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Biomedical subjects

C J Fagan

Publications and source records attributed to C J Fagan.

At least 37 records · Page 2Linked to original sources
PubMed1984

Plasma concentrations of cholecystokinin in patients with duodenal ulcer disease.

Cholecystokinin (CCK) is structurally similar to gastrin and is known to competitively inhibit the action of gastrin on the parietal cell, but little information has been accumulated about circulating levels of CCK in patients with duodenal ulcer (DU). In a group of 18 healthy volunteers (controls) and 22 DU patients (13 with active DU, nine with inactive DU), we stimulated endogenous release of CCK with oral administration of Lipomul corn oil. Plasma concentrations of CCK were measured by radioimmunoassay; ultrasonographic measurements of gallbladder volume were used as a biologic correlate for CCK in control patients and in patients with active DU. No significant difference was found in fasting plasma concentrations of CCK between controls (107 +/- 8 pg/ml) and DU patients (123 +/- 15 pg/ml), or in their total integrated release of CCK during the first hour after Lipomul ingestion (3.7 +/- 0.7 ng-min/ml in controls, 2.8 +/- 0.4 ng-min/ml in DU patients). Furthermore, no significant difference was found in integrated release of CCK between patients with active DU (2.9 +/- 0.6 ng-min/ml) and those with inactive DU (2.8 +/- 0.6 ng-min/ml). Gallbladder volume was highly correlated with plasma concentrations of CCK in controls (r = -0.91) and in active DU patients (r = -0.98). Patients with active DU had significantly smaller volumes of their resting gallbladders, they emptied less of their resting gallbladder contents in response to fat, and they showed diminished sensitivity to endogenously released CCK compared to controls. In six patients with active DU who underwent truncal vagotomy and drainage, integrated release of CCK increased significantly, from 1.9 +/- 0.6 ng-min/ml before vagotomy to 9.3 +/- 3.0 ng-min/ml after vagotomy. We found no evidence to suggest that abnormalities in release of CCK contributes to the development of duodenal ulcers. We speculate, however, that the increased release of endogenous CCK after truncal vagotomy may possibly play an etiologic role in the syndrome of postvagotomy diarrhea.

Adult↗
PubMed1984

Comparison of cholecystokinin release and gallbladder emptying in men and in women at estrogen and progesterone phases of the menstrual cycle.

Why are gallstones more common in women than in men? To investigate this, we measured gallbladder emptying (by ultrasonography) and release of endogenous cholecystokinin (CCK) (by specific radioimmunoassay) in eight men and nine women in response to ingestion of corn oil (1 gm/kg). Each woman was studied on the fourteenth and twenty-first day of her menstrual cycle, estimated to be the estrogen (women [E] ) and progesterone (women [P] ) peaks, respectively. Fasting plasma concentrations of CCK were significantly higher in women (E) (135 +/- 7 pg/ml) than in men (99 +/- 13 pg/ml) but not significantly higher than in women (P) (113 +/- 11 pg/ml). The peak increase in CCK concentration over basal concentration and the integrated release of CCK were not significantly different from one group to another. Men had a larger fasting gallbladder volume (GBV) (21.4 +/- 3.2 ml) than did women (E) (12.4 +/- 2.1 ml) and women (P) (14.2 +/- 2.1 ml) and emptied more GBV in response to fat than did the women. The residual GBV and fractional emptying after ingestion of corn oil were not different among the three groups. Measurements of plasma CCK and GBV during the contraction phase were highly correlated in all groups. It appears, from these data, that the increased prevalence of gallstones in women relative to men cannot be explained on the basis of significant differences either in release of CCK or in gallbladder motility. Linear regression lines that were developed indicated that the mean change in GBV relative to a given change in plasma CCK was significantly higher in men than in women. Differences between men and women in this hormonal-motility relationship may contribute to the incidence of gallstones in premenopausal women.

Adult↗
PubMed1983

Correlation between gallbladder size and release of cholecystokinin after oral magnesium sulfate in man.

In order to determine the effect of oral magnesium sulfate on gallbladder contraction and release of cholecystokinin (CCK) in man, magnesium sulfate (25 g in 100 ml distilled water) was given by mouth to five fasting adult male volunteers. Plasma samples were collected for measurement of CCK by a specific radioimmunoassay. Gallbladder volumes were determined from sonograms obtained from a phased-array real-time ultrasound scanner. Basal concentrations of CCK (82.2 +/- 10.1 pg/ml) increased significantly at 20 minutes after oral magnesium sulfate (113.8 +/- 7.1 pg/ml), and reached a maximal value at 50 minutes (150.0 +/- 42.0 pg/ml). The mean basal volume of the gallbladder was 30.8 +/- 5.3 cm(3) and maximum reduction of gallbladder volume (to one third of original) was achieved at 50 minutes after ingestion of magnesium sulfate. Linear regression analysis showed a close correlation (r = -0.9337) between plasma concentrations of CCK and gallbladder size in response to magnesium sulfate. Oral magnesium sulfate also caused a significant increase in serum gastrin (from basal of 51.4 +/- 9.9 pg/ml to 69.8 +/- 15.5 pg/ml at 5 min); there was no significant correlation between gastrin release and gallbladder contraction. This study provides direct evidence that the mechanism of magnesium sulfate-stimulated gallbladder contraction occurs through the release of CCK, and shows a close correlation between CCK release and contraction of the gallbladder.

