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Biomedical subjects

A Cuschieri

Publications and source records attributed to A Cuschieri.

At least 289 records · Page 16Linked to original sources
PubMed1987

Total pancreatectomy for chronic pancreatitis.

A survey of six British centres collected data on 83 patients undergoing total pancreatectomy (TP) for chronic pancreatitis between 1977 and 1986. There were 57 men and 26 women with a median age of 38 years (range 19-61 years). Half were alcoholics and half had had previous acute pancreatitis. Besides jaundice (14 per cent) severe pain was the indication for the operation; regular opiates had been needed in 82 per cent of patients and 37 per cent were addicted to these drugs. All but 12 had had previous pancreatic or biliary surgery, with a median of two operations and a maximum of six. TP was a one-stage procedure in 32 patients, 42 had had distal resections and 9 proximal resections in the past; the pylorus was preserved in 30. Median operation time was 4 h (range 2-18 h) and median blood loss was 3 units (1-21 units). Intraoperative complications in 11 patients included haemorrhage in 9. Four deaths occurred within 30 days from bleeding (2), respiratory failure (1) and Roux-loop infarction (1). All but one of the 79 survivors required full pancreatic supplementation and 38 per cent had difficulties in endocrine control. At a median follow-up of 1.5 years (range 0.25-10 years), 57 patients (72 per cent) were pain-free and 9 (11 per cent) needed only occasional analgesia. Though 13 (17 per cent) still took regular analgesics, all were symptomatically improved. There have been 10 late deaths (13 per cent), all but one of which are attributable to the operation.

Adult↗
PubMed1987

The solid bolus oesophageal egg transit test: its manometric interpretation and usefulness as a screening test.

The standardized 99mTc-labelled solid bolus oesophageal egg transit test (OET) was developed for assessing oesophageal motility. Its value in detecting oesophageal motility disorders was compared with oesophageal manometry in 102 symptomatic patients. Of 32 patients with normal OET, 22 (68.8 per cent) had normal manometry, whereas of 61 patients with abnormal manometry, 51 (84 per cent) had abnormal OET (chi 2 = 15.82, P less than 0.001). The computer-generated condensed image of the OET clearly defined five transit patterns: normal (n = 32); oscillatory (n = 21); non-clearance (n = 16); 'step' delay (n = 16) and non-specific delay (n = 17). The oscillatory pattern occurred in only one patient with normal manometry, but in all six with manometrically defined achalasia and two with diffuse oesophageal spasm. The predictive value of a positive (abnormal) OET test in detecting abnormal motility (both specific and non-specific disorders) was 73 per cent, and for specific motility disorders was 100 per cent. The predictive value of a negative (normal) test in excluding specific motor disorders was 94 per cent. Manometric tertiary contractions and low amplitude waves occurred in 6/32 and 1/32 patients with normal OET but in 31/70 and 21/70 with abnormal OET (chi 2 = 5.14, P less than 0.02; chi 2 = 7.85, P less than 0.001 respectively). Patients showing oscillation demonstrated significantly more tertiary contractions (17/21) and low amplitude waves (12/21) compared with 20/81 and 10/81 patients without oscillation (chi 2 = 20.47, P less than 0.001; chi 2 = 17.22, P less than 0.001 respectively). The solid bolus oesophageal transit test provides an objective screening test of specific oesophageal motility disorders and should be performed before oesophageal manometry.

Adult↗
PubMed1987

Ultrastructural localization of adenosine triphosphatase activity in HeLa cells at various stages of the cell cycle.

HeLa cells in a monolayer culture were synchronized to S, G2 and mitotic phases by use of excess (2.5 mM) deoxythymidine double-block technique. The localizations of Ca2++-activated adenosine triphosphatase (ATPase) at different phases of the cell cycle were studied using light- and electron-microscopic histochemical techniques, and microphotometric comparisons of the densities of reaction products. Enzyme reaction product was always localized in the endoplasmic reticulum, nuclear membrane, mitochondria and Golgi apparatus, but there were qualitative and quantitative differences related to the phases of the cell cycle. In S phase the activity was mainly concentrated in a perinuclear area of the cytoplasm whereas in G2 and mitosis the activity was scattered throughout the cell. The total activity per cell was maximal in G2, was less in S phase and least in mitosis. Activity in the mitochondria and endoplasmic reticulum was distinctly less in mitosis than in other phases of the cell cycle. The mitochondrial ATPase differed from the ATPase at other sites in ion dependence and sensitivity to oligomycin. The results suggest that there may be several distinct ATPases in proliferating cells.

