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Biomedical subjects

D C Carter

Publications and source records attributed to D C Carter.

At least 127 records · Page 7Linked to original sources
PubMed1988

Fatal acute pancreatitis.

Review of all deaths from acute pancreatitis recorded at Glasgow Royal Infirmary between 1974 and 1984 identified 126 patients, 53 (42%) of whom had pancreatitis first diagnosed at necropsy. Aetiologies of the fatal attacks of pancreatitis included gall stones (30%), alcohol (15%), other identified aetiological factors (17%), and was unknown (38%). Overall mortality fell from 14.9% in the early half of the study to 10.8% in the latter half although in the 73 patients in whom the diagnosis of acute pancreatitis was made during life, the mortality rate was unchanged throughout. Within the group of 73 patients diagnosed during life deaths from gall stone pancreatitis have fallen by almost 50% suggesting that improved treatment of this subgroup may have occurred. The findings of this study lend support to the concept of early, complete clearance of calculi from the biliary tree, either by an endoscopic or surgical approach.

Acute Disease↗
PubMed1988

An autoradiographic study of regional distribution of gastric mucosal blood flow.

Iodo[14C]antipyrine autoradiography was used to measure gastric mucosal blood flow in anesthetized rats and to study regional distribution. Blood flows of 61 +/- 8 ml.100 g-1.min-1 (means +/- SE) in corpus and 84 +/- 9 ml.100 g-1.min-1 in antral mucosa compared well with previously reported measurements by hydrogen clearance. Blood flow in the crests of corpus mucosal folds was significantly higher than in the valleys between folds, indicating that the greater susceptibility of the former areas to acute injury, documented in several studies, is not associated with a perfusion defect in the resting stomach. Corpus mucosal blood flow was also higher in the side walls of the stomach than in the greater curvature region, and in distal than in proximal locations. No systematic regional variations within antral mucosa were demonstrated.

Animals↗
PubMed1987

Evaluation of the prognostic factors in gastric cancer: the effect of chemotherapy on survival.

This is a retrospective review of 328 consecutive patients with histologically confirmed gastric adenocarcinoma diagnosed in one centre between 1974 and 1984. Of these patients, 128 (39 per cent) had a curative resection, 32 (9.8 per cent) had a palliative resection, 33 (10.0 per cent) had a gastro-enterostomy, 26 (7.9 per cent) had a Celestin tube inserted, 58 (17.7 per cent) had a laparotomy alone, and 51 (15.5 per cent) had no surgical procedure. The 5 year survival was 11 per cent but all long term survivors were patients who had a curative resection. Using multivariate analysis the best predictor of survival after curative resection was the presence or absence of serosal involvement (P = 0.0004). Patients with a long history of presenting symptoms (greater than 6 months) survived longer than those with a short history (P = 0.001). The impact of chemotherapy on the survival of 202 patients with advanced gastric cancer was analysed by multivariate analysis. The median survival of the 50 patients receiving combination chemotherapy was better than that of the 152 who did not (median survivals 160 versus 71 days; P less than 0.001). When deaths occurring within 14 days of diagnosis were excluded, the significance value dropped to P = 0.02. Comparison of the groups treated between 1974 and 1979, when 8 per cent of 92 patients received chemotherapy, with 1980-1984, when 45 per cent of 110 patients received chemotherapy, showed no significant difference in survival.

Adenocarcinoma↗
PubMed1987

Evaluating surgical risk: the importance of technical factors in determining outcome.

A total of 113 patients having elective resection of the alimentary tract were studied prospectively to examine the relationship of pre-operative clinical and nutritional assessment to the development of major postoperative complications. In addition, the operating surgeon made a risk assessment on a linear analogue scale before and immediately after operation. Major complications developed in 28 patients (25 per cent). Age, weight loss and relative weight did not select high risk patients, but patients with a serum albumin of 29 g/l developed significantly more complications than those with higher levels (60 versus 22 per cent, P less than 0.05). Clinical assessment also selected some high risk patients but patients selected by the surgeon's pre-operative assessment did not develop significantly more complications than those not selected (38 versus 21 per cent). However, the surgeon's postoperative assessment did select patients at significantly increased risk, especially when compared with his pre-operative assessment. Of 38 patients who were selected pre-operatively as high risk or who increased their risk ranking postoperatively, 20 (53 per cent) developed complications, as opposed to only 6 of 65 patients (9 per cent) who were low risk or decreased their risk ranking (P less than 0.001). The surgeons changed their ranking postoperatively in 44 patients and in 36 (82 per cent) the reason given was the technical ease or difficulty of the procedure. Using receiver-operating characteristic curves, immediate postoperative assessment was superior to any pre-operative method of selecting high risk patients. Of 15 patients with normal serum albumin levels whose risk ranking increased postoperatively 6 (40 per cent) developed complications while none of the 7 patients with low serum albumin (high risk) who decreased their risk ranking developed complications. It is concluded that operative performance is the main factor in the development of postoperative complications and should be assessed in future studies of outcome.

