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K Saeian

Publications and source records attributed to K Saeian.

At least 19 recordsLinked to original sources
PubMed2005

Feasibility and safety of endoscopic evaluation of gastric emptying.

BACKGROUND AND STUDY AIMS: Scintigraphy is the currently accepted method for evaluation of gastric emptying. Although quantitative, this method is complicated, time-consuming, and costly. If a simple endoscopic technique was available for those instances when quantification of an emptying abnormality is not needed, the same clinical information could be obtained in less time and with resource savings. Our aims in this study were therefore to assess the technical feasibility, tolerability, and safety of unsedated transnasal esophagogastroscopy (T-EG) as a technique for qualitative assessment of gastric emptying. METHODS: The study was done in two phases. In the first phase, 18 volunteers (ten men, eight women) underwent T-EG at 4 hours, 5 hours, or 6 hours after ingestion of a standard meal used for scintigraphic evaluation of gastric emptying without radiolabeling. In the second phase, ten volunteers underwent T-EG after scintigraphic imaging had demonstrated complete gastric emptying. RESULTS: Subjects in both phases tolerated the procedure well and completed the study. In the first phase, 13 of 15 volunteers exhibited complete gastric emptying at 6 hours (87%), while two (13%) revealed some particulate matter in the stomach at that time. In the second phase, one of the ten volunteers exhibited a small amount of solid food residue in the stomach despite documentation of scintigraphic complete emptying. CONCLUSIONS: Evaluation of gastric emptying by unsedated T-EG is both feasible and safe. In healthy, asymptomatic individuals, complete gastric emptying of solid food may take as long as 6 hours.

Adult↗
PubMed2004

High-dose vitamin E supplementation does not diminish ribavirin-associated haemolysis in hepatitis C treatment with combination standard alpha-interferon and ribavirin.

BACKGROUND: Ribavirin is associated with haemolytic anaemia. Antioxidants have been reported to decrease severity of this anaemia. AIM: To determine effect of vitamin E supplementation on ribavirin-associated haemolysis in chronic hepatitis C treated with standard alpha-interferon and ribavirin. METHODS: Fifty-one naive chronic hepatitis C patients were randomized to receive either alpha-interferon/ribavirin therapy (control) or therapy plus vitamin E 800 IU b.d. with 24-week follow-up. Alanine aminotransferase ALT, haemoglobin and reticulocyte percentage were monitored. Symptoms and health-related quality of life were also monitored at each visit. RESULTS: Forty-seven subjects were treated (27 vitamin E /20 controls). Thirteen withdrew because of adverse effects or non-compliance. Groups were similar in demographics, genotype and baseline lab indices. Comparison with baseline, treatment and follow-up values showed a significant haemoglobin and ALT reduction in both groups. There was no significant difference in haemoglobin and reticulocyte percentage between groups. Sustained viral response was not significantly different between vitamin E (11/18) and control (6/16) groups. Three patients required ribavirin dose-reduction in the vitamin E group compared with two controls. Health-related quality of life during and end-of-treatment was not different between groups. CONCLUSIONS: Vitamin E supplementation alone during standard alpha-interferon and ribavirin therapy does not appear to diminish ribavirin-associated haemolysis.

Adult↗
PubMed2001

Unsedated transnasal laryngo-esophagogastroduodenoscopy: an alternative to conventional endoscopy.

The introduction, refinement, and subsequent widespread use of flexible fiberoptic endoscopes have revolutionized the diagnosis and management of upper gastrointestinal (GI) disorders. There has been a simultaneous increase in the cost of managing upper GI disorders, which is in part attributed to the high price of endoscopy. Unfortunately, in the current cost-conscious health-care environment, the high cost of endoscopy has resulted in the underuse of this valuable clinical tool. Unsedated transnasal laryngo-esophagogastroduodenoscopy (T-EGD) is a new technique for upper endoscopy that uses an ultrathin endoscope and has a comparable yield to conventional upper endoscopy but obviates the need for conscious sedation because it is better tolerated. Studies have found that T-EGD is a feasible alternative to conventional endoscopy in terms of safety, efficacy, and cost containment. This article reviews these factors, the technique of T-EGD, patient and endoscopist considerations, tissue sampling, and the characteristics of ultrathin endoscopes used for T-EGD.

Procedural Sedation↗
PubMed2001

Hepatitis C, cryoglobulinemia, and cutaneous vasculitis associated with unusual and serious manifestations.

