our experience with a new self expandable metallic stent, a coil spring made from a nickel-titanium alloy. The super elastic characteristic of this metal offers a very strong radial force and previous dilatation of biliary strictures is not necessary. The stent is endoscopically inserted constricted over an introducing catheter, expanding spontaneously after release to its original 8 mm diameter. During the last six months, eleven stents were inserted in nine patients with pancreatic carcinoma to relieve jaundice. Another stent was percutaneously implanted treating a benign stricture in a patient with a choledochojejunostomy after a Whipple operation. Clinical improvement was achieved in all the patients except in one who died from liver metastases 5 weeks later. In two patients, although stents were obstructed after 2 and 4 months from insertion, they were easily removed by pulling their distal end through the endoscopic working channel. After a mean follow up of 4.5 months, patients had no evidence of biliary reobstruction. Although follow-up is short, these results are encouraging, and this new metallic stent seems to have several advantages over the current commercially available ones.

Aged↗
PubMed1993

Biliary and colonic cutaneous fistula successfully treated by endoscopic insertion of biliary stents.

We report a case in which a large, postoperative cutaneous biliary and a colonic fistula were successfully treated by means of endoscopic insertion of two endoprostheses into the common bile duct. Twenty-four hours after the procedure, bile flow through the leak ceased completely while the colonic fistula closed in 6 days. Six months after the treatment, when a new endoscopic cholangiography showed no evidence of leak or stricture, the stents were removed. For the treatment of postoperative biliary leaks, insertion of endoprostheses is a good and safe alternative to surgery.

Adult↗
PubMed1993

A unique presentation of lymphoma of the colon.

Non-Hodgkin's lymphoma often involves the gastrointestinal tract, but primary lymphoma of the colon is rare. Primary lymphoma of the colon masquerading as inflammatory bowel disease is even rarer. We report a patient with an initial diagnosis of Crohn's colitis, who later appeared to have had non-Hodgkin's lymphoma of the colon. We review the diagnosis and treatment of this rare disease.

Adult↗
PubMed1993

Combined transhepatic and endoscopic procedures in the biliary system.

Endoscopic biliary procedures are 89-97% successful in skilled hands. The commonest causes of failure are inability to cannulate the papilla of Vater due to difficult anatomy or tortuosity of the distal common bile duct and failure to cross a rigid biliary stricture. In nearly all of these cases, successful endoscopic procedures can be completed after percutaneous antegrade placement of a small catheter or guidewire to the duodenum. In 44 such combined procedures on 42 patients, the success rate was 43 (98%). There were two severe and eight mild complications. Combined procedures overcome the difficulties caused by tortuous biliary ducts and rigid strictures while obviating the need for more extensive percutaneous procedures and transhepatic tract dilatation.

Adult↗
PubMed1992

Effect of duodenal ulcer healing induced by omeprazole and ranitidine on the generation of gastroduodenal eicosanoids, platelet-activating factor, pepsinogen A, and gastrin in duodenal ulcer patients.

The effect of duodenal ulcer healing induced by omeprazole on gastroduodenal generation of eicosanoids, platelet-activating factor (PAF), pepsinogen A, and gastrin was evaluated. Sixty patients with endoscopically proven duodenal ulcer were randomized to receive 20 mg omperazole once daily or 300 mg ranitidine at bedtime for 2 weeks. Patients whose ulcers did not heal were treated for an additional 2 weeks. Endoscopic biopsy specimens and serum samples were obtained before and after treatment. There was no significant difference in the healing rate between the two treatment modalities. At 2 weeks healing rates were 60% and 56% in the omperazole and ranitidine groups, respectively, whereas at 4 weeks the respective healing rates were 96% and 86%. Ulcer healing induced by omeprazole and ranitidine was not accompanied by significant changes in mucosal leukotriene B4 or C4 generation. Mucosal PAF significantly decreased in patients treated with omeprazole for 4 weeks. In omperazole-treated patients there was a trend towards increase in mucosal prostaglandin E2 generation which was significant in the fundus after 4 weeks of treatment. After 2 weeks of omeprazole treatment, serum gastrin and pepsinogen A levels almost doubled when compared with their pretreatment levels. In conclusion, duodenal ulcer healing with 20 mg omeprazole daily is not superior to healing rates with 300 mg ranitidine at bedtime after both 2 and 4 weeks of treatment. In omeprazole-treated subjects ulcer healing was accompanied by a significant decrease in mucosal PAF generation and increased levels of serum gastrin and pepsinogen A.

Adolescent↗
PubMed1992

Palliation of malignant bile duct obstruction: our experience with endoscopic 14 French prostheses.

