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Biomedical subjects

C J Cahill

Publications and source records attributed to C J Cahill.

33 records · Page 2Linked to original sources
PubMed1987

Bile salts, endotoxin and renal function in obstructive jaundice.

Surgical treatment for the relief of obstructive jaundice is still complicated by postoperative acute renal failure in almost 10 per cent of patients. Renal failure in the patient with jaundice is associated with the presence of bacterial endotoxin in the peripheral blood, and enteric endotoxin absorption is facilitated by the absence of bile salts from the intestine. Oral replacement of bile salts should prevent endotoxemia and renal failure. Forty-six patients with jaundice were studied. Twelve patients received sodium deoxycholate preoperatively, 12 received chenodeoxycholic acid and 22 acted as controls. Endotoxemia was measured by the limulus test and renal function assessed by 24 hour creatinine clearance. No patient given deoxycholate preoperatively had systemic endotoxemia or postoperative impairment of renal function. Endotoxemia was reduced in the chenodeoxycholic acid group, but not significantly, and renal function was not protected. Sodium deoxycholate is undergoing further evaluation in a multicenter randomized prospective study.

Acute Kidney Injury↗
PubMed1986

Management of choledochal cysts in adults.

The management of 7 adults with choledochal cysts is described. Three patients presented with abdominal pain, 3 with jaundice and one with cholangitis. Three patients underwent total or partial cyst excision and the remaining patients underwent cyst drainage into a Roux-en-Y jejunal loop. There was no operative mortality and all patients have remained well for up to 6 years following surgery. It is argued that total cyst excision is the treatment of choice, but where this is not possible a Roux-en-Y choledochocystojejunostomy is the recommended alternative.

Adult↗
PubMed1984

Long term effects of callosal lesions in the auditory cortex of rats of different ages.

The corpus callosum was sectioned in groups of rats 3, 12, and 24 months of age, and the auditory cortex was examined three months later to determine whether there were age-related differences in the morphological response to the partial deafferentation. Material from the three groups of long-term callosally-lesioned rats were compared with three groups of age-matched control animals. Analysis focused on those cortical layers known to receive the heaviest callosal projection (layers II and III) and those neurons known to be postsynaptic to callosal afferents (layer V pyramidal neurons). There were no age-related changes in cortical thickness or in the relative thickness of the cortical layers in the control groups. However, the apical dendrites of layer V pyramidal neurons did lose dendritic spines and became thinner with age. In all three lesion groups, the cortex became thinner without altering the relative thickness of cortical layers; there was a decrease in the relative density of apical dendrite spines in layer III, but an increase in the density of these spines in layer IV. Both effects varied with age. Spine decreases in layer III were greatest in older animals and spine increases in layer IV were greatest in younger animals. The mean diameters of apical dendrites decreased in the youngest group of lesioned animals but increased in the oldest group. The results indicate that the effects of callosal deafferentation are age dependent.

Aging↗
PubMed1983

Prevention of postoperative renal failure in patients with obstructive jaundice--the role of bile salts.

Preoperative administration of the simple bile salt sodium deoxycholate has been shown in this study to prevent postoperative endotoxaemia and renal failure in patients with obstructive jaundice. Fifty-four per cent of jaundiced patients not given the salt were found to have systemic endotoxaemia, associated with renal impairment in two-thirds of the cases. No patient given sodium deoxycholate 500 mg 8 hourly for 48 hours before operation had portal or systemic endotoxaemia, and none had evidence of renal impairment (P less than 0 X 02, X2 with Yates' correction). The incidence of endotoxaemia in untreated jaundiced patients was very significantly greater than in non-jaundiced patients undergoing elective upper abdominal surgery (P less than 0 X 005), but this difference is abolished by the prophylactic administration of the oral bile salt. The mechanism of action of bile salts in preventing endotoxin absorption from the small bowel has been investigated, and the lack of any significant alteration in the small bowel microbial flora in obstructive jaundice suggests that a direct effect on the endotoxin molecule is involved. Nearly 20 per cent of patients with obstructive jaundice still develop postoperative renal insufficiency, but preoperative prophylactic use of sodium deoxycholate should reduce this very significantly.

Acute Kidney Injury↗
PubMed1983

Biliary cystadenoma.

Explore the source record for details and available documents.

Biliary Tract Neoplasms↗
PubMed1983

Invasive breast cancer--the tip of an iceberg.

Use of large (6 in. X 4 in.) paraffin sections in the routine examination of specimens from patients with operable breast cancer has revealed multiple quadrant involvement by carcinoma in 20% of 186 consecutive cases. Eighty-nine per cent of patients had invasive carcinomas, which were associated with carcinoma in situ (CIS) in 71%. CIS was frequently extensive, and in 47% was remote from the principal invasive lesion. Fourteen patients had multifocal invasive disease with 34 separate primary tumours. The involvement of 32% of sampled axillary nodes by tumour, combined with this significant incidence of multiple quadrant disease, brings into question the rationale of local surgery in most cases even of early breast cancer. Mastectomy with node sampling permits full assessment of the extent of disease, which is essential for the logical selection of patients for adjuvant therapy. The potential role for limited surgery in non-invasive and very small invasive tumours in combination with radiotherapy remains under evaluation.

Adult↗
PubMed1981

Features of mammorgraphically negative breast tumours.

Mammography is a highly sensitive and specific technique in the diagnosis of breast cancer, but some tumours show no radiological features of malignancy. A total of 9.3 per cent of 323 consecutive patients with operable breast cancer had negative mammographic reports, and the clinical radiological and pathological findings in these cases are compared with those in the mammographically diagnosed group. Misinterpretation of carcinoma as a benign lesion and diagnostic difficulties in the dense dysplastic breast were found to be the main causes of error.

Adult↗