Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty-six domestic reports of suspected adverse reactions from the guar gum-containing diet pill, Cal-Ban 3000 (filed with the FDA) were reviewed. There were 18 instances of esophageal obstruction, seven instances of small bowel obstruction, and one individual who was reported to have died after ingestion of Cal-Ban 3000, but for whom insufficient details were provided to assess causation. There were 14 women and 11 men (mean age 46.3 yr; range 17 to 67 yr) for whom sufficient information was available. Preexisting esophageal or gastric disorders were present in 50% of those with esophageal obstruction, including peptic stricture, pyrosis, hiatal hernia, esophagitis, gastric stapling procedure, Schatzki ring, and muscular dystrophy. Fourteen of these 18 patients with esophageal obstruction were treated successfully by endoscopy, although the tenacious gel-like consistency of the material was often difficult to remove. Two patients required rigid esophagoscopy when flexible endoscopy was unsuccessful. This resulted in the death of one patient who developed a pulmonary embolism after surgical repair of an intraoperative esophageal tear. For the seven patients with small bowel obstruction, no specific predisposing factors were mentioned. One individual required exploratory laparotomy, and inspissated tablets were found in the ileum. These cases, spontaneously reported to the FDA, are very similar to those reported in the literature. The water-holding capacity and gel-forming tendency of guar gum permits it to swell in size 10- to 20-fold, and may lead to luminal obstruction, especially when an anatomic predisposition exists. Such products have been banned in Australia, and Cal-Ban 3000 has recently been removed from the market in the United States. However, unsuspecting patients who are still in possession of the product should be apprised of the potential complications that may arise with its use.
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PMID:Esophageal and small bowel obstruction from guar gum-containing "diet pills": analysis of 26 cases reported to the Food and Drug Administration. 132 94

Antrectomy with Roux-en-Y gastrojejunostomy was performed in 83 patients with "complicated" forms of peptic esophagitis. The esophagitis was considered complicated either because of the severity of the lesions (stricture, brachyesophagus, or endobrachyesophagus) or because of postoperative conditions after one or more previous operations (Heller's myotomy, esophagogastric resections, or hiatal hernia repair). A standard procedure was performed in 56 patients while technical adjustments were required for 27 patients who had previously undergone surgery. Two patients died from pulmonary embolism. Early postoperative complications occurred in 11% of patients. Healing of esophagitis was observed for all the patients treated with the standard procedures. Six partial regressions and 1 complete regression of Barrett's mucosa were observed. Digestive sequellae were minor and decreased with time. Assessment of pH and small bowel manometry showed that the reflux was controlled and no small bowel motility disturbance was observed when the standard technique was used including a small gastric resection. The main digestive sequellae, including lack of healing of esophagitis, dumping syndrome, and gastrojejunal anastomotic ulcer, occurred when a two-thirds gastrectomy was performed in order to avoid vagotomy.
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PMID:What is the place of antrectomy with Roux-en-Y in the treatment of reflux disease? Experience with 83 total duodenal diversions. 156 23

Total duodenal diversion was performed in 60 patients with reflux oesophagitis complicated by stricture, brachyoesophagus, endobrachyoesophagus or previous oesophago-gastric surgery. The standard operation (truncal vagotomy, antrectomy, 70 cm Roux-en Y anastomosis) was carried out in 41 patients; technical adjustments were necessary in 19 patients previously operated. One patient died of post-operative pulmonary embolism. Lasting cure of the oesophagitis was obtained within less than 3 months in 56/59 patients (93 per cent). Three-hour post-prandial pH measurements showed control of the reflux in 48/52 patients (92 p. 100). Anastomotic ulcers developed in 3 patients who did not have vagotomy. One case of complete remission of endobrachyoesophagus was observed, and 4 cases are now in partial remission. Digestive tract sequelae were found in 9 patients who had undergone surgery, but they were disabling in only one of these. These results suggest that total duodenal diversion is a suitable treatment of complicated reflux oesophagitis.
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PMID:[Treatment of complicated peptic esophagitis. Role of total duodenal diversion]. 252 64

