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Biomedical subjects

A E Cowen

Publications and source records attributed to A E Cowen.

At least 19 recordsLinked to original sources
PubMed2001

The clinical risks of infection associated with endoscopy.

The cleaning of flexible endoscopes is difficult and time consuming. Any method of attempted sterilization or high level disinfection will fail if prior cleaning has been defective. Inadequate reprocessing of endoscopes may result in patient to patient transmission of serious bacterial and viral diseases or infection with endemic hospital pathogens. Antibiotic prophylaxis is required to prevent septicemia and bacterial endocarditis in high risk patients undergoing specific endoscopic procedures. Prevention of serious endoscopy-associated clinical infections requires strict compliance with detailed reprocessing protocols by specially trained nursing staff.

Antibiotic Prophylaxis↗
PubMed1997

Severe upper gastrointestinal polyposis associated with sparse colonic polyposis in a familial adenomatous polyposis family with an APC mutation at codon 1520.

BACKGROUND: Familial adenomatous polyposis usually results in colonic polyposis with hundreds to thousands of polyps, congenital hypertrophy of the retinal pigment epithelium (CHRPE), and variable extracolonic features. Recent reports indicate that patients with distal mutations between codons 1445 and 1578 do not express CHRPE and have a high incidence of desmoid tumours. PATIENTS: The family studied has an unusual phenotype of sparse colonic polyposis but profuse upper gastrointestinal polyposis. Affected subjects do not have CHRPE. METHODS: The protein truncation test followed by sequencing identified a 2 base pair deletion at codon 1520 in the APC gene. This results in a frameshift creating a stop codon 13 codons downstream. RESULTS: This family demonstrates that sparse colonic polyposis but severe upper tract polyposis may be associated with mutations between codons 1445 and 1578. CONCLUSIONS: Study of duodenal and colonic polyps in further cases with mutations in this region is warranted. Such mutations may preferentially cause duodenal adenomas and desmoid tumours as somatic mutations in these tumours also occur in this region, unlike colorectal tumours where somatic mutations occur more proximally. This study emphasises the importance of screening the upper gastrointestinal tract even when the colonic disease is mild.

Adenomatous Polyposis Coli↗
PubMed1996

Endoscopic laser therapy for watermelon stomach.

Eleven patients (nine females, two males) with anaemia due to acute and chronic gastrointestinal blood loss were found to have gastric antral vascular ectasia (watermelon stomach). Nine patients were transfusion-dependent, receiving a mean of 13.1 units over a mean period of 12.3 months. All patients received neodymium:yttrium-aluminium-garnet laser coagulation with a median of 3.0 treatment sessions. Post-treatment transfusion needs were abolished in six patients and minimal in two patients during a mean follow up of 27.3 months (range 12-60 months). Overall there was a mean reduction in transfusion requirement with treatment from 2.5 units per month to 0.4 units per month (P < 0.02). Mean pretreatment haemoglobin improved from 7.7 to 11.9 g/dL after treatment (P < 0.001). No complications occurred. Laser coagulation is safe and effective treatment for anaemia due to watermelon stomach and should be considered as first line therapy.

Aged↗
PubMed1993

The role of ERCP and endoscopic sphincterotomy in the era of laparoscopic cholecystectomy.

The advent of laparoscopic cholecystectomy (LC) has led to some controversy regarding the best method of managing bile duct calculi. This paper reviews the cases of 38 patients who underwent LC and endoscopic retrograde cholangiopancreatography (ERCP), from a series of 600 consecutive laparoscopic cholecystectomies. Twenty-nine patients had ERCP performed pre-operatively because of suspicion of choledocholithiasis. Duct stones were confirmed in eight patients. Recent or current jaundice was the best predictor of bile duct stones. Nine patients had ERCP done postoperatively because of duct stones seen on operative cholangiography. In two patients bile duct cannulation was not possible and a third procedure, open duct exploration, was necessary. Techniques in laparoscopic management of duct stones are improving and the role of ERCP and sphincterotomy should be limited to jaundiced patients or those with proven bile duct stones in whom laparoscopic procedures have been unsuccessful.

Adult↗
PubMed1992

Gastrointestinal endoscopy: an accurate and safe primary diagnostic and therapeutic modality.

