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Biomedical subjects

A K Burroughs

Publications and source records attributed to A K Burroughs.

At least 253 records · Page 14Linked to original sources
PubMed1989

A comparison of sclerotherapy with staple transection of the esophagus for the emergency control of bleeding from esophageal varices.

We compared two procedures for the emergency treatment of bleeding esophageal varices in patients who did not respond to blood transfusion and vasoactive drugs. We randomly assigned 101 patients with cirrhosis of the liver and bleeding esophageal varices to undergo either emergency sclerotherapy (n = 50) or staple transection of the esophagus (n = 51). Four patients assigned to sclerotherapy and 12 assigned to staple transection did not actually undergo those procedures, but all analyses were made on an intention-to-treat basis. Total mortality did not differ significantly between the two groups; the relative risk of death for staple transection as compared with sclerotherapy was 0.88 (95 percent confidence interval, 0.51 to 1.54). Mortality at six weeks was 44 percent among those assigned to sclerotherapy and 35 percent among those assigned to staple transection. Complication rates were similar for the two groups. An interval of five days without bleeding was achieved in 88 percent of those assigned to staple transection and in 62 percent of those assigned to sclerotherapy after a single injection (P less than 0.01) and 82 percent after three injections. In only 2 of the 11 patients who received a third sclerotherapy injection was bleeding controlled for more than five days, and 9 died. We conclude that staple transection of the esophagus is as safe as sclerotherapy for the emergency treatment of bleeding esophageal varices and that it is more effective than a single sclerotherapy procedure. We currently recommend surgery after two injection treatments have failed.

Adolescent↗
PubMed1989

Inhibition of platelet aggregation by abnormal high density lipoprotein particles in plasma from patients with hepatic cirrhosis.

ADP-induced aggregation of normal washed platelets was measured by nephelometry in the presence of plasma high density lipoprotein (HDL) from normal subjects and from 30 patients with hepatic cirrhosis. HDL, at one-eighth of its plasma concentration, inhibited platelet aggregation; the effect of cirrhotic HDL (40% [SD 29%] inhibition) was significantly greater than that of normal HDL (16% [11%]). The mean apolipoprotein E content of cirrhotic HDL was significantly higher than that of normal HDL, and strongly inhibitory HDL contained twice as many apolipoprotein-E-rich particles as weakly inhibitory HDL. Inhibition of platelet aggregation was correlated with the apolipoprotein E content of HDL from patients with cirrhosis.

Adenosine Diphosphate↗
PubMed1989

Variceal hemorrhage.

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Esophageal and Gastric Varices↗
PubMed1989

Cirrhotics with variceal hemorrhage: the importance of the time interval between admission and the start of analysis for survival and rebleeding rates.

The importance of variable time of entry for analysis of survival following variceal bleeding has recently been disputed. In a study of 194 cirrhotic patients with bleeding esophageal varices in whom 2-day mortality was 3%, statistically significant differences in both survival and rebleeding rates were obtained by shifting the starting point for analysis of survival by 2 weeks following admission to hospital or by 5 days for the analysis of rebleeding. In addition, the curve of hazard function for death or for failure to control bleeding following admission clearly showed that any change in entry time in a study of variceal bleeding would introduce bias and alter survival or rebleeding rates. Thus, the starting point for analysis following variceal hemorrhage is an important confounding variable when calculating both survival and rebleeding. It should always be taken into account, particularly in clinical trials, which are often performed in centers where patients are referred from other hospitals at different times following bleeding.

Epidemiologic Methods↗
PubMed1989

Antimitochondrial antibodies in primary biliary cirrhosis recognize both specific peptides and shared epitopes of the M2 family of antigens.

