The nonphysician provider in the gastroenterology practice.

Our nonphysician provider (NPP) experience has transformed the functioning and image of our practice. It allows the practice to care for poorly compensated or noncompensated patients and contains costs under managed care. NPPs enable our physicians to maintain reasonable workloads and focus their energy and skills on high-level diagnosis and treatment.

Revenue enhancement for the practice and the endoscopic ambulatory surgery center.

Gastroenterologists, like all physicians, are attempting to control more of the services they provide by developing programs that enhance quality of care and practice revenues, reduce physician stress, and improve the physician's quality of life. Many opportunities exist to accomplish these goals, including those discussed in this article. The overriding feature of any such activity, however, must always meet the criteria of improving patient care.

Bile leak after laparoscopic cholecystectomy. Diagnostic and therapeutic application of endoscopic retrograde cholangiopancreatography.

Background: Laparoscopic cholecystectomy, introduced less than 2 years ago, is widely accepted by patients and physicians despite the lack of controlled trials comparing this technology with conventional cholecystectomy. Recent series have described a variable incidence of biliary tract injury with laparoscopic gallbladder removal. The primary interaction of endoscopic retrograde cholangiopancreatography with this technology is usually in the preoperative or postoperative diagnosis and treatment of common bile duct stones.

Some biochemical indices of nutrition in treated cystic fibrosis patients.

Postprandial levels of copper, ceruloplasmin, iron, total iron binding capacity, cholesterol, vitamin A, carotene, folic acid, vitamin C, albumin, and total globulins in plasma, of 25-OH-vitamin D in serum, and of glutathione reductase activity, an index of riboflavin status, in erythrocytes were determined in a group of 18 juvenile cystic fibrosis patients receiving specialized outpatient care with attention to diet, vitamin supplementation, and pancreatic enzyme replacement. Bone mineralization was assessed by radiographic and photon beam technique. In the plasma of cystic fibrosis patients, levels were elevated for copper, ceruloplasmin, total globins, and total proteins and were depressed for iron, vitamin D, vitamin A, carotene, and albumin.

Multicentric colonic lymphoma complicating ulcerative colitis.

A 72-year-old female with ulcerative colitis of 30 years duration underwent total proctocolectomy for a cecal mass thought to be an adenocarcinoma. Pathologic examination of the colon revealed 22 tumors, all of which proved to be malignant lymphoma, histiocytic type. Thirteen cases of non-Hodgkins malignant lymphoma and 2 cases of Hodgkins disease of the colon arising in ulcerative colitis are reviewed and discussed.

Skeletal demineralization and growth retardation in inflammatory bowel disease.

Skeletal growth and mineralization in 54 adolescent and adult patients with inflammatory bowel disease have been analyzed comprehensively. Quantitative and qualitative radiologic techniques consisted of conventional roentgenography, photon absorptiometry, and radiographic morphometry. The data are correlated with the type, duration, and severity of disease, and with several modes of therapy.

Comparison of vitamin D and 25-hydroxy-vitamin-D in the therapy of primary biliary cirrhosis.

Skeletal demineralisation and low serum concentrations of 25-hydroxy-vitamin-D were observed in patients with primary biliary cirrhosis. Neither oral nor parenteral vitamin-D increased 25-hydroxy-vitamin-D in serum or prevented further skeletal demineralisation. In contrast, oral 25-hydroxy-vitamin-D increased serum-25-hydroxy-vitamin D concentrations in all patients, and bone mineral content either improved or stabilised in all but one, 25-hydroxy-vitamin-D may be the preferred form of vitamin-D therapy in primary biliary cirrhosis.

Leiomyosarcoma of the duodenum in a 10-year-old boy.

An unusual incidence of a duodenal leiomyosarcoma in a 10-year-old boy is presented. The corrected diagnosis was made after a 27-month course of occult gastrointestinal bleeding, vague abdominal complaints, and anemia. Gastrointestinal radiography and upper gastrointestinal endoscopy were useful in localizing the lesion.

Acute dilation of the colon in malignant lymphoma.

Acute dilatation of the colon with signs of systemic toxicity developed in an elderly man with malignant lymphoma. Although barium contrast X-rays taken previously were interpreted as consistent with granulomatous colitis, rectal biopsy had revealed features characteristic of malignant lymphoma, poorly differentiated lymphocytic type. Bone marrow and lymph nodes were also involved.