Hepatitis C viral infection is currently the leading cause of chronic hepatitis and cirrhosis. It also is a major predisposing factor for the development of hepatocellular carcinoma. It is estimated that approximately 1-2% of patients with hepatitis C infection have nonhepatic manifestations that are protean in nature. In this report, we describe six unusual cases of nonhepatic manifestations: abdominal vasculitis in two, peripheral neuropathy in two, and one patient each with central nervous system vasculitis and necrotizing cutaneous vasculitis. All patients had cutaneous vasculitis and cryoglobulinemia. None of our patients had cirrhosis, yet three of the six patients died. Because of the severe manifestations, aggressive therapy was instituted with interferon, immunosuppressive medications, i.v. immunoglobulin, and plasmapheresis. Our report underscores the importance of recognizing nonhepatic manifestations in patients with hepatitis C infection that may be associated with high morbidity and mortality.

Adult↗
PubMed2000

Sigmoid stiffener for decompression tube placement in colonic pseudo-obstruction.

BACKGROUND AND STUDY AIMS: Decompression tube placement improves outcome in colonic pseudo-obstruction (CP) which is refractory to conservative measures, especially if the decompression tube is placed proximal to the hepatic flexure. We evaluate the ability of a sigmoid stiffener to facilitate more proximal colonoscopy and decompression tube placement. PATIENTS AND METHODS: A sigmoid stiffener is used in the standard fashion during colonoscopic decompression for pseudo-obstruction. After cecal wire placement, the colonoscope is withdrawn, leaving the stiffener and wire in place. By passing through the stiffener, an over-wire decompression tube can avoid sigmoid looping. We compared proximal extent of colonoscopy, tube position, endoscopy time, and patient outcomes using a sigmoid stiffener, with a control group of patients treated previously. Patients with colonic ischemia were excluded. RESULTS: Using this technique, nine consecutive colonoscopies and decompression tube placements reached the right colon. Significantly, only three of seven control colonoscopies and two control decompression tubes did so. However, improvements in procedural time and patient outcome did not reach statistical significance. No complications occurred. CONCLUSION: The use of a sigmoid stiffener during colonic decompression allows more proximal colonoscopy and decompression tube placement, with possible clinical benefit. We do not use this technique in the setting of left colon ischemia.

Adult↗
PubMed2000

Does open access endoscopy close the door to an adequately informed patient?

BACKGROUND: The use of open access endoscopy is increasing. Its effect on the adequacy of patient informed consent, procedure acceptance and the impact on subsequent communication/transfer of procedure results to the patient have not been evaluated. The aim of our study was to compare the extent of preknowledge of procedures and test explanation, patient medical complexity, information transfer and overall patient satisfaction between a patient group referred for outpatient open access endoscopy versus a patient group from a gastrointestinal (GI) subspecialty clinic. METHODS: Information was obtained from all patients presenting for outpatient upper and lower endoscopy by using a 1-page questionnaire. Patients from the two groups who had an outpatient upper/lower endoscopic procedure were contacted by phone after the procedure to obtain information with a standardized questionnaire. RESULTS: The open access patients reported receiving significantly less information to help them identify the procedure (p < 0.01) and less explanation concerning the nature of the procedure than the group of patients referred from the subspecialty clinic (p < 0.005). There was no difference between the two groups in satisfaction scores for examinations performed under conscious sedation. For flexible sigmoidoscopy without sedation, however, the GI clinic patient group were more satisfied with their procedure. The majority of patients, regardless of access, were more likely to receive endoscopic results from a gastroenterologist than the referring physician. Furthermore, the patients in the GI clinic group who underwent colonoscopy felt significantly better at follow-up. CONCLUSIONS: Patients undergoing open access procedures are less likely to be properly informed about their endoscopic procedure. Our results indicate that with open access endoscopy, a defined mechanism needs to be in place for communication of endoscopic results to the patient.

Adult↗
PubMed1999

Hepatocellular carcinoma after renal transplantation in the absence of cirrhosis or viral hepatitis: a case series.

