Search PubMed⌕ Search

Biomedical subjects

A Cuschieri

Publications and source records attributed to A Cuschieri.

At least 307 records · Page 17Linked to original sources
PubMed1985

Surgical pathology at early elective operation for suspected acute gallstone pancreatitis: preliminary report of a prospective clinical trial.

Fifty-five patients presenting with acute abdominal symptoms and found to be hyperamylasaemic underwent early biliary tract investigation, giving 31 patients in whom the presence of gallstones was suspected. In accordance with the protocol of a randomized controlled trial of early elective biliary tract surgery for patients suspected of having acute gallstone pancreatitis, 19 of these patients underwent laparotomy at a mean of 6.9 days after emergency admission. In this group operation showed that four patients had biliary tract stones and pancreatitis; ten patients had calculous cholecystitis (53 per cent) but no stigmata of pancreatitis; four patients had pancreatitis but no stones; one had a negative laparotomy. None of this group was found to have ampullary obstruction due to an impacted stone. Biliary tract investigations carried out during the first week following admission were unhelpful or misleading in 14 out of the whole group of 55 patients, and in all of those patients (11 per cent) who died or required surgical intervention during the same hospital admission. There appears to be a pathological heterogeneity among patients diagnosed as 'gallstone pancreatitis' on clinical and biochemical grounds alone.

Acute Disease↗
PubMed1985

Proteinase-like peptidase activities in malignant and non-malignant gastric tissue.

Activities of several proteinase-like peptidases have been determined in homogenates of malignant tissue, non-malignant tissue adjacent to the tumour (A-NM) and non-malignant tissue distant to the tumour (D-NM) from 17 patients undergoing surgery for histologically confirmed gastric malignancies. In homogenates of malignant tissues the activities of collagenase, cathepsin B, cathepsin (B+L), cathepsin H and cathepsin D were significantly higher than in D-NM tissues. By contrast, the levels of plasminogen activator were significantly lower in malignant tissues than in the D-NM tissues. Furthermore, the activities of collagenase-like and the cysteine-proteinase-like peptidases in the A-NM tissues were lower than in malignant tissues but higher than in the D-NM tissues. Separation of full-thickness non-malignant tissues into mucosal and seromuscular layers revealed significantly higher activities in the former. The elevated levels of these proteinase-like peptidases in homogenates of gastric cancer tissue suggests an important role for these enzymes in tumour invasion.

Aged↗
PubMed1985

Prophylactic postoperative nasogastric decompression. A prospective study of its requirement and the influence of cimetidine in 200 patients.

To determine the need for prophylactic nasogastric decompression following laparotomy and the influence of cimetidine, 200 consecutive patients who underwent major abdominal procedures were prospectively randomized into one of four limbs: no tube-placebo; no tube-cimetidine; tube-placebo; and tube-cimetidine. Patients were evenly distributed among these groups with respect to age, sex, alcohol and tobacco use, previous operations, and types of operations. There was significantly longer time until passage of flatus, bowel movement, and cessation of intravenous fluids in the tube group (p less than 0.05). Duration of postoperative stay increased from 11.4 to 14.1 days in the intubated patients (p less than 0.05). There was also significantly more pain with and frequency of swallowing, and nose/throat discomfort in the tube group. Nasogastric tubes reduced the incidence of vomiting from 28 in the no-tube group to 10 in the tube group (p less than 0.05), but most had only one or two episodes. Cimetidine did not affect either the incidence of vomiting or the duration of intubation, but was associated with a significant increase in pneumonias (p less than 0.05). Five patients without tubes initially, and seven patients with tubes had to have them inserted or replaced for vomiting or abdominal distention, which occurred equally in the placebo and cimetidine limbs. There were no cases of aspiration pneumonia, gastric dilatation, or wound dehiscence in the trial, and the four anastomotic leaks were divided equally between the tube and no-tube groups. The results indicated that prophylactic decompression was unnecessary in most patients and associated with increased morbidity and delayed return of gastrointestinal function. Cimetidine lowered nasogastric output on the first postoperative day (p less than 0.05), but did not prevent vomiting.

Cimetidine↗
PubMed1985

Pyloric reconstruction for severe vasomotor dumping after vagotomy and pyloroplasty.

