Computed tomography colonography (virtual colonoscopy): a new method for colorectal screening.
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Colorectal Neoplasms↗
Biomedical subjects
C D Johnson
Publications and source records attributed to C D Johnson.
Platelet-activating factor and platelet-activating factor antagonists in acute pancreatitis.
INTRODUCTION: Acute pancreatitis causes platelet-activating factor (PAF) to be released which induces systemic effects that contribute to circulatory disturbances and multiple organ failure. PAF has also been implicated as a key mediator in the progression of severe acute pancreatitis, which can lead to complications and unacceptably high mortality rates. MODE OF ACTION OF PAF IN ACUTE PANCREATITIS: Synthesis of PAF is sensitive to biologically active mediators seen in many inflammatory processes. PAF significantly potentiates pancreatic tissue damage; it causes serum amylase and lipase levels to rise significantly, causes scattered haemorrhages and may serve as a primary mediator of inflammation. PAF ANTAGONISTS: Several classes of compounds show significant PAF antagonisms, and all have shown significant local and systemic effects to reduce inflammatory changes. Only lexipafant, however, has been studied in human acute pancreatitis. Lexipafant specifically binds to the PAF receptor and is more potent than other PAF antagonists. In clinical trials lexipafant reduces organ failure and suppresses some aspects of the inflammatory response. CONCLUSION: Our understanding of the pathology of systemic complications, and of a central role of PAF in mediating an inappropriate inflammatory response has improved in recent years. Confirmation of clinical findings with lexipafant will indicate an effective new therapy for the treatment of severe acute pancreatitis.
Acute Disease↗
Effect of a microwave coagulator on implanted liver neoplasms in rats.
An experimental study was conducted to determine the applicability of a microwave (MW) source for coagulation and dissection of metastatic tumour and liver parenchyma. Twenty PVG rats were studied after implantation of MC28 tumour cells into the liver. Eleven days later they underwent sham laparotomy (control) MW coagulation of the tumour deposit, local resection of the tumour deposit with 2 mm clearance or resection of the tumour with MW coagulation of the resection zone. The control animals all died with blood-stained ascites and heavy tumour burden in the liver. After MW coagulation, tumours disappeared in all but one rat. Local resection also led to tumour clearance in 4 of 5 rats. MW coagulation of the resection zone allowed rapid bloodless resection, and no tumour recurrence was observed after 40-89 days. We conclude that MW coagulation is a potentially useful tool for ablation of hepatic metastasis and as an adjunct to hepatic resection.
Animals↗
Therapeutic recreation treats depression in the elderly.
Therapeutic recreation can be an effective method to treat depression in elderly home care patients. Home care is the fastest growing component in the Medicare budget. The co-occurrence of physically limiting conditions and depression in the elderly is well documented. Untreated depression carries an enormous risk and cost. Therapeutic recreation is an ideal psychosocial treatment for use in the home care setting because of its effectiveness and versatility. Certified therapeutic recreation specialists use various interventions such as poetry, music, and exercise as part of a treatment team. In addition to effectively managing depression, therapeutic recreation can be beneficial in reducing the effects of many concurrent physical conditions.
Aged↗
Pancreas divisum.
Endoscopic retrograde cholangiopancreatography (ERCP) is diagnostic. Similarly, secretin stimulated ultrasonography may positively predict the outcome of minor papilla therapy. Computed tomography is only helpful for the detection of complications. Magnetic resonance cholangiopancreatography (MRCP) is a new noninvasive diagnostic tool in development. It is accurate and might replace ERCP for diagnosis. Clinically, symptomatic patients with PD may be divided into five groups: group 1, those with minimal symptoms; group 2, those with recurrent acute pancreatitis or upper abdominal pain with no other cause; group 3, those with chronic pancreatitis; group 4, those with chronic pancreatic pain; and group 5, those with other complications. Group 1 should be treated with medical therapy alone. The response to surgical or endoscopic therapy of the minor papilla is good in group 2 (75-90%), moderate in group 3 (40-60%), and poor in group 4 (20-40%). A few patients require other forms of pancreatic surgery, such as Puestow's operation, Beger's operation, or distal pancreatectomy. With careful selection of patient and therapy, good response to the therapy can be achieved. Pancreas divisum (PD) is the most common congenital anomaly of the pancreas, with an incidence of up to 10%. Symptoms or complications developing in individuals with PD are uncommon (5% of individuals with PD). It seems unlikely that PD alone could cause obstructive pancreatitis and the presence of another factor, such as minor papilla insufficiency, is probably required for this relatively common anomaly to develop complications.
