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Biomedical subjects

N Tabibian

Publications and source records attributed to N Tabibian.

At least 19 recordsLinked to original sources
PubMed1991

Endoscopy versus x-ray studies of the gastrointestinal tract: future health care implications.

I did esophagogastroduodenoscopy in 147 patients and colonoscopy in 59 patients who had had gastrointestinal x-ray studies. The endoscopic procedure was done within 7 days after the x-ray study and/or while the patient was still symptomatic. The barium swallow findings were confirmed in only 40%; in the other 60%, the x-ray findings could not be confirmed. These unconfirmed x-ray findings were false-positive in 37.4%, false-negative in 16.3%, and suboptimal or nondiagnostic in 6.2%. The barium enema findings were confirmed in 32%. In the other 68%, the x-ray findings were false-positive in 42.3%, false-negative in 22%, and suboptimal in 3.3%. We conclude that in clinical or private practice, relying on x-ray studies alone may be associated with a high margin of diagnostic errors. When all factors are considered, the initial cost advantage of the x-ray studies appears to be lost. In future recommendations on the continuing dilemma of x-ray studies versus endoscopy, consideration should be given to factors other than the initial lower price of the x-ray studies.

Barium Sulfate↗
PubMed1989

Streptococcus bovis septicemia and large bowel neoplasia.

Streptococcus bovis septicemia is a relatively uncommon entity that is associated with an increased incidence of colonic neoplasms. Three of four patients with S. bovis endocarditis subsequent to septicemia underwent colonoscopy. The fourth patient underwent a barium enema and a proctoscopic examination. Polyps were found in three patients, and adenocarcinoma of the colon in one. Patients with S. bovis endocarditis should be considered at high risk for colonic neoplasms. Screening colonoscopy is recommended for these patients, and follow-up colonoscopy may be warranted.

Adenocarcinoma↗
PubMed1989

Diarrhea in critically ill patients.

The onset of diarrhea complicates the care of critically ill patients, who often have complex cardiopulmonary, renal or metabolic problems. Diarrhea further upsets fluid and electrolyte balance and creates difficulties in nutritional support. Common causes of acute diarrhea in critically ill patients include medications, enteral feedings, ischemic bowel disease, pseudomembranous colitis, short bowel syndrome, intestinal fistulas, pancreatic insufficiency and opportunistic infections in patients with AIDS.

Critical Care↗
PubMed1989

Acute gastrointestinal bleeding in anticoagulated patients: a prospective evaluation.

Acute gastrointestinal hemorrhage is one of the most feared complications of anticoagulation therapy. We prospectively evaluated 18 episodes of acute gastrointestinal bleeding in 17 patients anticoagulated with coumadin or heparin. Endoscopic examination revealed significant lesions irrespective of age, duration of anticoagulation, level of anticoagulation or symptoms. The high frequency of objective findings (e.g., 44% ulcers) suggests that diagnostic endoscopy should be performed in patients with acute gastrointestinal bleeding associated with anticoagulant therapy.

Acute Disease↗
PubMed1988

Hepatocellular carcinoma in the United States.

In the United States, the majority of patients with hepatocellular carcinoma have underlying cirrhosis; overall, their prognosis is very poor. Although the surgical morbidity and mortality rates are high and the chance for cure is low, resection may be curative in a few carefully selected patients. Invasive diagnostic interventions should be avoided in those who are not likely to survive the surgery or in whom the disease is too advanced.

Adult↗
PubMed1988

Cost-effective methods of treating ascites.

In patients with a 24-hour urinary sodium excretion of less than 80 mEq (80 mmol), prompt diuretic therapy is recommended. Not all patients will require therapeutic paracentesis, but in those who are symptomatic, removal of 4 to 6 L of ascitic fluid should not be unnecessarily delayed. Urinary sodium monitoring is a simple, accurate and effective method of directing therapy, particularly when patients do not readily respond to diuretics or when they have recurrent ascites as outpatients.

Ascites↗
PubMed1988

Sclerotherapy for esophageal varices.

Sclerotherapy is an effective early treatment for bleeding esophageal varices. The procedure can be performed without general anesthesia and can be used to stabilize the situation until a decision is reached regarding long-term therapy. Sclerotherapy has a failure rate of up to 30 percent. Portacaval shunt is recommended if either acute or long-term sclerotherapy fails. Prophylactic sclerotherapy is not recommended.

Esophageal and Gastric Varices↗
PubMed1987

Source of upper gastrointestinal bleeding in patients with esophageal varices seen at endoscopy.

Many claim that upper gastrointestinal hemorrhage in patients with varices is frequently not of variceal origin. Such teaching is contrary to our experience. We therefore reviewed the records of 127 consecutive patients with 165 episodes of acute upper gastrointestinal bleeding who were found to have esophageal varices by endoscopy. Varices were the only potential site of the index bleed in 101 of the 127 patients (79.5%). In addition to varices, other potential sites of bleeding were gastric ulcer in 9 (7%), Mallory-Weiss tear in 4 (3.1%), duodenal ulcer in 3 (2.3%), and multiple gastroduodenal erosions in 10 (7.8%). We used the characteristics of the clinical presentation (e.g., varix seen bleeding) and the known natural course of the variceal bleeding to attempt to define the site of bleeding in the group with more than one potential site. In 15 we could make a judgment as to the likely source: In 9 it was variceal and in 6 nonvariceal. When varices are seen at endoscopy in a patient with a major hemorrhage, they are responsible for the bleeding in greater than 80% of cases.

Esophageal and Gastric Varices↗
PubMed1987

Clinical impact of stool cultures for Campylobacter in adults with acute or chronic diarrhea.

Campylobacter jejuni has emerged as a frequent cause of diarrhea. During a 12-month period at the Houston Veterans Administration Medical Center, we isolated C jejuni from 3.4% of the 290 stool cultures from patients with diarrhea. This compared to an isolation rate of 4.1% for Salmonella and 3.1% for Shigella. During the same period, 17 additional cases of Campylobacter-associated diarrhea were identified in adults at the two other Baylor College of Medicine teaching hospitals. We correlated the clinical history, treatment, and outcome of these 27 cases of Campylobacter-associated diarrhea (22 cases of acute diarrhea and five of chronic diarrhea). In most patients with acute disease, the diarrhea was resolving by the time the results of the cultures were available. The duration of illness was the same whether treated with antibiotics to which Campylobacter was susceptible (effective therapy) or antibiotics to which it was not susceptible (ineffective therapy); the mean duration of diarrhea after submitting the culture was 5.2 days for those with ineffective therapy versus 5.6 days for those receiving effective therapy. Thus, antibiotic therapy did not appear to shorten the duration of acute diarrhea due to Campylobacter. Five patients had chronic diarrhea; all had an unrelated underlying disease, and antibiotic treatment did not change the clinical course despite bacteriologic cure. This study raises questions as to the value of antibiotic therapy for campylobacteriosis, and in this light, we discuss the value of routine culturing for Campylobacter.

Acute Disease↗
PubMed1987

Captopril-induced liver dysfunction.

We have described a patient with captopril-induced cholestatic jaundice. Captopril was confirmed as the causative agent, because jaundice occurred after administration of captopril and resolved quickly after administration was stopped.

Captopril↗