OBJECTIVE: To review the place of gastrointestinal endoscopy in the management of upper and lower gastrointestinal disorders. DATA SOURCES: We reviewed articles on endoscopy reported over two decades. A Medline search complementing our experience and knowledge of the literature was used to identify the articles. STUDY SELECTION: Papers were selected which focused on indications, comparison with radiology, including clinical outcome measures, and complications. One hundred papers, including those from radiology journals, were reviewed. DATA EXTRACTION: Results of studies are referenced as appropriate. DATA SYNTHESIS AND CONCLUSIONS: Endoscopy allows direct visualisation of the mucosa of the upper gastrointestinal tract, colon and terminal ileum. Subtleties of colour change, vascular pattern abnormalities and scarring are easily detected at endoscopy and are often of diagnostic importance. Endoscopy also provides access for tissue biopsy and allows a wide variety of therapeutic interventions. Traditionally barium studies have been the first step in the evaluation of many gastrointestinal symptoms and still retain cost advantages over endoscopy. However, endoscopy is frequently more sensitive and specific than barium studies. Costs associated with incorrect diagnoses may undermine the apparent cost benefits of barium studies. Advances in endoscopic design have allowed wider therapeutic options and increased safety. Gastrointestinal endoscopy should now be the first line of investigation where diagnostic precision is required or where therapeutic intervention is likely.

Barium Sulfate↗
PubMed1992

Infection and endoscopy: who infects whom?

Infection is one of the major hazards of endoscopic procedures and is the commonest complication of endoscopic retrograde cholangio-pancreatography (ERCP) causing death. Prevention of endoscopy-associated infections is based on adequate cleaning and disinfection regimens. Scrupulous mechanical cleaning is fundamental; even prolonged chemical disinfection will be ineffective if cleaning has not been adequate. Special measures are required to prevent ERCP-related infections. It is important to recognize various special circumstances that increase a patient's susceptibility to infection and to administer antibiotic prophylaxis when appropriate.

Cross Infection↗
PubMed1991

Successful treatment of two patients with gastric antral vascular ectasia 'watermelon stomach' using endoscopic Nd-YAG laser therapy.

Two patients with gastric antral vascular ectasia--'watermelon stomach'--successfully treated with endoscopic Nd-YAG laser are described. This condition is an uncommon cause of iron deficiency anaemia due to chronic blood loss and is usually managed by antrectomy. Endoscopic therapy with Nd-YAG laser offers an effective and safe alternative to surgery particularly in the elderly poor-risk patient.

Aged↗
PubMed1989

Early postoperative endoscopic sphincterotomy for retained common duct stones.

The results of endoscopic sphincterotomy in 30 patients with retained common bile duct stones and a T-tube in situ following surgical exploration of the common bile duct are presented. Successful stone extraction was achieved in 27 cases (90%). There was one death, which was not procedure related. Early postoperative T-tube cholangiography is advocated and if necessary sphincterotomy can be safely performed 1 week following surgery. This approach has advantages in shortening hospital stay and minimising patient discomfort.

Adult↗
PubMed1986

A comparison of colloidal bismuth subcitrate tablets and ranitidine in the treatment of chronic duodenal ulcers.

In a randomized, endoscopically controlled trial, the effects of colloidal bismuth subcitrate (CBS) tablets on the healing of chronic duodenal ulcers were compared with those of ranitidine (R). 38 patients were originally allocated to the CBS group and 37 to ranitidine. There were 5 dropouts in each group. Of 33 patients given CBS, 25 (75%) showed complete ulcer healing by 4 weeks and 30 (91%) by 8 weeks. Of the 32 patients given ranitidine, 28 (87%) showed complete ulcer healing by 4 weeks and 30 (94%) by 8 weeks. There was no significant difference between these results. Symptom resolution was similar in both groups and no significant adverse effects were noted.

Adult↗
PubMed1984

Endoscopic sphincterotomy for common bile duct calculi.

A series of 74 patients having endoscopic sphincterotomy for common bile duct calculi is reported. Complete stone extraction was achieved in 53 cases (72%). Seventeen of 21 patients with retained calculi following recent biliary surgery had successful extractions (80%). Of 30 patients having had a cholecystectomy, 21 (70%) were successful, but only 15 of 23 patients with obstructive jaundice and no previous biliary surgery had the ducts cleared of calculi. Failure was due to multiple stones in the duct, or calculi too large to pass through the sphincterotomy. Endoscopic sphincterotomy is advocated in patients with obstructive jaundice due to stones, moving to early surgery should it prove unsuccessful. The results in patients with a T-tube in situ are comparable to extraction of the calculi along the T-tube tract.

