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Biomedical subjects

A S Mee

Publications and source records attributed to A S Mee.

At least 37 records · Page 2Linked to original sources
PubMed1984

Conservative surgery in the Zollinger-Ellison syndrome.

Laparotomy failed to show an obvious primary lesion in two patients with the Zollinger-Ellison syndrome (ZES), one of whom had metastatic gastrinoma in a solitary lymph node which was removed. Both patients underwent a truncal vagotomy and pyloroplasty. Postoperative acid studies have shown a marked and sustained diminution in acid hypersecretion which was particularly striking in the patient with a solitary metastatic lymph node. The patient without a detectable lesion is now well-controlled on half the dose of cimetidine required pre-operatively and the other no longer requires therapy. We believe that patients in whom pre-operative investigations have shown no evidence of extensive metastases should undergo laparotomy in the hope of finding a solitary primary or isolated metastatic lesions unassociated with an obvious primary in the pancreas. Available evidence suggests that simple removal of such lesions offers the patient an excellent chance of long-term remission. However, if no such lesion is discovered, vagotomy may be the logical procedure to assist in the subsequent pharmacological control of the acid hypersecretory state.

Adult↗
PubMed1983

Evaluation of an extended pancreatic function test in normal subjects and in patients with chronic pancreatitis.

Exocrine pancreatic response was evaluated in patients with varying degrees of pancreatic damage and in control subjects by means of an extended pancreatic function test (PFT). A second injection of secretin and pancreozymin was given after completion of the standard test. The discriminatory value of the standard PFT with regard to bicarbonate and enzyme output was not enhanced by a second bolus dose of hormones. It is concluded that the secretory potential of damaged pancreatic exocrine tissue cannot be exhausted by prolonged stimulation employing repeat bolus stimulation.

Adult↗
PubMed1983

Comparative study of pancreatic polypeptide (PP) secretion, endocrine and exocrine function, and structural damage in chronic alcohol induced pancreatitis (CAIP).

The serum pancreatic polypeptide response to intravenous Boots secretin (1.5 U/kg), glucose tolerance, and insulin responses have been studied in 25 patients with chronic alcohol induced pancreatitis of varying severity, and these results compared with a secretin-pancreozymin test, and the structural damage noted on pancreatography. For the pancreatic polypeptide response 16 healthy subjects acted as controls. There was a marked reduction in pancreatic polypeptide response in patients with advanced structural changes of chronic alcohol induced pancreatitis compared with patients with minimal/moderate changes (p less than 0.01) and with healthy controls (p less than 0.05) although there was no difference between the latter two groups. Similarly, while the ratio of peak to mean basal pancreatic polypeptide concentration was also significantly reduced in patients with advanced changes compared with healthy controls (p less than 0.05) there was a marked degree of overlap in patients with lesser degrees of structural damage and control subjects. For all patients with chronic alcohol induced pancreatitis, however, there was a significant correlation between the pancreatic polypeptide response and each parameter of the standard secretin-pancreozymin test and with glucose tolerance and the integrated insulin response. We conclude therefore that while the secretin stimulated pancreatic polypeptide response correlates significantly with accepted tests of pancreatic structure and function, there is a significant degree of overlap in the response obtained in patients who have minimal/moderate damage and healthy controls making the test insufficiently sensitive for routine diagnostic use.

Adult↗
PubMed1983

Changing concepts in the presentation, diagnosis and management of the Zollinger-Ellison syndrome.

Nine patients with the Zollinger-Ellison syndrome seen at a single referral centre between 1976 and 1981 are presented to highlight changes in the recognition, diagnosis and management of the condition. Less well recognized manifestations such as diarrhoea and features of the multiple endocrine neoplasia (MEN) type I syndrome are described, and the simplification of the pre-operative diagnosis by the use of both the serum gastrin estimation and the secretin provocation test considered. The problem of tumour localization is discussed with special reference to the newer techniques such as ultrasound, endoscopic retrograde cholangiopancreatography (ERCP) and CAT scanning, and the value of arteriography confirmed. The striking advances in management during the past few years are stressed with special reference to the role of the H2-receptor blocking drugs. Despite their profound inhibitory effect on both acid secretion and symptoms, all patients with the exception of those with proven metastases or the MEN type I syndrome underwent laparotomy to exclude a resectable lesion. If no resectable lesion was found truncal vagotomy was performed to facilitate acid secretory control post-operatively and H2-receptor blocking drugs continued in a dose necessary to maintain basal acid secretion under 5 mmol/hr.

Adolescent↗
PubMed1983

Immunoproliferative small-intestinal disease: follow-up of an alpha-chain negative, lymphoma-free group.

Six patients had the clinical and pathological features of immunoproliferative small-intestinal disease (IPSID). All were female with malabsorption or growth retardation in whom testing for alpha-heavy chains was repeatedly negative. They were followed for a mean of 7.5 years, during which time no significant alteration in the jejunal biopsy appearances of five patients has occurred, none have developed lymphomas.

Adolescent↗
PubMed1982

Crohn's disease of the colon. Problems and delays in diagnosis.

Four cases of Crohn's disease of the colon are presented in order to illustrate some of the difficulties which may arise in making a correct diagnosis. A combination of a high index of suspicion and suggestive clinical, sigmoidoscopic, radiological and histological features is necessary if the disease is not to be missed or misdiagnosed.

Adolescent↗
PubMed1982

Ranitidine in the treatment of gastric ulceration.

