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Biomedical subjects

C A Loehry

Publications and source records attributed to C A Loehry.

At least 19 recordsLinked to original sources
PubMed1994

Long-term survival associated with metastatic small cell carcinoma of the esophagus treated by chemotherapy, autologous bone marrow transplantation, and adjuvant radiation therapy.

A 44-year-old woman had small cell carcinoma of the esophagus complicated by liver and lymph node metastases. She was treated with aggressive combination chemotherapy, followed by autologous bone marrow transplantation and adjuvant radiation therapy. (The authors believe this to be the first use of autologous bone marrow transplantation for treatment of this condition.) This regimen resulted in apparent complete regression of the disease as documented by computed tomography and endoscopic study. Three years later, she again experienced general malaise and was found to have extensive recurrent disease in the lung, bone, and liver. Her condition deteriorated rapidly, and she died within 1 month. A review of the literature reveals that this patient survived longer than any others who have had this rare but aggressive tumor. The authors suggest that this form of therapy should be considered for future patients.

Adult↗
PubMed1994

Systemic arteriovenous malformations: a feature of advanced liver disease.

Arterial and arteriovenous abnormalities are reported in association with advanced liver disease, those most commonly recognised are spider naevi, pulmonary arteriovenous shunts, and generalised vasodilatation. The first two cases of peripheral systemic arteriovenous malformations in association with cirrhosis are reported. After liver transplantation in one of these patients the vascular malformation regressed. A review of published works shows that other vascular complications of advanced liver disease such as pulmonary shunts and generalised vasodilation also regress after orthotopic liver transplantation.

Arteriovenous Malformations↗
PubMed1993

Mycotic aneurysm of left subclavian artery.

Bacterial endarteritis is rare and usually affects the abdominal aorta. A case of bacterial left subclavian arteritis complicated by mycotic aneurysm is presented. An early diagnosis of infective arteritis was made based on a history of fever, sweats, rigors, and a progressive macular rash, polyarthralgia splinter haemorrhage (limited to the left arm), and a loud left subclavian bruit on admission. A mycotic aneurysm was diagnosed by computed tomography and treated surgically. In cases of endarteritis the possibility of a mycotic aneurysm should be borne in mind even when there is no evidence of endocarditis.

Aneurysm, Infected↗
PubMed1992

Thrombotic thrombocytopenic purpura mimicking acute small bowel Crohn's disease.

A 39 year old woman presented with a short history of bloody diarrhoea. She subsequently developed microangiopathic haemolysis, platelet consumption, and renal impairment. Initial investigations suggested underlying Crohn's disease of the terminal ileum complicated by sepsis and disseminated intravascular coagulation. However, after resection of a perforated caecum and terminal ileum, the diagnosis of thrombotic thrombocytopenic purpura was made. There was weak serological evidence of yersinia infection, this may have caused the early localisation of the lesions to the terminal ileum. This is believed to be the first report of thrombotic thrombocytopenic purpura affecting the small bowel alone at presentation.

Crohn Disease↗
PubMed1988

Hepatic metastases due to choriocarcinoma.

A 34 year old female presented with weight loss and hepatomegaly. Liver biopsy revealed clinically unsuspected metastatic choriocarcinoma. Severe haemorrhage occurred, and the patient died following complications after laparotomy. The possibility of choriocarcinoma should be remembered in women of child-bearing age who present with liver metastases; biopsy must be avoided until this diagnosis can be excluded.

Adult↗
PubMed1983

Scoring system to improve cost effectiveness of open access endoscopy.

The introduction of an open access general practitioner endoscopy service may result in many unnecessary examinations being performed. In an attempt to prevent this, 235 patients attending for endoscopy were interviewed and the results analysed to determine which factors best discriminated between those with major disease (ulcers, cancers, oesophageal strictures; n = 48) and those without (n = 187). The six characteristics which best discriminated between the two groups were increasing age, history of vomiting, male sex, smoking, and a past history of peptic ulcer or hiatus hernia. With the use of these six features a scoring system was devised, designed to give an indication of the likelihood of finding such disease in an individual patient. This was assessed prospectively in a further 356 patients. The results showed that by utilising this scoring system it would be possible to reduce the number of examinations performed by 30% yet still detect 98% of serious disease. If confirmed in further prospective studies, this scoring system (or a modification) could more accurately assess individual priority for endoscopy and enable optimum use to be made of limited resources.

Age Factors↗
PubMed1981

A double-blind controlled trial of the effect of sodium cromoglycate in preventing relapse in ulcerative colitis.

A double-blind controlled trial of the effect of sodium cromoglycate (SCG) in preventing relapse in ulcerative colitis has been completed in 100 subjects. In patients already taking sulphasalazine, SCG did not prove to be of any additional benefit. However, in patients not on any other maintenance therapy, the relapse rate was 40% for SCG as compared with 75% for placebo. A large study of the effect of SCG in patients intolerant of sulphasalazine is indicated.

