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Biomedical subjects

A K Burroughs

Publications and source records attributed to A K Burroughs.

284 records · Page 16Linked to original sources
PubMed1981

Long-standing asymptomatic primary sclerosing cholangitis: report of three cases.

Three patients, two males and one female, with asymptomatic primary sclerosing cholangitis (PSC) are described. The diagnosis was made in each case by endoscopic retrograde cholangiography after investigation of persistent elevation of the serum alkaline phosphatase. All three have remained completely well without any medical or surgical treatment for 3, 7, and 15 years, respectively, despite extensive involvement of the biliary tree. Follow-up liver biopsies in two have shown no histological evidence of progression to secondary biliary cirrhosis. PSC may occur more frequently and may follow a less severe clinical course than previously recognized.

Adult↗
PubMed1978

Medical students, medical records and clinical skills.

140 Liverpool medical undergraduates from all three clinical years completed a two part questionnaire. The first part gave their opinion on the contents of medical case records and how they personally recorded and used them. The second part showed the usefulness to students of their teachers' assessments of their clinical skills. The results indicated that the present case record and assessment of clinical skills were unhelpful in the students' education. The type of record-keeping which students thought best was very similar to the problem-orientated medical record (POMR). The kind of assessment of clinical skills which they would like was very similar to the educational audit linked with POMR. In view of these findings, the introduction of POMR into the undergraduate curriculum is strongly advocated.

Clinical Competence↗
PubMedDate not supplied

The ontogeny of liver copper metabolism in the guinea pig: clues to the etiology of Wilson's disease.

The normal human neonate has a copper profile indistinguishable from Wilson's disease, and we have previously postulated that this disease is caused by genetic failure to switch from the fetal to adult mode of copper metabolism. This study validates the developing guinea pig as a suitable animal in which to study copper ontogeny. At birth, liver copper concentrations are 7 times higher than in adults and serum copper and ceruloplasmin are 27 and 21% of adult values, respectively. A 53% fall in liver copper occurs in the 4 days after birth. This is associated with a marked increase in bile copper output, which does not parallel increasing bile flow. Liver copper falls, and serum copper and ceruloplasmin increase to near adult levels in the 30 days after birth. Until the sixtieth day of gestation, liver copper was significantly increased in copper-stressed littermates, although paradoxically at birth, concentrations were significantly lower. In copper-stressed fetal animals, bile copper output increased markedly before birth. Metallothionein was the dominant copper-binding protein in the fetal liver but a minor component in the adult. Superoxide dismutase activity only developed after birth. We conclude that the postnatal switch from the fetal to adult mode of copper metabolism involves activation of biliary excretion and ceruloplasmin export as well as changes in the association of copper with hepatic copper proteins. Similarities between the fetus and Wilson's disease suggest that this disease is caused by failure of this postnatal adaptation process.

Aging↗
PubMedDate not supplied

Relation between liver pathology and prognosis in patients with portal hypertension.

The most common causes of variceal bleeding are cirrhosis, schistosomiasis, and extrahepatic portal venous obstruction. The prognosis for an individual patient depends on the severity of the bleeding episode and the underlying liver function. Liver function is determined to a large extent by the underlying liver pathology. Patients with noncirrhotic portal hypertension or cirrhosis with good liver function have good short- and long-term prognoses. In patients with established cirrhosis, the presence of alcoholic hepatitis, hepatocellular carcinoma, or portal venous thrombosis may adversely affect prognosis. In addition to affecting prognosis, the underlying pathology may also influence choice of treatment. This point is particularly true for treatments such as shunt surgery, liver transplantation, or transjugular intrahepatic shunts.

Esophageal and Gastric Varices↗
PubMedDate not supplied

Prognostic significance of the white nipple sign in variceal bleeding.

The prognostic significance of the white nipple sign in variceal bleeding was evaluated prospectively in 203 separate admissions for bleeding esophageal varices in 145 cirrhotic patients. During all admissions a standardized protocol of management defined the failure of transfusion and vasoactive drugs (conservative measures) to stop bleeding and the occurrence of early rebleeding, at which time either emergency sclerotherapy or a staple transection of the esophagus was used. The finding of a white nipple in 18 admissions (9%) did not have predictive value as regards the failure of conservative measures to stop bleeding within 24 hours or rebleeding within 5 days, and there was no association with increased mortality. In one case, a white nipple was seen to occur after spontaneous cessation of a variceal venous spurt, suggesting it is a platelet-fibrin plug. The white nipple sign is diagnostic of a varix that has bled but has no adverse prognostic significance.

Aged↗
PubMedDate not supplied

Portal hemodynamics in chronic liver disease.

Portal hypertension is a result of interplay of numerous static and dynamic forces. Portal hemodynamic characterization involves pressure and flow studies which in turn estimate portal pressure. Hepatic venous pressure gradient is the gold standard for determining portal pressure. Portal hemodynamic measurement has helped to understand the pathogenesis and prognosis of chronic liver disease and to define clinically important hepatic venous pressure gradients. Management strategies for ascites and prevention of variceal hemorrhage have been influenced by hemodynamic studies in animals and humans. The hemodynamics in non-cirrhotic portal fibrosis is ambiguous. The role of portal hemodynamic studies outside clinical trials needs further study.

Animals↗
PubMedDate not supplied

Somatostatin in the treatment of bleeding oesophageal varices.

Somatostatin has been evaluated in the treatment of patients with bleeding varices for the past 10 years. Six controlled trials are published and a large placebo controlled trial has been reported in abstract form. From these trials it appears that somatostatin is at least as effective as vasopressin or H2-antagonists and is more effective than placebo in the control of variaceal haemorrhage. It is also remarkably free of side effects in clinical practice.

Esophageal and Gastric Varices↗
PubMedDate not supplied

Transjugular intrahepatic portosystemic stent-shunt.

The transjugular intrahepatic portosystemic stent-shunt is a non-surgical method for creating a portosystemic shunt. Early reports suggest that it is effective for treating portal hypertension and variceal bleeding. This review describes the technique and discusses the indications and complications.

Angioplasty, Balloon↗
PubMedDate not supplied

Pregnancy and liver disease.

Liver disease in pregnancy should be considered in 3 categories: pre-existing disease, disease peculiar to pregnancy and coincident acute liver or gall-stone disease. In addition the time of onset of diagnosis in terms of the trimester of gestation must be verified, as the diseases peculiar to pregancy have a characteristic time of onset. In the last trimester closes obstetric management is required for the constellation of abnormal liver function tests, nausea and/or vomiting and abdominal pain. This may be due to severe pre-eclampsia, HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome or acute fatty liver of pregnancy with or without sub-capsular hepatic haematomas, amongst which there is an overlap. Early delivery is curative. A molecular basis consisting of long chain 3-hydroxyl CoA dehydroxegenase deficiency in heterozygote mothers underlies this clinical syndrome. Ursodeoxycholic acid is now established treatment for intra-hepatic cholestasis of pregnancy and appears to improve foetal outcome. Hepatitis B vaccination and immunoglobulin at birth prevents chronic hepatitis B in children of HBsAg (hepatitis B surface antigen) positive carrier mothers.

3-Hydroxyacyl CoA Dehydrogenases↗