Adenosine Triphosphatases↗
PubMed1987

A biliary endoscopy model.

Intraoperative biliary endoscopy (choledochoscopy) is often not practiced by surgeons despite the availability of both rigid and flexible endoscopes in many operating rooms. The main reasons for this reluctance are lack of familiarity and experience with endoscopic techniques. A biliary model was designed that permits the procedure to be learned. Its important features are mobilization of the duodenum, the use of irrigation, and the possibility of practicing the removal of calculi under visual control. We stress that the use of the choledochoscope is important to reduce the incidence of retained stones after common bile duct explorations.

Biliary Tract↗
PubMed1987

Efficacy of ceruletide controlled saline infusion for retained ductal stones after cholecystectomy and exploration of the common bile duct.

The synthetic peptide ceruletide induces maximal relaxation of the sphincter of Oddi. In a preliminary communication, ceruletide controlled saline infusion of the common bile duct (CBD) was found to be effective in promoting the passage of retained ductal calculi after cholecystectomy and exploration of the common bile duct. This paper reports on the further experience with this simple treatment which was administered to 27 patients with retained ductal calculi in 16 different hospitals within the U.K. The success of the procedure was documented by repeat T-tube cholangiography. Passage of stones into the duodenum was documented in 13 patients (48%) with complete clearance in 9 (33%) following one saline infusion/ceruletide treatment. The radiological stone size ranged from 3 to 15 mm. Within this range, there was no correlation between a successful outcome and size of retained stones. The duration of the saline T-tube infusion during ceruletide treatment averaged 54.7/min (SD 14.3). There was no correlation between flow rate of saline through the T-tube and a successful outcome. A significant inverse correlation was observed between the CBD pressure during ceruletide controlled saline T-tube infusion and successful stone passage (chi 2 = 9.9, P less than 0.01). Ampullary impaction by a stone was encountered in one patient. These results are encouraging and indicate that pharmacological dilatation of the sphincter of Oddi together with saline infusion is effective in the management of retained stones after exploration of the common bile duct. This treatment, which does not require any special expertise, should be tried in the first instance before more invasive procedures are used.

Adult↗
PubMed1987

Jejunal interposition for benign esophageal disease. Technical considerations and long-term results.

Thirty patients with benign intractable or complicated esophageal disease were treated with esophageal resection and isoperistaltic jejunal interposition. There were three anastomotic leaks (2 radiologic only) and one postoperative death (3.5%). Long-term follow-up results were favorable in all but one patient who had scleroderma. Despite this, radionuclide transit studies with a standardized solid egg white bolus showed a delayed transit (3.6 +/- 0.4 minutes) compared with normal controls (10.4 +/- 2.6 seconds) (p less than 0.001). The time activity curves and condensed image computer analysis of the 1-second frames showed that the contractions of the interposed jejunum were segmental rather than peristaltic. This accounts for the delayed transit in the esophageal group. Histologic studies on endoscopic biopsies of the jejunal loops obtained after 12 months of the operation confirmed the retention of a normal villous architecture with Paneth cell hyperplasia but no evidence of metaplasia.

Adult↗
PubMed1987

Short-term biliary dilatation and stenting in primary sclerosing cholangitis.

Operative biliary dilatation and prolonged percutaneous transhepatic biliary stenting have been useful in the management of primary sclerosing cholangitis, both intrahepatic and extrahepatic biliary strictures regressing after 12-16 months of treatment. We report the results of less prolonged treatment in a further four patients, in whom removal of a percutaneous transhepatic biliary stent 3-11 months after treatment led to an improvement in radiological appearances of the extrahepatic bile ducts, with no discernible effect on intrahepatic disease. Extrahepatic stricture recurred rapidly in one patient stented for only 3 months. Operative biliary dilatation and stenting for 5-11 months may lead to regression of extrahepatic biliary strictures in patients with primary sclerosing cholangitis, whereas intrahepatic disease requires stenting for 12-16 months. Further study is required to determine the applicability of this approach to primary sclerosing cholangitis.

