Sedation for ambulatory endoscopy.

Diagnostic and therapeutic fiberoscopy of gastrointestinal tract is often performed ambulatory and sedation is sometimes also required. Indication for sedation can be the intervention itself or the patient's psychological state. Aim of the study was to compare the effects of midazolam and combination of midazolam and fentanyl during endoscopy. Twenty eight cases were investigated: oesophagogastroduodenoscopy (n = 14) and colonoscopy (n = 14). Anaesthetics were midazolam (M) in 16 cases, midazolam-fentanyl (MF) in 12 cases. Non-invasive mean arterial pressure, pulse rate, acid-base balance and blood gases (by Astrup method) were recorded before endoscopy, at the 5th and 10th minutes of endoscopy, 15 minutes after intervention and also before emission. Pulse rate changed between 78-92/min. Mean arterial pressure appeared between 84-90 mm Hg. In MF group both were lower but there was not significant difference between the groups. The values were in normal range, there were not metabolic acidosis which needed correction. Onset of sedative effect was 2.8 min. in M group, 2.3 min. in MF group. The ability for adequate reaction returned within 11 min. in M group, within 14 min. in MF group. Fentanyl prolongs sedative effect of midazolam and offers sufficient pain relief. After 3 hours, patients could be emitted from the hospital.

Helicobacter pylori and congestive gastropathy.

This study evaluates the prevalence and significance of Helicobacter pylori (H. Pylori) infection in patients with portal hypertension. 118 patients were selected, i. e. 90 patients with portal hypertension (66 males, 24 females, mean age 49.1 +/- 2.1 years) and 28 noncirrhotic patients with nonulcerative dyspepsia as a control group (twelve males, 16 females, mean age 47.6 +/- 2.8 years). In all patients diagnostic upper endoscopy was performed and gastric biopsies were taken for histological examination and diagnosis of H. pylori infection. Of the portal hypertensive patients, 42 patients (47%) had congestive gastropathy, eleven (26%) of whom were positive for H. pylori infection and 48 (53%) did not have gastropathy, twelve (25%) of whom were positive for H. pylori infection. In the control group, 15 of 28 (54%) were positive for H. pylori infection. H. pylori was found less frequently in congestive gastropathy patients than in the control group. We found also that the presence and severity of congestive gastropathy is independent of the H. pylori status. We conclude that the role of H. pylori infection in the pathogenesis of congestive gastropathy seems to be unlikely and we suggest that there is no need for its routine eradication in cirrhotic patients.

[Gastroenterologic endoscopic ultrasonic examinations using a convex transducer]. / Gastroenterologiai endoscopos ultrahangvizsgálatok convex transducerrel.

Interest in endoscopic ultrasonography (EUS) has increased during the past fifteen years. Since few years new instrument have been produced, which was equipped with a small curved array transducer mounted in a front of the optic lens. The instrument, which is connected to a Hitachi ultrasonic scanner allows for duplex examination, colour flow imaging, and spectral analysis for measurement of flow velocity. Comparing to the recent unit with mechanical sector transducer, this instrument was equipped with a working channel, which allows to perform biopsies and define the TNM stages. The paper is discussed the evaluation of 55 patient data. This method developing worldwide quickly. By this new EUS technology there is a growing opportunity to substitute other either costly or more invasive methods, and using the TNM classification there is also possible to define whether the patient is suitable for curative surgical intervention or not.

Helicobacter pylori infection in congestive gastropathy.

BACKGROUND: This study determines the prevalence and significance of Helicobacter pylori infection in portal hypertensive patients. MATERIALS AND METHODS: Patients numbered 118 and consisted of 90 patients with portal hypertension (66 men; 24 women; mean age, 49.1 +/- 2.1 years) and 28 noncirrhotic patients with nonulcer dyspepsia, (12 men; 16 women; mean age, 47.6 +/- 2.8 years), who made up the control group. In all patients, diagnostic upper endoscopy was performed, and gastric biopsies were taken for histological examination and diagnosis of H. pylori. RESULTS: Of the portal hypertensive patients, 42 (47%) had congestive gastropathy, 11 (26%) of whom were positive for H. pylori, and 48 (53%) did not have gastropathy, 12 (25%) of whom were positive for H. pylori. In the control group, 15 of 28 (54%) were positive for H. pylori. H. Pylori was found less frequently in congestive gastropathy patients than in the control group. We found also that the presence and severity of congestive gastropathy is independent of H. pylori status. CONCLUSIONS: We conclude that the role of H. pylori in the pathogenesis of congestive gastropathy is unlikely, and we suggest that there is no need for its routine eradication in cirrhotic patients.

Occurrence and significance of Helicobacter pylori infection after gastric surgery.

Occurrence and significance of Helicobacter pylori (Hp) infection in patients having undergone partial and total gastric resection was studied. Forty-nine patients after gastric resection with Billroth I and II operation (28 patients due to ulcer and 21 patients due to gastric cancer), and 8 patients with total gastrectomy due to gastric cancer were selected. In addition, 40 patients with active peptic ulcer disease, 32 patients suffering from gastric cancer, and 28 patients with non-ulcer dyspepsia as a control group were enrolled. Occurrence of Hp in patients having been operated on due to ulcer disease was slightly lower than in controls (50% vs. 54%), but it was significantly lower than in patients with active peptic ulcer (50% vs. 85%, p < 0.001). On the other hand, in patients who were operated on due to gastric cancer, Hp was much less frequent than in the control group, as well as in patients in the preoperative period (9.5% vs. 54% and 72%, p < 0.001). As a conclusion, since in our series colonization with Hp was found to be less frequent after gastric resection than before surgery, its aetiologic significance in postoperative chronic gastritis and ulceration seems to be unlikely. Therefore, the routine postoperative eradication of Hp appears to be unnecessary in such patients.