The performance of vagotomy and pyloroplasty is followed by the occurrence of dumping symptoms in 10-30% of patients. In a few, these are severe, persistent, and refractory to dietary and medical management. Pyloric reconstruction was performed in nine patients with severe dumping symptoms. All patients were treated conservatively for at least 1 year before reconstruction. Gastric emptying studies, using a 99mTc-sulphur colloid labeled 15% dextrose, were performed before and after reconstruction in each case. All were Visik grade IV before surgery. After pyloric reconstruction, interviews were conducted by a separate clinician not involved in any management of the patients. Overall improvement was obtained in eight of nine patients. Four patients improved to Visik grade II, and four to Visik grade III. With regard to dumping symptoms only, seven of nine were improved to Visik grade II. All patients had double exponential gastric emptying curves before surgery, and six of the nine reverted to single exponential curves similar to those of unoperated controls. The initial 10-minute emptying rate was significantly decreased (p less than 0.05), and the per cent retention at 60 minutes (p less than 0.02) was significantly increased. Improvement in gastric emptying correlated well with relief of symptoms. Pyloric reconstruction is relatively simple and corrects rapid gastric emptying at the gastric outlet. These results indicate that pyloric reconstruction significantly benefits most patients with severe dumping symptoms and should be considered as the initial remedial procedure for dumping after pyloroplasty.

Dumping Syndrome↗
PubMed1985

Computerized 24-hour esophageal pH monitoring: a new ambulatory technique using radiotelemetry.

A computerized telemetric system using a portable microprocessor receiving unit has been designed for clinical use in ambulatory 24-hour esophageal pH monitoring. The receiving unit can be used with either a pH-sensitive radiotelemetry pill or a standard intraesophageal pH probe. Esophageal pH data is collected under microprocessor control while the patient is in the usual home or work environment. Computerized plotting and analysis of the compiled pH data is performed at the conclusion of the ambulatory testing. The system has been successfully used in patients with symptoms of esophageal reflux and healthy volunteers with no symptoms. The development of a computer-based radiotelemetry system for prolonged monitoring of esophageal pH represents a substantial advance in existing investigational technology. It allows the use of new radiotelemetric techniques of esophageal pH recording with increased patient comfort and acceptance over a 24-hour ambulatory testing period. Microprocessor control of both data collection and analysis allows rapid interpretation of complex 24-hour esophageal pH tracings and greatly facilitates the performance of esophageal pH monitoring as a routine clinical investigation.

Adult↗
PubMed1985

The fate of phytohaemagglutinin-activated human lymphocytes following their peak proliferative activity.

Morphological and histochemical studies and cell counts were performed on phytohaemagglutinin-stimulated lymphocyte cultures at intervals from 1 to 17 days. Following a phase of proliferative activity lasting from the second to the sixth days, different cell types became evident in the later stages of culture. Some of the cells were large and characterised by an abundant cytoplasm containing numerous electron-dense bodies with a characteristic internal structure, a well developed Golgi apparatus, a highly irregular plasma membrane, numerous pinocytoses and intense acid phosphatase activity localised within the dense bodies. These cells resembled epithelioid cells in which phagocytic vacuoles were very infrequent. In contrast, phagocytic cells distended with phagocytosed debris were present throughout the period of culture. In later cultures many of the cells were smaller than activated lymphocytes. Intermediate sized cells were characterised by a paucity of organelles and low acid phosphatase activity, and small cells were similar to unstimulated lymphocytes but frequently contained numerous mitochondria. A few cells with a highly developed endoplasmic reticulum were observed at 3 days and also in later stages. The large cells with intense acid phosphatase activity constituted 20-30% of the total cells at 6 days but were more sparse in later stages when intermediate and small lymphocytes predominated. The total cell count on the seventeenth day was 50% of the initial cell count and the cells were almost entirely small, apparently healthy lymphocytes.

Acid Phosphatase↗
PubMed1985

Surface morphology of mitogen-activated human lymphocytes and their derivatives in vitro.