Adult↗
PubMed1987

Gall bladder emptying in normal subjects--a data base for clinical cholescintigraphy.

Biliary excretion scintigraphy with a cholagogic test meal may be used to assess patients with suspected disorders of gall bladder motility. The interpretation of results is frustrated, however, by the lack of information about the range of normal responses in a form suitable for comparative analysis. We present the results of 41 gall bladder emptying studies on 32 normal healthy subjects (14 men, 18 women) 30 minutes after intravenous injection of 74 MBq 99Tcm-EHIDA. Gall bladder emptying was provoked by the ingestion of 300 ml milk. Gamma camera scintigraphy was used to plot gall bladder activity against time. Gall bladder emptying occurred within 10 minutes in all men and 12/18 women (p = 0.02). Gall bladder ejection fractions were significantly greater in women (p less than 0.05). Duplicate studies in nine subjects showed good reproducibility (r = 0.959). A plot of mean and (m + 2 SD) values of gall bladder activity against time has been derived. The data provide an estimate of normal gall bladder emptying response, which may be used to aid interpretation of clinical studies.

Adult↗
PubMed1986

Surgical management of severe intractable postvagotomy diarrhoea.

Experience with the surgical management of 23 patients with postvagotomy diarrhoea is outlined. The most common pre-operative abnormalities are rapid gastric emptying (14/23) and fast small bowel transit (23/23). Three patients were found to have steatorrhoea due to organic disease. Peptic ulcer surgery performed at a young age (means = 29 years, range 21-37) appears to be the only identifiable risk factor. The results of medical treatment with bile salt binding agents were disappointing in the long term. In 10 out of 13 patients treated with antiperistaltic segments, the procedure had to be reversed because of episodes of severe postprandial colic, intestinal obstruction and bacterial overgrowth. A good result with relief of the explosive diarrhoea was obtained by the distal onlay reversed ileal graft in six out of seven patients. This procedure creates a passive non-propulsive segment, and has no undesirable sequelae. It should be considered in those patients in whom the diarrhoea is not controlled by conservative measures.

Diarrhea↗
PubMed1986

Histochemical localization of adenosine triphosphatase activity in thymus: a light microscopical and ultrastructural study.

Ultrastructural localization of ATPase at high pH in the presence of Ca2+ showed that activity in thymocyte precursors was stronger than in mature thymocytes. The activity was localized in the nuclear envelope, rough endoplasmic reticulum, Golgi apparatus and mitochondria. The difference in activity was attributed to a marked decrease in ATPase-containing organelles, mainly the endoplasmic reticulum in the mature thymocytes. This appears to be related to the proliferative activity of the cells rather than to the immunological maturity of the thymocytes. A very strong activity, also localized in the same organelles, was present in the macrophages and interdigitating cells which might have a secretory function and possibly contribute to thymocyte maturation. The Ca2+-ATPase activity in the nuclear envelope-endoplasmic reticulum system suggests that these may be the sites for storage and regulation of cytoplasmic calcium.

Animals↗
PubMed1986

Enterogastric reflux and gastric clearance of refluxate in normal subjects and in patients with and without bile vomiting following peptic ulcer surgery.

A noninvasive scintigraphic technique was used to estimate enterogastric reflux and subsequent gastric evacuation of refluxate in 35 normal, healthy subjects and 55 patients previously treated by vagotomy or partial gastrectomy. Reflux was provoked by a milk drink and quantitated by counting 99Tcm-EHIDA activity within the gastric area during gamma camera imaging. Seven normal subjects (20%) showed reflux of 5-18% of initial activity (mean: 10%), with peak values occurring at 5-30 minutes (mean: 14 minutes) following the milk. Gastric evacuation of activity in these subjects was monoexponential (r = 0.993, T1/2 = 24.1 minutes). Reflux occurred more frequently than normal in patients with truncal vagotomy and drainage (22/28 patients) and partial gastrectomy (20/21 patients). All of 16 patients with Billroth II anastomoses exhibited reflux, which was excessive compared with refluxing normal subjects (mean: 25%; p less than 0.01) and occurred later into the study (mean: 34 minutes; p less than 0.01). Ten of 11 asymptomatic patients showed reflux of similar amounts of activity (mean: 21%) compared with 16 patients who complained of bile vomiting (mean: 22%). However, asymptomatic patients exhibited gastric evacuation of refluxate at a rate similar to that of refluxing normal subjects, while bile vomiters showed significant gastric retention of refluxate at 25-30 minutes following peak gastric activity (p less than 0.05). This result confirms that post-operative bile vomiting is essentially a problem of gastric emptying.

