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Biomedical subjects

F Navab

Publications and source records attributed to F Navab.

At least 19 recordsLinked to original sources
PubMed1998

Hemobilia complicating hepatic cryosurgery.

We describe a 58-year-old man who developed hemobilia following hepatic cryotherapy. This was complicated by acute pancreatitis and recurrent cholangitis, which necessitated multiple endoscopic procedures (including biliary stenting) for successful management. As cryotherapy becomes more widely applied in the management of patients with liver tumors, it is essential that surgeons safeguard against the development of arteriobilious fistulae.

Acute Disease↗
PubMed1997

Significance of short-segment Barrett's esophagus.

Barrett's esophagus can progress to dysplasia and adenocarcinoma. Although the incidence of adenocarcinoma of the gastroesophageal junction has increased suddenly in the United States and Europe, we do not know how much of this increase is related to Barrett's esophagus. Interest in mucosal cell abnormalities at the gastroesophageal junction has led researchers to re-examine short-segment Barrett's esophagus. In this recently described condition, specialized columnar epithelium is found in the distal 2 to 3 cm of the esophagus, yet it is not clear how it relates to conventional long-segment Barrett's esophagus, in which the metaplastic epithelium extends higher than 2 to 3 cm above the squamocolumnar junction. The reported prevalence of short-segment Barrett's esophagus found on diagnostic endoscopy varies from 8% to 32%. This wide variation would be lessened by standardized location of biopsy specimens and of endoscopic and histologic staining techniques. Based on the information available, it is apparent that the age range and sex ratios are similar. Although reflux symptoms may be more common in short-segment Barrett's esophagus, disturbances in esophageal motility are less severe and there is less reflux as measured by continuous pH monitoring. Furthermore, recognized complications of Barrett's esophagus, such as ulceration, stricture, high-grade dysplasia, and adenocarcinoma, appear to be uncommon in short-segment Barrett's esophagus.

Barrett Esophagus↗
PubMed1996

Gastric perforation in a case of gastric volvulus.

We describe a case of organoaxial gastric volvulus in which the axis was through the body of the stomach. The intraabdominal part of the volvulus was complicated by bleeding from two necrotic ulcers, one of which was perforated by the tip of a nasogastric tube.

Aged↗
PubMed1995

Clinical utility of In-111 leukocyte imaging in Crohn's disease.

Thirty six patients with Crohn's disease were studied with In-111 leukocyte imaging. There was a correlation of the presence of activity on early (4 hour) imaging (r = 0.516, P < 0.001) and on delayed 18-24 hour) imaging (r = 0.457, P < 0.003). In the total group of 36 patients, the results of imaging were useful in the immediate management of 13 patients (36.1%). These included four patients (11.1%) who refused to undergo colonoscopic examination and nine patients (25%), six of whom had previous intestinal resection.

Adult↗
PubMed1995

Prevalence of Helicobacter pylori infection in patients with large gastric folds: evaluation and follow-up with endoscopic ultrasound before and after antimicrobial therapy.

OBJECTIVES: Large gastric folds may result from infectious, inflammatory, neoplastic, vascular, and infiltrative disorders involving a part or the entire gastric wall. Helicobacter pylori infection of the gastric mucosa is associated with an active gastritis characterized by infiltration of the mucosa and submucosa with neutrophils, eosinophils, macrophages, and lymphocytes. The purposes of the study were: 1) to study patients with large gastric folds noted on computed tomography, upper gastrointestinal series, or endoscopy, with endoscopy and biopsies and endoscopic ultrasound to determine the prevalence of H. pylori infection and the location of the thickening within the gastric wall; 2) to reexamine H. pylori-infected patients with EUS after antimicrobial therapy to determine whether resolution of the wall thickening accompanied eradication of H. pylori and improvement of histological gastritis. METHODS: Thirty-two patients with thickened gastric folds were studied. Eighteen patients had H. pylori infection and were treated with amoxicillin 1 g b.i.d. and omeprazole 40 mg b.i.d. x 14 days. One month after antimicrobial therapy, patients were reexamined by EUS, and gastric biopsies were obtained. RESULTS: Eighteen of 32 patients had H. pylori infection and gastritis. In the H. pylori-infected patients with gastritis, EUS demonstrated diffuse thickening of the inner three layers (mucosa-lumen interface, deep mucosa, submucosa) without thickening of the 4th and 5th layers of the gastric wall. After antimicrobial therapy and resolution of gastritis, EUS demonstrated concomitant resolution of this thickening and normalization of layers 1-3. CONCLUSIONS: H. pylori gastritis is a common cause of gastric wall thickening. EUS allows intrinsic localization of the gastric wall thickening in patients with large gastric folds and H. pylori infection and documents the resolution of this wall thickening upon eradication of H. pylori and resolution of gastritis.