Adult↗
PubMed1982

Correlation between release of cholecystokinin and contraction of the gallbladder in patients with gallstones.

The role of endogenously released cholecystokinin (CCK) in mediating gallblader (GB) contraction was evaluated in 12 normal volunteers and 24 patients with gallstones (11 additional gallstone patients were excluded because of failure of adequate ultrasonographic visualization). CCK concentrations before and after oral administration of fat (Lipomul((R))) were measured by a specific radioimmunoassay. CCK release was correlated with changes in GB volume determined simultaneously by ultrasonography. On the basis of gallbladder contraction and operative findings, gallstone patients were divided into "contractors" (14), "noncontractors" (6), and "hydrops" (4). Lipomul caused prompt release of CCK in normal volunteers and all groups of gallstone patients. The changes (basal to peak) in plasma CCK (pg/ml) for the different groups were as follows: normal volunteers (108 +/- 9 to 200 +/- 16), contractors (77 +/- 10 to 128 +/- 13), noncontractors (59 +/- 7 to 159 +/- 38), and hydrops (43 +/- 5 to 113 +/- 47). The total integrated output of CCK (0-60 min) was greater in normal volunteers (3975 +/- 762 pg-min/ml) than in contractors (1530 +/- 567 pg-min/ml). Lipomul caused similar GB contraction in normal volunteers and contractors (from basal volumes to maximal contraction); these changes were from 19.5 +/- 2.3 ml to 5.6 +/- 1.0 ml in normal volunteers, and from 19.6 +/- 3.2 to 5.2 +/- 1.0 in contractors. Plasma concentrations of CCK and GB volume were highly correlated in the 12 normal volunteers (r = -0.89, p < 0.01) and in the 14 contractors (r= -0.99, p < 0.01)), but the GB was significantly (p < 0.01) more sensitive to changes in plasma CCK in the gallstone contractors than in the normal volunteers. The authors suggest that there may be two groups of gallstone patients, noncontractors and contractors. Stasis may be important in the pathogenesis of gallstones in the noncontractors, whereas in contractors, the authors speculate that an abnormality in the CCK-gallbladder relationship (characterized by diminished CCK release and increased GB sensitivity to CCK) may be involved in the evolution of the disease.

Adult↗
PubMed1982

Page kidney.

The computed tomographic (CT) findings of a classic case of Page kidney (hypertension resulting from compression of the renal parenchyma by a subcapsular hematoma) is presented. An excretory urogram and renal arteriogram performed prior to the CT study resulted in nonspecific findings. The CT findings of a well circumscribed, elliptically shaped, low density, subcapsular hematoma producing parenchymal compression was correlated with the onset of hypertension following remote trauma, permitting the CT diagnosis of Page kidney.

Adolescent↗
PubMed1982

Benign urachal cyst in an adult.

Benign urachal cyst is a rare lesion in the adult. Prompt diagnosis and management are important to avoid complications. This report illustrates the value of computed tomography (CT) in establishing the diagnosis of urachal cyst in a case in which conventional radiography and ultrasonography were normal. In any patient with a history or physical findings suggestive of a urachal anomaly, CT is most useful in establishing the nature of the anomaly and extent of the lesion. In this case, CT findings of a soft tissue mass at the bladder apex continuing superiorly as a tubular structure were consistent with infected urachal cyst.

Adult↗
PubMed1981

The sonographic features of intra-abdominal pregnancy.

The sonographic features of three cases of extrauterine, intra-abdominal pregnancy are presented in conjunction with a brief review of the clinical and radiographic features of the condition. Based on our experience and a review of the literature, we found that the major criteria for the sonographic diagnosis of extrauterine, intra-abdominal pregnancy include: 1) demonstration of a fetus in a gestational sac outside the uterus, or the depiction of an abdominal or pelvic mass identifiable as the uterus separate from the fetus; 2) failure to see a uterine wall between the fetus and urinary bladder; 3) recognition of a close approximation of the fetus to the material abdominal wall; and 4) localization of the placenta outside the confines of the uterine cavity.

Adult↗
PubMed1981

Sonographic features of carcinoma of the gallbladder.