Human peripheral blood lymphocytes were cultured with phytohaemagglutinin or pokeweed mitogen for various intervals up to 17 days and studied by scanning electron microscopy. Activated lymphocytes in 3 day cultures were large irregular cells characterised mainly by an abundance of very fine microvilli, which were much thinner, shorter and more densely packed than the microvilli on uncultured lymphocytes. Cells intermediate in size and surface morphology between these and unstimulated lymphocytes were numerous in 1 day cultures. Some motile cells and large cells with finger-like or conical microvilli were also present. Cell counts showed that after 6 days in phytohaemagglutinin culture small villous cells resembling normal healthy lymphocytes were progressively more numerous, suggesting that most of the activated cells reverted to small lymphocytes. Very large cells were also present and displayed a heterogeneous surface morphology of villi, ridges, blebs and ruffles. A few of these cells had typical monocytoid features but others were predominantly villous. In pokeweed mitogen cultures there was extensive cellular degeneration affecting all cell types after 6 days. In unstimulated cultures the lymphocytes had fewer microvilli or were smooth-surfaced. There was extensive lymphocyte degeneration after 3 days and eventually typical monocytes were the predominant cells. Large, villous cells, which could be activated lymphocytes, were occasionally encountered in unstimulated cultures.

Cell Movement↗
PubMed1985

Body composition in the cirrhotic patient with ascites: assessment of total exchangeable sodium and potassium with simultaneous serum electrolyte determination.

The precise mechanism of initiation and maintenance of the disturbed fluid and electrolyte balance in cirrhotic patients remains unclear. Measurement of total exchangeable potassium in 11 cirrhotic patients with ascites revealed marked depletion compared to 9 healthy volunteers. Total exchangeable potassium was 50.8 +/- 5.1 m moles/L TBW in the patient group compared to 75.2 +/- 3.4 m moles/L TBW in the control group (P less than 0.01, Mann-Whitney U Test). Total body exchangeable sodium measured 80.1 +/- 3.7 m mole/L TBW in the cirrhotic group, which is not significantly elevated compared to the value in healthy volunteers of 74.1 +/- 1.9 m mole/L TBW. Serum sodium was low in four of the cirrhotic patients (129-133 mEq/L); exchangeable sodium was low in only one of these four (53.4 m mole/L TBW). Serum potassium was low in two of the cirrhotics (2.6-2.9 mEq/L); total body potassium was depressed in both of these patients (43.5-50.1 m mole/L TBW). An additional three patients had a low total body potassium (29.6-48.9 m mole/L TBW) with normal serum levels (4.0-4.2 mEq/L). There was no correlation between serum and total exchangeable electrolyte levels (Pearson's regression, r = 0.16 and 0.23). This work confirms that serum levels are not reliable indicators of true body sodium and potassium stores. The decreased total exchangeable potassium appears to be related to loss of body cell mass rather than intracellular potassium depletion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

The effect of dose and osmolality of lactulose on the oral-caecal transit time determined by the hydrogen breath test and the reproducibility of the test in normal subjects.

The lactulose hydrogen breath test was used to determine the oral-caecal transit time in healthy volunteers. An inverse relationship between the dose of lactulose ingested and the oral-caecal transit time was found. The osmolality of the lactulose solution did not effect the transit time. Results obtained from the test were found to be reproducible in normal subjects. Standardization of the meal and what constitutes a sustained rise in the breath hydrogen excretion following administration of lactulose are essential in the valid interpretation of this test as a measure of oral-caecal transit time.

Adolescent↗
PubMed1984

Evidence for sphincter dysfunction in patients with gallstone associated pancreatitis: effect of ceruletide in patients undergoing cholecystectomy for gallbladder disease and gallstone associated pancreatitis.

The functional activity of the sphincter of Oddi complex has been examined by ceruletide manometry in patients undergoing cholecystectomy with a normal peroperative cholangiogram. In Group I (n = 14), which included patients with previous acute cholecystitis/biliary colic, the sphincter activity appeared to be normal and responded to intravenous ceruletide by a marked relaxation with a significant fall in both the infusion and postinfusion pressures. In patients undergoing cholecystectomy for gallstone-associated pancreatitis (n = 8), the sphincter exhibited manometric features of hypotonia with low infusion and postinfusion pressures which were not significantly altered by intravenous ceruletide.

Acute Disease↗
PubMed1984

Percutaneous cervical pharyngostomy. A comfortable and convenient alternative to protracted nasogastric intubation.

