Pseudoulcerating mass of the esophagus caused by cardiomegaly.
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Aged↗
Biomedical subjects
C S Ho
Publications and source records attributed to C S Ho.
D-mannose as a preservative of glucose in blood samples.
We studied the changes in blood glucose concentration in blood samples collected in heparinized specimen tubes containing no other preservative, or containing NaF, D-mannose, or a combination of NaF and D-mannose. Blood concentration in samples taken into NaF decreased by 0.40 mmol/L in the first 2 h; thereafter, there was no change. In samples collected into mannose there was a small but significant decrease in blood glucose concentration with time. When samples containing mannose were analyzed immediately after collection, the concentration of glucose was higher than in later analyses, probably because of an exchange of intracellular glucose for extracellular mannose. When a combination of NaF and mannose was used, the blood glucose concentration was relatively stable but slightly higher than nonpreserved samples for the next 24 h. However, samples containing mannose were unsuitable for electrolyte analysis. We conclude that a combination of D-mannose and NaF may be a better preservative for blood glucose than either compound alone.
Adult↗
Intractable gastroparesis: treatment with percutaneous fluoroscopically guided gastrostomies.
Gastroparesis is a relatively uncommon disorder which may develop in some patients with diabetes mellitus, or after gastric surgery. It is often manifested by intractable nausea and vomiting, leading to malnourishment and poor blood sugar control in the diabetic patient. We describe such a patient who was diabetic, and who also had a previous vagotomy and pyloroplasty. Currently acceptable pharmacologic treatment was unsuccessful. The patient's problems were successfully treated, however, by double-percutaneous fluoroscopically guided gastrostomy catheter insertions. One of the gastrostomy catheters was placed in the gastric fundus and linked externally to a second (feeding) catheter that had been placed previously at the duodenal-jejunal flexure. The patient has remained symptom free in the 14 months since the procedure. Other available treatments are discussed, and the authors recommend that this simple and safe method be considered in treating severe intractable gastroparesis.
Adolescent↗
Percutaneous transhepatic biliary drainage for malignant biliary obstruction: a report of two cases with five year survival.
We report two cases of malignant biliary obstruction in whom percutaneous transhepatic biliary drainage has contributed to patient survival of more than 5 years. To our knowledge, this represents the first such case report in the literature. Both patients suffered biliary obstruction from poorly differentiated adenocarcinoma, in all likelihood from the head of the pancreas. Morbidity has been low with only two episodes of significant sepsis and one episode of GI haemorrhage in one patient and both patients were able to enjoy an excellent quality of life. These cases demonstrate that percutaneous biliary drainage has a place not only in the short term palliation of patients with malignant biliary obstruction, but in the long term as well.
Adenocarcinoma↗
Interference of D-mannose in glucose measurements by glucose oxidase and hexokinase methods.
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Blood Glucose↗
Fluoroscopically guided percutaneous gastrostomy: is gastric fixation necessary?
In this animal study the authors evaluated the safety of inserting gastrostomy catheters percutaneously without the aid of gastric fixation. In a laboratory model (excised dog stomachs) there was not leakage around gastrostomy tubes of different sizes (nos. 8 to 18 French), despite maximum gastric distension and intragastric pressures of up to 100 mm Hg. When the tubes were removed, the risk of leakage from the gastrostomy increased in proportion to the size of the gastric defect. Percutaneous gastrostomy catheters (no. 14 French) were then placed in five live dogs without gastric fixation and were immediately withdrawn. All animals remained well. Autopsies performed 7 days later showed no evidence of leakage. The authors conclude that there is no leakage around correctly placed gastrostomy tubes. Although gastric defects larger than no. 10 French leak easily in vitro, a defect of no. 14 French is well tolerated in vivo. The authors suggest that percutaneous gastrostomy may be performed safely without gastric fixation devices in patients as long as the size of the initial cathether used is no. 14 French or smaller.
Animals↗
US guidance of interventional procedures.
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Humans↗
Percutaneous feeding gastrostomy in patients with head and neck tumors: a 5-year review.
Since the beginning of this decade major advances have taken place in the alimentation of patients with tumors of the head and neck. Gauderer and Ponsky described a percutaneous method of gastrostomy and, in 1983, a number of radiologists, including the senior author, described a percutaneous radiologic method using the Seldinger technique to create a feeding gastrostomy. This method is ideally suited for patients with advanced tumors of the head and neck because it requires neither endoscopy nor general anesthesia. Over the past 5 years, 55 patients with tumors of the head and neck have undergone this procedure. Eighty-one percent of the patients had advanced disease at initial presentation. One patient (1.8%) had a procedure-related death and another patient (1.8%) had a complication that required a laparotomy. Three patients (5.4%) had minor complications that required minimal medical attention. None of the patients required general anesthesia and an endoscopy was not required. Patient discomfort during the procedure was minimal.
Adult↗
Gallstone dissolution in methyl tert-butyl ether after mechanical fragmentation: in vitro study.
Twenty sets of three gallstones matched for weight and appearance were selected from 20 surgically resected human gallbladders to test the effect of intracorporeal mechanical fragmentation on gallstone dissolution with methyl tert-butyl ether in vitro. One stone from each set was fragmented by a mechanical lithotriptor and then treated with methyl tert-butyl ether, and one was used as control and was treated intact. The third stone was analyzed for its density pattern on CT and biochemically for its cholesterol and calcium content. On the basis of CT appearance, the stones were classified as noncalcified, partially calcified, or heavily calcified. Mechanical fragmentation reduced dissolution time by 25-69% (mean +/- SD, 44 +/- 16%) for the noncalcified stones and by 20-42% (mean +/- SD, 30 +/- 8%) for the partially calcified stones. No significant reduction was observed for the heavily calcified stones. The degree of reduction was inversely related to maximal stone density (r = -.72) and was independent of its pattern of calcification. This study shows that mechanical fragmentation is effective in accelerating gallstone chemolysis by methyl tert-butyl ether for noncalcified and partially calcified but not for heavily calcified stones.