The Angelchik prosthesis was used in 26 cases of gastroesophageal reflux disease resistant to medical therapy. The operations were crowned with success in 24 cases out of 26 (92.3%), with complete disappearance of reflux. The procedure failed in two cases: the prosthesis was removed in one case due to postoperative acute haemorrhagic gastritis with a subsequent positive outcome; in this patient the Angelchik ring had been removed as a precaution. Failure in the second case, a patient with oesophageal stenosis and a short oesophagus, was due to mediastinal migration of the prosthesis. In this latter case, a successful duodenal bypass was created with antrectomy and a long Roux-en-Y anastomosis. The only intraoperative complication in the patient sample was a splenectomy for rupture of the splenic capsule. Postoperative complications not directly related to the prosthesis were perforation of a duodenal ulcer not diagnosed preoperatively and treated with raphia without impairing the functional efficacy of the ring, one case of pulmonary embolism and one case of cardiac infarction, all resolved with medical therapy. In all, the prostheses were removed in 3 cases out of 26 (11.5%). In addition to the two cases already described, the prosthesis was removed in one patient one year after the operation at the patient's specific request for "psychological" reasons. Migration of the prosthesis occurred in four cases of severe oesophageal stenosis with a short oesophagus, in three of which the prosthesis functioned perfectly even in the intrathoracic site. At follow-up examinations there was radiological disappearance of the hiatal hernia in 20 cases out of 25. In one case there was no hernia even before the operation, and in four cases there was a short oesophagus with severe oesophagitis. Owing to the very easy performance of the operation together with its unquestionable antireflux efficacy, in our opinion three reliable indications emerge, namely: (i) in elderly patients at high surgical risk; (ii) in obese, brachytypical patients; and (iii) in the presence of severe oesophagitis, even with a short oesophagus.
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PMID:[Our experience on the use of the antireflux prosthesis by the Angelchik method (personal contribution of 26 cases)]. 263 19

Total duodenal diversion (TDD) has been carried out in 59 patients with complicated forms of peptic oesophagitis (acquired short oesophagus, columnar lined oesophagus, previous oesophagogastric surgery, stenosis). A standard procedure (truncal vagotomy, antrectomy and gastrojejunal anatomosis using a 70 cm Roux-en-Y loop) was performed in 41 patients, and some technical adjustments were required in 18 patients previously operated on. One patient died from postoperative pulmonary embolism. Bowel movements were resumed before the fifth postoperative day in 93 per cent of patients (54/59). Early postoperative complications (gastroparesis, 5; fistula, 1; subsequent operation, 1) occurred in 12 per cent of patients. Stabilization of the oesophagitis was achieved in less than 3 months in 95 per cent of cases (55/58). There were two cases of regression of columnar lined oesophagus. A 3-h postprandial pH assessment showed that the reflux had been controlled in 92 per cent of cases (47/51). One patient who still had an acid reflux died subsequently of a perforated oesophageal ulcer. Three anastomotic ulcers occurred in eight patients who did not have vagotomy. Digestive side-effects have been observed in nine patients, but only in one case were they crippling. Our results suggest that TDD is a suitable form of treatment for complicated forms of peptic oesophagitis.
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PMID:Total duodenal diversion in the treatment of complicated peptic oesophagitis. 320 45

From January 1973 through December 1979, 131 patients underwent proximal gastric vagotomy (PGV) for duodenal ulcer. There were 78 men and 53 women, whose age ranged from 19 to 73 years, with a mean age of 45 years. One hospital death occurred as a result of pulmonary embolism (0.7% mortality). There were 12 late deaths unrelated to ulcer disease, and each of the 12 patients was graded Visick I or II prior to death. Nine patients were lost to follow-up. This report is an analysis of the remaining 109 patients followed from 6 to 13 years. One hundred two patients (93.5%) underwent PGV for intractability. Seven patients (6.5%) who underwent PGV in selective circumstances for either acute perforation (3 patients), bleeding (1 patient), and moderate outlet obstruction (3 patients) are included. Follow-up results reveal that 52 patients (47%) are graded Visick I, 40 patients (36%) Visick II, five patients (5%) Visick III, and 12 patients (12%) Visick IV. Mild diarrhea occurred in 2.8% and mild dumping in 1.9%, and no reflux gastritis or esophagitis was noted. Recurrent ulceration took place in 10 patients, and seven subsequently required reoperation. Two additional patients had the antral pump mechanism denervated and later required antrectomy. PGV has yielded satisfactory results over a 6-13 year follow-up when operation was done for intractability. The low incidence of unpleasant long-term side effects is an appealing feature of the operation. A recurrent ulcer rate of 9.2% (10 patients) has, however, been of major concern. Those with a prime interest in gastric surgery are urged to continue the use of PGV in cases of intractability. Another 10 years of clinical investigative work will no doubt be necessary to determine the ultimate rate of recurrent ulceration.
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PMID:Proximal gastric vagotomy. Follow-up of 109 patients for 6-13 years. 374 Oct 1

