ABSTRACT
BACKGROUND: The contribution of the crural diaphragm to the gastroesophageal high pressure zone (HPZ) may be important in prevention of gastroesophageal reflux. The purpose of this study was to investigate the manometric characteristics of the thoracoabdominal junction in patients after surgical removal of the lower esophageal sphincter. METHODS: Ten patients with prior esophagogastrectomy were studied manometrically. RESULTS: Esophageal manometry showed a HPZ and pressure inversion point distal to the anastomosis in 9 of 10 patients. Midrespiratory and end expiratory pressures were 14 +/- 7 and 6 +/- 4 mm Hg above intra-abdominal pressure, respectively. Breath holding caused inhibition of the phasic pressure component. This HPZ relaxed partially in response to deglutition (60% +/- 22%) and contracted in response to increased intra-abdominal pressure induced by either leg lifts or abdominal compression (delta HPZ/delta intra-abdominal pressure = 1.87 +/- 0.64 and 1.96 +/- 0.40, respectively). CONCLUSIONS: This study shows an HPZ at the thoracoabdominal junction after surgical removal of the lower esophageal sphincter. We suggest that this sphincterlike HPZ is due to the crural diaphragm.
Subject(s)
Diaphragm/physiology , Esophagogastric Junction/physiology , Esophagogastric Junction/surgery , Abdomen , Adult , Aged , Deglutition , Esophagoscopy , Esophagus/physiology , Female , Humans , Male , Middle Aged , Pressure , ThoraxABSTRACT
Aspirin and nonsteroidal antiinflammatory drugs have been implicated in the pathogenesis of gastrointestinal hemorrhage. To evaluate their impact on inpatients, charts from Temple University Hospital with a discharge ICD-9 code which included upper gastrointestinal hemorrhage during a one-year period were reviewed. Aspirin and/or nonaspirin nonsteroid antiinflammatory drug (NSAID) use was identified in 34 patients (19 daily users and 15 intermittent users). Sixty-seven patients who bled, but did not use these agents, served as controls. Daily NSAID users were older than intermittent users and controls (P < 0.05). A higher frequency of bleeding ulcers was associated with NSAID use. Patients using NSAIDs spent more time in intensive care than controls (median 1 day vs 0 days). Daily users had a higher transfusion requirement (4 units) than non-users (0 units; P < 0.05). This study suggests that NSAID use has a substantial impact on health care resource utilization in patients admitted to an urban hospital for upper gastrointestinal hemorrhage.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Aspirin/adverse effects , Gastrointestinal Hemorrhage/chemically induced , Age Factors , Blood Transfusion/statistics & numerical data , Case-Control Studies , Female , Gastrointestinal Hemorrhage/epidemiology , Health Resources/statistics & numerical data , Hospitals, Urban , Humans , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Outcome and Process Assessment, Health Care , Philadelphia/epidemiologyABSTRACT
The New York Hospital has enjoyed a long, rich history in the development of American health care. AIDS has made relevant an understanding of the failures and successes achieved during past epidemics. Innovations in disease prevention and patient care have been essential in the conquest of pestilence. However, public indifference toward the people at greatest risk for these diseases has traditionally delayed attempts to prevent significant loss of life and socioeconomic destruction.
Subject(s)
Disease Outbreaks/history , Hospitals, Voluntary/history , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/history , Communicable Diseases/epidemiology , Communicable Diseases/history , Facility Design and Construction , History, 18th Century , History, 19th Century , History, 20th Century , Hospitals, Teaching/history , Humans , New York City/epidemiology , Sanitation/historyABSTRACT
Seven familial polyposis patients with desmoid tumors were treated with indomethacin, sulindac, or tamoxifen either as single agents or in combination. Serial computed tomographic (CT) scan examination was employed for objective measurement of tumor size since physical examination alone was an inaccurate means to evaluate intraabdominal and retroperitoneal desmoids. Only one patient with minimal tumor burden demonstrated a favorable response with complete resolution of an abdominal wall desmoid.