Adult↗
PubMed1979

Open-access endoscopy service for general practitioners.

An open-access general-practitioner referral service for endoscopy of the upper gastrointestinal tract was established in a district general hospital, and the impact of the service over three years was assessed. The reason for referral, duration of symptoms, and amount of disease detected were the same in patients referred by general practitioners and those attending from hospital outpatient departments. Despite a steady increase in the number of patients referred for endoscopy, the number of barium-meal examinations performed did not correspondingly decrease. The number of ulcers and cancers detected in each six-month period of the study did not increase, and the combined overall pick-up rate for these two conditions fell from 25% to 13%. All general practitioners in the area were sent questionnaires. Most thought that clinic referral had been reduced and patient management helped as a result of the introduction of the service. While the value of negative endoscopic findings cannot be assessed, there is little objective evidence of benefit. Hence the large increase in numbers of endoscopies performed as a result of the introduction of the service cannot be justified.

Diagnostic Services↗
PubMed1978

Selectivity of small intestinal exudate in celiac disease and Crohn's disease.

The small intestinal exudates of patients with protein-losing enteropathies produced by celiac disease or proximal jejunal Crohn's disease were compared with controls. The exudates in control subjects were highly selective, whereas those of the celiac and Crohn's disease subjects were relatively nonselective. It is believed that this loss of selectivity is secondary to basement membrane damage. An analogy is drawn with the renal lesion in nephrotic syndrome where basement membrane damage is associated with nonselective proteinuria.

Adult↗
PubMed1978

Autoradiographic study of the permeability characteristics of the small intestine.

This autoradiographic study demonstrates the distribution of a range of small solutes and macromolecules in the mucosa of the guinea-pig small intestine after intracardiac injection. The substances investigated were: 14C-urea, 3H-mannose, 3H-inulin, and 125I polyvinylpyrrolidone (PVP). Small bowel biopsies were taken at intervals from one to 60 minutes after injection and the tissues processed for autoradiography. Light microscopic examination of the autoradiographs showed that the compartmental distribution depended on the molecular size of the substances being studied. Urea and mannose, as small solutes, were uniformly distributed throughout the intravascular, extravascular, and epithelial compartments. Inulin was evenly distributed in the vessel lumen and extravascular space but there was a considerable drop in concentration in the epithelium. PVP exhibited the most marked gradients, the concentration being greatest in the vascular lumina, lower in the extravascular space, least in the epithelium. Thus there appear to be two barriers to macromolecular passage which are freely permeable to small solutes: the capillary wall and the epithelium. At a light microscopical level it is not possible to observe whether the limiting membrane of each of these barriers is the cell plasmalemmal membrane or the basement membrane. The selectivity of the epithelial barrier is greater than that of the capillary barrier.

Animals↗
PubMed1977

Upper gastrointestinal endoscopy--a GP service.

Since 1974 there has been an open endoscopy service available to general practitioners in the Bournemouth and Christchurch area. Patients are referred directly with a standard form. A retrospective comparison of requests for barium-meal examinations and for endoscopy by general practitioners showed that the reasons for referral were similar. Forty per cent of patients in each group showed no abnormality. Ulceration was found in 21.1% of patients who underwent endoscopy and 9.7% investigated by barium meal. Duodenitis or gastric erosions were found in a further 16% of endoscopies. More hiatus hernias and deformed duodenal caps were found at barium meal. Despite these differences the results of follow-up were similar.

Adult↗
PubMed1976

Small intestinal permeability. 1. Effects of ischaemia and exposure to acetyl salicylate.

Permeability of the small intestinal mucosa was estimated using a perfusion technique after either a period of ischaemia or exposure to acetyl salicylate. It was shown that these procedures increased the passive permeability of the mucosa to macromolecules while maintaining normal mucosal selectivity. Histologically, there was derangment of the epithelial cell layer of the villous tips without damage to the epithelial basement membrane or subepithelial structures. It is concluded that the epithelial cell layer is purely limiting with no selective function and that the role of selectivity must be ascribed to either or both of the other mucosal barriers, the capillary and the epithelial basement membrane.

Animals↗
PubMed1976

Permeability of the small intestine after intra-arterial injection of histamine-type mediators and irradiation.

Permeability and selectivity of rabbit small intestine were estimated by a perfusion technique after intra-arterial injection of histamine-type mediators and intestinal irradiation. It was shown that the histamine-type mediators caused an increase in capillary permeability which produced an overall moderate increase in transmucosal permeability with a moderate loss of selectivity. Local intestinal irradiation caused a very marked increase in permeability and a profound loss of selectivity. It was felt that this was produced partly by an increase in capillary permeability but largely by damage to the epithelial basement membrane. It is concluded that the intestinal capillary endothelium is both rate-limiting and selective, though not to a major degree in either case. The epithelial basement membrane, however, appears to be both rate-limiting and markedly selective.

Animals↗