Ultra high field MRI at 8 Tesla of subacute hemorrhagic stroke.

Purpose: Optimal treatment strategies and neurologic outcome after stroke depend on an accurate characterization of the lesion. There is a need for high resolution noninvasive imaging for assessment of the infarct size, perfusion, and vascular territory. MRI at the ultra high field (UHF) of 8 T offers unprecedented resolution, but its utility for stroke evaluation has not been determined yet.

Hybrid classification of sphincter of Oddi dysfunction based on simplified Milwaukee criteria: effect of marginal serum liver and pancreas test elevations.

To date, when using the Milwaukee classification for sphincter of Oddi dysfunction (SOD), one cannot accurately classify patients with marginal elevations in laboratory tests; ie, < 1.5 x the upper limit of normal (ULN). Since subsequent treatment may depend on how they are classified, we sought to determine whether these patients should be considered as type II or type III.

High-dose methylprednisolone treatment in experimental focal cerebral ischemia.

Previous studies using steroids for experimental focal stroke have demonstrated conflicting results, possibly related to dose used or ischemic models employed. In this study we examined high-dose methylprednisolone treatment following permanent and temporary focal cerebral ischemia in the rat. Focal stroke was induced in spontaneously hypertensive rats by permanent right common carotid and either permanent or 3 h of temporary middle cerebral artery (MCA) occlusion.

Pancreatic duct stents for "obstructive type" pain in pancreatic malignancy.

Objective: Obstruction of the main pancreatic duct from malignancy with secondary ductal hypertension may be an important contributor to pain. The aim of our study was to determine the efficacy and safety of pancreatic stent placement for patients with "obstructive" pain due to pancreatic malignancy.

Methods: Pancreatic duct stents were placed in 10 consecutive patients with malignant pancreatic duct obstruction and abdominal pain.

ERCP and stent therapy for progressive jaundice in hepatocellular carcinoma: which patients benefit, which patients don't?

Jaundice in hepatocellular carcinoma (HCC) can be due to biliary obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) can be both diagnostic and therapeutic. Biliary stenting can relieve jaundice and allow further chemotherapy, but at additional expense and potential morbidity.

The effect of endoscopic sphincterotomy on acute and chronic complications of biliary endoprostheses.

Background: Endoscopically placed biliary stents have become routine therapy for bile duct obstruction and bile leaks. Controversy exists regarding the use of biliary sphincterotomy to facilitate placement of 10F plastic stents.

Methods: We retrospectively studied the effect of sphincterotomy on acute and chronic complications of 10F stent therapy.

Endoscopic pancreatic duct stenting to treat pancreatic ascites.

Background: Management of pancreatic ascites with conservative medical therapy or surgery has met with limited success. Decompression of the pancreatic ductal system through transpapillary stent placement, an alternative strategy, has been reported in only a handful of cases of pancreatic ascites.

Methods: We reviewed all cases from 1994 to 1997 in which patients with pancreatic ascites underwent an endoscopic retrograde pancreatogram documenting pancreatic duct disruption with subsequent placement of a transpapillary pancreatic duct stent.

Postcholecystectomy pain syndrome: pathophysiology of abdominal pain in sphincter of Oddi type III.

Background & Aims: Persistent abdominal pain occurs in many patients after cholecystectomy, some of whom are described as having sphincter of Oddi dysfunction (SOD). Pain in SOD type III is thought to be of biliary origin with little objective data, and treatment is often unsatisfactory. Chronic abdominal pain without a biological disease marker is similar to irritable bowel syndrome, in which many patients exhibit visceral hyperalgesia.

Visceral algesia in irritable bowel syndrome, fibromyalgia, and sphincter of oddi dysfunction, type III.

Visceral hyperalgesia has been demonstrated in patients with irritable bowel syndrome who are seen in tertiary care centers. It has been hypothesized that visceral hyperalgesia may be related to psychological distress associated with health care seeking behavior in these patients. Patients with fibromyalgia and sphincter of Oddi dysfunction, type III, share many demographic and psychosocial characteristics with patients with irritable bowel syndrome and provide an opportunity to test the hypothesis that rectal hyperalgesia is unique to IBS.

Comparison of laparoscopic versus open repair of paraesophageal hernia.

Background: Recent reports suggest that laparoscopic paraesophageal hernia repair (LPHR) is feasible, but no direct comparisons with the standard open paraesophageal hernia repair (OPHR) have been reported. The purpose of this study was to compare the short-term outcome of LPHR versus OPHR at a single institution.

Methods: The operative and postoperative courses of 95 consecutive patients undergoing open or laparoscopic repair of a paraesophageal hernia (PEH) were retrospectively reviewed, and outcomes of LPHR versus OPHR were compared.

Palliation of malignant gastric outlet obstruction using an endoscopically placed Wallstent.

Background: Treatment options for malignant gastric outlet obstruction are limited. Surgical gastrojejunostomy, commonly performed, has significant morbidity and mortality.

Methods: Over 2 years, we prospectively studied the safety, feasibility, and outcomes for use of a newly designed expandable metal stent (Wallstent Enteral; Schneider, Minneapolis, Minn.

Endoscopic sphincterotomy for stones by experts is safe, even in younger patients with normal ducts.

Objective: To provide current information on the risks of endoscopic sphincterotomy for stone.

Summary Background Data: In recent years (since the popularity of laparoscopic cholecystectomy), endoscopic sphincterotomy has been used increasingly for the management of bile duct stones in relatively young and healthy patients. The validity of this trend has been questioned using data on short-term complications derived from earlier decades that involved more elderly and high-risk patients.

Does allopurinol reduce pain of chronic pancreatitis?

Conclusion: A dosage of 300 mg/d of allopurinol was not effective in reducing pain or improving activities of daily living in chronic pancreatitis.

Background: Allopurinol prevents the generation of oxygen-derived free radicals by inhibiting xanthine oxidase. The purpose of this study was to determine whether allopurinol is effective in reducing pain of chronic pancreatitis.

Gastrointestinal bleeding in cirrhotic patients with hepatocellular carcinoma undergoing intrahepatic artery chemotherapy.

Background: Hepatocellular carcinoma in cirrhotic patients increases the risk of variceal bleeding. We sought to characterize bleeding in a cirrhotic patient population undergoing intrahepatic artery chemotherapy for hepatocellular carcinoma and to determine the possible influence of this treatment on gastrointestinal bleeding.

Methods: We retrospectively reviewed 179 patients with hepatocellular carcinoma who underwent intrahepatic artery doxorubicin and cis-platinum chemotherapy to determine the incidence of gastrointestinal bleeding and compared them with 434 hepatocellular carcinoma historic controls not undergoing regional chemotherapy.

Pattern and frequency of recurrent transient ischemic attacks.

Objectives. Natural history studies and stroke prevention trials in patients with transient ischemic attacks (TIAs) have focused primarily on stroke or death outcomes and not recurrent TIA, yet treatment decisions are often based on recurrences. This study was undertaken to evaluate the frequency and pattern of recurrent TIAs in patients presenting with their first TIA.