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F C Ramirez

Publications and source records attributed to F C Ramirez.

34 records · Page 2Linked to original sources
PubMed1996

Endoscopic retreatment after successful initial hemostasis prevents ulcer rebleeding: a prospective randomized trial.

BACKGROUND AND STUDY AIMS: Rebleeding after initial endoscopic hemostasis remains an important determinant of poor prognosis in patients with ulcer hemorrhage. Prospective identification of patients who are at high risk for rebleeding, and directing further therapeutic measures in these patients, would be expected to improve the prognosis. PATIENTS AND METHODS: We used our previously described scoring system (the Baylor Bleeding Score) to identify patients at increased risk for rebleeding after initially successful endoscopic hemostasis, and randomized them into retreatment and no-retreatment groups. Patients in the retreatment group received additional endoscopic heat probe therapy at 24 hours, the follow-up was otherwise similar. Forty men with major ulcer hemorrhage were randomized, 19 to the retreatment group and 21 to the no-retreatment group. Patients in the two groups had similar Baylor Bleeding Scores, blood transfusion needs (median three vs. two units), ulcer sites (duodenal 57% vs. 43%), stigmata of hemorrhage (actively bleeding 68% vs 67%), and received similar initial endoscopic therapy (heat probe 240 J vs. 300 J). Patients in the retreatment group received additional heat probe therapy (median 165 J) at 24 hours. RESULTS: Rebleeding, requiring significantly more blood transfusion, occurred in 24% of the no-retreatment group patients compared to none of the retreatment group patients (p < 0.05). CONCLUSIONS: Endoscopic retreatment after successful initial endoscopic hemostasis prevents rebleeding in highrisk patients with ulcer bleeding.

Adult↗
PubMed1995

Prospective validation of the Baylor bleeding score for predicting the likelihood of rebleeding after endoscopic hemostasis of peptic ulcers.

Endoscopic therapy is effective in securing hemostasis for bleeding ulcers, but bleeding recurs in 10% to 30% of patients. Prospective identification of patients at increased risk for rebleeding is requisite to reducing rebleeding rates. We previously developed a three-component scoring system that identifies patients at increased risk for rebleeding. In the present study, we prospectively validated our scoring system. Forty-seven men ranging in age from 23 to 95 years in whom endoscopic therapy for bleeding ulcers was successful were studied. Patients with pre-endoscopy scores greater than 5 or postendoscopy scores greater than 10 were stratified as high-risk, and patients with pre-endoscopy scores of 5 or less and post-endoscopy scores of 10 or less as low-risk. Twenty-six patients were categorized as high-risk and 19 as low-risk. All patients were followed until discharged from the hospital. The rebleeding rate for high-risk patients was 31% (8 of 26), compared with 0 for low-risk patients (p < .05). We conclude that our scoring system accurately predicts patients at increased risk for rebleeding after successful endoscopic therapy of bleeding ulcers.

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PubMed1994

Clarithromycin, tetracycline, and bismuth: a new non-metronidazole therapy for Helicobacter pylori infection.

OBJECTIVE: Metronidazole resistance has become an increasing problem that has limited the usefulness of the original triple therapy. Our objective was to evaluate clarithromycin, a new macrolide compound active against Helicobacter pylori. METHODS: We evaluated a new clarithromycin triple therapy for H. pylori infection consisting of the combination of clarithromycin (500 mg t.i.d.), tetracycline (500 mg q.i.d.), and bismuth subsalicylate tablets (2 q.i.d.) for 14 days. Patients with ulcer also received concomitant ranitidine, 300 mg after the evening meal, for 6 wk. RESULTS: Thirty men with documented H. pylori infection were studied; 29 had peptic ulcer disease. Seven had previously failed antimicrobial therapy, including three with metronidazole-based triple therapy. H. pylori status was determined by histology. H. pylori status and ulcer status were evaluated 4 wk after the end of antimicrobial therapy. The ulcer was healed in 90%. The H. pylori infection was cured in 93%, including all three patients who previously failed metronidazole-based triple therapy. CONCLUSION: We conclude that the combination of clarithromycin, tetracycline, and bismuth is an effective new therapy for treatment of H. pylori infection.

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PubMed1994

All lactase preparations are not the same: results of a prospective, randomized, placebo-controlled trial.

OBJECTIVE: To compare the efficacy of three commercially available oral lactase preparations in adults with lactose intolerance. METHODS: Design--Prospective, randomized, placebo-controlled trial. Setting--Outpatient study in a General Clinical Research Center. Subjects--Ten lactose-intolerant healthy volunteers were challenged with ice cream containing 18 g of lactose. Lactase or placebo was given immediately prior to challenge. Measurements--Symptoms and breath hydrogen excretion were recorded for 3 h following lactose challenge. RESULTS: The three products differed in their abilities to influence symptoms and breath hydrogen excretion. Only Lactaid reduced the breath hydrogen excretion with lactose (mean peak, area under the curve and cumulative breath hydrogen excretion) (p < 0.05). Lactrase and Dairy Ease influenced symptoms: Lactrase reduced pain, bloating and total symptomatic scores (p < 0.05), whereas Dairy Ease only reduced pain (p < 0.05). Lactaid administration did not reduce symptoms. CONCLUSION: In lactose-intolerant subjects, the available lactase preparations differ in their ability to improve both breath hydrogen excretion and symptoms. Lactrase may be the product of choice for achieving symptomatic improvement.

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PubMed1993

Endoscopic stent placement for internal and external pancreatic fistulas.

