1/7. Patient-physician discordance about benefits and risks in gastroenterology decision-making.AIMS: To illustrate the characteristics of situations in gastroenterology when patients and physicians harbour different perspectives of medical costs and benefits, and how such different perspectives affect the outcome of medical decision-making. methods: Two exemplary scenarios are presented, in which threshold analysis yields different results depending on the varying values assigned to identical medical events. The occurrence of varying values is subsequently phrased in economical terms of varying utility functions that characterize patient vs. physician behaviour. RESULTS: safety and therapy are the two major preferences that determine patient and physician utility functions. patients and physicians make medical decisions based on two different utility functions. In comparison with their patients, gastroenterologists are more concerned with safety and inclined to spend more health care resources on safety than therapy because safety and the occurrence of medical complications affect their own professional status. In trying to maximize their own utility, gastroenterologists tend to spend more resources on safety than the patient him/herself might have spent given a free choice of management options. CONCLUSIONS: In instances of potential complications associated with risky medical interventions, patients may receive less medical therapy in exchange for more procedural safety.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Acute gastric necrosis in anorexia nervosa and bulimia. Two case reports.In recent years we have treated two patients with gastric infarction as a complication of anorexia nervosa and bulimia. We found only three other cases reported in the literature. Surgical intervention was delayed in all five patients either because the diagnosis was missed by the physician or because the patient failed to seek medical attention. physicians should be alerted to the possibility of acute gastric dilatation if a young woman, who may be undernourished and anorexic, complains of abdominal pain after ingestion of a large meal. Often this condition can be treated conservatively before irreversible damage to the gastric wall has taken place. If the gastric dilatation progresses, the stomach loses its contractility, resulting in venous occlusion, infarction, and gastric perforation. An extensive operation is required, and the patient undergoes an often complicated and prolonged hospital course.- - - - - - - - - - ranking = 0.125keywords = physician (Clic here for more details about this article) |
3/7. Corrosive injury to the stomach: the natural history and role of fiberoptic endoscopy.Most physicians recognize that the ingestion of lye is associated with severe esophageal damage. It is much less widely known that gastric injury is the predominant finding when acid is ingested. We are reporting on five patients who had severe gastric damage after ingestion of diluted sulfuric acid (three cases), capsules of potassium hydroxide, and Clinitest tablets (one case each). Fiberoptic endoscopy was used to localize the extent and severity of injury and to follow the evolution of the damage. The extent and location of injury varied with the amount and type of agent ingested. Acid ingestion resulted in severe gastritis, which eventually led to antral stenosis and gastric outlet obstruction requiring operative intervention in two cases. potassium hydroxide capsules produced diffuse esophagitis, gastritis, and a non-healing large gastric ulcer. Clinitest tablets produced distal esophagitis and stricture and antral damage leading to gastric outlet obstruction which required operative intervention. These cases demonstrate the natural history of corrosive injury to the stomach and the value of fiberoptic endoscopy in the management of this problem.- - - - - - - - - - ranking = 0.125keywords = physician (Clic here for more details about this article) |
4/7. Foreign body and caustic ingestion: management 1979.Most physicians involved in the diagnosis and management of foreign body aspiration and caustic ingestion assume that the numbers of these cases are decreasing. A sizeable number of patients die of caustic ingestion and poisoning annually, and deaths from foreign body ingestion have more than doubled since 1950. Increasing the significance of these needless tragedies is the fact that the most frequent victim is a young, healthy child. physicians should encourage educational campaigns to alert parents to the dangers of caustic agents and small items capable of being aspirated. They should be conversant with the treatment of both. This paper reviews current opinions regarding management.- - - - - - - - - - ranking = 0.125keywords = physician (Clic here for more details about this article) |
5/7. Occult bronchogenic carcinoma masquerading as esophageal cancer. case reports with recommendations for a change in reporting esophageal cytology.We describe two patients with benign esophageal stricture in whom exfoliative esophageal cytologic features positive for squamous cell carcinoma is attributed to roentgenographically occult lung cancer. The discovery of alveolar macrophages within the esophageal washings of these patients prompted a retrospective analysis assessing the prevalence of esophageal washings contaminated by cellular material from the lower respiratory tract. Alveolar macrophages were observed in 11 of 28 patients (39%) and in 12 of 33 specimens (36%). Alveolar macrophages were noted in half of patients with benign esophageal disease, but in only one of eight cases with proved esophageal cancer. Criteria alerting physicians to the coexistence of benign esophageal stricture and occult respiratory neoplasm are given, and recommendations for a change in reporting esophageal cytologic features are proposed.- - - - - - - - - - ranking = 0.125keywords = physician (Clic here for more details about this article) |
6/7. Achalasia, the valsalva maneuver, and sudden death: a case report.A 48 year old woman with no significant prior medical history was found dead by her husband in their home. The autopsy disclosed no anatomic reason for her death; however, the length of the esophagus was found to be massively dilated, with stenosis of the cardiac sphincter, and contained swallowed food material. Her husband disclosed that she had experienced difficulty in swallowing for over 10 years, and had to "strain" to move food into the stomach, although she had never consulted a physician regarding the problem. No gross or microscopic anatomic cardiac abnormalities were identified. The death was ascribed to a cardiac arrhythmia arising from the valsalva maneuver, which she used to move her ingested food across the stenotic gastroesophageal juncture. The valsalva maneuver, which increases the intrathoracic pressure by forcing expiratory effort against a closed glottis, has been associated with cardiac arrhythmias and rarely, sudden death. Lethal cardiac arrhythmias should be considered when sudden deaths occur in individuals with esophageal motility disorders, as well as in other situations where the valsalva maneuver may have been used, and where no other anatomic cause of death is identified.- - - - - - - - - - ranking = 0.125keywords = physician (Clic here for more details about this article) |
7/7. Esophageal stricture: an uncommon complication of foreign bodies.Ingestion of foreign bodies is common in infants. As a rule, the infant is being observed and the event is witnessed. When it is unwitnessed, acute symptoms bring the problem to the attention of a physician. When the ingestion is not witnessed or symptomatic, its presence can only be surmised. The object can create injuries and chronic symptoms that are not typical for this accident. Here is reported an ingestion of a coin that went undiagnosed and untreated for more than a year. The result was a transmural esophageal injury with stricture formation. The diagnostic methods and transcervical repair are described.- - - - - - - - - - ranking = 0.125keywords = physician (Clic here for more details about this article) |