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Biomedical subjects

C W Imrie

Publications and source records attributed to C W Imrie.

At least 91 records · Page 5Linked to original sources
PubMed1987

Mesenteric venous thrombosis and antithrombin III deficiency.

Of the 123 patients with acute mesenteric infarction treated over the past 12 years, 16 (13%) had mesenteric venous thrombosis. Eight of the patients with mesenteric venous thrombosis survived the initial episode; two have since died. The remaining six patients were studied for evidence of haemostatic deficiencies or abnormalities. Antithrombin III deficiency, which is known to be associated with recurrent venous thrombosis, was found in three patients. It is recommended that all patients with mesenteric venous thrombosis should be screened for antithrombin III deficiency as treatment with coumarin anticoagulants may be indicated, providing effective prophylaxis against further thrombotic episodes.

Adult↗
PubMed1987

A new pattern of histologic predominance and distribution of malignant diseases of the small intestine.

One hundred and six patients presenting with primary malignant lesions of the small intestine during a 15 year period from 1969 to 1983 have been reviewed with respect to the histologic nature and location of the neoplasms within the small intestine. In contrast with the results of previous reports, we have found lymphoma to be the most common primary malignant condition of the small intestine. Two populations of patients with lymphomas may exist--those associated with celiac disease being confined to the proximal part of the jejunum and those arising de novo from lymphomatous tissue in the distal part of the ileum. Patients with carcinoma had the primary tumor frequently located in the distal portion of the small intestine.

Age Factors↗
PubMed1986

Amylase and gut infarction.

Serum amylase has been determined on admission in 63 (52 per cent) of 122 patients with acute mesenteric infarction. Amylase levels were normal in 34 (54 per cent) and reached greater than twice normal in 15 patients (24 per cent). In 5 patients (3 on admission) amylase levels were in the diagnostic range of acute pancreatitis (greater than 1200 units/l) leading to inappropriate non-operative treatment in 4. Hyperamylasaemia was found in association with all aetiologies of infarction. The magnitude of the hyperamylasaemia appeared to be related to the extent of the bowel infarction, the highest levels occurring when infarction involved the small bowel and colon. The mechanism of hyperamylasaemia in acute mesenteric infarction is discussed.

Amylases↗
PubMed1986

Parathyroid hormone levels, hyperparathyroidism and acute pancreatitis.

Since 1971, in Glasgow Royal Infirmary 880 patients with acute pancreatitis (AP) have been prospectively studied. Only two (0.23 per cent) have been found with associated hyperparathyroidism (HPT), one of whom also had gallstones. During the period of study daily serum calcium levels were measured routinely in all patients with AP and, in addition, a consecutive series of 200 patients had daily mineral metabolism screening of blood and urine in an attempt to identify patients with hypercalcaemia as an aetiological factor. A separate group of 90 patients had sequential daily serum calcium and parathyroid hormone assays (PTH) performed for the first five days of their hospital admission and one of the patients described in this paper came from this group. She is the first patient, to our knowledge, documented in this manner. The overall pattern of the PTH and calcium response from all these patients is also recorded according to the severity of the AP. Hyperparathyroidism is uncommonly associated with AP and when it is other aetiological factors must be excluded.

Acute Disease↗
PubMed1986

Survival of surgical patients with carcinoma, lymphoma and carcinoid tumours of the small bowel.

We have analysed the effects of 'curative' and palliative surgery and adjuvant therapy on actuarial 5 and 10 year survival in 97 local patients with primary small bowel malignancies presenting to five Glasgow teaching hospitals over a 15 year period. The 5 year survival rates in 18 patients with lymphoma undergoing 'curative' surgery was 48 per cent while in patients whose surgery was considered palliative the figure was 12 per cent (P less than 0.001). In the 29 patients with carcinoma, 17 had 'curative' surgery and 12 a palliative procedure with respective 5 year survival rates of 38 per cent and 0 per cent (P less than 0.01). In 16 patients with carcinoid tumours the surgeons' assessment of curative or palliative surgery was of little consequence with 51 per cent of the palliative group alive at 10 years. Mean survivals were increased in lymphoma patients in both 'curative' and palliative groups receiving adjuvant therapy but not significantly so. We suggest that all detectable macroscopic tumour, where possible, should be removed and that adjuvant therapy may be of benefit in all patients with lymphoma, even when surgery is considered 'curative'.

Aged↗
PubMed1986

Total colonic ischemia.

The involvement of the entire colon in an ischemic process is unusual because of the dual source of blood supply to the large bowel. Three cases of total ischemic colitis are presented. A precipitating cause to account for the distribution of ischemia was identified in each patient.

Aged↗
PubMed1986

Occult pancreatic cancer with recurrent acute pancreatitis.

A patient with occult pancreatic carcinoma associated with recurrent acute pancreatitis is reported. Endoscopic retrograde cholangiopancreatography after the first attack was normal, the diagnosis being made at repeat examination 10 months later.

Acute Disease↗
PubMed1986

Histology and bacteriology of closed duodenal loop models of experimental acute pancreatitis in the rat.

Three variants of closed duodenal loop models of experimental acute pancreatitis in the rat have been analysed histologically and bacteriologically. Histological studies showed that the resulting pancreatitis was usually mild to moderate, being severe only in association with sepsis. Furthermore the duodenal wall became necrotic in most animals. Bacteriological studies revealed gross infection as a major complication. Peritoneal fluid and blood cultures taken at the time of animal sacrifice consistently demonstrated large numbers of bacteria. It is concluded that although these models undoubtedly cause acute pancreatitis, other more severe pathological events occur. Deductions regarding acute pancreatitis drawn from this type of model are therefore not relevant to the human disease.

