Search PubMed⌕ Search

Biomedical subjects

A W Hall

Publications and source records attributed to A W Hall.

At least 19 recordsLinked to original sources
PubMed2001

Radiation induced valvulitis with late leaflet rupture.

Various cardiac sequelae of mediastinal irradiation have been reported, from pericarditis to conduction defects. Despite the potentially fatal nature of some of these abnormalities, many may present with few or no symptoms. In this case report, the patient, who had received 4000 rads to the mediastinum 24 years previously, presented with worsening shortness of breath and two episodes of lightheadedness. Subsequently, he was found to have aortic valve rupture associated with fibrosis. A review of the literature indicates that valve rupture is a novel consequence of mediastinal radiation.

Aortic Valve↗
PubMed1999

Production and evaluation of guidelines for the management of inflammatory bowel disease: the Leicester experience.

Consensus guidelines for the management of patients with inflammatory bowel disease were produced by gastroenterologists, gastrointestinal surgeons and a cross-section of general practitioners (GPs) from Leicestershire in order to develop a seamless pattern of care with a common approach to diagnosis and treatment. It was hoped that the guidelines would encourage a movement towards care in the community for many patients with stable disease and so speed up new consultation rates. The study then assessed the impact of these guidelines on the referral letters of GPs to hospital consultants, the prediction of disease and adherence to them on re-referring patients after discharge. The guidelines were distributed to all 487 GPs in the Leicester Health Authority area and the gastroenterology teams within the hospitals. The value of the guidelines was assessed by an audit of referral letters, the length of time from referral letter to out-patient appointment, both before and after the launch of the guidelines, adherence to the guidelines on re-referral, and monitoring the outcome of the discharged patients. Whilst the guidelines may have helped GPs to manage stable patients in the community, the content of referral letters and the diagnostic abilities of GPs were not seen to improve since the launch of the guidelines. However, only 5% of stable patients who were discharged from one clinic were re-referred for inflammatory bowel disease.

Attitude↗
PubMed1998

Severe acute respiratory distress syndrome secondary to acute pancreatitis successfully treated with extracorporeal membrane oxygenation in three patients.

OBJECTIVE: To review three patients who underwent extracorporeal membrane oxygenation (ECMO) for acute respiratory failure secondary to pancreatitis. SUMMARY BACKGROUND DATA: Severe acute pancreatitis often causes the acute respiratory distress syndrome (ARDS), and if ventilation is required, the mortality rate is more than 50%. If the ratio of PaO2/FiO2 falls below 100 mm Hg or the Murray lung injury score exceeds 3.5, the mortality rate rises to more than 80%. Three patients who have severe ARDS secondary to pancreatitis, who were hypoxic despite ventilation with 100% oxygen and high airway pressures, and who were all successfully treated with ECMO are reported here. The consensus here is that all three patients would have died without ECMO. METHODS: Retrospective chart review and discussion of the literature. RESULTS: Pre-ECMO data: mean PaO2/FiO2 59.3 mm Hg, mean Murray lung injury score 3.7, one patient administered 20 ppm inhaled nitric oxide. ECMO data: mean extracorporeal flow at initiation of ECMO 56.3 mL/kg per minute, all patients administered veno-venous ECMO, mean duration of ECMO 104.7 hours. All patients were successfully weaned from ECMO and extubated. One patient had a protracted hospital stay because of a colo-cutaneous fistula. All patients are long-term survivors. CONCLUSIONS: Extracorporeal membrane oxygenation proved an effective therapy for severe ARDS complicating acute pancreatitis. Extracorporeal membrane oxygenation was conducted without bleeding complications in these three patients.

Acute Disease↗
PubMed1996

Physiologic control of cardiac assist devices.

