ABSTRACT
We have reported a case of gastrocolic fistula with gastric outlet obstruction as a complication of benign gastric ulcer. The single-stage surgical procedure described resulted in a successful outcome. Benign gastric ulcer currently appears to be the most prevalent cause of gastrocolic fistula.
Subject(s)
Colonic Diseases/etiology , Gastric Fistula/etiology , Intestinal Fistula/etiology , Pyloric Stenosis/complications , Stomach Ulcer/complications , Adult , Colonic Diseases/surgery , Female , Gastric Fistula/surgery , Humans , Intestinal Fistula/surgeryABSTRACT
Until two decades ago the Zollinger-Ellison syndrome (ZES) was difficult to diagnose and stage accurately. Total gastrectomy was often the ultimate treatment. Improvements in the measurement of serum gastrin and in radiographic imaging have greatly improved the precision of diagnosis and staging. Treatment with histamine-2 receptor antagonists and proton pump blockers have eliminated the need for gastrectomy, and current surgical intervention is directed at cure through removal of the localized gastrinoma. We reviewed the management of eight patients with this diagnosis seen at Henry Ford Hospital from 1983 to 1988. Time from first presentation to diagnosis varied from two months to ten years (mean 4.5 years) and four patients had peptic ulcer surgery before the ZES diagnosis. A high level of suspicion is required in order to make early diagnosis. Prior to elective peptic ulcer surgery, all patients should have serum gastrin assay to exclude ZES.
Subject(s)
Zollinger-Ellison Syndrome/diagnosis , Adult , Aged , Female , Gastrins/blood , Histamine H2 Antagonists/therapeutic use , Humans , Male , Middle Aged , Zollinger-Ellison Syndrome/therapyABSTRACT
A retrospective study of 89 patients with surgically proven primary hyperparathyroidism was done to gain insight into the pathogenesis of hypertension associated with this condition. The 43 patients (48%) who were hypertensive did not differ significantly from the normotensive patients with regard to age, sex, serum calcium and phosphate levels, and creatinine clearance. However, the mean serum magnesium level was significantly lower in hypertensive hyperparathyroid patients (1.52 +/- 0.24 mEq/L) than in normotensive hyperparathyroid patients (1.76 +/- 0.18 mEq/L; P less than .001), irrespective of use of diuretics in the former group. Although some studies implicate hypomagnesemia in the pathogenesis of essential hypertension, we are unaware of any previous human study reporting a link between hypomagnesemia and hypertension associated with primary hyperparathyroidism. This study suggests that a low level of serum magnesium may play a role in the pathogenesis of hypertension associated with primary hyperparathyroidism, a finding that needs further evaluation.
Subject(s)
Hyperparathyroidism/complications , Hypertension/etiology , Magnesium Deficiency/complications , Aged , Humans , Hyperparathyroidism/blood , Hypertension/blood , Magnesium Deficiency/blood , Middle Aged , Regression Analysis , Retrospective StudiesABSTRACT
Biologically active PTH (bio-PTH) has been assayed by the cytochemical bioassay in five members (three affected) of a family with typical features of familial hypocalciuric hypercalcaemia (FHH). Carboxy-terminal immunoreactive PTH was undetectable and bio-PTH was within the normal range in all the subjects regardless of whether or not they were hypercalcaemic. These results suggest that increased biological activity of circulating PTH cannot account for the hypercalcaemia of FHH.
