Prospective study of the standard meal provocative test in Zollinger-Ellison syndrome
Article Abstract:
Zollinger-Ellison syndrome (ZES) is a disorder characterized by extreme hyperacidity of the stomach, severe peptic ulcer disease and tumors of the pancreas. It is usually diagnosed on the basis of a fasting blood test which shows an elevated level of gastrin, a hormone which stimulates the secretion of gastric acid in the stomach. However, elevated gastrin levels may also be indicative of antral syndrome, or hyperactivity of antral cells (located in the antrum of the stomach). It is thought that after eating a meal, patients with ZES experience little or no change in their gastrin level, while those with antral syndrome show an exaggerated increase in gastrin (normally distension of the antrum causes an increased release of gastrin). Previous studies have suggested that a provocative meal test can help to distinguish between these two conditions and identify the location of a gastrinoma (gastrin tumor). It has been suggested that patients with multiple endocrine neoplasia type I (MEN-I), a genetic disorder associated with endocrine glands tumors, have a high rate of antral syndrome and gastrinomas. A patient's response to the meal test may be different if he or she has undergone stomach surgery. An evaluation of the usefulness of the provocative meal test was conducted to distinguish ZES from antral syndromes, to determine the location of gastrinomas and to suggest that patients who have MEN-I also have a higher frequency of antral syndrome. Seventy-four patients with ZES were given standard provocative meal testing. The results indicate that the provocative meal test was not reliable in differentiating ZES from antral syndrome, and there was no indication that patients with MEN-I have a higher incidence of antral syndrome. In addition, the meal test was not found to be useful in locating gastrinomas. No conclusion was drawn about whether the patient's response to the test was affected by prior surgery.
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1989
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Cost-effectiveness of prospective and continuous parenteral antibiotic control: experience at the Palo Alto Veterans Affairs Medical Center from 1987 to 1989
Article Abstract:
Antibiotics account for a large portion of the money spent on drugs by hospitals. As a consequence, hospitals have tried a number of methods for eliminating unnecessary use of these drugs, but most such cost-control measures seem to have little effect. The effectiveness of one hospital's policy toward reducing antibiotic costs was studied. The new policy was implemented in August of 1987. It restricted prescribing and using certain antibiotics until an infectious disease service (IDS) review was performed. The IDS team was also given broad powers to review and limit the use of antibiotics, particularly special and expensive ones, in the hospital. The new policy was evaluated by comparing costs before and after it was implemented and by examining the records of patients who had received intravenous antibiotic treatment before or after the policy was implemented. Results showed that antibiotic costs were reduced by 23 percent after the policy was implemented, a yearly savings of $91,125. Results from patient data revealed no significant differences in mortality or length of hospital stay in patients before or after implementation of the policy. The amount of antibiotics given per patient was similar in the two groups, but the patients from the group evaluated after implementation of the policy had shorter durations of therapy, lower doses, and cheaper drug costs. These results show that antibiotic usage and costs can be decreased without affecting patient care when a carefully designed policy involving a review team is implemented. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Increased all-cause and cardiac morbidity and mortality associated with the diagonal earlobe crease: a prospective cohort study
Article Abstract:
A diagonal earlobe crease (ELC) has been suggested to be linked with a risk for coronary artery disease (CAD) for over 30 years. The basis of a link between the two is unclear, and may reflect similar circulatory patterns by the end-arteries, which have no alternative blood supply from neighboring blood vessel branches, or it may be related to decreases in elastic fibers reflective of microvascular (small blood vessel) disease. Both CAD and ELC are acquired, are very unusual in subjects under 35 years, and the incidences within a given country correlate with each other crudely. To better understand the association of ELC and CAD, the two factors were studied in 108 patients who were similar except for the presence or absence of ELC or CAD, identified between 1979 and 1982. The results from nine to 10 years of follow-up are discussed. Risk factors for CAD, such as hypertension, were similar between the groups. In groups with or without CAD, those without ELC survived significantly longer. Only two of nine deaths in patients initially without CAD or ELC were caused by CAD. In the group without an initial CAD diagnosis, 13 of 18 deaths in those with ELC were due to CAD. Seven of 12 deaths in those with CAD but no ELC were due to CAD, and 17 of 19 deaths in the group with ELC and CAD were due to heart problems. The study indicates that ELC is a strong risk factor or predictor of CAD, and patients with ELC fared significantly poorer, regardless of CAD diagnosis, than those without ELC. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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