Adult↗
PubMed1986

Diagnosis of exocrine pancreatic insufficiency in cystic fibrosis by use of fluorescein dilaurate test.

In the fluorescein dilaurate test fluorescein dilaurate is cleaved by the pancreas specific cholesterol ester hydrolase activity and the liberated fluorescein is absorbed and excreted in the urine. Fluorescein recovery is a reflection of exocrine pancreatic function. The test was evaluated in 14 patients with cystic fibrosis and 16 healthy volunteers. The test was well tolerated by patients, was easy to perform, and gave significantly lower values in the patients suffering from cystic fibrosis. The result of the pancreolauryl test was also correlated with the result of the faecal chymotrypsin test in 11 of the patients suffering from cystic fibrosis. A positive correlation was found between the two test results. The test is a practical and reliable index of pancreatic exocrine function and may have a useful role as a screening procedure.

Adolescent↗
PubMed1986

Prospective study of a planned approach to the surgical management of bleeding oesophageal varices.

A policy of joint management of patients with acute variceal bleeding was constructed and applied prospectively to 37 consecutive patients. According to the protocol, every patient underwent an initial joint assessment by a physician and a surgeon soon after admission and resuscitation, which included age, previous history, physical examination and biochemical profile. Pugh's modification of Child's scoring system was used to assess the severity of the underlying hepatic disorder. Patients in groups A and B who were less than 70 years of age were treated by shunt surgery carried out during the same admission. Patients outwith this category were managed conservatively and a blood transfusion limit (10 units) imposed unless the clinical picture subsequently improved or the liver function was good but the patient was not eligible for surgery because of age. Twenty seven patients underwent shunt surgery, the most frequent procedure being a Warren shunt (n = 21). The average hospital stay in the surgically treated group was 18 days. The 30 day operative mortality was 15%. Two further deaths in the shunted group occurred during the follow-up period (mean = 30 months, range = 6-97 months). Seventeen patients in the shunted group remain well but three have required further therapy because of rebleeding episodes (two with sclerotherapy, one by surgery). Two patients who went abroad after recovery from their shunt surgery have been lost to follow up. The survival in the conservatively treated group was short and recurrent bleeding common. This experience indicates that an initial joint assessment using established criteria reliably identifies the poor prognosis group of patients with variceal haemorrhage and allows the rationalisation of the hospital resources.Early and expeditious selective shunt surgery in the good risk category carries an acceptable mortality and is cost effective in the long term.

Adolescent↗
PubMed1985

R2/3 gastrectomy for gastric carcinoma: an audited experience of a consecutive series.

A consecutive series of 27 patients with gastric neoplasm (24 carcinoma, 3 lymphoma) have been staged at laparotomy using the Japanese criteria for macroscopic staging. In 20 patients the radical R2/3 resection was considered potentially curative as defined by the Japanese Society for Research in Gastric Cancer. The operative mortality in this subgroup was 1/20 (5 per cent) and 3/27 (11 per cent) in the entire series. Locoregional recurrence was not observed in the potentially curative group. Follow-up has varied from 6 months to 7 years. An overall survival of 12/27 (48 per cent) has been observed to date. Death from cancer dissemination is maximal in the first and second year after resection. The R2/3 resection was considered non-curative in seven patients. In this subgroup there were two postoperative deaths and four have died of metastatic disease within 12 months of the resection. The only 5 year survivor in this group had a gastric lymphoma.

Adenocarcinoma↗