1,721,042 research outputs found
Laser treatment of intestinal vascular abnormalities
No full textMucosal vascular abnormalities, including haemangioma, angiodysplasia and telangiectasia, are thought to be responsible for one third of chronic lower gastrointestinal blood loss. One hundred and ninety-one patients were referred for endoscopic diagnosis and treatment of acute or chronic blood loss. In 24 (13%) of patients no bleeding source could be found, in 23 (12%) laser treatment was not indicated and in another 23 (12%) follow-up was insufficient. Of 121 evaluable patients, 107 had angiodysplasia with colonic localisation in 54, 9 had telangiectasia diffusely within the digestive tract, and 5 haemangioma with colonic location in 3. In angiodysplasia effective haemostasis was obtained in 78% with a recurrence rate of 34% at prolonged follow-up, which responded to treatment in 82%. In patients with Rendu-Osler-Weber disease the haemostasis rate was 56%, with recurrence occurring in 33% and a retreatment response in 21%. Colonic haemangioma responded in 67% of cases but there was a high recurrence rate of 67% and a low retreatment response (33%). There were five major complications and all occurred with colonic angiodysplasia (5/54, 9.3%). These included serosal irritation (2), CO2 distension (1) and posttreatment bleeding (2). Minor complications consisted of CO2 retention in one case treated for angiodysplasia, and fever (1) and posttreatment bleeding (2) in haemangioma. Effective and safe haemostasis can be obtained by Neodymium-YAG laser-photocoagulation in often difficult circumstances without perforation or mortality. The method has proven to be indispensible for elderly and inoperable patients with intestinal vascular abnormalitie
Voeding en gezondheid - streefgewicht bij obesitas niet realistisch; wel gezondheidswinst door matige stabiele gewichtsreductie
No full textThe aim of achieving a normal or ideal body weight in the treatment of obesity is an obsolete goal. It stems from the time that obesity was not yet seen as a chronic incurable disease. A more realistic treatment goal is to reduce the body weight by 10-15% over a prolonged period of time. This moderate weight loss will result in a decreased risk for and incidence of obesity-associated diseases. Weight reduction and maintenance is countered by a decrease in resting-energy expenditure and in thermogenesis by food intake, a decreased energy expenditure through physical exercise, a reduced fat oxidation, a relative leptin deficiency and an excess of the gastrointestinal hormone ghrelin. Just as with hypertension and diabetes, the only option is life-long management with the normalisation of abnormal values within a given rang
Endobarrier: een uniek maar onvoldoende uitgerijpt concept
No full textThe EndoBarrier, an endoscopically delivered duodeno-jejunal bypass device, is a unique concept that starts to ameliorate the symptoms of diabetes mellitus type 2, soon after positioning. Weight-loss results are moderate, with 85% of patients showing a more than 10% excess weight loss in the 12 weeks preoperatively. Sufficient implant training is required, but problems can still occur, e.g., due to a short duodenal bulb length. The stability of the anchors and the tolerability of the device still leave much to be desired. In 25% of patients the EndoBarrier is explanted early, because of migration, physical symptoms, gastrointestinal haemorrhage, rotation and obstruction. Only seven studies on the EndoBarrier are available and these are mostly small in size, short-term and with limited follow-up, and many questions regarding the safety and long-term effects of the device remain. This calls for a large, long-term, randomised, placebo-controlled, double-blind trial. Lessons should have been learned from the disastrous results with intragastric balloon implantation before commercialising another such produc
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