Stents have been effectively used for various pancreatic conditions. Pancreatic fistulas, however, have traditionally been considered a surgical disease, and if the fistula does not respond to conservative measures, an operation is usually performed. Stents were placed endoscopically in five consecutive patients who presented with pancreatic fistulas that did not respond to conservative management. Fistulas resolved in all patients after endoscopic stent placement, and after 14-30 months of follow-up, none has recurred. The cases comprise two patients with pancreaticocutaneous fistula and one each with pancreaticopleural, pancreaticoperitoneal, and pancreaticocholedochal fistula. The need for an operation can be obviated in many patients with internal and external pancreatic fistulas.

Adult↗
PubMed1993

Short report: a non-metronidazole triple therapy for eradication of Helicobacter pylori infection--tetracycline, amoxicillin, bismuth.

Triple therapies using bismuth, metronidazole and tetracycline or amoxicillin were the first truly successful anti-H. pylori therapies. Metronidazole resistance has become an increasing problem that has severely limited the usefulness of the original triple therapy. Resistance to tetracycline or amoxicillin has not been reported and both are effective against H. pylori. We therefore tested a new triple therapy consisting of 500 mg tetracycline, 500 mg amoxicillin, and 2 tablets of bismuth subsalicylate each administered four times daily (with meals and at bedtime) for 14 days during treatment with ranitidine 300 mg daily. H. pylori eradication was defined as no evidence of H. pylori one or more months after stopping therapy. H. pylori status was evaluated by a combination of urea breath test and histology. Sixteen patients with H. pylori infection and active peptic ulcers were enrolled. The new triple therapy was successful in only 7 individuals (43%). Metronidazole appears to be critical for the effectiveness of the original triple therapy. An alternative to metronidazole will be required for a new successful triple therapy.

Adult↗
PubMed1993

Treatment of Helicobacter pylori reduces the rate of rebleeding in peptic ulcer disease.

BACKGROUND: We evaluated whether therapy designed to eradicate Helicobacter pylori infection resulted in a reduction in rebleeding in patients with peptic ulcer disease. Patients presenting because of major upper gastrointestinal hemorrhage from peptic ulcer and whose ulcers healed in a study in which they were randomized to receive ranitidine alone or triple therapy plus ranitidine were followed up regularly with endoscopy. No maintenance anti-ulcer therapy was given after ulcer healing. METHODS: Patients received ranitidine, 300 mg, or ranitidine plus triple therapy. Triple therapy consisted of tetracycline, 2 g; metronidazole, 750 mg; and bismuth subsalicylate, 5 or 8 tablets (151 mg bismuth per tablet), and was administered for the first 2 weeks of treatment; ranitidine therapy was continued until the ulcer had healed or 16 weeks had elapsed. After ulcer healing, no maintenance antiulcer therapy was given. Development of ulcer recurrence with or without recurrent upper gastrointestinal bleeding was evaluated. RESULTS: Thirty-one patients with major upper gastrointestinal bleeding from peptic ulcer were studied; 17 received triple therapy and 14 ranitidine alone. Major rebleeding occurred significantly (p = 0.031) more often in those in the ranitidine group (28.6%), compared with none (0%) in the triple therapy group. CONCLUSION: Eradication of H. pylori infection reduces the rate of ulcer recurrence and rebleeding in complicated ulcer disease.

Adult↗
PubMed1993

A study of the frequency of recovery of unexpected Giardia lamblia and Cryptosporidium from duodenal aspirates taken during routine upper endoscopy.

UNLABELLED: In this study, our objective was to determine whether the microscopic examination of duodenal aspirates recovered during routine upper endoscopy in unselected, immunocompetent patients, would disclose unsuspected Giardia lamblia or Cryptosporidium. DESIGN: Prospective, cross-sectional study to determine the prevalence of duodenal parasitosis. SETTING: Endoscopy unit in a university hospital. PATIENTS: One hundred and thirty-one unselected, immunocompetent patients undergoing upper endoscopy. MEASUREMENTS: Microscopic examination of duodenal aspirates, obtained during upper endoscopy. No pathogenic or commensal parasite was identified in any patient. CONCLUSIONS: No case of unsuspected parasitosis was found in the present study. On the basis of our findings, we do not recommend routine collection of duodenal aspirates during upper endoscopy.

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PubMed1992

Agrobacterium tumefaciens peritonitis mimicking tuberculosis.

Agrobacterium species have been previously implicated in the development of clinical disease. We report what we believe to be the first case of ascites caused by Agrobacterium tumefaciens in a cirrhotic patient. Since the correct diagnosis was made only after laparoscopy-guided collection of specimens from two different tissues, we suggest that Agrobacterium may be an underdiagnosed pathogen in clinical situations in which tuberculosis is considered to be the cause of high-protein ascites.

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PubMedDate not supplied

Endoscopic variceal ligation in patients who have failed endoscopic sclerotherapy.

Endoscopic variceal ligation has been developed as an alternative to endoscopic sclerotherapy. We report a series of 12 men with a history of bleeding esophageal varices who were treated with endoscopic variceal ligation after they had failed sclerotherapy. Hemostasis was achieved in all 10 patients who were bleeding at the time of initial endoscopy and again in those who subsequently re-bled. Over a follow-up period of up to 22 months, varices have been and remain eradicated in five patients; in four others, a reduction in grade was noted before death (two patients), liver transplant, or loss to follow-up (one patient each); two patients died before they could be re-evaluated, while in the remaining patient, no reduction in variceal grade was noted before loss to follow-up. No complication was recorded after 35 endoscopic treatment sessions involving a total of 245 rubber band ligations. Our results indicate that endoscopic variceal ligation may be used with success in patients who fail sclerotherapy.

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