The occurrence of hepatocellular carcinoma (HCC) in renal transplant recipients has typically been associated with hepatitis B or C infection. We encountered two cases of HCC in renal transplant recipients with negative hepatitis B and C markers and no underlying liver pathology, in whom immunosuppression therapy consisted of prednisone and azathioprine (AZA). Patient no. 1 is a 66-year-old man with diabetes who underwent cadaveric renal transplantation 13 years before presentation. An ultrasound obtained for evaluation of a prolonged prothrombin time and decreased serum albumin level showed a suspicious nodular lesion in the left lobe of the liver. A computed tomographic (CT) scan confirmed a 4- x 5- x 5-cm mass that, on biopsy, was determined to be well-differentiated HCC. There was no evidence of metastasis, and the results of random biopsies of the surrounding parenchyma were normal. The patient underwent a left lateral segmentectomy, did well, and an initial alpha-fetoprotein (AFP) level of 85995 ng/mL decreased to 9 ng/mL. Approximately 20 months postoperatively, however, a surveillance CT scan showed three hypervascular lesions in the right lobe of the liver and the AFP level increased to 28,370 ng/mL. Subsequent percutaneous alcohol injections yielded good results, and the patient is alive and well 13 months later. Patient no. 2 is a 57-year-old man who underwent cadaveric renal transplantation 24 years earlier. A CT scan of the abdomen obtained for evaluation of lower abdominal pain showed a 4- x 4- x 6.5-cm mass in the right lobe of the liver that, on biopsy, was found to be poorly differentiated HCC. Multiple biopsies of adjacent liver parenchyma showed no evidence of cirrhosis, AFP level was normal, and imaging studies showed no evidence of tumor spread. The patient underwent a right hepatic lobectomy and is doing well without evidence of recurrence 27 months postoperatively. Our two patients had no evidence of viral hepatitis, cirrhosis, or metabolic liver disease, yet both developed HCC. The use of AZA may have had a role in the development of HCC. In renal transplant recipients on long-term immunosuppression therapy, particularly AZA, it is prudent to maintain a high index of suspicion for HCC when liver enzyme level or function abnormalities are encountered.

Aged↗
PubMed1999

Biliary tract inflammatory disorders: primary sclerosing cholangitis and primary biliary cirrhosis.

Primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC) are chronic progressive cholestatic diseases that frequently lead to biliary cirrhosis. The exact pathogenesis of these diseases remains elusive but is likely immunologically based. Complications range from fatigue and pruritus to end-stage liver disease. The risk of developing hepatocellular carcinoma is low for patients with PBC, whereas cholangiocarcinoma is common in PSC and carries an ominous prognosis. Although ursodeoxycholic acid is effective in slowing the progression of PBC, no effective medical therapy exists for PSC. Liver transplantation is the only option for patients with end-stage liver disease and yields excellent long-term survival in both groups.

Bile Duct Neoplasms↗
PubMed1999

Unsedated transnasal EGD: an alternative approach to conventional esophagogastroduodenoscopy for documenting Helicobacter pylori eradication.

BACKGROUND: The aim of this study was to assess the yield of antral biopsies performed via unsedated transnasal esophagogastroduodenoscopy, a technique that does not require conscious sedation with its concomitant costs and complications, for documentation of Helicobacter pylori eradication. METHODS: Nineteen patients who were previously CLO test positive on conventional esophagogastroduodenoscopy and subsequently treated for H pylori infection were enrolled. The subjects had not received antibiotic therapy in the prior month and had no prior gastric surgery. By using a GIF-N30 fiberoptic endoscope and a tiny cup biopsy forceps (1.8 mm diameter), unsedated transnasal endoscopy was performed and antral biopsy specimens were taken for a CLO test, histologic analysis (Dieterle stain), and tissue culture. On the same day, the subjects underwent a carbon 13-labeled area urea breath test. All subjects completed a visual analog scale, rating the acceptability of the unsedated transnasal examination and the previous sedated conventional esophagogastroduodenoscopy. RESULTS: There was no statistically significant difference between the results of the CLO tests (5/19 positive) versus the 13C-urea breath test (4/19 positive) (p = 0.96), the CLO tests versus histologic findings (5/19 positive) (p = 0.71), or the 13C-urea breath test versus histologic findings (p = 0.96). All tissue culture results were negative. The overall acceptability of unsedated transnasal esophagogastroduodenoscopy was similar to that of sedated conventional esophagogastroduodenoscopy. CONCLUSION: Unsedated transnasal esophagogastroduodenoscopy, a technique that eliminates the costs and complications associated with conscious sedation, is a feasible and accurate alternative to conventional esophagogastroduodenoscopy when documentation of H pylori eradication and confirmation of gastric ulcer healing are both indicated.

Adult↗
PubMed1999

Diagnostic laparoscopy: an update.

With new technical advances, wider availability, and the recent proliferation of less invasive surgery, the use of diagnostic laparoscopy has expanded far beyond its traditional role in the evaluation of chronic liver disease. Short of open laparotomy, diagnostic laparoscopy is the most accurate modality for staging of intra-abdominal malignancies, and is particularly well-suited for patients who otherwise would not require surgical palliation. In addition to avoiding unnecessary laparotomy in this group, diagnostic laparoscopy has proved valuable in the assessment of abdominal trauma, acute abdomen, and ischemic bowel disease. We briefly review here some of the new developments in the field of diagnostic laparoscopy.