We evaluated the efficacy of wide 14F endoprostheses endoscopically placed in en patients with malignant extrahepatic bile duct stenosis. Large-bore stents were successfully placed in all patients. There were no early complications. Stent clogging occurred in two patients after one month and after three months in another patient. Seven patients remained free of symptoms after a mean follow-up period of 4.5 months.

Aged↗
PubMed1991

Idiopathic gastroparesis in patients with unexplained nausea and vomiting.

Nausea and vomiting are symptoms sometimes associated with motor dysfunction. We compared a group of young patients suffering from chronic nausea and/or vomiting and normal upper gastrointestinal x-ray series with a control group. The members of both groups underwent isotopic examinations of their stomachs. The aim of the study was to find a simple method of checking the stomach and proving a motor dysfunction in a group of patients with chronic, inexplicable nausea and vomiting. Patients and controls fasted for at least 6 hr were given 0.5 mCI of [99mTc] diethylene triaminopentaacetic acid orally in 150 cc milk with 50 g cornflakes. A time-activity curve was obtained and radioactivity over the stomach was recorded exponentially. The parameter of the T1/2 emptying time was used. In normal controls T1/2 emptying time ranged from 18 to 26 min. Twenty-five symptomatic patients were examined, three of whom achieved normal values, but 22 patients showed pathologic results ranging from 36 to 184 min. In patients with chronic nausea and/or vomiting an isotopic examination of the stomach may provide a simple and rapid diagnostic method of evaluation.

Adult↗
PubMed1990

Diarrhea in hypothyroidism: bacterial overgrowth as a possible etiology.

Constipation is common but diarrhea is very rare in myxedematous patients. We report a young woman with myxedema in whom chronic diarrhea was the dominant symptom. A fasting breath hydrogen test was positive, indicating bacterial overgrowth as the cause of the diarrhea. Antibiotic treatment was successful. We conclude that bacterial overgrowth due to hypomotility may be the etiology of the diarrhea in such patients.

Adult↗
PubMed1990

Treatment of fistulas of the biliary tract by endoscopic insertion of endoprostheses.

Five patients with fistulas of the biliary tract are reported; three had fistulas caused by operative injury and two, by accidental blunt abdominal trauma. All patients were treated successfully by endoscopic transpapillary insertion of biliary endoprostheses. The endoprostheses were removed after four to 17 weeks in all patients, and no evidence of biliary leakage was revealed by repeat cholangiograms and other clinical follow-up study. This effective, simple and safe method allows the fistula to heal and is a good alternative to surgical treatment.

Adolescent↗
PubMed1990

Gastrointestinal manifestations in Castleman's disease.

Castleman's disease is a relatively rare disorder of lymphoid tissue. The disease is considered benign in its localized form, but severe in the multicentric type. Gastrointestinal manifestations were occasionally described. We herein report four patients with histologically proved Castleman's disease in whom various and different clinical and pathological manifestations were found in the gastrointestinal tract, correlated with the primary disease. We believe that the digestive tract may be secondarily involved in Castleman's disease and, in some cases, gives the first manifestation of the disease.

Adult↗
PubMed1989

Indomethacin-induced gastroduodenal damage is not affected by cotreatment with ranitidine.

A randomized, double-blind, placebo-controlled study was conducted to determine whether concomitant administration of ranitidine reduces gastroduodenal mucosal damage associated with 1 week of indomethacin treatment. One hundred ten subjects with acute musculoskeletal conditions and who received indomethacin 150 mg/day completed the trial: 55 were treated with ranitidine 150 mg b.i.d. and 51 subjects received placebo b.i.d. Endoscopic gastric and duodenal injury were assessed before and after one week of treatment. There was no statistically significant difference in the percentage of patients with gastroduodenal damage or in the severity of the lesions in both treatment groups. Ranitidine did not ameliorate indomethacin-induced gastrointestinal symptoms and there was no correlation between upper gastrointestinal symptoms and endoscopic findings.

Adolescent↗
PubMed1988

No correlation between indomethacin-induced gastroduodenal damage and inhibition of gastric prostanoid synthesis.

The effect of 1 week of treatment with indomethacin 150 mg/day on human gastric prostanoid synthesis was correlated with its effect on gastric and duodenal mucosa. Before and following 1 week of treatment, endoscopic appearance of the mucosa was evaluated and scored. Following 1 week of treatment with indomethacin, antral PGE2 and 6-keto-PGF1 alpha were significantly lower than in normal subjects, but similar in patients with significant or with no mucosal damage. Co-treatment with ranitidine 150 mg b.d. or with cimetidine 400 mg b.d. reduced the mean mucosal damage score but did not affect gastric prostanoid synthesis, which was similar irrespective of the presence or absence of mucosal damage. It is therefore suggested that there is no correlation between indomethacin-induced inhibition of gastric prostanoid synthesis and its induction of mucosal damage.