Seventy-two patients with endoscopically proven gastric ulcers were entered into a prospective controlled trial to assess the efficacy of ranitidine and cimetidine in ulcer healing. All patients were biopsied on entry and at subsequent endoscopies. After exclusion of 7 patients during the first month of treatment, the remaining 65 patients, 47 males and 18 females, mean age 48.2 +/-1.5 years, at 1 month had a healing rate of 47% and 52% respectively. The non-healers continued their treatment for a further 4 weeks. This increased the healing rate to 77% and 76% respectively. If the defaulters and poor compliers are withdrawn the healing rate rises to 58% and 57% at 4 weeks and to 91% and 79% at 8 weeks respectively. There was no significant difference between the two groups as regarded initial ulcer size and severity of dyspepsia. Antacid tablet consumption during the study was comparable. The initial size of the ulcers which failed to heal after 4 weeks of treatment tended to be larger than those which healed (P less than 0.05), but smoking did not appear to influence ulcer healing. No obvious side-effects or evidence of dysplasia were found. The study shows that ranitidine is at least as effective as cimetidine in gastric ulcer healing.

Aged↗
PubMed1981

Endoscopic removal of sharp foreign objects using an oversleeve.

We describe a method for the endoscopic removal of sharp foreign objects from the stomach using a plastic oversleeve. This sleeve allows repeated passage of the endoscope without discomfort and minimizes the risk of the foreign body causing damage to the mucosa or of its being dislodged from the grasping forceps as it is withdrawn.

Adolescent↗
PubMed1981

Non-operative removal of bile duct stones by duodenoscopic sphincterotomy in the elderly.

Between January 1975 and December 1979, 71 patients over the age of 70 underwent attempted duodenoscopic sphincterotomy for stones in the common bile duct. Fifteen patients still had gall bladders in situ. Sphincterotomy was possible in 69 of the patients and in 65 of these duct clearance was achieved, giving an overall success rate of 92%. Failure to achieve sphincterotomy in two cases was due to substantial peripapillary diverticula. Duct clearance failed in four patients, mostly due to the size of the retained stones. The largest stone extracted was 24 mm diameter. There were no deaths but complications occurred in nine patients (13%); these were haemorrhage in four (requiring surgery in one), cholangitis in four (two of whom required surgical extraction of stones), and pancreatitis in one. The average duration of hospital stay in successful cases was 11 days (range three to 30). Clinical follow-up of 55 patients one to five years after sphincterotomy showed no evidence of stones or of stenosis of the sphincter. Duodenoscopic sphincterotomy is a major advance in the management of elderly patients with stones in the common bile duct.

Aged↗
PubMed1981

Non-surgical palliation of malignant oesophageal obstruction in the elderly.

Fourteen elderly patients with malignant oesophageal obstruction have undergone palliative intubation with a modified Celestin tube inserted under intravenous sedation using a fibreoptic endoscopic technique. Eleven patients surviving the two-week post-insertion period had a mean survival time of five months (range 1--20 months). In the majority, palliation was excellent, most patients being able to eat a virtually normal diet within 36 hours of the procedure. This technique has a much lower mortality and morbidity in the elderly than palliative surgery and allows for early mobilization and discharge. Earlier referral of suitable patients is necessary and the technique deserves wider application.

Adenocarcinoma↗
PubMed1980

Monocytes in inflammatory bowel disease: monocyte and serum lysosomal enzyme activity.

1. The activity of a specific lysosomal marker enzyme N'-acetyl-beta-D-glucosaminidase has been determined fluorimetrically in the monocytes and in the serum of patients with Crohn's disease and ulcerative colitis and compared with results obtained from healthy and disease control subjects. 2. Enzyme activities were measured in a monocyte-enriched suspension from a Ficoll-Triosil gradient and in an adherent monocyte preparation. 3. The results indicate that enzyme activity is greater in both monocytes and sera of patients with Crohn's disease and ulcerative colitis than in those from control subjects (P less than 0.01). 4. Enzyme activity within monocytes correlated with disease activity (P less than 0.05). 5. Lysosomal enzymes may contribute to the pathogenesis of the mucosal inflammation in inflammatory bowel disease.

Acetylglucosaminidase↗
PubMed1980

Monocytes in inflammatory bowel disease: absolute monocyte counts.

Using a cytochemical staining technique, peripheral blood monocytes have been precisely identified and enumerated in patients with inflammatory bowel disease and compared with healthy and disease control subjects. For ulcerative colitis there was a significant monocytosis, which was closely correlated with the total white cell count and with the activity of the disease. For patients with Crohn's disease, the peripheral blood monocyte count was also raised compared with that of the control groups, but the difference did not reach statistical significance. There was no correlation between the monocyte count in patients with Crohn's disease and the total white cell count or the disease activity. Some of the mechanisms that may influence the production and distribution of peripheral blood monocytes are discussed.

Adolescent↗
PubMed1980

Monocytes in inflammatory bowel disease: phagocytosis and intracellular killing.

The ability of peripheral blood monocytes from patients with ulcerative colitis and Crohn's disease to phagocytose and kill a standard strain of Staphyloccus aureus has been studied. Using lysostaphin, a rapidly acting muralytic enzyme, phagocytosis could be accurately differentiated from intracellular killing. When compared with normal healthy individuals and patients with gastrointestinal diseases not thought to be immunologically mediated, monocytes from patients with inflammatory bowel disease showed a statistically significant increase in the number of bacteria phagocytosed in 2 hours. There was no difference, however, between patients with Crohn's disease and those with ulcerative colitis. For all groups studied, more than 95% of ingested organisms were killed, and there was no difference between groups. These results suggest that peripheral blood monocytes in patients with Crohn's disease and ulcerative colitis are activated. It is unlikely that the granulomata of Crohn's disease result from a defect in the microbicidal function of the monocyte/macrophage system.

Adolescent↗