AIM:To study the efficacy and safety of pharmacolo-gical treatment of constipation in geriatrics.METHODS:Pub Med,MEDLINE,google scholar,and Ovid were searched to identify human studies performed on the use of laxative...AIM:To study the efficacy and safety of pharmacolo-gical treatment of constipation in geriatrics.METHODS:Pub Med,MEDLINE,google scholar,and Ovid were searched to identify human studies performed on the use of laxatives in elderly with constipation,which were conducted between January1990 and January 2013 using the specified keywords.Controlled studies that enrolled geriatric patients with a diagnosis of constipation and addressed the efficacy and/or the safety of pharmacological treatments were included.Studies were excluded from this review if they were non-controlled trials,case series,or case reports.RESULTS:Out of twenty three studies we initially retrieved in our search,only nine studies met the eligibility criteria of being controlled trials within geriatrics.The laxatives examined in the nine studies were senna,lactulose,sorbital,polyethylene glycol(PEG),lubiprostone,linaclotide,and prucalopride.In those studies,senna combinations had a higher efficacy than sorbitol or lactulose as well as,a very good adverse effect profile.PEG was also shown to be safe and effective in geriatric population.Furthermore,it has been shown that PEG is as safe in geriatrics as in general population.New agents like lubiprostone and prucalopride show promising results but the data about these agents in geriatrics are still limited which warrant further investigation.CONCLUSION:Senna combinations and PEG appear to have a more favorable profile over the other traditionally used laxatives in elderly patients with constipation.展开更多
AIM: To examine the discrepancy, if any, between the endoscopist's estimate and pathologist's measurement of colonic polyp size. METHODS: We retrospectively studied 88 patients who underwent colonoscopy with a...AIM: To examine the discrepancy, if any, between the endoscopist's estimate and pathologist's measurement of colonic polyp size. METHODS: We retrospectively studied 88 patients who underwent colonoscopy with a clear unequivocal documentation of polyp size by both the endoscopist and pathologist. Endoscopist measurements were based on the visual estimate of polyp size seen on high definition screens. The measurement was done by our pathologists after formalin fixation. We compared the endoscopist estimate of the polyp size to the pathologist measurement in order to explore the discordance between the two readings. Data regarding demographics and method of polypectomy(snare polypectomy vs excisional biopsy) was collected, as well. Statistical analysis software statistical software was used to analyze the data. RESULTS: Our cohort included 88 patients from which 111 polyps were removed. Fifty-two(46.8%) of the 111 polyps were excised using biopsy forceps and fiftynine(53.2%) were removed by snare. In the biopsy forceps group, the mean polyp size documented by the pathologist was 0.38 ± 0.19 cm and the mean polyp size documented by the endoscopist was 0.54 ± 0.16cm. The mean difference was 0.15 cm(P < 0.001). In the snare group, the mean polyp size documented by the pathologist was 0.54 ± 0.24 cm and the mean polyp size documented by the endoscopist 0.97 ± 0.34 cm. The mean difference was 0.42 cm(P < 0.001). Combining both groups, the mean size documented by pathologist was 0.46 ± 0.23 cm compared to 0.76 ± 0.35 cm documented by the endoscopist. The mean difference was 0.3 cm(95%CI: 0.23-0.36).CONCLUSION: Post polypectomy measurement by the pathologist are generally smaller than the endoscopist's estimate.展开更多
Background:Obesity is commonly observed in patients with cirrhosis,especially with the increasing prevalence of nonalcoholic steatohepatitis(NASH).Bariatric surgery has been avoided in these patients given concerns ab...Background:Obesity is commonly observed in patients with cirrhosis,especially with the increasing prevalence of nonalcoholic steatohepatitis(NASH).Bariatric surgery has been avoided in these patients given concerns about increased perioperative risk;therefore,data are lacking regarding long-term outcomes.In this study,we aimed to evaluate the long-term outcomes of patients with cirrhosis who underwent bariatric surgery.Methods:We reviewed the charts of adult patients with compensated cirrhosis who underwent bariatric surgery after they were prospectively enrolled between February 23,2009 and November 9,2011,and followed in a pilot study for evaluation of bariatric surgery outcomes.Only patients with more than 4 years of follow-up were included in the analysis.Data regarding their liver disease,metabolic status,and survival were collected.A descriptive analysis was performed.Results:The cohort consisted of 10 patients,of whom 7 were females.The median post-surgical follow-up was 8.7 years(61.4 years).All patients had biopsy-proven NASH;two patients had concurrent,untreated hepatitis C infection.During the observation period,there was a mean weight loss of 24 kg(19.2%of total body weight pre surgery,P<0.001)and only one patient regained weight to the baseline pre-surgical measurement.One patient who was not eligible for transplant developed hepatic encephalopathy 3 years after surgery and later died.The remainder of the patients did not have any hepatic decompensation,cardiovascular event,or mortality.Except for one patient with Gilbert syndrome,bilirubin was normal in all patients at last follow-up.Conclusions:Bariatric surgery in patients with compensated cirrhosis can lead to sustained weight loss and stable hepatic function on long-termfollow-up.展开更多