Cholangiopancreatography, Endoscopic Retrograde↗
CT colonography: potential pitfalls and problem-solving techniques.
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Adult↗
Early ERCP is an essential part of the management of all cases of acute pancreatitis.
The role of early endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy in acute pancreatitis is controversial. Recent randomised controlled trials mostly support the value of this procedure, but concerns remain as to its safety, efficacy and practicability. This debate critically assesses the evidence for and against the use of early ERCP in acute pancreatitis.
Acute Disease↗
Treatment of pancreatic exocrine insufficiency after pancreatic resection. Results of a randomized, double-blind, placebo-controlled, crossover study of high vs standard dose pancreatin.
BACKGROUND: Steatorrhea following major pancreatic resection can be difficult to control, requiring high doses of pancreatic enzyme supplements. The aim of this study was to demonstrate equivalent efficacy of high-dose and standard-dose pancreatin in treating steatorrhea after pancreatectomy. METHODS: A randomized, double-blind, crossover study was conducted with a 2-wk run-in period for stabilization on a suitable dose of standard-dose pancreatin and two 14-d treatment periods using either high-dose or standard-dose pancreatin at this dosage. Parameters used to demonstrate efficacy of treatment were stool fat excretion, stool volume, and clinical symptoms. RESULTS: Thirty-nine patients who had undergone total or partial pancreatectomy were randomised; 37 completed all parts of the study. During stabilization, the mean daily capsule intake was 19.4 (range 9-54); even so, 22 (56%) patients had stool fat excretion > 7 g/d. There were significant correlations between stool fat excretion and stool volume (p < 0.0001) and stool frequency (p < 0.01), but not with indices of abdominal pain and global symptoms. Both high-dose and standard-dose pancreatin demonstrated statistically similar efficacy in the treatment period. CONCLUSION: The use of high-dose pancreatin for the treatment of pancreatic insufficiency in patients following pancreatectomy should significantly reduce capsule intake with increased convenience and greater compliance rate. Our results, however, indicate that further progress is needed to resolve steatorrhea following pancreatic resection.
Adult↗
Six-fold suture:wound length ratio for abdominal closure.
Midline laparotomy incision is generally closed as a continuous single layer with monofilament suture. To achieve safe abdominal closure, it is advised to have a suture:wound length (SL:WL) ratio of more than 4:1. The importance of a high SL:WL ratio led us to standardise a safe abdominal closure technique. We calculated the subsequent SL:WL ratio and support our finding with a mathematical model. Between March 1996 and February 1997, 100 consecutive patients undergoing elective or emergency laparotomy through a midline incision were entered into this prospective study. The wounds were closed with a single layer continuous suture to approximate the abdominal muscles. Suture and wound lengths were recorded. Patients were followed for one year. Five patients developed incisional hernia at 12 months postoperatively. There was no burst abdomen. The mean SL:WL ratio: was 6.2:1. A mathematical model confirms that a SL:WL ratio of 6:1 should be achieved with this suture technique. We recommend an optimal SL:WL ratio: greater than or equivalent to 6:1 to achieve safe closure of midline laparotomy incision.
Abdominal Muscles↗
Focally recorded single sympathetic postganglionic neuronal activity supplying rat lateral tail vein.
1. In anaesthetized rats, using a focal recording technique, activity was recorded from single sympathetic postganglionic neurones innervating the lateral tail veins. On-going activity was examined in order to determine whether it had similar or different characteristics to those recorded from the caudal ventral artery in a previous study. 2. Animals were artificially ventilated, vagotomized, paralysed and given a pneumothorax. 3. The discharges of fourteen out of seventeen sympathetic postganglionic neurones were rhythmic. Such units had a mean firing frequency of 1.62 +/- 0. 70 Hz. The mean frequency of the dominant sympathetic rhythm under control conditions was 0.82 +/- 0.05 Hz. 4. The frequency of the dominant sympathetic rhythm was different from that of the phrenic rhythm in nine out of fourteen cases. 5. The mean frequency of the dominant sympathetic rhythm was: (i) not influenced significantly by hypocapnic apnoea, (ii) decreased by hyperthermia, which increased the frequency of the phrenic rhythm, (iii) in all cases different from that of the artificial ventilation cycle. 6. The above characteristics are similar to those recorded from the sympathetic supply to the caudal ventral artery of the same vascular bed under comparable conditions.
