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Biomedical subjects

C E Brady

Publications and source records attributed to C E Brady.

At least 37 records · Page 2Linked to original sources
PubMed1988

Biopsy evaluation of chronic active hepatitis. Peritoneoscopy with directed liver biopsy versus blind percutaneous liver biopsy.

In this prospective study of chronic active liver disease, we compared the assessment of hepatic histology in samples obtained by peritoneoscopy with directed liver biopsy and blind percutaneous liver biopsy in 23 cases (22 patients, one patient studied twice). In blinded fashion, a pathologist assessed all specimens for evidence of cirrhosis and degree of necroinflammatory change. Two clinicians independently reviewed clinical and laboratory findings in both sets of biopsies. Each committed in writing recommendations regarding immunosuppressive therapy, follow-up interval, and rebiopsy date. The final diagnosis differed from that made by percutaneous and directed biopsy in 2 of 23 (9%) and 1 of 23 (4%) cases, respectively. Six cases of cirrhosis were correctly diagnosed by both biopsy methods, but only four of the six cirrhotic cases were diagnosed by gross peritoneoscopic findings. In only 2 of 23 (9%) cases was there disagreement in the degree of necroinflammatory change between the blind and directed biopsies that affected treatment recommendations. We conclude that blind percutaneous biopsy adequately diagnoses and monitors activity in viral chronic hepatitis for treatment purposes.

Adult↗
PubMed1988

Secretin provocation: gastrin results in various clinical situations.

Our previous secretin provocation studies in normal volunteers and unoperated duodenal ulcer patients suggested that the gastrin rise in gastrinoma may be an exaggeration of the normal response rather than paradoxical. We report further studies in various clinical settings having normogastrinemia (normal, n = 17; unoperated duodenal ulcer, n = 13; primary hyperparathyroidism, n = 7) and hypergastrinemia (postvagotomy, n = 5; hypochlorhydria, n = 7; achlorhydria, n = 10; chronic renal failure, n = 10; gastrinoma, n = 5). Under all nongastrinoma conditions, there were similar gastrin rises of 9-19% between 2 and 5 min after bolus intravenous GIH secretin (2 CU/kg), which fell to baseline by 8 min, except for chronic renal failure. In chronic renal failure, gastrin remained elevated from 7 to 30 min and was significantly different (p less than 0.05) at 10-30 min compared to all other nongastrinoma conditions except hyperparathyroidism. Peak rises occurred within 5 min in all entities, but only three gastrinoma patients had positive secretin provocation tests by the predefined criterion of a gastrin rise greater than 200 pg/ml. The results of secretin provocation in various clinical entities with and without hypergastrinemia further support the hypothesis that the gastrin rise in gastrinoma is an exaggeration of the normal response. The prolonged gastrin rise seen in chronic renal failure may be due to altered renal clearance, inasmuch as other hypergastrinemic states had responses similar to normal and duodenal ulcer.

Adult↗
PubMed1987

Secretin provocation in normal and duodenal ulcer subjects. Is the gastrin rise in Zollinger-Ellison syndrome paradoxic or exaggeration?

The secretin provocation test for gastrinoma is based on the premise that secretin decreases or has no effect on serum gastrin in normal and duodenal ulcer subjects while inducing a paradoxical rise in gastrinoma. We reexamined the serum gastrin response to pharmacologic amounts of secretin in normal volunteers (N = 17) and unoperated duodenal ulcer patients (N = 10). GIH secretin caused significant early gastrin rises from baseline in both groups (P less than 0.05). The gastrin response curves after secretin were not significantly different between normal and ulcer subjects. Similar gastrin rises were seen when synthetic secretin was administered to normal subjects (N = 6). In normal volunteers, intravenous bolus saline (N = 10) or amino acid (L-cysteine, N = 8) caused no change in serum gastrin from baseline. The gastrin response curves to GIH secretin and saline were significantly different (P less than 0.05). Our findings suggest that the gastrin rise in gastrinoma patients after secretin is an exaggeration of the normal response and not paradoxical.

Adult↗
PubMed1987

Steakhouse spasm.