The sonographic features of carcinoma of the gallbladder are reviewed. Four cases of carcinoma of the gallbladder are presented which illustrate some, but not all, of the sonographic findings resulting from this abnormality. The findings illustrated are (a) a small gallbladder containing stones associated with a mass in the porta hepatis, (b) diffuse gallbladder thickening, fixation, and irregularity, (c) a papillary mass with an irregular border projecting from the gallbladder wall, and (d) a small, localized area of gallbladder wall thickening associated with cholelithiasis. Although inflammatory disease of the gallbladder can present similar sonographic findings, the correlation of the clinical findings and close inspection of the sonographic changes illustrated and described in this publication may allow the only means of a preoperative diagnosis of carcinoma of the gallbladder.

Adenocarcinoma↗
PubMed1981

Release of cholecystokinin in man: correlation of blood levels with gallbladder contraction.

Although it is generally assumed that release of cholecystokinin (CCK) is the chief mechanism by which a fatty meal causes contraction of the gallbladder, measured release of CCK and gallbladder contraction have never been correlated. We have achieved this correlation in eight adult male volunteers, by means of a specific radioimmunoassay for CCK and by ultrasonographic imaging of the gallbladder. This study validates our CCK radioimmunoassay and correlates measured concentrations of CCK with changes in gallbladder size measured by ultrasonographic examination. Basal concentrations of CCK (82.6 +/- 10.4 pg/ml) rose significantly to a maximum of 411.1 +/- 79.9 pg/ml at 16 minutes after intraduodenal instillation of medium-chain triglyceride (Lipomul). Mean basal volume of the gallbladder was 34.6 cm3; maximum reduction of gallbladder volume (to one-third of original) was achieved at 18 minutes. Elevated CCK concentrations began to fall toward basal, and the gallbladder began to refill at 25 minutes. Results obtained after oral ingestion of Lipomul provide similar results. Linear regression analysis demonstrated excellent correlation between concentrations of CCK and gallbladder size during both contraction and relaxation phases. Future study of this correlation may be useful in patients with manifest dysfunction of the gallbladder, as well as in individuals known to be at risk of gallbladder disease.

Adult↗
PubMed1981

Pseudocoarctation of the aorta.

A case of pseudocoarctation of the thoracic aorta manifested by a mediastinal mass on a roentgenogram of the chest and subsequently evaluated with computed tomography (CT) is presented. The following combination of CT findings is thought to be diagnostic of this rare congenital anomaly: (a) demonstration that the mass is part of the aorta, (b) the depiction of the unusual aortic arch high in the mediastinum, (c) visualization of the isthmus portion of the descending aorta not adjacent to the spine but rather located ventral to it and surrounding by aerated lung, and (d) more caudal origin of the subclavian artery resulting in a vascular shadow posterior to the kinked aortic arch.

Aorta, Thoracic↗
PubMed1980

Lithopedion: stone baby.

Two cases of lithopedion were encountered. In one case, computerized tomographic (CT) findings are illustrated. There are no classical clinical signs or symptoms that aid in the diagnosis of this rare condition. A calcified fetus and investing membranes are readily identified on a plain film of the abdomen, and these constitute an absolute sign of lithopedion. Excretory urography, barium enema examination, ultrasound, and CT represent other diagnostic modalities in the evaluation of this condition, but they are rarely indicated or valuable.

Adult↗
PubMed1979

Retroperitoneal fibrosis: ultrasound and CT features.

The sonographic and computed tomographic (CT) findings in three cases of retroperitoneal fibrosis are illustrated. Its clinical, laboratory, and conventional radiographic findings are often nonspecific. The sonographic findings consist of an extensive retroperitoneal, extrarenal, anechoic, well marginated, and irregularly contoured mass. Computed tomography depicts a paraspinal, extrarenal, and well marginated lesion that is isodense with the surrounding muscles. Through other abnormalities present similar sonographic and CT findings, the differential diagnosis is limited so that correlation of the clinical and radiographic changes allows a preoperative diagnosis with high confidence.

Adult↗
PubMed1978

Persistence of the dens as the body of C1. A case report of a rare anomaly.

A patient with persistence of the dens as the body of the first cervical vertebra is described. This is an extremely rare anomaly and in this patient was associated with instability of the first cervical vertebra. Embryologic considerations and the clinical implication- of this anomaly are discussed.

Adult↗
PubMed1976

Traumatic lung and paramediastinal pneumatoceles.

Traumatic pulmonary and paramediastinal pneumatoceles are definite, acutely formed, primary structural manifestations incident to nonpenetrating chest trauma. They are not secondary lesions, i.e., cavities or pneumatoceles resulting from the resolution of a pulmonary hematoma. Awareness of this fact will explain the not uncommon finding of a cavitary lesion, often containing an air-fluid level, on initial emergency room radiographs of patients who have sustained closed chest trauma. This will avoid unnecessary and unpleasant diagnostic procedures, including thoracotomy, for traumatic pneumatoceles are self-limiting, benign abnormalities which usually require no therapy other than observation.

Adolescent↗