Anesthesia, General↗
Quality of life assessment in chronic pancreatitis.
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Chronic Disease↗
Quality of life after treatment of pancreatic cancer.
In the past decade there has been increasing focus on assessment of the quality of life (QoL) of patients with cancer. QoL is now a mandatory endpoint in many cancer clinical trials, particularly in interventions with palliative intent alone. Although QoL is difficult to define, a variety of specially designed and validated questionnaires has been developed to measure QoL in the clinical setting. In pancreatic cancer, assessment (QoL) is of paramount importance; however, little research has been conducted and until recently no disease-specific QoL questionnaire existed. In this review we consider the quality of life of patients with pancreatic cancer, with particular reference to the symptoms and psychosocial consequences of the disease. The literature is critically examined on the approaches to evaluation of QoL in previous pancreatic cancer clinical trials. We then describe the impact on QoL following both "curative" and palliative surgical interventions and medical treatment, including endoscopic palliation and chemotherapy for pancreatic cancer. In the European Organisation for Research and Treatment of Cancer (EORTC) the questionnaire specific for pancreatic cancer, the QLQ-PAN26, is discussed as a standardised and valid assessment of QoL in international clinical trials. Finally, recommendations are made for future QoL research in pancreatic cancer.
Combined Modality Therapy↗
The application of a risk-approach model to reduce mortality in infancy.
OBJECTIVES: To examine the utility of a risk-approach model in identifying infants at greater risk of postneonatal mortality (PNM) and to determine whether there is a relationship between PNM and linkage of at-risk infants to primary health care. METHODS: The Sheffield Birth Score instrument was applied to 90,846 newborn infants to determine high-score (HS) and low-score (LS) infant risk groups. Health care visit data were collected on all HS infants who were referred for primary pediatric care. Mortality rates were calculated for both HS and LS infant groups and for HS infants who were linked and not linked to care. RESULTS: The HS infant group was at significantly greater risk of PNM (p < 0.0001). The linked group had a lower PNM rate (p < 0.05), and linked/not-linked group differences were noted for 11 of 20 variables. When these 11 variables and the linked/not-linked variable were entered into a logistic regression analysis, linkage was the only significant variable (p < 0.01) in predicting PNM. CONCLUSIONS: The Sheffield Birth Score differentiated at birth those infants who were at greater risk of PNM. The lower incidence of PNM among linked HS infants suggests a promising argument for early pediatric intervention. Further research to clarify specific factors that influence health care participation decisions is suggested.
Humans↗
The relationship between chronic cocaine or alcohol use and blood pressure in black men during uncomplicated tooth extraction.
PURPOSE: The object of this study was to determine whether a history of cocaine or alcohol use is associated with blood pressure changes in patients undergoing an uncomplicated mandibular molar extraction. PATIENTS AND METHODS: The blood pressure (BP) values of middle-aged (30 to 40 years of age) black men with different chronic drug histories were compared during extraction procedures. The four different groups were 1) no-drug control, (n = 10); 2) alcohol (n = 15); 3) "crack" cocaine (n = 9); and 4) cocaine (n = 22). RESULTS: The cocaine group's blood pressures were significantly different compared with the blood pressures within the no-drug and alcohol groups (P < .05). The cocaine group's BPs decreased throughout the procedure, and the BPs of the no-drug and alcohol groups rose during administration of the local anesthetic and extraction, and then fell. The BPs of the crack group were highly variable and not significantly different when compared with other groups. CONCLUSION: There is a paradoxical effect of chronic cocaine use on blood pressure that needs to be considered when treating such patients.
Adult↗
Growth hormone: a paracrine growth factor in embryonic development?
Although pituitary growth hormone is obligatory for normal postnatal growth and development, early embryonic and fetal growth is generally considered to be independent of pituitary GH. Indeed, in chickens, somatotrophs and serum GH are not detectable until late in embryogenesis, and neither partial decapitation nor pre-hatch GH administration greatly affects embryonic growth. However, since it is now known that GH can be produced and act in many extra-pituitary tissues, early embryonic growth may be independent of pituitary GH but dependent upon the paracrine actions of extra-pituitary GH. The possibility that growth hormone may be a paracrine growth factor during early development will therefore be considered in this brief review, which is based on the embryogenesis of the domestic fowl.
