PubMed · 8318084
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D Mezwa. 1993. Errors in proofreading galley proofs.. https://doi.org/10.1007/bf02053520
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Endoscopic ultrasound was introduced in the early 1980s. Today, endoscopic ultrasound remains the most accurate modality for local staging of gastrointestinal cancers but the emphasis is now on what findings will impact patient care. At the same time, a new era of interventional endoscopic ultrasound that might also be called image-directed therapies is emerging. The future looks bright for the further application of endoscopic ultrasound in gastrointestinal endoscopy. This article provides the current status and a glimpse into the future of endoscopic ultrasound.
Gastrointestinal system changes following spinal cord injury (SCI) are generally less obvious than other body system changes. These alterations in function and the response to management, however, may have profound implications on the social, emotional, and physical well-being of the individual with SCI. This article reviews changes in gastrointestinal function following SCI and discusses current issues related to the management of the neurogenic bowel.
Multiple organ failure is the consequence of many pathological processes, an acute reduction in oxygen supply being one of the most important. The splanchnic region is particularly susceptible to hypoxic injury, and the ischaemic gut mucosa may act as a neutrophil activating site. This is followed by leukocyte adhesion to endothelium and migration into the tissues where cytotoxic chemicals are released, producing tissue injury. This process is aggravated by multiple and sequential physiological insults, some of which may not be evident using basic clinical monitoring. The factors which precipitate cell injury and organ failures may be amenable to relatively simple preventative interventions, but once damage has occurred the process becomes increasingly complex and self-sustaining. Natural defence systems may become pathologically hyperactive, or suppressed, at different stages in critical illness, making it difficult to target therapies directed at the immunoinflammatory cascade with any degree of accuracy or safety, explaining in part the failure of immunotherapy for sepsis. There are significant genetic and constitutional components to susceptibility to critical illness, the most important of which affect cardiac reserve and the ability to maximise tissue oxygen supply. Whether the gut is the most important target organ for oxygen delivery in stress is still the subject of continued research.