Adult↗
PubMed1987

Management of periampullary carcinoma.

Forty-one patients presented to our hospital between 1959 and 1983 with periampullary carcinoma. Twenty-six (63 per cent) underwent radical surgery, eight (20 per cent) local excision of the tumour, six (15 per cent) had bypass procedures and one was treated by endoscopic sphincterotomy (2 per cent). Potentially curative resection was performed in 83 per cent of the 41 patients. The operative mortalities for radical, local and bypass surgery were 7.7 per cent, 25 per cent and 16.6 per cent respectively. The degree of tumour differentiation significantly affected survival while local spread did not significantly affect survival in patients treated radically. The 5 year survival rates (calculated actuarially) for radical, local and bypass surgery were 34, 44 and 0 per cent respectively.

Adenocarcinoma↗
PubMed1987

Total pancreatectomy for chronic pancreatitis.

A survey of six British centres collected data on 83 patients undergoing total pancreatectomy (TP) for chronic pancreatitis between 1977 and 1986. There were 57 men and 26 women with a median age of 38 years (range 19-61 years). Half were alcoholics and half had had previous acute pancreatitis. Besides jaundice (14 per cent) severe pain was the indication for the operation; regular opiates had been needed in 82 per cent of patients and 37 per cent were addicted to these drugs. All but 12 had had previous pancreatic or biliary surgery, with a median of two operations and a maximum of six. TP was a one-stage procedure in 32 patients, 42 had had distal resections and 9 proximal resections in the past; the pylorus was preserved in 30. Median operation time was 4 h (range 2-18 h) and median blood loss was 3 units (1-21 units). Intraoperative complications in 11 patients included haemorrhage in 9. Four deaths occurred within 30 days from bleeding (2), respiratory failure (1) and Roux-loop infarction (1). All but one of the 79 survivors required full pancreatic supplementation and 38 per cent had difficulties in endocrine control. At a median follow-up of 1.5 years (range 0.25-10 years), 57 patients (72 per cent) were pain-free and 9 (11 per cent) needed only occasional analgesia. Though 13 (17 per cent) still took regular analgesics, all were symptomatically improved. There have been 10 late deaths (13 per cent), all but one of which are attributable to the operation.

Adult↗
PubMed1987

A comparison of emergency resection and staged management in perforated diverticular disease.

This retrospective view examines the outcome of surgical treatment of perforated diverticular disease in one hospital in the period 1976 to 1983. Of the 78 patients, 38 underwent emergency colonic resection (group A) whereas 40 (group b) were treated by proximal colostomy and drainage (37 patients) or suture of the perforation with drainage (three patients). There was no significant difference between groups A and B in terms of operative mortality (21 percent vs. 24 percent, respectively). Mortality rates were highest in patients with generalized peritonitis treated by colostomy and drainage (36 percent), whereas those with localized disease undergoing resection had a mortality rate of 17 percent (P less than .05). Eight of the 40 patients in group B developed fistulas whereas none of the group A patients had this complication. Only four (16 percent) of the surviving group A patients were left with a permanent colostomy as opposed to 15 (56 percent) of their counterparts in group B. In the presence of perforated diverticular disease, emergency resection carries a lower morbidity than colostomy and drainage, although the present review shows no statistically significant differences in terms of mortality.

Adult↗
PubMed1987

Pancreatic carcinogenesis: effect of secretin in the hamster- nitrosamine model.

The effect of exogenous secretin on pancreatic carcinogenesis in WO strain hamsters has been examined in the nitrosamine-ductular adenocarcinoma model. Secretin, 20 clinical U/kg, stimulated a maximal secretory response of pancreatic juice and bicarbonate when given iv. The same dose given sc for 6 weeks had no significant effect on pancreatic wet weight and DNA or RNA contents. However, when given to animals receiving N-nitrosobis(2-oxopropyl)amine [(BOP) CAS: 60599-38-4] (5 mg/kg), it reduced the latency and increased the induction rate of tumor development when compared with the carcinogen given alone to animals (secretin + BOP, 15 of 17 animals with tumors; BOP alone, 4 of 13 with tumors at 15 wk; P less than .002). These effects are consistent with secretin acting as a cocarcinogen in this model of pancreatic carcinogenesis.

Adenocarcinoma↗
PubMed1987

Acute pancreatitis and non-Hodgkin's lymphoma.

We report two patients presenting with acute pancreatitis, the aetiology of which was subsequently proven to be non-Hodgkin's lymphoma. Histological confirmation of tumour-associated pancreatitis is essential so that appropriate therapy can be planned.