文摘AIM:To study the efficacy and safety of pharmacolo-gical treatment of constipation in geriatrics.METHODS:Pub Med,MEDLINE,google scholar,and Ovid were searched to identify human studies performed on the use of laxatives in elderly with constipation,which were conducted between January1990 and January 2013 using the specified keywords.Controlled studies that enrolled geriatric patients with a diagnosis of constipation and addressed the efficacy and/or the safety of pharmacological treatments were included.Studies were excluded from this review if they were non-controlled trials,case series,or case reports.RESULTS:Out of twenty three studies we initially retrieved in our search,only nine studies met the eligibility criteria of being controlled trials within geriatrics.The laxatives examined in the nine studies were senna,lactulose,sorbital,polyethylene glycol(PEG),lubiprostone,linaclotide,and prucalopride.In those studies,senna combinations had a higher efficacy than sorbitol or lactulose as well as,a very good adverse effect profile.PEG was also shown to be safe and effective in geriatric population.Furthermore,it has been shown that PEG is as safe in geriatrics as in general population.New agents like lubiprostone and prucalopride show promising results but the data about these agents in geriatrics are still limited which warrant further investigation.CONCLUSION:Senna combinations and PEG appear to have a more favorable profile over the other traditionally used laxatives in elderly patients with constipation.
文摘AIM: To examine the discrepancy, if any, between the endoscopist's estimate and pathologist's measurement of colonic polyp size. METHODS: We retrospectively studied 88 patients who underwent colonoscopy with a clear unequivocal documentation of polyp size by both the endoscopist and pathologist. Endoscopist measurements were based on the visual estimate of polyp size seen on high definition screens. The measurement was done by our pathologists after formalin fixation. We compared the endoscopist estimate of the polyp size to the pathologist measurement in order to explore the discordance between the two readings. Data regarding demographics and method of polypectomy(snare polypectomy vs excisional biopsy) was collected, as well. Statistical analysis software statistical software was used to analyze the data. RESULTS: Our cohort included 88 patients from which 111 polyps were removed. Fifty-two(46.8%) of the 111 polyps were excised using biopsy forceps and fiftynine(53.2%) were removed by snare. In the biopsy forceps group, the mean polyp size documented by the pathologist was 0.38 ± 0.19 cm and the mean polyp size documented by the endoscopist was 0.54 ± 0.16cm. The mean difference was 0.15 cm(P < 0.001). In the snare group, the mean polyp size documented by the pathologist was 0.54 ± 0.24 cm and the mean polyp size documented by the endoscopist 0.97 ± 0.34 cm. The mean difference was 0.42 cm(P < 0.001). Combining both groups, the mean size documented by pathologist was 0.46 ± 0.23 cm compared to 0.76 ± 0.35 cm documented by the endoscopist. The mean difference was 0.3 cm(95%CI: 0.23-0.36).CONCLUSION: Post polypectomy measurement by the pathologist are generally smaller than the endoscopist's estimate.
文摘Background:Obesity is commonly observed in patients with cirrhosis,especially with the increasing prevalence of nonalcoholic steatohepatitis(NASH).Bariatric surgery has been avoided in these patients given concerns about increased perioperative risk;therefore,data are lacking regarding long-term outcomes.In this study,we aimed to evaluate the long-term outcomes of patients with cirrhosis who underwent bariatric surgery.Methods:We reviewed the charts of adult patients with compensated cirrhosis who underwent bariatric surgery after they were prospectively enrolled between February 23,2009 and November 9,2011,and followed in a pilot study for evaluation of bariatric surgery outcomes.Only patients with more than 4 years of follow-up were included in the analysis.Data regarding their liver disease,metabolic status,and survival were collected.A descriptive analysis was performed.Results:The cohort consisted of 10 patients,of whom 7 were females.The median post-surgical follow-up was 8.7 years(61.4 years).All patients had biopsy-proven NASH;two patients had concurrent,untreated hepatitis C infection.During the observation period,there was a mean weight loss of 24 kg(19.2%of total body weight pre surgery,P<0.001)and only one patient regained weight to the baseline pre-surgical measurement.One patient who was not eligible for transplant developed hepatic encephalopathy 3 years after surgery and later died.The remainder of the patients did not have any hepatic decompensation,cardiovascular event,or mortality.Except for one patient with Gilbert syndrome,bilirubin was normal in all patients at last follow-up.Conclusions:Bariatric surgery in patients with compensated cirrhosis can lead to sustained weight loss and stable hepatic function on long-termfollow-up.
