Systemic amyloidosis secondary to tumoral calcinosis.
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Adult↗
Biomedical subjects
R Stalnikowicz
Publications and source records attributed to R Stalnikowicz.
Risk of gastric cancer after gastric surgery for benign disorders.
The objective of this review was to evaluate published evidence for the association between gastric resection for benign disorders and subsequent cancer of the gastric remnant. We searched the literature through Medline (1970 to 1988) and through the references of relevant articles. Fifty-eight studies consisting of case series, uncontrolled surveys, and case control or cohort analyses were identified and critically assessed using defined methodological criteria. There were no consistent differences between the expected and observed number of cancers occurring within 15 years after gastric resection. However, all case control studies and seven of the eight cohort analyses, in which the prevalence of cancer was stratified by time since gastric resection, indicated a twofold to fourfold increase in the risk of gastric cancer in patients who survived 15 or more years after gastric surgery. We conclude that most studies of the association of gastric surgery with subsequent gastric cancer have relatively weak designs. Still, the repetitive demonstration of this association by different investigators using different research designs supports the hypothesis that gastric resection increases the risk of cancer in the gastric remnant.
Case-Control Studies↗
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↗
Crohn's disease in the elderly.
We compared eleven patients in whom symptoms of Crohn's disease appeared at age greater than or equal to 65 with a younger group in whom symptoms had appeared earlier. Only 64% of the older patients were initially recognized as having Crohn's disease, as compared with 96% of the younger patients even though clinical characteristics and initial response to medical treatment were similar in both groups. A higher rate of complications occurred in the older group and follow-up data showed that they had higher mortality and a greater need for continuous treatment. We suggest that awareness of Crohn's disease in the elderly is less than in the young; the diagnosis is more often missed despite the similarity of the clinical features to those of younger patients.
Adult↗
Erythromycin-induced dynamic ileus?
A 39-year-old man and a 79-year-old woman developed dynamic ileus soon after erythromycin stearate was administered for a respiratory tract infection. Both had had prior uncomplicated abdominal operations: the man, vagotomy and pyloroplasty for bleeding duodenal ulcer, 3 years earlier; and the woman, an appendectomy some 44 years before. The temporal association with erythromycin therapy, resolution of signs and symptoms when the drug was stopped, an uneventful recovery, and the absence of other causes, suggest a possible role of erythromycin in the pathogenesis of dynamic ileus in these patients. Disturbed gastrointestinal motility patterns caused by erythromycin, in the presence of structural changes of the alimentary tract due to prior surgical procedures, may have contributed and we review these events.
Adult↗
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↗
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↗
(2'-5')Oligoadenylate synthetase activity in intestinal mononuclear and epithelial cells of inflammatory bowel disease patients.
The activity of (2'-5')oligoadenylate synthetase, an enzyme induced by and mediating the antiviral action of interferon, was measured in extracts of intestinal mononuclear and epithelial cells isolated from patients with Crohn's disease, ulcerative colitis, and a control group. No significant differences were detected among (2'-5')oligoadenylate synthetase activities of lamina propria mononuclear cells derived from inflammatory bowel disease-involved and histologically normal control mucosa. Similarly, epithelial cells from inflammatory bowel disease and control patients expressed comparable levels of the enzyme, but these were significantly higher (p less than 0.01) than those found in autologous mononuclear cells. These results indicate that interferon is locally produced along the human intestinal mucosa under normal and inflammatory conditions. While this study supports the contention that induction of an antiviral state does not play a significant role in the pathogenesis of inflammatory bowel disease, it does not exclude the activation of the interferon system for other immunologic functions.
2',5'-Oligoadenylate Synthetase↗
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↗
Should gastric carcinoid tumors associated with pernicious anemia be treated aggressively?
Two patients with pernicious anemia developed gastric carcinoid, one 20 years and the other 1 year after diagnosis of pernicious anemia. One of the patients underwent successful resection of the tumor, while the second, with diffuse gastric carcinoid, was managed conservatively. She is well and asymptomatic 32 months after the diagnosis. We discuss the dilemma in management of gastric carcinoid associated with pernicious anemia.
Aged↗
Drug-induced bleeding of gastric leiomyoma.
Gastrointestinal bleeding is a major sign by which smooth muscle tumors are brought to medical attention. Bleeding usually occurs from an ulceration on the mucosal surface of the tumor. Agents such as nonsteroidal antiinflammatory drugs and steroids may damage the gastric mucosa, thus becoming predisposed to bleeding. Three patients presenting with ulcerated or bleeding leiomyomas while on either nonsteroidal antiinflammatory drugs or steroid therapy are herein reported.
Adult↗
[Role of prostanoids in the pathogenesis and therapy of peptic ulcer].
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Anti-Ulcer Agents↗
Amitriptyline for intractable hiccups.
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Adolescent↗
Hyperkalemic left bundle branch block and hyporeninemic hypoaldosteronism (hyperkalemic left bundle branch block).
A 70-year-old woman was admitted to the intensive coronary care unit with suspected myocardial infarction. During the follow-up period, the patient twice developed left bundle branch block, which was shown to be related to high serum potassium levels secondary to hyporeninemic hypoaldosteronism and moderate renal failure.
Aged↗
Nonfunctioning islet cell tumor presenting as gastrointestinal bleeding.
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Adenoma, Islet Cell↗
(2'-5') oligo adenylate synthetase activity in leucocytes of patients with inflammatory bowel disease.
The activity of an interferon induced enzyme, (2',5') oligo adenylate synthetase, was determined in peripheral blood mononuclear cells and granulocytes of patients with inflammatory bowel disease and compared with its activity in cells isolated from normal subjects. In spite of the fact that circulating interferon is detected in patients with inflammatory bowel disease, we failed to see any increase in (2',5') oligo adenylate synthetase activity in these patients. The mean +/- SE enzyme activity given in nmol ATP incorporated into (2',5') isoadenylate oligomers by extracts of 10(5) peripheral blood mononuclear cells/21 hours was in normal subjects 1.84 +/- 0.30 (n = 27), in patients with active Crohn's disease 1.38 +/- 0.15 (n = 20) and in patients with active ulcerative colitis 1.14 +/- 0.23 (n = 21). (2',5') oligo adenylate synthetase activity in granulocytes was also similar in normal subjects and in patients with active ulcerative colitis or Crohn's disease. The enzyme activity in patients with active disease was similar both prior to and during steroid therapy. The low (2',5') oligo adenylate synthetase activity in peripheral blood mononuclear cells and granulocytes of patients with active inflammatory bowel disease may reflect decreased cellular response to interferon or a difference in the type of interferon elevated in viral diseases and in inflammatory bowel disease.
2',5'-Oligoadenylate Synthetase↗
Near drowning in the dead sea. Electrolyte imbalances and therapeutic implications.
Unusual serum electrolyte abnormalities developed in eight patients who nearly drowned (ND) in the Dead Sea. Elevations in serum calcium and magnesium levels in particular required specific therapeutic intervention. The Dead Sea has a uniquely high concentration of calcium, magnesium, sodium, potassium, and chloride. The unusual serum electrolyte elevation that was observed in the ND victims in the Dead Sea apparently reflected the large solute load to which they were exposed. Four patients died subsequent to ND. Near drowning in the Dead Sea therefore represents a clinical entity that is associated with a high fatality rate and in which unrecognized major electrolyte abnormalities, in addition to the known respiratory complications, may influence the outcome.
Aged↗