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We describe the occurrence of a renoduodenal fistula related to a nephrostomy tube in a patient with xanthogranulomatous pyelonephritis and renal calculi. The patient was successfully treated by nephrectomy. Etiological, diagnostic and therapeutic aspects are discussed.
BACKGROUND: A novel 1-h topical method eradicated Helicobacter pylori in 96% of dyspeptic patients. The eradication rate of amoxycillin/omeprazole therapy varies from 0 to 93%. AIM: To compare both methods in patients with endoscopically proven duodenal ulcer. METHODS: Eighty patients (59 males, 21 females; median age 43 years) were randomized into two therapeutic groups. The first group (group A) was treated with a 6-week course of ranitidine 300 mg/day, then omeprazole 20 mg b.d. with pronase 36000 units/day for 2 days, followed by 1-h topical therapy with a solution of bismuth, metronidazole, amoxycillin and pronase. The second group (group B) consisted of patients treated with omeprazole 20 mg b.d. and amoxycillin 2 g/day for 2 weeks, followed by a 4-week course of ranitidine 300 mg/day. Eradication of H. pylori was assessed by urease test, histology, a polymerase chain reaction and a 13C-urea breath test, all of which were performed 4 weeks after discontinuation of the antibacterial treatment. RESULTS: Eradication rates in groups A and B were 2.5% and 35% in an intention-to-treat analysis, respectively. Side-effects were encountered in 40.5% and 12.5% of subjects in groups A and B, respectively. Treatment tolerance was rated as poor by 54% of patients in group A and 2.5% of patients in group B. CONCLUSIONS: Both treatment regimens, the 1-h topical method and amoxycillin with omeprazole, have low eradication rates in patients with duodenal ulcer. In addition, the topical treatment is characterized by a high rate of side-effects and poor tolerance. Based on the results of our study, neither method can be recommended for eradication of H. pylori in patients with duodenal ulcer.
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Recurrent superior mesenteric artery syndrome is an infrequent complication following reconstructive spinal surgery. However, if diagnosis and treatment are delayed, life-threatening dehydration and electrolyte abnormalities may occur. Recent advances in oral and parenteral alimentation have simplified the treatment of superior mesenteric artery syndrome following the early recognition of the characteristic clinical and radiographic presentation. This case report describes the early diagnosis and various methods of conservative treatment of recurrent superior mesenteric artery syndrome following staged reconstructive spinal surgery.
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Hourly gastric aspiration has commonly been used to assess the efficacy of antisecretory compounds. We have compared continuous ambulatory 24-hour pH monitoring using a radiotelemetry capsule with standard nasogastric aspiration. Eight studies were performed on four male duodenal ulcer patients in remission receiving either placebo or an antisecretory agent. A significant correlation was found between capsule and aspirate pH measurements (r = 0.88, p less than 0.01). Radiotelemetry capsule measurements clearly showed the onset of action of an antisecretory drug, and the buffering effect of food. Radiotelemetric pH monitoring is shown to be as good as gastric sampling in the measurement of 24-hour intragastric acidity, allows continuous measurement of pH during normal activity and can accurately assess the effect of drugs on gastric acidity.
Duodenal Crohn's disease is rare, and patients without obstruction are treated medically. We herein report one case whose duodenal Crohn's disease was successfully managed with low-speed elemental diet infusion through a nasogastric tube. A 28-year-old female developed acute duodenal Crohn's disease. Upper GI radiologic and endoscopic examinations showed a stricture in the duodenal bulb. Using the duodenal biopsy specimens, mucosal cytokine levels were measured; interleukin (IL)-1beta, IL-6, IL-8, and tumor necrosis factor-alpha levels were remarkably elevated. For initial 2 wk, powdered mesalazine was orally given but it was not effective. For the next 2 wk, she was treated with low-speed elemental diet therapy using a commercially available Elental(TM), which was infused continuously through a nasogastric tube using an infusion pump. The tip of the nasogastric tube was placed at an immediate oral side of the pylorus. The infusion speed was 10 mL/h (usual speed, 100 mL/h). After the 2-wk treatment, her symptoms were very much improved, and endoscopically, the duodenal stricture and inflammation improved. The duodenal mucosal cytokine levels remarkably decreased compared with those before the treatment. Although our experience was limited, low-speed elemental diet infusion through a nasogastric tube may be a useful treatment for acute duodenal Crohn's disease.
It is suggested that only those patients in whom symptoms begin within two weeks after application of the cast should be included in the cast syndrome. Early diagnosis with prompt treatment in the form of replacement therapy and a nasogastric tube is important. Operation should be reserved for those patients in whom conservative treatment fails or the cast cannot be removed.
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The author has analyzed the data of 163 patients operated because of their duodenal ulcer disease. There were in existence 30% of the first degree, 53% of the second degree and 17% of third degree emaciated patients. The author developed a new scheme of the enteral feeding. This new scheme proved to be effective based on the analysis of biochemical indices in patients at the early postopeartive period.
Among 115 patients with gastroduodenal hemorrhage 60 received nonoperative treatment, 30 of them underwent enteral correction with a monomer electrolyte solution. Emergency operation was carried out on 55 patients, 35 of them were subjected to enteral correction in the postoperative period. Enteral administration of the monomer electrolyte solution in the early posthemorrhagic and postoperative periods promoted filling up of the blood circulation volume and its components and stabilization of the values of central hemodynamics. It was established on grounds of the clinical data, studies of the volemic indices and central hemodynamics that enteral correction does not yield to the traditional intravenous infusion-transfusion therapy in efficacy.
Detoxicating therapy is necessary to patients with diffuse purulent peritonitis and acute ileus. One of the simplest methods of detoxication is an intraintestinal administration of sorbents, Enterodesis in particular. The application of this drug reduced toxicity of blood serum controlled by protozoa which facilitated rapid recovery of the intestine function. Most pronounced effect of enterosorption was observed in cases with acute ileus. In more severe cases the dosage of the medicine was greater without visible sequellae in the patients. The effect of detoxication was positive as a whole.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.