Sera from patients with primary biliary cirrhosis exhibit variable autoantibody reactivity against mitochondria, the commonest antigen (designated M2) including three structures of approximate M.W. 70, 50 and 40 kD. The nature of these antigens has only recently been established; the 70 and 50 kD are the transacetylase E2 and component X, respectively, of the pyruvate dehydrogenase complex and are distinct polypeptides. We have demonstrated, by immunoblotting, elution and rebinding of antibodies, unequivocal cross-reactivity between the major bands of the M2 antigen. In addition, cross-reactivity has been shown between antibodies binding to each of the three M2 bands of mitochondria and two major antigenic bands of both Gram-negative and Gram-positive bacteria. Conversely, antibodies eluted from these two bands of Escherichia coli were found to bind all three M2 bands of mitochondria. These results suggest that the antibodies of primary biliary cirrhosis contain both peptide-specific and cross-reacting antibodies, the latter recognizing a common "M2 epitope" that might include nonprotein components of the peptides. However, direct and competitive enzyme-linked immunosorbent assays failed to implicate the coenzyme of the pyruvate dehydrogenase complex, lipoic acid or its amide, as the common antigenic moiety.

Autoantibodies↗
PubMed1989

Significant bacteriuria has prognostic significance in primary biliary cirrhosis.

Significant bacteriuria in women has been found to be associated with increased mortality in community-based studies. We have previously reported a high prevalence of significant bacteriuria with a high recurrence rate in females with primary biliary cirrhosis (PBC), particularly those with late stage disease on liver biopsy. During a 5-year period we prospectively screened for significant bacteriuria in 187 women with primary biliary cirrhosis, (median follow-up of 47 months, range 1-83). Significant bacteriuria was found in 30 (17%) in their first urine (index bacteriuria), 90 (48%) died and 15 (8%) had liver transplants. Cox's proportional hazard models showed that age, serum bilirubin, ascites and cirrhosis were independent prognostic variables. Index bacteriuria added significantly to this model (P = 0.069) being independent from other variables, with an increased relative hazard for death of 1.65 (65% increase in risk of death) compared to non-bacteriuric patients. This effect was due mainly to non-cirrhotic patients with significant bacteriuria as shown by using multiplicative variables for histological stage and significant bacteriuria. An index of recurrent bacteriuria was significantly increased in patients with index bacteriuria (P less than 0.001) and in those who died or underwent transplantation (P less than 0.001). In this study, significant bacteriuria defined a specific sub-group of PBC patients with an increased risk of death.

Adult↗
PubMed1989

Carcinoma of the esophagus and long-term sclerotherapy.

We report a case where a chronic non-healing esophageal ulcer which developed following a course of endoscopic sclerotherapy proved to be an esophageal carcinoma. In view of 2 similar previous reports we discuss the possibility that sclerotherapy may act as a carcinogen, and suggest that all such non-healing esophageal ulcers should be biopsied.

Carcinoma, Squamous Cell↗
PubMed1989

Copper overload in the developing guinea pig liver: a histological, histochemical and biochemical study.

The copper profile in Wilson's disease resembles that of human and guinea pig neonates. Microvesicular steatosis is characteristic of early histological damage in Wilson's disease. The aim of this study was to relate the histological, histochemical and ultrastructural changes seen in developing guinea pig liver to the developmental pattern of liver copper in these animals. Copper-stressed and control guinea pigs were studied. Liver biopsies were stained with haematoxylin and eosin, rhodanine (for copper), orcein (for copper-associated protein) and oil Red 0 (for fat). Selected specimens were examined by electron microscopy. Liver and serum copper levels and copper oxidase activity were also determined. Fetal liver copper increased during the last trimester of pregnancy, reaching five times the adult level in the perinatal period and falling rapidly in the 4 days after birth. Marked steatosis developed in both control and copper-stressed guinea pig liver. The fat score correlated strongly with liver copper concentration (r: 0.60; p less than 0.001). Orcein and rhodanine staining correlated with liver copper concentration (r: 0.52 and r: 0.40 respectively, p less than 0.01). Marked prenatal hepatic steatosis and its postnatal clearance correlates with changes in liver copper concentration. This experimental model provides an opportunity to study the pathogenesis of hepatic steatosis and the relationship between copper retention and steatosis.

Animals↗
PubMed1989

Surgery and sclerotherapy for treatment of portal hypertension and oesophageal varices.

