prospective trials. 8,9 However, the incidence of hemorrhage The incidence and the risk factors of hemorrhage from from FV has not been fully investigated. 3,7 Although several gastric fundal varices (FV) have not been fully evaluauthors have mentioned the incidence of hemorrhage from ated. We therefore conducted a retrospective and pro-FV, 3,7 to our knowledge, there has been no prospective study spective study to define the incidence and risk factors documenting the cumulative risk for FV hemorrhage in a for such episodes. We investigated 132 patients with cirlarge number of patients. The aim of this study was to define rhosis and gastric FV. Of these 132 patients, 15 patients the incidence and the risk factors for hemorrhage from FV. had hemorrhagic FV at the time of enrollment. The clinical characteristics were compared between these pa-PATIENTS AND METHODS tients and those without a first hemorrhage from FV. In Baseline Clinical Assessment. From January 1985 through Decemthe patients who had never previously bled, the inciber 1995, a total of 1,392 cirrhotic patients consecutively underwent dence and risk factors were prospectively investigated.upper gastrointestinal endoscopy at our institute. Of these patients, The size of FV was greater and red-spot on the FV were 540 patients had esophageal varices, 96 patients had gastric varices, more prevalent in patients with hemorrhagic FV. Child's and 253 patients had both esophageal and gastric varices. In the status was also more severe in these patients. In the 117 patients with gastric varices, 143 patients had FV, while the repatients who had never bled, 34 hemorrhages from FV maining 206 patients had varices in the cardia. In the 143 patients occurred during the follow-up period. The cumulative with FV, 11 patients were subsequently excluded from further evaluation because of their refusal to participate in the study. We thus risk for such hemorrhage at 1, 3, and 5 years was 16%, investigated a total of 132 patients with FV in the current study. 36%, and 44%, respectively. A multiple regression analy-The subjects consisted of 89 men and 43 women ranging in age from 1 The blood flow of such collaterals is abundant, 2 and apy. All patients were informed of the scientific nature of the investihemorrhage from FV is more serious than that of esophageal gation and gave their informed consent. The study protocol was apvarices. [3][4][5][6] The treatment of hemorrhagic FV by endoscopic proved by the Hospital Ethics Committee. procedures sometimes fails to cease the bleeding, and surgiAssessment of Endoscopic Findings. The diagnosis of FV was made cal modalities are thus often required for hemostasis.3-6 As a based on endoscopy with the agreement of two experienced endoscoresult, the mortality rate is high in patients with hemor-pists when one or more distinct venous channels were found in the rhagic FV. [3][4][5][6] In addition, because hemorrhagic esophageal gastric fundus. In patients with hemorrhagic FV, the endoscopic findings were analyzed after the cessation o...
The aim of this study was to clarify patients', physicians', and nurses' perceptions with regard to the communication of diagnosis to cancer patients in Japan. Sixty-three cancer patients, 35 physicians and 21 nurses were enrolled for this study: 54 of the patients wished to be informed of the diagnosis, of whom 34 had actually been told that they had cancer. Physicians did not tell the truth to the remaining 20 patients, of whom seven were not told the diagnosis because family members objected. Twenty-one of the 35 physicians thought that telling the true diagnosis had a positive effect and 27 thought that disclosure of the diagnosis to cancer patients should be promoted. Sixteen of the 21 nurses did not experience any difficulties with patient care after the diagnosis was disclosed. The present study suggests that medical staff and family members should respect the patient's standpoint because patients have the right to know about their own condition. Physicians should first provide the details of the disease to their patients. Thereafter, family members should be informed, but only with the patient's consent.
These observations indicate that abdominal surgical trauma induces the production of NO, TNF-alpha and CINC/GRO, and enhances neutrophil functions such as chemotaxis, phagocytosis and active oxygen production. Furthermore, L-NMMA likely modulates the neutrophil functions and the production of TNF-alpha and CINC/GRO after the surgical trauma.
We investigated the effects of nifedipine on splanchnic haemodynamics in 13 patients with cirrhosis and portal hypertension, and in 10 control subjects using hepatic venous catheterization and pulsed Doppler ultrasound. There were no significant changes in systemic or splanchnic haemodynamics in control patients. In contrast, systemic vasodilatation, evidenced by significant decreases in mean arterial pressure and systemic vascular resistance, was observed in patients 20 min after sublingual application of 10 mg nifedipine. Moreover, hepatic venous pressure gradient and portal vein blood flow significantly increased after nifedipine administration. There was a significant correlation between the percentage increases in portal vein blood flow and in hepatic venous pressure gradient. However, no correlation was found between the percentage change in cardiac output and that in portal vein blood flow. Thus the increase in portal vein blood flow appears to be related to splanchnic arterial vasodilatation by nifedipine. Consequently, nifedipine has deleterious effects on portal haemodynamics in patients with cirrhosis. As nifedipine may potentially increase the risk of variceal haemorrhage in patients with less advanced varices, this drug should be used with caution in patients with chronic liver disease.
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