Total artificial hearts (TAHs) and biventricular assist devices (BVADs) have varying levels of acceptance and reliability, and the research on both focuses on their control mechanisms. Efforts generally aim to achieve a response to physiologic demand and left/right output balance, and beneficial cardiac output (CO) and effective control mechanisms have been achieved by eliciting a Starting-like response to preload and afterload. Such control mechanisms, however, generally base device output on a single parameter, such as the preload on the heart. Current TAHs and BVADs provide relatively fixed oxygen delivery to patients with large physiologically induced variations in oxygen consumption. This paper aims to document fluctuations in oxygen consumption that are normal in BVAD and TAH patients, identify a number of patient-generated signals that reflect these fluctuations, and describe a multitiered control algorithm based upon these signals. Such a control system may offer better response times and more physiologic cardiac outputs. There currently exists a microprocessor-based control mechanism that can be adapted to control TAHs and BVADs using input from a variety of sensors, and it can be found in modern implantable pulse generators (IPGs). Today's pacemakers are capable of rate control and can run diagnostic programs and store data that could be valuable in the evaluation of the patient's condition.

Adult↗
PubMed1996

The management of chronic fissure in-ano with botulinum toxin.

Five patients with a chronic fissure in-ano each received an injection of Clostridium botulinum type A toxin into the lower internal anal sphincter. A mean lowering of maximum resting anal pressure by 23.3 (SEM 5.6) cm H2O was achieved within seven days. Maximum voluntary squeeze pressures were not significantly altered. Anal compliance increased in all cases. Healing of the fissure with an apparent reduction in anal sensation occurred in three of the patients and partial resolution of symptoms in the other two. No adverse effects resulted from injections of the toxin. A controlled trial to compare the relative efficacies of botulinum toxin and lateral sphincterotomy is required.

Adult↗
PubMed1992

Presentation of abdominal tuberculosis to general surgeons.

Abdominal tuberculosis (TB) continues to give rise to diagnostic and therapeutic challenges. A total of 24 patients with abdominal TB who presented to general surgeons over a 9-year period have been reviewed. Most (92 per cent) of these patients were Asian; only one had a past history of pulmonary TB. The most common presenting complaint was abdominal pain in 21 patients (88 per cent) with the associated symptoms of weight loss in 18 (75 per cent), anorexia in 15 (62 per cent) and night sweats in 13 (54 per cent). A tissue diagnosis was obtained in 18 patients (75 per cent) and 17 patients (71 per cent) underwent laparotomy. These results show that the diagnosis of abdominal TB is still difficult to establish, and that many patients undergo laparotomy despite the existence of less invasive diagnostic procedures.

Abdominal Pain↗
PubMed1990

Spontaneous benign pneumoperitoneum complicating scleroderma in the absence of pneumatosis cystoides intestinalis.

We describe a 64 year old woman with a 3-year history of scleroderma who presented as an emergency with increasing painless abdominal distention. Radiological investigations revealed a pneumoperitoneum in the absence of either visceral perforation or pneumatosis cystoides intestinalis. This is only the fourth report of spontaneous benign pneumoperitoneum complicating scleroderma without pneumatosis cystoides intestinalis. The possible aetiology of this condition is discussed.

Female↗
PubMed1987

Multicentre clinical trial of low volume fresh frozen plasma therapy in acute pancreatitis.

Fresh frozen plasma (FFP) has been proposed as a specific therapy for acute pancreatitis. Reduced mortality encountered in an uncontrolled clinical study and a controlled experimental study may be attributable to replenishment by FFP of the naturally occurring antiprotease system. To investigate this potential therapy further, 202 patients presenting with acute pancreatitis were randomized to receive FFP (2 units daily for 3 days) or a similar volume of colloid control as part of their intravenous fluid therapy. Clinical progress was monitored and the major serum antiproteases (alpha 1-antiprotease and alpha 2-macroglobulin) were measured on days 1, 3 and 7. There was no significant difference between the two groups in terms of clinical outcome. alpha 1-Antiprotease levels rose significantly from day 1 to day 3 in both groups (P less than 0.0001) and remained elevated at day 7. alpha 1-Antiprotease is an acute phase protein in man and raised serum levels would be anticipated. FFP appears to have no effect on the magnitude of this rise. Serum alpha 2-macroglobulin levels were reduced in both groups on day 1 and continued to fall significantly from day 1 to day 3 in the colloid control group (P less than 0.005) whilst remaining substantially unaltered in patients receiving FFP (P = 0.6527). alpha 2-Macroglobulin plays a central role in the elimination of proteases during acute pancreatitis and the ability of relatively low volumes of FFP to reduce the fall in serum alpha 2-macroglobulin levels seen during the early stages of this disease may have therapeutic implications.