Adult↗
PubMed1984

A clinical approach to improving survival in colorectal cancer.

The majority of large bowel cancers arise from benign adenomatous polyps. The identification of groups at high risk, the effective investigation and surveillance of these groups, together with a more discerning clinical approach to patients with bowel symptoms provides the best hope of cure.

Adult↗
PubMed1983

Comparison of ranitidine and cimetidine in the treatment of chronic gastric ulcer. A double-blind trial.

The aim of the study was to compare the effectiveness of ranitidine and cimetidine in accelerating the healing of chronic gastric ulcer. 44 outpatients with endoscopically proven gastric ulcer whose duration of symptoms was greater than 4 weeks and who were without major systemic disease were studied. Patients were randomly allocated to receive either ranitidine, 150 mg twice a day or cimetidine, 200 mg three times a day and 400 mg at night for 4 weeks. If the ulcer had not healed, treatment was continued for a further 4 weeks, when patient assessment and endoscopy were repeated. By 4 weeks, 13 of 22 patients taking ranitidine (59%) and 14 of 22 patients taking cimetidine (64%) had healed (p2 = 1.0, 95% confidence interval - 20%, 38%). At 8 weeks, 91% on ranitidine and 91% on cimetidine had healed (p2 = 1.0, 95% confidence interval - 18%, 18%). Symptomatic improvement was similar with both drugs. Smoking did not influence healing rates. There were no major side effects with either medication. It is concluded that ranitidine and cimetidine are of similar efficacy in accelerating the healing of chronic gastric ulcer.

Adolescent↗
PubMed1981

Colonoscopic polypectomy.

Seven hundred and forty-one colonic polyps have been removed by colonoscopic polypectomy during 300 examinations. Up to 36 polyps were removed at a single examination. Colonoscopic treatment of villous adenomas to 7 cm has been successfully performed in elderly and infirm patients. There were no deaths or incidents of perforation and the only significant complications were two secondary haemorrhages requiring transfusion. The presence of a polyp was not definitely reported in 40% of barium enema X-ray examinations carried out within three months of polypectomy. Double contrast X-ray examinations were significantly more sensitive in the detection of polyps. Colonoscopic polypectomy is a safe and effective technique. All colonic polyps should be removed by this technique after diagnosis.

Adenoma↗
PubMed1979

Efficacy of cimetidine and tri-potassium di-citrato bismuthate (De-Nol) in chronic gastric ulceration: a comparative study.

Sixty patients with benign chronic gastric ulcer were treated in a controlled clinical trial to assess the relative efficacy of cimetidine and tri-potassium di-citrato bismuthate (De-Nol). Patients were assigned at random either to cimetidine or to De-Nol treatment after initial endoscopic diagnosis. Healing was assessed endoscopically after six weeks by an endoscopist who had no knowledge of the patients' treatment. Consumption of analgesic preparations (both for medical and for non-medical reasons), of other anti-inflammatory agents, and of alcohol and cigarettes was recorded. Of the 57 patients who were reassessed at six weeks, 30 had been assigned to De-Nol and 20 of these patients (66%) had completely healed; 27 patients had been assigned to cimetidine and 17 of these (63%) had also completely healed. Those patients who regularly ingested more than four analgesic preparations a day healed less frequently, but this effect was not statistically significant. There was no significant difference between cimetidine and De-Nol in the initial healing of chronic gastric ulceration. The choice of therapy for chronic gastric ulceration will depend on cost, patient acceptance, and data from studies of more complex therapeutic regimens.

Analgesics↗
PubMed1979

Liver disease associated with chronic arsenic ingestion.

The association of chronic liver disease with long-standing arsenic ingestion is well documented, although the spectrum and incidence of liver disease due to arsenic remain uncertain. We report two patients with chronic liver disease and arsenical skin changes that followed previous chronic arsenic ingestion. One patient developed macronodular cirrhosis and the other non-cirrhotic portal hypertension with perisinusoidal fibrosis. The latter patient developed a primary liver cell cancer. There is only one previously reported case of malignant hepatoma in a non-cirrhotic liver complicating chronic arsenicism. Lack of awareness of this uncommon but well described cause of chronic liver disease may account for a small proportion of patients with "cryptogenic" liver disease. Previous arsenic administration should be considered as a cause of chronic liver disease, especially when typical skin changes or internal neoplasia develop.

Arsenic↗