Adolescent↗
PubMed1988

Cimetidine decreases indomethacin induced duodenal mucosal damage in patients with acute musculoskeletal disorders.

The effect of two doses of cimetidine, 400 mg at night and 400 mg bd, on the protection of indomethacin (50 mg tid) induced mucosal damage was evaluated in a double blind study in patients with acute musculoskeletal disorders. Endoscopic mucosal lesions were scored before and after five to seven days of treatment. One hundred and ninety one patients were endoscoped before the trial, 34 (17.8%) had greater than one erosion and were not recruited. Forty patients were excluded for non-compliance, or lost to follow up. At the second endoscopy, oesophageal, and fundic damage was negligible. Gastric and duodenal lesion score in patients treated with cimetidine 400 mg bd: 2.7 (0.5) (SE); n = 42) was significantly lower (p less than 0.0122) than in placebo treated patients: 6.1 (0.9) (n = 50) or in patients treated with cimetidine 400 mg at night 7.1 (0.8) (n = 21). Cimetidine 400 mg bd provided significant protection for the duodenum, but its protection of antral mucosa did not reach statistical significance. There was no correlation between upper gastrointestinal symptoms and endoscopic findings.

Adolescent↗
PubMed1988

Somatostatin release by human gastric mucosa. Studies in peptic ulcer disease and pernicious anemia.

Somatostation has been postulated to have a paracrine modulating role in gastrin and gastric acid secretion. We applied the organ culture technique to examine somatostatin release by explants of human gastric mucosa taken from patients with active duodenal ulcer, from control subjects, and from patients with pernicious anemia. Somatostatin was found to be released at a constant rate by antral explants during 3 h of incubation. In active duodenal ulcer antral and fundic 2-h somatostatin release (18.7 +/- 2.6 pg/mg tissue (means + SE), n = 75; and 27 +/- 3 pg/mg tissue, n = 94, respectively) was significantly lower than release by control antral and fundic mucosa (83 +/- 17 pg/mg tissue, n = 39, and 72 +/- 16 pg/mg tissue, n = 42, respectively) (P less than 0.01). Somatostatin release by antral and fundic mucosa of patients with pernicious anemia was also significantly decreased (20 +/- 8 pg/mg tissue, n = 12, and 7.6 +/- 2 pg/mg tissue, n = 12, respectively) (P less than 0.05). These results imply possible impairments of the paracrine release of somatostatin in peptic ulcer disease and in pernicious anemia.

Anemia, Pernicious↗
PubMed1988

Burkitt's lymphoma in an old patient with diarrhea: ileoscopic diagnosis.

A 61-yr-old man with Burkitt's lymphoma who presented with 6 months of diarrhea was found, at ileoscopy, to have inflammation of the mucosal narrow lumen, deep linear ulcerations, and a "cobblestone" appearance of the terminal ileum. Endoscopic biopsies were diagnostic of Burkitt's lymphoma, and no laparotomy was necessary. Presentation with diarrhea and the age of the patient were unusual, and the endoscopic features and diagnosis of the disease in the terminal ileum made by ileoscopy have not been previously reported.

Age Factors↗
PubMed1987

Cytoprotective doses of arbacet with minimal antisecretory properties are not effective in duodenal ulcer healing.

The efficacy of arbacet (a synthetic analog of prostaglandin E2) in definite cytoprotective but minimal antisecretory dose was evaluated in the treatment of duodenal ulcer. One hundred five patients with endoscopically proven duodenal ulcer were randomized in a double-blind manner to receive four times daily either arbacet 25 micrograms or placebo. Ulcer healing was assessed endoscopically after two and four weeks of treatment. The mean age, sex distribution, and tobacco and alcohol consumption were similar in the two treatment groups. The ulcers of 16 patients in both the placebo and the arbacet-treated group healed after 14 days of treatment. At the end of the study, healing of the ulcer was observed in 69.2% of the arbacet-treated patients and in 60.4% of patients in the placebo treated group. (Difference was not statistically significant). We conclude that cytoprotective doses of arbacet with minimal antisecretory properties are not effective in duodenal ulcer healing.

Adolescent↗
PubMed1987

Collagenous colitis and rheumatoid arthritis with response to sulfasalazine. A case report and review of the literature.

Collagenous colitis has been associated with rheumatoid arthritis in only a few cases. We describe a 76-year-old man with chronic rheumatoid arthritis whose diarrhea and abdominal pain came from collagenous colitis. He had a good clinical response to sulfasalazine. We review the clinical and histopathological features of collagenous colitis, together with the different therapeutic approaches.

Aged↗