Hepatitis C: prevention and treatment.

Widespread screening of donor blood for hepatitis B led to the recognition that most cases of post-transfusion hepatitis were due to an agent or agents, collectively known as non-A, non-B. Until recently, the causative agent for non-A, non-B hepatitis was unknown. In 1988, a new agent, hepatitis C virus, was identified. It is estimated that 150,000 new cases of hepatitis C occur each year and that one-half of patients with hepatitis C develop chronic liver disease. Hepatitis C is responsible for 15,000 new cases of cirrhosis annually. In 1990, an antibody assay was approved for commercial use. Widespread screening of donor blood with this assay should reduce the risk of transfusion-associated hepatitis C. For those patients already infected, antiviral therapy with alpha interferon may offer the chance of cure or significant palliation.

Gastric bezoars. A technique of endoscopic removal.

Gastric bezoar formation is an uncommon sequela of gastroduodenal surgery or unusual eating habits. Because they generally produce severe symptoms, their removal is always necessary. Previously, this required surgical extirpation or slow enzymatic dissolution. We present here an endoscopic procedure for bezoar removal utilized successfully in five patients with vegetable-mucus bezoars. This technique employs a jet spray of water under direct vision to mechanically disrupt the bezoar, which may then be removed using a large gastric lavage tube. This procedure is simple, safe, and rapid and is therefore recommended as an alternative to surgical removal or enzymatic dissolution of gastric bezoars.

Treatment of toxic megacolon. A comparative review of 29 patients.

A review of 29 patients with toxic megacolon complicating ulcerative colitis was undertaken to (1) compare the results of medical and surgical treatment; (2) determine the optimal timing for surgical intervention, and (3) identify possible precipitating factors. Twenty-one patients were treated medically with nasogastric suction, steroids, parental fluids, blood transfusions, and antimicrobial agents. Of the 21 patients, 11 (53%) showed improvement by subjective and objective criteria and 10 (47%) failed to respond. Sixteen patients were treated surgically. This group was subdivided into 8 patients who failed to respond to medical treatment and 8 treated surgically. Total proctocolectomy with ileostomy was performed in 8 and subtotal colectomy and ileoproctostomy in 8, with subsequent proctectomy and ileostomy in 6 patient. Six of 8 patients (75%) treated primarily surgically improved, and 2 (25%) died. Seven of 8 patients (87.5%) treated surgically after failure of medical trial showed definite postoperative improvement, and 1 (12.5%) failed. Those who were operated on within the first 48-72 hr after the diagnosis of toxic megacolon was made responded uniformly well. Anticholinergics, opiates,, barium enema, and colonoscopy were identified as possible precipitating factors in 70% of cases. The results of this tudy in this patient population indicate that early surgical therapy in toxic megacolon is associated with better results than medical therapy (P less than 0.025). Although intensive, optimal medical therapy plays a significant role in the management of toxic megacolon, failure to induce rapid improvement within 48-72 hr constitutes an indication for definitive surgical treatment.

Spontaneous pseudocystogastrostomy associated with pancreatitis. Detection by endoscopy.

A pseudocystogastrostomy complicating the course of acute hemorrhagic pancreatitis was detected by upper endoscopy. Aspiration of the cyst contents during endoscopy showed greatly elevated amylase values confirming the diagnosis. Peritoneal lavage therapy was used in the acute phase of the patient's illness with dramatic clearing of the peritoneal fluid, reduction of ascitic fluid amylase values, and subjective clinical improvement.

Early detection and prevention of colon cancer. The role of colonscopy.

The incidence of and mortality associated with colon cancer has not decreased during the past 25 years despite several innovations in therapy. Earlier detection and prevention by polypectomy though the sigmoidoscope and colonoscope have been suggested as one alternative offering improvement. The polyp-cancer sequence is controversial, but recent evidence indicates that polyps with a papillary component have a substantial potential for becoming malignant. Forty-four polyps were resected from 26 patients. Nineteen polyps from 14 patients had papillary features of "in-situ" carcinoma. Thus, colonoscopic polypectomy may play an important role not only in early detection but also in the prevention of colon cancer.

Paraprosthetic-enteric fistula. Role of Preoperative endoscopy.

A case of paraprosthetic-enteric fistula occurring after aortic aneurysectomy and Dacron graft placement is reported. Two and one-half years after aneurysectomy, the patient presented with the problems of fever of obscure origin, arthralgias, and anemia. The diagnosis of paraprosthetic-enteric fistula was made preoperatively by endoscopy. The role of endoscopy in the evaluation of postaneurysectomy complications is emphasized.