For patients who require lengthy periods of enteral nutrition or gastrointestinal decompression, the use of a tube placed through a cervical pharyngostomy provides a convenient means of access to the upper gastrointestinal tract. The discomfort and complications of nasogastric intubation can be avoided, and the use of parenteral nutrition can be reduced in many cases where the gastrointestinal tract is functioning but the patient is unable to ingest food normally. The result of this technique in 42 patients over a 4 year period have been described herein. The patients found the method comfortable, cosmetically acceptable, and easily managed both in the hospital and at home. The technique of inserting the tube through the pyriform sinus is easy and safe to perform, and there have been no major complications in using the technique for periods up to 119 days. If accidentally displaced, the tube is easily reinserted through the neck without special equipment and with no discomfort. The method can provide a considerable improvement in the effectiveness of overall patient management. We suggest it could be more widely used in general surgical practice.

Adenocarcinoma↗
PubMed1984

Serum proteinase-like peptidase activities and proteinase inhibitors in women with breast disease.

The pre-treatment serum activities of several proteinase-like peptidases and the proteinase inhibitors, alpha 1-antitrypsin (alpha 1AT) and alpha 2-macroglobulin (alpha 2M), have been determined in 102 women with breast cancer and compared with those in 20 women with benign disease and in 30 healthy women of cancer bearing age. There were no significant differences in serum proteinase-like peptidase activities associated specifically with breast cancer. However, trypsin-like and plasmin-like activities were significantly lower than normal in women with breast disease. Serum alpha 1AT and alpha 2M levels were higher in patients with breast cancer than in healthy women or women with benign breast disease. These results indicate that, at presentation, breast cancer is not associated with abnormal serum levels of the proteinase-like peptidases studied, possibly as a result of an increase in the concentration of proteinase inhibitors.

Adult↗
PubMed1984

Serum and tissue proteinase-like peptidase activities in women undergoing total mastectomy for breast cancer.

Serum proteinase-like peptidases and proteinase inhibitor activities have been determined in 40 women with breast cancer at presentation and following total mastectomy. Activities of these enzymes have also been determined in homogenates of malignant (n = 13) and non-malignant (n = 11) breast tissue and benign breast lesions (n = 10). Following surgical treatment, the serum collagenase-like, cathepsin B-like and cathepsin H-like peptidase activities were significantly reduced. In addition, the activities of collagenase-like, cathepsin B-like and elastase-like peptidases were significantly higher in malignant breast tissue than in either non-malignant tissue from the same breast, or benign breast lesions. These findings are consistent with the suggestion that proteinases may have a role in tumour invasion.

Adult↗
PubMed1984

Computerized 24-hour ambulatory esophageal pH monitoring and esophagogastroduodenoscopy in the reflux patient. A comparative study.

Ambulatory 24-hour esophageal pH monitoring and esophagogastroduodenoscopy were performed in 72 patients with symptoms suggestive of gastroesophageal reflux. Additionally, 22 asymptomatic healthy volunteers underwent pH monitoring. In patients with classic reflux symptoms and endoscopic esophagitis, a mean of 5.41 minutes/hour of reflux below pH 4 was found compared to 0.70 minutes/hour in controls (p less than 0.0001). The mean number and duration of reflux events in this group were 1.51 events/hour and 4.0 minutes/event, compared with 0.31 events/hour and 2.26 minutes/event in volunteers (p less than 0.001, p less than 0.01). A new system for ambulatory esophageal pH monitoring is presented using a pH-sensitive radiotelemetry pill or a pH probe and computerized methods for ambulatory data collection, analysis, and storage. An overall sensitivity of 76% was obtained with a 91% selectivity for detection of acid reflux in 51 patients having classic symptoms of gastroesophageal reflux. Ambulatory pH monitoring was positive for acid reflux in seven of 11 patients with normal endoscopic findings. Conversely, eight of 12 patients with normal pH monitoring had endoscopic esophagitis. In 19 patients presenting with atypical symptoms or previous gastric surgery, endoscopic findings were normal in 15. Nine of these 15 were identified as acid refluxers by pH monitoring. A combined approach using both pH monitoring and endoscopy is warranted for maximal detection and quantification of disease. A clear clinical role for pH monitoring is seen in the early diagnosis of acid reflux, particularly in patients having normal endoscopic findings with nonspecific gastrointestinal complaints or previous gastric operations.

Adult↗