Amoxicillin↗
PubMed1995

Stress ulcer: is routine prophylaxis necessary?

Recent observations have suggested that stress ulcer prophylaxis should not routinely be used to prevent upper gastrointestinal hemorrhage in critically ill patients. This is because our understanding of stress ulcer pathogenesis has shifted from a problem limited to back diffusion of acid to a phenomenon of gastric ischemia. The purpose of this article is to review the proposed mechanism of stress ulcer bleeding and to discuss prophylaxis.

Critical Illness↗
PubMed1994

Cytomegalovirus gastritis associated with pseudolymphoma.

A man who previously had several episodes of upper gastrointestinal hemorrhage from erosive gastritis developed recurrent hemorrhage. Endoscopy showed punctate hemorrhages in the fundus and body of the stomach, plus a discrete area of thickened folds in the anterior wall. Biopsies revealed a dense mucosal infiltrate that included cytomegaloviral inclusions. Bleeding continued despite treatment with blood transfusions and ranitidine. Because of continued hemorrhage, and to distinguish the cause of the thickened folds, surgical biopsy was performed that showed lymphoid germinal formations, characteristic of pseudolymphoma. He responded to i.v. ganciclovir and has had no further bleeding during 2 years of follow-up.

Aged↗
PubMed1993

Nosocomial pneumonia during stress ulcer prophylaxis with cimetidine and sucralfate.

BACKGROUND: Recent studies have questioned the use of histamine (H2) receptor antagonist in stress ulcer prophylaxis because of an increased incidence of nosocomial pneumonia and subsequent death. DESIGN: This prospective randomized study compared prophylaxis with cimetidine vs sucralfate. SETTING: Medical/surgical intensive care unit in Springfield, Mass. PATIENTS: One hundred fourteen patients were enrolled. INTERVENTIONS: Cimetidine, administered as a primed continuous infusion using a 300-mg bolus followed by 37.5 mg/h, was compared with sucralfate, administered via nasogastric tube, at a dosage of 1 g every 6 hours suspended in 20 mL of sterile water. MAIN OUTCOME MEASURES: End points of the study included nosocomial pneumonia, gastrointestinal hemorrhage, and death. RESULTS: Fifty-six patients were randomized to receive cimetidine and their rate of pneumonia was 12.5%; upper gastrointestinal hemorrhage, 3.6%; and mortality, 33.9%. Fifty-eight patients were given sucralfate, and their rate of pneumonia was 13.8%; upper gastrointestinal hemorrhage, 3.4%; and mortality, 37.9%. There were no significant differences between these study end points. In patients who had pneumonia, 80% of isolates were aerobic gram-negative bacilli. CONCLUSIONS: These observations suggest that the rate of nosocomial pneumonia is not increased in patients in the intensive care unit who receive prophylaxis with cimetidine to prevent stress ulcer bleeding.

Administration, Oral↗
PubMed1989

Multinodular adult hypertrophic pyloric stenosis.

A case of multinodular hypertrophic pyloric stenosis is described in a 57-year-old woman. Over a 3-month interval, there was progressive enlargement of several mucosal nodules overlying hypertrophied muscularis, and one nodule obstructed the pyloric opening. Diagnosis was made at operation and symptoms resolved after Billroth I gastrectomy.

Female↗
PubMed1989

Angiodysplasia in patients with renal insufficiency.

Sixty-five patients with angiodysplasia were studied: 42 (64.6%) had normal renal function and 23 (35.4%) had renal insufficiency, defined as serum creatinine consistently greater than 1.5 mg/dl. Comparison of results in the two groups showed that there were no significant differences in the mode of presentation or anatomic distribution of angiodysplasia. Systemic hypertension, congestive cardiac failure, coronary artery disease, and diabetes mellitus were significantly more common in patients with renal failure. Recurrent bleeding from upper alimentary angiodysplasias occurred significantly more often in patients with renal failure than in those with normal renal function. However, a second source, as a cause of bleeding, was found significantly more often in patients with normal renal function.

Aged↗
PubMed1988

Penetrating duodenal ulcer from hepatic artery chemotherapy infusion catheter. Successful conservative medical management.

A 45-year-old woman receiving continuous infusions of 5-fluoro-2'-deoxy-uridine into the hepatic artery through a surgically implanted intraarterial catheter for hepatic metastases from adenocarcinoma of the colon, developed acute epigastric pain and anemia. Endoscopy demonstrated a duodenal ulcer with a portion of the catheter visible in the crater. Conservative management with sucralfate and ranitidine allowed endoscopically proven healing of the penetrating ulcer with subsequent successful reuse of the catheter.

Adenocarcinoma↗
PubMed1988

Effect of aging on intestinal absorption of aromatic amino acids in vitro in the rat.