Sudden esophageal obstruction after eating poorly chewed meat has been called the Steakhouse syndrome. Some cases have demonstrable esophageal narrowing above which food impacts, but in many patients with identical symptoms no underlying obstruction is demonstrated. We report four patients with acute dysphagia who were unable to swallow liquids or solids for as long as 72-96 h. Onset occurred after eating meat in three patients and after taking psyllium in one. All had a structurally normal esophagus demonstrated by x-ray and endoscopy, but motor disorders were defined by manometry in three. We hypothesize that an underlying motor abnormality led to food impaction and call this presumed spastic variant "Steakhouse spasm." We suspect that this is a common but frequently unrecognized manifestation of esophageal dysmotility.

Adult↗
PubMed1987

Effect of bisacodyl on gut lavage cleansing for colonoscopy.

The effect of 10 mg oral bisacodyl (n = 19) or placebo (n = 26) on colon cleansing with polyethylene glycol electrolyte lavage solution was studied during colonoscopy. Patient tolerance was evaluated by questionnaire. During colonoscopy endoscopists graded adequacy of cleansing and subjective amounts of residual fluid and recorded the actual amount of fluid suctioned. Patient tolerance and adequacy of cleansing were not different between bisacodyl and placebo. There was no difference in subjective and measured residual fluid between the two groups. Compared to placebo, 10 mg oral bisacodyl does not influence adequacy of cleansing, patient tolerance, or residual fluid following polyethylene glycol electrolyte lavage solution for colonoscopy. This suggests that the beneficial cleansing effects with bisacodyl for barium enema may occur by mechanisms other than simple fluid evacuation.

Adolescent↗
PubMed1986

Urinary excretion of polyethylene glycol 3350 and sulfate after gut lavage with a polyethylene glycol electrolyte lavage solution.

Ingestion of an electrolyte lavage solution containing polyethylene glycol 3350 and sulfate is an effective method of cleansing the colon for diagnostic studies. Polyethylene glycol and sulfate are considered poorly absorbed from the gastrointestinal tract. Because of the quantities administered, concern exists about potential toxicity of absorption of even a small percentage, particularly for polyethylene glycol. We measured the urinary excretion of both polyethylene glycol and sulfate in normal subjects and inflammatory bowel patients. Absorption of polyethylene glycol can be assessed by measuring recovery in urine, as 85%-96% of an intravenous load is excreted in urine. Similarly, appreciable sulfate absorption would exceed renal tubular reabsorption and result in increased urinary excretion. Mean percent polyethylene glycol load recovered in urine was minimal and similar for normal (0.06%) and inflammatory bowel (0.09%) subjects. Urinary sulfate excretion after lavage was also similar for both groups and was not different from baseline. These results do not suggest the likelihood of toxicity due to polyethylene glycol 3350 or sulfate absorption during gut lavage with this solution.

Colitis, Ulcerative↗
PubMed1986

Muscle anatomy of the human esophagus.

We studied the esophageal musculature of 11 cadavers to assess the distribution of striated and smooth muscle. The lower 54-62% of the esophagus was found to be exclusively smooth muscle, the proximal 4.1-5.6% to be exclusively striated, and the remainder to be mixed. The area in which striated and smooth muscle portions were approximately equal, the 50/50 point, was found to be 4.7 +/- 0.6 cm from the proximal portion of the cricopharyngeus muscle. This point corresponds to the previously described physiologic low pressure zone in the proximal esophagus.

Adult↗
PubMed1986

Colon cleansing: acceptance by older patients.

The influence of age on patient acceptance and adequacy of preparation was evaluated in 557 patients from our previous colon cleansing studies for colonoscopy, barium enema, and elective colon surgery. Since study design was similar for all studies, the patients were combined and stratified to those over age 60 (old) and those 60 or younger (young). Patients were previously randomized in their respective studies to polyethylene glycol electrolyte gut lavage solution (old, 105; young, 181) or standard prep (old, 71; young, 20). Patient response data were analyzed in two fashions; distribution of response scores and minimal responses. When the distribution of scores were compared, older gut lavage patients had fewer cramps but more overall discomfort than younger patients receiving the lavage preparation. Older standard prep patients had less overall discomfort than younger standard prep subjects. Comparison of responses rated as minimal showed the older lavage patients to have fewer cramps than younger lavage patients and fewer cramps than standard preparation patients of similar age. None of the other assessed symptoms was significantly different between age groups or prep method. Most patients had minimal symptoms regardless of age or prep. Age did not influence adequacy of preparation for gut lavage or standard prep methods.

Age Factors↗
PubMed1985

Upper gastrointestinal endoscopy--how far does the endoscope go?