Calcium↗
Percutaneous transhepatic biliary drainage: a review.
Percutaneous transhepatic biliary drainage (PTBD) was conceptualized more than 35 years ago, but its clinical application only flourished in the past 10 years after a number of technical refinements. Initially it was used primarily as a means of providing palliative decompression for patients with malignant biliary obstructions. Despite a number of well-recognized problems associated with its long-term use, including relatively high prevalences of cholangitis and other catheter-related complications, PTBD remains a viable treatment for patients with advanced malignancies where few therapeutic alternatives exist. In recent years, PTBD has increasingly been employed in the management of benign biliary diseases. Since only short-term drainage is required in the majority of patients with benign diseases, much of the catheter-related complications can be avoided. Through the transhepatic tract created by PTBD, various therapeutic manipulations can be performed, including biliary lithotripsy, stricture dilatation, and sphincterotomy. The impact of PTBD in the management of benign biliary diseases is expected to increase with the development of more sophisticated transhepatic instruments and techniques. In this article, the technique and complications of PTBD are described, followed by a review of the applications of PTBD in both malignant and benign biliary diseases.
Bile Duct Neoplasms↗
Handling of blood specimens for glucose analysis.
There is no consensus concentration of sodium fluoride (NaF) required for preserving glucose in blood specimens. We examined the effectiveness of different concentrations of NaF. Glucose concentration in blood samples decreased with time, despite the presence of a high concentration of NaF (12 g/l). The decrease in glucose concentration was less with increasing amounts of NaF but could not be totally abolished. The clinical implications of these pre-analytical errors is discussed.
Adult↗
The hypotensive action of Desmodium styracifolium and Clematis chinensis.
The cardiovascular pharmacology of aqueous extracts of Desmodium styracifolium (DSE) and Clematis chinensis (CCE) were studied in rats both in vivo and in vitro. DSE produced two successive hypotensive actions: the first one via cholinergic receptor stimulation, while the second one potentiated by blockades of autonomic ganglion and alpha-adrenoceptor. In contrast to DSE, CCE produced only one hypotensive response which was mediated through histaminergic activity. Furthermore, both extracts relaxed isolated methoxamine preconstricted helical tail artery strips. CCE also produced both negative chronotropic and inotropic effects on isolated atria, while DSE was positive chronotropic without apparent effect on the contractile force.
Animals↗
Percutaneous feeding gastrostomy with the Seldinger technique: review of 252 patients.
Over a period of 60 months, percutaneous nonendoscopic gastrostomy for enteral feeding was successfully performed with the Seldinger technique in 250 of 252 consecutive patients. Local anesthetics alone (without intravenous sedatives) were used in 248 patients (98%). The 30-day mortality was 14.2% and included two procedure-related deaths (0.8%). Major complications necessitating surgery occurred in three patients (1.2%), and one patient had a major gastrointestinal hemorrhage (0.4%) treated medically. Minor complications occurred in 4.4% of patients. The results compare favorably with those found with alternative techniques (surgical or endoscopic) for gastrostomy. The authors conclude that this procedure is simple, is relatively safe, and represents a preferred method of gastrostomy for enteral feeding.
Anesthetics, Local↗
A digoxin-like immunoreactive substance and atrioventricular block induced by a Chinese medicine "kyushin".
The attempted suicide by 2 women with a kyushin overdose is reported. Kyushin caused them to produce a significant elevation of a serum digoxin-like immunoreactive substance (2.35 and 1.84 ng/ml) and symptoms of nausea, vomiting and general malaise. Their blood biochemistry and electrolytes were normal. In one patient, an electrocardiogram revealed a second degree Wenckebach atrioventricular block and T-wave change. Toad venom, a kyushin ingredient, is possibly responsible for the development of these clinical features and electrocardiographic changes.
Adult↗
Fine needle aspiration biopsy.
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Biopsy, Needle↗
Barium study of small bowel endometriosis.
Small bowel involvement by endometriosis is uncommon and can present as an acute, chronic, or intermittent obstruction. Enteroclysis identifies the site and extent of involvement in patients known to have endometriosis.
Adult↗
Complications of surgical and percutaneous nonendoscopic gastrostomy: review of 233 patients.
A retrospective study was undertaken to compare the complications of surgical feeding gastrostomy in 100 consecutive patients with those of percutaneous nonendoscopic gastrostomy in 133 consecutive patients. The age and sex distribution and indications for gastrostomy were similar in both groups. Thirty-day mortality in the surgical group was 12% and in the percutaneous group 7.5%. Complications requiring surgical treatment occurred in 8% and 1.5% of the surgical and percutaneous patients, respectively. Significant nonsurgical complications, such as bleeding, aspiration, and myocardial infarction, occurred in 11% of patients undergoing surgical gastroscopy and 3.0% of those with percutaneous gastrostomy. Minor complications, such as mild wound infection and pericatheter leakage, occurred in 14% of surgical patients and in 0.7% of percutaneous patients. Overall, there were significantly fewer complications with percutaneous gastrostomy than with surgical gastrostomy (p less than 0.01). We conclude that percutaneous, nonendoscopic gastrostomy is safer than surgical gastrostomy and hence the preferred method for long-term enteral feeding.
Adolescent↗