Animals↗
Growth inhibitory effect of lithium gammalinolenate on pancreatic cancer cell lines: the influence of albumin and iron.
Essential fatty acids, especially gamma linolenic (GLA) and eicosapentaenoic acids, have been proposed as potential anticancer drugs. Our aim was to study the effect of the lithium salt of gamma linolenic acid (LiGLA) on the growth of two human pancreatic cancer cell lines (MIA PaCa2 and Panc 1) and primary human fibroblasts (HFF 5) in vitro. Cell growth was assessed by a microculture tetrazolium (MTT) assay. LiGLA had a selective growth inhibitory effect on pancreatic cancer cell lines with 50% growth inhibition (IC50) at approximately 6-16 mumol/l compared with approximately 111 mumol/l for the fibroblasts. The degree of growth inhibition increased with the time of exposure to LiGLA. Special attention was paid to the influence of albumin and iron on LiGLA-mediated growth inhibition. Albumin incorporated into essentially serum-free culture medium inhibited the effect of LiGLA in a dose-dependent manner, associated with reduced GLA uptake by cancer cells. Ferric ions were confirmed as potentiators of the growth inhibitory effect of LiGLA but more physiologically relevant transferrin-bound iron was ineffective. With further improvements in the fatty acid delivery mechanism, LiGLA may become a useful adjunct in the management of pancreatic cancer patients.
Albumins↗
Effect of lithium gamma-linolenate on the growth of experimental human pancreatic carcinoma.
BACKGROUND: The lithium salt of gamma-linolenic acid (Li-GLA) is growth inhibitory to pancreatic cancer cells in vitro and is reported to prolong the survival of patients with pancreatic cancer. The effect of Li-GLA on the growth of human pancreatic carcinoma in vivo is not known. In this study the effect of parenterally administered Li-GLA on the growth of human pancreatic carcinoma in nude mice was tested. METHODS: Pancreatic tumours were produced in nude mice by subcutaneous implantation of MIA PaCa-2 cells. This cell line is sensitive to Li-GLA in vitro. Mice were randomly treated with intraperitoneal, intravenous or intratumoral Li-GLA. Each group also had controls. RESULTS: Both intravenous and intraperitoneal administration of Li-GLA had no significant effect on tumour growth or tumour phospholipid fatty acid composition. Intratumoral administration of Li-GLA was, however, associated with a significant antitumour effect. CONCLUSION: Within the limitations of this tumour model, the benefit seen with intravenous Li-GLA in patients with pancreatic carcinoma cannot be explained by tumour growth inhibition. Local administration appears to be more effective than intravenous or intraperitoneal therapy.
Animals↗
Racial and gender differences in quality of life following kidney transplantation.
PURPOSE: To determine if race or gender affected changes in quality of life (QoL) reported by nondiabetic kidney transplant recipients from pre- to 6 and 12 months post-transplant and offer possible explanations. Information gained may offer direction for interventions designed to enhance post-transplant QoL for patients who may be less likely to attain improved outcomes. DESIGN: Descriptive, prospective clinical study. A convenience sample of 90 male and female Caucasian-American and African-American patients was used. Patients were 19 to 67 years of age, nondiabetic, and undergoing kidney transplantation at one university hospital located in the southern United States. Data were collected 1990 to 1995. METHODS: Three questionnaires measuring QoL were used: the Sickness Impact Profile, Ferrans and Powers' Quality of Life Index, and the Adult Self-Image Scales. Patients completed questionnaires at the time of transplant and at their routine 6- and 12-month post-transplant evaluation visits. Repeated measures analysis of variance with multiple pre-planned comparisons of least-squares (LS) means were performed to determine if differences existed between and within study groups over time. FINDINGS: African-Americans achieved less improvement than Caucasian-Americans in affective as well as functional measures of QoL. Women scored consistently lower than men on most QoL measures at baseline and reported greater improvement in functional ability while perceptions of self-image remained low. CONCLUSIONS: Although transplantation dramatically improves QoL, some segments of the patient population, namely African-Americans and women, do not benefit to the same extent as others. Nurses need to recognize sociocultural differences in patients and how these differences affect care requirements.
Adult↗