Acute Disease↗
PubMed1986

Operative transampullary extraction of pancreatic calculi.

Transduodenal sphincteroplasty (TDS) was performed upon five patients with chronic pancreatitis shown on endoscopic retrograde cholangiopancreatography to have stones in the pancreatic ductal system. Stone removal was achieved after TDS using either a Fogarty balloon catheter, a Dormia basket or surgical forceps. All had suffered from a two to three year history of severe pain and weight loss which was relieved in each after stone removal. One patient suffered recurrent pain in the follow-up period of 21 to 45 months (a median of 35 months) and a recurrent stone in the pancreatic duct was removed endoscopically using a Dormia basket. Contrary to widely held views, TDS and simple stone extraction have a place in the management of some patients with chronic pancreatitis.

Adult↗
PubMed1985

Prediction of severity in acute pancreatitis: prospective comparison of three prognostic indices.

The prognostic value of three predictive indices was compared in 436 attacks of acute pancreatitis in 418 patients. The outcome of an attack was graded as uncomplicated (324), complicated (70), or fatal (41); 1 attack was excluded because of puncture of the caecum. The overall mortality rate was 9.4%. Clinical assessment on admission identified only 34% of patients whose attack was severe (ie, complicated or fatal). Multiple laboratory criteria and peritoneal lavage were more sensitive (61% and 53%, respectively) while retaining diagnostic accuracy (79% and 74%). An erroneous diagnosis of pancreatitis was corrected by the findings on lavage in 5 patients. The major advantage of peritoneal lavage over multiple laboratory criteria was the shorter delay between admission to the study and determination of severity (median 4 v 24 h), but visceral puncture during insertion of the cannula occurred in 2 of 253 patients (0.8%). When used together, the three indices correctly predicted 82% of the attacks with a severe outcome and identified all patients destined to die within 10 days of admission.

Acute Disease↗
PubMed1985

Controlled clinical trial of peritoneal lavage for the treatment of severe acute pancreatitis.

We performed a multicenter, randomized, controlled clinical trial of therapeutic peritoneal lavage (2 liters per hour for three days) in 91 patients with severe acute pancreatitis. Patients were entered into the study if severe pancreatitis was indicated by multiple laboratory criteria or diagnostic peritoneal lavage. All patients received full supportive treatment. The median time between the onset of symptoms and randomization was 38 hours. Forty-six patients were assigned to the control group and 45 to the lavage group. There were 13 deaths (28 per cent) and 16 patients with major complications (35 per cent) in the control group, as compared with 12 deaths (27 per cent) and 17 patients with major complications (38 per cent) in the lavage group. Lavage did not appear to modify the length of survival, the incidence of pancreatic collections (pseudocysts or abscesses), or the plasma amylase concentration. Considering the statistical power of the design, we conclude that the outcome of severe pancreatitis was not greatly, if at all, influenced by the regimen of peritoneal lavage used in this study.

Acute Disease↗
PubMed1985

The use of endoscopic retrograde choledocho pancreatography (ERCP) in the diagnosis of internal fistulae complicating severe acute pancreatitis.

Three patients are presented in whom internal pancreatic fistulae were accurately demonstrated by ERCP. It is recommended that this procedure be considered in the investigation of patients with continuing acute pancreatitis who are not settling on standard conservative treatment and in whom internal fistula formation is suspected. The procedure should also be considered in patients who present with unusual respiratory symptoms or with amylase-rich effusions.

Acute Disease↗
PubMed1984

Hyperlipidaemia, alcohol abuse and acute pancreatitis.

Of 311 patients with primary acute pancreatitis, seven revealed major and seven minor lipid abnormalities on hospital admission. One pregnant woman suffered acute pancreatitis associated with Fredrickson type I hyperlipoproteinaemia. Twelve of the 13 men with types IV and V hyperlipoproteinaemia suffered alcohol abuse pancreatitis and represented 13.2 per cent of this aetiological group. However, only one of the 157 patients (0.6 per cent) with biliary disease had lipid abnormalities. Two of the 13 men died--the oldest, who had gallstones, and one with alcohol related disease. The remaining 11 were subject to follow-up (5-10 years). Six, who had improvement of their lipid abnormalities, had abstained from alcohol. The other five had a persistent lipid disorder, and all admitted continuing heavy alcohol ingestion. The clinical diagnosis of acute pancreatitis was supported by serum amylase elevation in only nine of the fourteen patients. Urinary amylase levels were consistent with the diagnosis in 11 of the 12 patients. Estimation of both serum and urinary amylase gave 100 per cent support to the clinical diagnosis of acute pancreatitis. Hyperlipidaemia associated with acute pancreatitis may be secondary to alcohol abuse but the possible role of HLP cannot be discounted. Urinary amylase is useful in diagnosing acute pancreatitis in the presence of hyperlipidaemia.

Acute Disease↗
PubMed1984

Prognostic factors in acute pancreatitis.

Prognostic factor scoring systems provide one method of predicting severity of acute pancreatitis. This paper reports the prospective assessment of a system using nine factors available within 48 hours of admission. This assessment does not include patient data used to compile the system. Of 405 episodes of acute pancreatitis occurring in a seven year period, 72% had severity correctly predicted by the system; 31% of 131 episodes with three or more factors present were severe and 8% of 274 episodes with less than three factors were severe. Assessment of individual factors revealed only one which did not predict severity. A scoring system based on the other eight factors correctly predicted severity in 79% of episodes. Prognostic factor scoring systems (i) alert the clinician to potentially severe disease, (ii) allow comparison of severity within and between patient series and (iii) will allow rational selection of patients for trials of new treatment.

Acute Disease↗