Acute Disease↗
PubMed1986

TNO-6 has no effect in gastrointestinal cancer: N-acetyl-glucosaminidase shows renal damage.

Twenty-five patients, 16 with gastric cancer and nine with colonic cancer, received TNO-6 30 mg m-2 every four weeks. No objective tumour response was recorded. Nausea and vomiting occurred in 21 patients and was severe in 17. Severe marrow suppression developed in five patients. Renal function was unaffected in all but one patient who developed renal failure, probably as a result of septicaemia. However, the renal tubular enzyme N-acetyl-beta-D-glucosaminidase was measured in six patients and showed a rise in all. In this study TNO-6 had no anti-tumour activity in gastrointestinal malignancy, but produced significant renal tubular damage.

Acetylglucosaminidase↗
PubMed1986

Intratumoral Bacillus Calmette-Guérin immunotherapy prior to surgery for carcinoma of the lung: results of a prospective randomized trial.

A prospective randomized trial of preoperative intratumoral therapy with Bacillus Calmette-Guérin (BCG) was conducted in non-small cell lung cancer patients. Eighty-eight patients (48 BCG-treated and 40 control subjects) were entered into the study; three control subjects were removed from data analysis because histology revealed pathology other than non-small cell lung cancer. There were no differences between BCG-treated and control patients in sex, age, cigarettes smoked per day, pack-years of cigarette smoking, white blood cell count, or number of peripheral blood lymphocytes. Toxicity of BCG was limited to transient malaise and fever (average peak temperature, 38.7 degrees C). There was no significant difference in outcome (recurrence or survival) between BCG-treated and control groups with Stage I or Stage III tumors; there were too few Stage II tumors for separate statistical analysis. Outcome was not affected within or between the two treatment groups by tuberculin skin test status. Combining both treatment groups, Stage III patients had a worse outcome than did Stage I-II patients, non-squamous cell tumor patients (large cell and adenocarcinoma) had worse outcomes than did squamous cell tumor patients, and men had a worse outcome than women. We conclude that, although preoperative intratumoral BCG therapy is safe, it does not lengthen disease-free interval or prolong survival in patients with non-small cell lung cancer.

Bacterial Vaccines↗
PubMed1985

Crystal structure of Azotobacter cytochrome c5 at 2.5 A resolution.

The crystal structure of cytochrome c5 from Azotobacter vinelandii has been solved and refined to an R value of 0.29 at 2.5 A resolution. The structure of the oxidized protein was solved using a monoclinic crystal form. The structure was solved by multiple isomorphous replacements, re-fit to a solvent-leveled multiple isomorphous replacement map, and refined by restrained least squares. The structure reveals monomers associated about the crystallographic 2-fold axis by hydrophobic contacts at the "exposed heme edge". The overall conformation for the monomer is similar to that of Pseudomonas aeruginosa cytochrome c551. However, relative to a common heme conformation, c5 and c551 differ by an average of 6.8 A over 82 alpha-carbon positions and the propionates of c5 are much more exposed to solvent. The shortest heme--heme contact at the "dimer" interface is 6.3 A (Fe to Fe 16.4 A). Alignment of c5 and c551 shows that the two cytochromes, in spite of sequence differences, have remarkably similar charge distributions. A disulfide stacks on a tyrosine between the N- and C-terminal helices.

Amino Acid Sequence↗
PubMed1985

Plasma beta-thromboglobulin, fibrinopeptide A and B beta 15-42 antigen in relation to postoperative DVT, malignancy and stanozolol treatment.

Plasma levels of betathromboglobulin (BTG), fibrinopeptide A (FPA) and B beta 15-42 fragment, indices of platelet release, thrombin generation and plasmin activity respectively, were measured in 32 high risk patients during a double blind study of a single dose of the anabolic steroid stanozolol (50 mg IM) in the prevention of DVT after major gastro-intestinal surgery. The prevalence of malignancy and the incidence of DVT (125I fibrinogen scan) were similar in the two treatment groups. On the first postoperative day, BTG, FPA and B beta 15-42 levels were increased in most patients. Plasma BTG levels were significantly increased on the first post-operative day in patients who developed a DVT (n = 14) compared to those patients who did not (n = 18). A significant increase in FPA levels was found in the DVT group, 7 days after surgery. On the morning before surgery, plasma B beta 15-42 levels were significantly increased in patients who developed a DVT. In patients undergoing surgery for early malignancy (n = 17), we observed a pre-operative increase in FPA levels when compared to patients without malignancy. At post-operative day 7, B beta 15-42 levels were significantly increased in patients who received stanozolol (n = 15), when compared to the placebo group, suggesting that intramuscular stanozolol increases fibrinolysis in vivo.

Beta-Globulins↗