Whole-thickness everted jejunal rings were used to measure uptake of L-tyrosine (L-Tyr), L-phenylalanine (L-Phe), and L-tryptophan (L-Trp) in 6-, 12-, and 24-mo-old rats. The rate of uptake of all three amino acids (1 mM) was significantly reduced after 20 min of incubation in 24-mo-old compared with 6-mo-old rats. Results of influx (2 min) of 0.5-40.0 mM L-Phe and L-Trp suggested an increased affinity but decreased capacity for the transporter with age; these differences were significant for L-Trp (P less than 0.05). Respective values for apparent Kt and Vmax were the following: L-Phe 6-mo-old rats, 5.46 mM and 1.03 mumol.g-1.2 min-1; 24-mo-old rats, 2.54 mM and 0.51 mumol.g-1.2 min-1; L-Trp 6-mo-old rats, 5.09 mM and 0.38 mumol.g-1.2 min-1; 24-mo-old rats, 3.20 mM and 0.25 mumol.g-1.2 min-1. Values for 12-mo-old rats fell in between the other two age groups.

Aging↗
PubMed1987

Early and delayed indium 111 leukocyte imaging in Crohn's disease.

Twenty-seven patients with Crohn's disease were studied for the presence and location of activity by both early (4 h) and delayed (18-24 h) indium 111 leukocyte imaging. The results were compared with other parameters of disease activity including Crohn's disease activity index, barium studies, and endoscopy. There was a correlation between early images and Crohn's disease activity index (r = 0.78) and between delayed images and index (r = 0.82). Based upon the corresponding Crohn's disease activity index, the sensitivity of early and delayed imaging was 81.0% and 95.2%, respectively. Specificity of early and delayed imaging was 75.0% and 87.0%, respectively. Presence of activity on the early and delayed imaging agreed with activity on barium studies and colonoscopy in approximately 80% of cases. Correlation of location of disease by leukocyte imaging and x-ray was observed in 58.9% of early scans and 55.0% of delayed scans. Correlation of the location of disease by imaging and endoscopy was observed in 71.4% of early and 75.0% of delayed studies. Because of the possibility of occurrence of false-negative results in early images, delayed imaging should always be included in evaluation of disease activity in patients with Crohn's disease who are suspected of having mild activity. Delayed imaging is not required if the early imaging study clearly shows activity.

Adult↗
PubMed1986

Maintenance therapy of duodenal ulcer with famotidine. A multicenter United States study.

The decision to treat a patient with duodenal ulcer should be based upon the following: severity of disease; effectiveness of treatment; and risk and cost of treatment. A number of drugs are effective for this condition. When administration of the drug is discontinued, a recurrence of the ulcer occurs most often within three months, with the rate approaching 90 percent at one year. Maintenance therapy has evolved as a method of preventing recurrence. A double-blind, randomized, multicenter study was done to compare 40 mg of famotidine at bedtime, 20 mg of famotidine at bedtime, and placebo in the maintenance treatment of patients with recently healed duodenal ulcer. In 37 centers in the United States, 303 patients received randomly allocated treatment with 40 mg of famotidine at bedtime (107 patients), 20 mg of famotidine at bedtime (97 patients), or placebo (99 patients). The treatment groups were comparable as to the risk factors and other characteristics. Esophagogastroduodenoscopies were scheduled at three, six, and 12 months of treatment. Additional endoscopies could be done at any time if symptoms suggested a relapse. Cumulative relapse rates were significantly lower in the famotidine groups than in the placebo group at all time points (p less than 0.01). The cumulative life-table relapse rates at three, six, and 12 months were 9.2, 20.9, and 24.8 percent for the 40-mg famotidine group; 13.5, 16.1, and 23.3 percent for the 20-mg famotidine group; and 39.3, 51.5, and 56.8 percent for the placebo group. No significant difference between the two famotidine groups was observed. Within each period, the relapse rate was lower with famotidine than with placebo. Famotidine is more effective than placebo as maintenance therapy. It is generally well tolerated for periods of up to one year. A dose of 20 mg at bedtime is proposed as the maintenance dose. Fewer relapses occurred in non-smokers, in females, and in patients in whom healing occurred with placebo. More relapses occurred in patients under 40 years of age, patients with a long ulcer history, or patients who were younger than 40 years of age at onset of ulcer disease.

Adult↗
PubMed1986

Precise intraoperative location of gastrointestinal bleeding with a hand-held counter. Work in progress.

The nuclear medicine bleeding scan is frequently insufficient to locate sites of bleeding precisely, in spite of its great sensitivity. A small, hand-held Geiger-Müller counter, placed directly on exposed intestine in the operating room, enables precise location of the probable bleeding site. In three patients, the technique allowed a minimal amount of intestine to be resected, distinguished between large- and small-intestinal hemorrhage, and eliminated other foci as sites of bleeding.

Gastrointestinal Hemorrhage↗