Two adult-size endoscopes (Olympus GIF-K2 and ACMI TX-8) were compared for extent of duodenal intubation by the endoscopist's estimate of location and x-ray position in 55 patients. The endoscopes were not different in duodenal position when separately analyzed for the endoscopist's estimate or x-ray location. Combining the results for both endoscopes showed the endoscopist's estimate to differ significantly from x-ray location in 47% of patients (p = 0.02). When incorrect, the endoscopist overestimated 62% of the time and underestimated 38% of the time. X-ray evaluation of insertion depth confirmed that the second portion of the duodenum was reached in 96%, third portion in 51%, and fourth portion or beyond in 38% of patients. We conclude that fluoroscopic confirmation may be necessary when endoscopically assessing distal duodenal segments for pathology.

Adult↗
PubMed1985

Bowel cleansing with polyethylene glycol electrolyte lavage solution.

We reviewed our experience with an oral gut lavage solution (GoLYTELY), used as a rapid bowel cleansing preparation, and the prospective clinical trials reported in the literature to compare the overall experience with this type of preparation for colonoscopy and colon surgery. Five studies (546 patients) compared GoLYTELY to standard preparations for colonoscopy, while three trials (177 patients) have studied surgical patients. After evaluating patient tolerance, quality of colonic cleansing, and changes in microflora and colonic gas, GoLYTELY was found to be safe, rapid, and effective. It is well tolerated by patients and may become the preferred method of bowel cleansing.

Colonic Diseases↗
PubMed1985

Golytely lavage--is metoclopramide necessary?

During Golytely cleansing for colonoscopy, two dose forms of oral metoclopramide were evaluated in separate studies for patient tolerance and adequacy of preparation. In study 1, patients were randomized to 10 mg metoclopramide (n = 21) or placebo (n = 27); in study 2, 20 mg metoclopramide (n = 21) was compared to placebo (n = 25). Ten milligrams metoclopramide was not significantly different from placebo in patient acceptance for any of the assessed symptoms. Patients taking 20 mg metoclopramide had less cramping (p = 0.02), but more nausea (p = 0.03) than placebo. Time for rectal effluent to clear was similar in all groups. The percentage of patients preferring Golytely was similar in both studies (70-79%, p = NS) and 85% of all patients were willing to repeat Golytely. Physician assessment of colon cleansing showed no difference between metoclopramide or placebo in either study, with adequate preparations in 97% and optimal cleansing in 80% of all patients. Neither 10 nor 20 mg oral metoclopramide improved adequacy of colon cleansing for colonoscopy or decreased symptoms associated with Golytely lavage.

Adolescent↗
PubMed1984

X-ray-negative dysphagia: is endoscopy necessary?

We reviewed our experience with patients with symptoms of dysphagia to determine whether endoscopy increased the chance of finding esophageal carcinoma when barium studies of the esophagus were normal. Endoscopy reports from 1974 to 1982 identified 195 patients with x-ray-negative dysphagia. In no patient was esophageal carcinoma found endoscopically. When patients with hiatal hernia (22) or endoscopic Grade I or II esophagitis (52) were excluded, only eight patients were found to have an endoscopic abnormality not demonstrated previously by x-ray. In addition, 56 cases of esophageal carcinoma seen at our institution over the same period all showed abnormal barium esophagrams at the time of presentation. We conclude that endoscopy to exclude esophageal carcinoma in patients with dysphagia is not as necessary as claimed, at least when adequate barium studies of the esophagus are normal.

Adolescent↗
PubMed1984

Comparison of Golytely lavage with standard diet/cathartic preparation for double-contrast barium enema.

In a two-part study, two groups of 100 outpatients each were randomly assigned a colon preparation. In part 1, a standard 1-day diet/cathartic combination was compared with Golytely. In part 2, diet/cathartics was compared with Golytely plus Dulcolax (bisacodyl). The standard preparation provided good or excellent feces removal in 81 (80%) of 101 subjects. Golytely alone was successful in only 21 (53%) of 40 patients, but Golytely followed by Dulcolax achieved good or excellent feces removal in 31 (82%) of 38. Degraded mucosal coating with Golytely alone, due to excessive fluid retention, was also corrected by the addition of Dulcolax. Golytely alone is not an adequate method of colon cleansing for double-contrast barium enema, but Golytely plus Dulcolax is as effective as the standard preparation.

Adult↗