Surgery and sclerotherapy are both used for the prevention of rebleeding from varices and for primary prevention. Prophylactic shunt surgery has been shown to be harmful, but devascularisation procedures are in use in Japan. Shunt surgery is the most effective therapy for the prevention of rebleeding and does not decrease survival rates in patients, compared with those not receiving therapy. However, the risk of encephalopathy, which may be severe, is increased. Sclerotherapy reduces the number of patients rebleeding by only a small proportion, but greatly diminishes the number of episodes of rebleeding. However, the value of emergency sclerotherapy in preventing rebleeding throughout the long term studies, as opposed to the solely elective component, has not been evaluated. The non-injection arm received neither emergency nor elective injection. Randomised studies comparing sclerotherapy and shunt surgery show surgery to be more effective and to have similar survival rates to sclerotherapy, with the exception of 1 study. Devascularisation, as practised by Sugiura, results in bleed-free rates equivalent to those achieved with shunts. These results have not been reproduced in the West. Since liver transplantation is a reality today, shunt surgery involving the portal vein and devascularisation should be avoided.

Esophageal and Gastric Varices↗
PubMed1988

Randomised controlled trials for variceal bleeding.

The variceal bleeding episode represents several days of high risk of bleeding, thus therapy should be evaluated not only in terms of immediate cessation of bleeding but also in terms of providing a bleed-free interval of a few days. As the risk of continued bleeding or very early rebleeding from varices diminishes rapidly following admission, time is an important confounding variable when comparing therapies within and between trials. Cirrhotics with better liver function are more likely to stop bleeding with simple measures than those with worse liver function. Vasopressin, glypressin, vasopressin combined with nitroglycerin and somatostatin have all been used as splanchnic arteriolar vasoconstrictors thus reducing portal pressure. No trial has demonstrated increased survival with use of these agents. The efficacy of vasopressin is now disputed. Vasopressin combined with nitroglycerin and somatostatin have the fewest side-effects and may be more effective than vasopressin alone. Balloon tamponade arrests bleeding and prevents exsanguination, but should be used solely as a temporizing measure before the use of emergency sclerotherapy or surgery. Sclerotherapy is the only non-operative emergency technique which has been shown not only to stop variceal bleeding, but to reduce the frequency of very early rebleeding. Emergency oesophageal transection is equally if not more effective in arresting bleeding than sclerotherapy and has a lower early rebleeding rate and a similar mortality. Choice of treatment depends on expertise available. Further studies in the management of variceal bleeding should evaluate 3 main areas. Firstly improvement of existing therapies or new therapies. Secondly, investigation of therapies not related to bleeding, eg prophylaxis against infection, improvement in renal support. Lastly evaluation of predictive factors which may a priori determine a high risk of continued bleeding or early rebleeding thus justifying immediate sclerotherapy or surgery in a sub-group of patients.

Balloon Occlusion↗
PubMed1987

Delta hepatitis in Lebanon. Prevalence studies and a report on six siblings with chronic delta-positive active hepatitis.

The prevalence of delta infection in Lebanon is reported for the first time. Delta antigen and antibody were screened for in serum of 43 patients consecutively seen in hospital, 22 with acute hepatitis B (anti-HBc IgM-positive), and 21 with histological evidence of chronic active hepatitis, 6 of whom were brothers in a sibship of eleven. Twenty asymptomatic HBsAg carriers without clinical or biochemical evidence of liver disease were similarly studied. None of the asymptomatic carriers or acute hepatitis B patients had markers of delta infection. In contrast, delta antibody in high titre (greater than 1:5000) was found in 12 (57%) of the patients with chronic active hepatitis, including all six brothers. Five sisters in the sibship were anti-HBs-positive without evidence of liver disease, suggesting a horizontal mode of transmission of the delta virus, as a superinfection on a hepatitis B carrier state. Excluding the sibship, delta infection was present in 6 of 15 (40%) chronic active hepatitis patients. This prevalence is similar to other Middle Eastern countries. Delta infection was associated with severe liver disease.

Acute Disease↗