Acute Disease↗
PubMed1987

Treatment and outcome in 52 consecutive cases of ampullary carcinoma.

The results of treatment and outcome in 52 consecutive patients presenting to Leicester from 1972 to 1984 are presented. The number of patients diagnosed increased from two per year before the introduction of duodenoscopy to nearly five per year afterwards. Endoscopic drainage (ED) was attempted in 21 patients with a success rate of 81 per cent. In eight cases ED was used pre-operatively and in the remainder as definitive treatment. Twenty-four patients had a Whipple's resection (12.5 per cent mortality), four patients had a local resection (no deaths), ten patients had surgical bypass (60 per cent mortality) and thirteen patients had ED alone (23 per cent mortality). The major risk factor score was significantly greater in patients undergoing surgical bypass compared with Whipple's resection. Age and risk factor scores were significantly greater in patients who had ED drainage alone than in surgical patients. The 5 year survival rate for resection was 56 per cent versus 13 per cent for drainage procedures (P less than 0.001). Survival in resection cases was directly related to the degree of tumour differentiation and a new staging system. It is proposed that all patients with ampullary tumours should have endoscopic biopsy followed by ED; Whipple's resection remains the surgical treatment of choice.

Adenocarcinoma↗
PubMed1987

Synthesis of some [N-(2-haloalkyl)amino]tetralin derivatives as potential irreversible labels for bovine anterior pituitary D2 dopamine receptors.

A series of hydroxylated 2-aminotetralins were prepared in the search for irreversible labels for D2 dopamine receptors. N-2-Haloacetyl and N-2-haloalkyl substituents were chosen as potential receptor alkylating groups. Titrimetric studies were carried out on [N-(chloroethyl)-N-methylamino]tetralins 10, 10a, 24, and 26 to demonstrate that aziridinium ions were formed as reactive intermediates from these compounds. This observation was confirmed by 1H NMR studies on compound 10. The majority of the aminotetralins prepared showed reasonably high affinity binding to anterior pituitary D2 dopamine receptors and exhibited agonist properties. Structure-activity results are presented together with preliminary studies designed to identify irreversible receptor binding agents. [N-(2-Chloroethyl)-N-propylamino]-6,7-dihydroxytetralin hydrobromide (18) proved most promising in these studies.

Acylation↗
PubMed1987

Oat cell carcinoma of the bronchus and acute pancreatitis.

A case of small cell carcinoma of the lung presenting with acute pancreatitis is described. We believe this to be the first such case reported, despite the frequency of metastasis to the pancreas from such tumours. We discuss the investigation and management of such cases.

Acute Disease↗
PubMed1986

Guanine nucleotide effects on agonist binding at D2 dopamine receptors in bovine anterior pituitary.

[3H]Spiperone binding to D2 dopamine receptors on bovine anterior pituitary membranes is of high affinity, saturable and unaffected by guanine nucleotides. Antagonist displacement of [3H]spiperone binding is characterised by pseudo Hill coefficients close to one and is unaffected by guanine nucleotides. Agonist displacements show pseudo Hill coefficients less than one and agonist affinities are reduced by guanine nucleotides, although pseudo Hill coefficients are essentially unchanged. Agonist displacement curves may be treated in terms of two agonist binding sites with different agonist affinities, and in the presence of guanine nucleotides the two-binding site model remains the best description of the data.

Animals↗
PubMed1984

The urgent diagnosis of gallstones in acute pancreatitis: a prospective study of three methods.