Abdomen, Acute↗
PubMed1999

Effect of pharyngeal stimulation on the motor function of the esophagus and its sphincters.

OBJECTIVE/HYPOTHESIS: Sensory impulses from the pharynx induce contraction of the upper esophageal sphincter (UES), relaxation of the lower esophageal sphincter (LES), and inhibition of peristalsis. To determine 1) the magnitude of UES contractile response to threshold volume of fluid that induces LES relaxation and 2) the effect of rapid pharyngeal air stimulation on LES resting pressure and its concurrent influence on the UES and progression of esophageal peristalsis. METHODS: Eleven healthy volunteers (age, 31 +/- 2 y) were studied by concurrent UES, esophagealbody, and LES manometry. RESULTS: At a threshold volume of 0.3 +/- 0.05 mL, injections of water into the pharynx directed posteriorly, resulted in complete LES relaxation. Duration of these relaxations averaged 19 +/- 1 seconds. In 10 of 11 subjects, these relaxations were accompanied by a simultaneous increase in UES resting tone that averaged 142% +/- 27% above preinjection values. Pharyngeal stimulation by rapid air injection resulted in complete LES relaxation in 8 of the 11 subjects (threshold volume, 14 +/- 6 mL). Five of 8 developed a concurrent mild increase in resting UES pressure (17% +/- 6% above preinjection values) (P < .05). Pharyngeal water injection inhibited the progression of the peristaltic pressure wave at all tested sites and in all subjects, but pharyngeal air injection in only 2 of the 11 studied subjects. CONCLUSIONS: The inhibitory effect of pharyngeal water injection on LES resting pressure is accompanied by a substantial contractile effect on the UES. Although stimulation of the pharynx by rapid air injection may induce LES relaxation, its inhibitory effect on esophageal peristalsis and stimulatory effect on UES pressure are negligible compared with that of water injection.

Adult↗
PubMed1995

Inhibition of resting lower esophageal sphincter pressure by pharyngeal water stimulation in humans.

BACKGROUND/AIMS: Normal inhibition of lower esophageal sphincter (LES) tone occurs during swallowing and belching. However, it is known that it may occur independently of these functions. The aim of this study was to characterize the effect of pharyngeal water stimulation on resting LES pressure. METHODS: The effect of rapid-pulse and slow continuous intrapharyngeal injection of minute increments of water on the resting tone of the upper and LES of 14 healthy young volunteers was evaluated by concurrent manometry, submental electromyography, and respirography. RESULTS: At a threshold volume, pharyngeal water injection induced an isolated LES relaxation in all volunteers. The threshold volume inducing LES relaxation by rapid-pulse injection, 0.16 +/- 0.01 mL, was significantly lower than that with slow continuous injection (0.5 +/- 0.05 mL) (P < 0.05). The duration and magnitude of LES relaxation were not volume dependent. The duration of LES relaxation induced by rapid-pulse injection was significantly longer than that of swallows. CONCLUSIONS: Minute amounts of liquid injected into the pharynx induce LES relaxation different from that of the normal swallow. Neither the duration nor the magnitude of this relaxation is volume dependent. Whereas the contribution of this finding to the mechanism of transient LES relaxation remains to be ascertained, it may partially explain the variability of the basal LES pressure.

Adult↗
PubMed1994

Ultrasonic tissue characterization for diagnosis of acute myocardial infarction in the coronary care unit.

The purpose of this study was to determine the use of ultrasonic tissue characterization (UTC) for the diagnosis of acute myocardial infarction (AMI). Real-time UTC and conventional 2-dimensional echocardiography were performed with a research prototype and commercially available ultrasonoscope, respectively, in 60 consecutive patients with suspected AMI. Diagnosis of AMI was documented by the presence of 2 of the 3 following clinical criteria: (1) typical history, (2) characteristic electrocardiographic changes, and (3) an increase in creatine phosphokinase-MB. Myocardial infarction was present in 24 of 60 patients and absent in 36 of 60 patients. Tissue characterization correctly diagnosed the presence of myocardial infarction in 22 of 24 patients and the absence in 33 of 36 patients. Two-dimensional echocardiography detected the presence of myocardial infarction in 21 of 24 patients and the absence in 34 of 36 patients. UTC had 2 false-negative and 3 false-positive studies, all in the region of apical infarcts. Two-dimensional echocardiography had 3 false-negative studies in patients with non-Q-wave myocardial infarction and 2 false-positive studies in patients with complete left bundle branch block. Both techniques had a comparable sensitivity, specificity, and accuracy.

Coronary Care Units↗