The extended mantle field eliminates the necessity for splicing at the level of the diaphragm and thereby eliminates the potential for radiation-induced transverse myelitis. Our experience to date with 95 patients with H.D. or M.L. is described. Modifications in technique, including changes in the geometry of the field, shielding, time, dose, fractionation, and simulation are described. End results, an analysis of failures, and complications encountered are presented. Morbidity was acceptable despite the increase in integral dose, particularly in young patients who were not debilitated by disease. The danger of radiation-induced esophagitis, dehydration, hemoconcentration, and pulmonary embolism is stressed.
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PMID:Extended mantle radiotherapy in Hodgkin's disease and malignant lymphoma. 461 Dec 42

Although vertical banded gastroplasty is considered as a safe and efficient bariatric procedure, reoperation rates either because of failure, or the induction of unacceptable side effects are important. In this study we evaluated 54 obese subjects with a history of vertical banded gastroplasty. One patient (2%) died postoperatively due to pulmonary embolism. Seven patients (13%) underwent a reoperation. A new vertical banded gastroplasty because of dilatation of the pouch with weight regain resulted in a loss of 26% of the initial weight after 3 years (1 patient). The vertical staple line disrupted in 4 patients: restapling failed after 1.5 year (1 patient), conversion into a gastric bypass resulted in a loss of only 12% of the initial weight after 3 years (1 patient), conversion into a biliopancreatic diversion resulted in a loss of 43 and 32% of body weight after 18 and 6 months, respectively (2 patients). In 2 cases a Nissen fundoplication was performed with good result for reflux oesophagitis. Since regastroplasty was not entirely successful in our hands, we consider biliopancreatic diversion as the method of choice for failed vertical banded gastroplasty.
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PMID:Operations for failed vertical banded gastroplasty. 805 90

Two duodenal diversion was performed in 107 patients with complex peptic oesophagitis (peptic stenosis, Barrett's mucosa, past history of gastro oesophageal surgery). A standard operation included truncular vagotomy, antrectomy and gastro-jejunal anastomosis on a 70 cm Y loop in 68 patients. Technical adaptations were required in 39 patients. Two patient died (pulmonary embolism and duodenal fistula). The operation was successful with stable cure of the oesophagitis at 3 months in 89% of the patients. Post-prandial pHmetry over 3 hours confirmed control of the reflux in 92% of the cases. Anastomotic ulcer occurred in 4 patients who did not have a vagotomy. One complete regression of Barret's oesophagitis was achieved and in 6 other cases the regression was partial. Stenosis improved in all patients except 1, sometimes after 1 or several dilatations. Digestive sequellae, were observed during the first few months after surgery in 27% of the cases. Persistant sequellae were found in 14% of the operation patients after a delay of 36 months. These results suggest that duodenal diversion is a useful treatment for complicated and complex peptic oesophagitis.
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PMID:[Total duodenal diversion in the treatment of complex peptic esophagitis]. 894 35

Esophageal cancer frequently expresses cyclooxygenase-2 (COX-2) enzyme. In preclinical studies, COX-2 inhibition results in decreased cell proliferation and potentiation of chemotherapy and radiation. We report preliminary results of a phase II study conducted by the Hoosier Oncology Group in patients with potentially resectable esophageal cancer. All patients received cisplatin at 75 mg/m2 given on days 1 and 29 and fluorouracil (5-FU) at 1000 mg/m2 on days 1 to 4 and 29 to 32 with radiation (50.4 Gy beginning on day 1). Celecoxib (Celebrex) was administered at 200 mg orally twice daily beginning on day 1 until surgery and then at 400 mg orally twice daily until disease progression or unexpected toxicities, or for a maximum of 5 years. Esophagectomy was performed 4 to 6 weeks after completion of chemoradiation. The primary study endpoint was pathologic complete response (pCR). Secondary endpoints included response rate, toxicity, overall survival, and correlation between COX-2 expression and pCR. Thirty-one patients were enrolled from March 2001 to July 2002. Respective grade 3/4 toxicities were experienced by 58%/19% of patients, and consisted of granulocytopenia (16%), nausea/vomiting (16%), esophagitis (10%), dehydration (10%), stomatitis (6%), and diarrhea (31%). Seven patients (24%) required initiation of enteral feedings. There have been seven deaths so far, resulting from postoperative complications (2), pulmonary embolism (1), pneumonia (1), and progressive disease (3). Of the 22 patients (71%) who underwent surgery, 5 had pCR (22%). We conclude that the addition of celecoxib to chemoradiation is well tolerated. The pCR rate of 22% in this study is similar to that reported with the use of preoperative chemoradiation in other trials. Further follow-up is necessary to assess the impact of maintenance therapy with celecoxib on overall survival.
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PMID:Cisplatin, fluorouracil, celecoxib, and RT in resectable esophageal cancer: preliminary results. 1568 29


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