Ultrasonography (US), radionuclide biliary scanning (RBS), and biochemical tests were performed within 72 h of admission in 83 patients with acute pancreatitis in an attempt to define those with gallstones as an aetiological factor. US was 92 per cent accurate in the 80 per cent of patients in whom the gallbladder was demonstrated. There were no false positives. Sixty-seven per cent of patients with gallstones were diagnosed although this improved to 78 per cent when US was repeated following the patients' clinical improvement. The pattern of RBS was completely normal in 46.5 per cent of patients with biliary pancreatitis and 64 per cent of patients with non-biliary pancreatitis. Biochemical tests completely separated 47 per cent of patients with gallstones from those without. Used in combination with US these two methods accurately identified 81 per cent of patients in the biliary group. In conclusion US was found to be a rapid and accurate method of gallstone detection but used alone it has limited usefulness. RBS can be time consuming and was found to be of doubtful value. Biochemical tests were helpful in indicating a proportion of patients who had gallstones which were not detected by US, and therefore have a practical application. Current methods of gallstone detection in patients with acute pancreatitis are far from ideal and further studies are indicated.

Acute Disease↗
PubMed1981

The place of hepatobiliary isotope scanning in the diagnosis of gallbladder disease.

The present trend towards a more aggressive operative policy in acute cholecystitis has led to a search for more accurate methods of diagnosis. A possible contender in this field is hepatobiliary isotope scanning. Ninety-nine patients with right-sided upper abdominal pain were studied after the intravenous injection of 99Tcm-pyridoxylideneglutamate. In addition, contrast radiology was performed in 87 of these. Subsequently 23 were shown to have acute cholecystitis, 45 to have other gallbladder disease and 31 to have no evidence of cholecystic pathology. Isotope scanning was found to be reliable when negative at excluding acute cholecystitis (predictive value 100 per cent) and when positive at confirming gallbladder disease (predictive value 100 per cent). In these respects it compared favourably with contrast radiology (corresponding predictive values 80 per cent and 94 per cent) but was greatly inferior for the exclusion of cholelithiasis. A practical method of scanning for routine clinical use is outlined and it is suggested that the method may be clinically useful as a first investigation in those patients presenting with acute right-sided upper abdominal pain. It may also be helpful in confirming pathology in a nonfunctioning gallbladder on oral cholecystography. When the isotope scan is negative (normal) contrast radiology is still required to exclude cholelithiasis. By a combination of the two techniques the correct diagnosis was arrived at in each of the 99 patients studied, suggesting that the methods may have complementary roles.

Acute Disease↗
PubMed1981

The effect of isoperistaltic jejunal interposition upon gastric emptying.

Ten patients with severe postgastrectomy-postvagotomy symptoms, all of whom had the features of vasomotor dumping, underwent gastric emptying studies, using a 300 milliliter meal of 15 per cent dextrose labeled with 99mTc-sulphur colloid. Studies were repeated two to 11 months following remedial operative treatment, using a 12.5 to 15.0 centimeter isoperistaltic jejunal interposition. Preoperatively, all patients had rapid gastric emptying with a typical biphasic pattern. Following isoperistaltic interposition, the rate of gastric emptying was similar to that found in control patients. Gastric emptying reverted to a more normal pattern but, as in the preoperative studies, was best described by a double exponential function, consisting of slow and fast components. Analysis of these particular functions suggests the manner in which isoperistaltic interposition modified the underlying disorder of gastric motility.

Adult↗
PubMed1980

Prospective evaluation of some candidate tumor markers in the diagnosis of pancreatic cancer.

As part of a prospective diagnostic protocol, patients suspected of having pancreatic cancer had systemic and portal venous blood samples assayed, in coded batches, for peptide hormones and enzymes thought to be of potential value as tumor markers. An average of 111 patients were tested for each candidate marker. Results were analyzed by dividing patients into three groups according to the definitive diagnoses. These were pancreatic cancer (32% of patients), other cancers (27%), and benign diseases (41%). Although elevated mean levels of fasting plasma glucose and serum alkaline phosphatase were found in the pancreatic cancer group, there were no significant differences in the mean levels of any of the candidate markers studied in the three groups. The diagnostic values of normal and elevated levels of each candidate marker studied have been calculated. None has proven to be as useful as the serum level of pancreatic oncofetal antigen, fasting plasma glucose, or serum alkaline phosphatase in the diagnosis or exclusion of pancreatic cancer.

Alkaline Phosphatase↗