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Biomedical subjects

D C Carter

Publications and source records attributed to D C Carter.

At least 145 records · Page 8Linked to original sources
PubMed1985

Prediction of outcome following acute variceal haemorrhage.

In order to identify factors predicting survival following acute variceal haemorrhage, data were collected prospectively from 100 admissions in 70 patients managed by a standard policy employing oesophageal tamponade, injection sclerotherapy and, if necessary, oesophageal transection. Of the ten predictive factors identified by univariate analysis, only prothrombin ratio, serum creatinine and the presence of encephalopathy on admission were shown by stepwise logistic regression to have independent significance. The derived regression equation allowed clearer identification than conventional scoring systems of high and low risk groups and successfully predicted outcome in 90 per cent of admissions.

Acute Disease↗
PubMed1985

Reimplantation of the papilla of Vater.

Detachment of the papilla of Vater from the duodenum may happen (a) deliberately, during duodenal resection for tumour without concomitant resection of the pancreatic head, and (b) accidentally in the course of gastrectomy for duodenal ulcer, when attempts to exteriorize the ulcer are made. In this report two case histories are cited encompassing both of these circumstances, in which the ampulla was successfully reimplanted into a Roux loop.

Aged↗
PubMed1985

Endocrine and protein response to elective surgery: effect of nursing at two different environmental temperatures.

Twenty male patients undergoing elective abdominal surgery were studied on one control day pre-operatively and for the first 4 days postoperatively at an environmental temperature of either 20 degrees C or 28 degrees C. Glucose, insulin, growth hormone and urinary catecholamine levels all rose significantly on the first postoperative day returning to within normal limits by day 4. Urine nitrogen excretion also increased significantly postoperatively in both groups. Environmental temperature did not influence these responses. Concentrations of C-reactive protein and a1-antichymotrypsin increased significantly on the first postoperative day and were returning to normal by day 4 while concentrations of haptoglobin, a1-antitrypsin and a1-acid glycoprotein, which also showed a significant increase, remained elevated at the end of the study. Concentrations of albumin, transferrin, a2-macroglobulin, prealbumin and retinol binding protein all decreased significantly following operation. Elevated environmental temperature did not affect the protein response to surgery. Urine cortisol and 17-hydroxycorticosteroid excretion rose significantly postoperatively and remained elevated throughout the study. Patients nursed at 28 degrees C showed significantly lower postoperative excretion of both hormones than patients nursed at 20 degrees C.

Journal Article↗
PubMed1985

Pancreatic carcinogenesis-enhancement by cholecystokinin in the hamster-nitrosamine model.

The role of the pancreaticotrophic hormone cholecystokinin (CCK) in modifying the pancreatic response to carcinogen has been examined in the hamster-nitrosamine pancreatic cancer model. Exogenous CCK, 30 IDU kg-1, stimulated a maximal pancreatic secretory response when given intravenously and caused hypertrophy and hyperplasia of the pancreas when given subcutaneously over a period of 6 weeks (pancreatic wet weight, mg per 100 g body weight, controls 295.6 +/- 61; CCK treated 466.4 +/- 77, P less than 0.001). When the same dose of CCK was given to animals receiving N-nitrosobis (2-oxopropyl)amine (BOP; 5 mg kg-1 weekly) there was a reduction in latency period and increase in induction rate of tumour development (CCK + BOP vs. BOP alone, 12 animals with tumours vs. 2 at 15 weeks; P less than 0.02). These effects are consistent with CCK acting as a co-carcinogen or promoter of pancreatic carcinogenesis in this model.

Adenocarcinoma↗
PubMed1985

Effect of cimetidine and omeprazole on aspirin- and taurocholate-induced gastric mucosal damage in the rat.

The effect of varying doses of cimetidine and omeprazole, on acute gastric mucosal lesions produced by topical aspirin (200 mg/kg; 1 ml/100 g) in 0.175 M HCl or topical sodium taurocholate (40 mM; 1 ml/100 g) in 0.175 M HCl was studied in the pylorus ligated rat. Preliminary studies revealed dose dependent inhibition of acid secretion with both cimetidine and omeprazole. Intraperitoneal cimetidine 50 mg/kg and 100 mg/kg given before topical acidified aspirin reduced mucosal lesions from a control score of 23.7 +/- 3.5 (mean +/- SEM) in which 83% of stomachs contained lesions, to 6.9 +/- 2.2 and 3.5 +/- 2.1 respectively (p less than 0.05), 36% and 27% of stomachs containing lesions. A dose of 250 mg/kg failed to reduce lesion score significantly (17.8 +/- 4.9) and 64% of stomachs contained lesions. Taurocholate-induced lesion score was reduced from a control value of 32.7 +/- 4.3 in which 97% of stomachs contained lesions to 10.8 +/- 3.3 and 15.5 +/- 3.8 by cimetidine 10 mg/kg and 25 mg/kg respectively (p less than 0.05), 62% and 68% of stomachs containing lesions. Cimetidine 50 mg/kg and 100 mg/kg failed to significantly reduce mucosal damage. Intraduodenal omeprazole (1.25 to 50 mumol/kg) given before topical acidified aspirin or taurocholate failed to reduce mucosal lesions, as did intragastric omeprazole 5 mumol/kg and 50 mumol/kg given before acidified aspirin. Cimetidine showed cytoprotective properties over a specific dose range beyond which the effect was lost despite continuing suppression of acid secretion. Omeprazole exhibited no cytoprotective activity.

Animals↗
PubMed1985

The effect of omeprazole on insulin induced gastric secretion in man.

The effect of oral omeprazole on insulin induced gastric secretion was studied in 12 healthy subjects. Each subject participated in two secretory tests receiving an intravenous infusion of insulin (0.03 units/kg/h) and being randomly allocated to receive 30mg or 60mg omeprazole suspended in 100ml water containing 16 mmol NaHCO3 on the second study day. Peak plasma concentrations of omeprazole were achieved within 30 minutes of administration in all but one subject and plasma half life was 30 minutes. Mean peak stimulated acid output in the six subjects receiving 30mg omeprazole was reduced to 4.3 +/- S.E. 1.8 mmol/h from a control value of 16.8 +/- 2.2 mmol/h (p less than 0.05) and in six subjects receiving 60mg omeprazole, mean peak output fell to 3.4 +/- 2.1 mmol/h from a control value of 12.3 +/- 2.6 mmol/h (p less than 0.05). The two doses of omeprazole produced similar reduction in acid secretion (74% and 73% respectively) but neither dose affected pepsin secretion. Both doses of omeprazole were associated with a small statistically insignificant increase in the plasma gastrin response to insulin infusion.

Adult↗
PubMed1985

The prevention of recurrent variceal haemorrhage by chronic injection sclerotherapy.

Forty eight patients who have survived admission with acute variceal haemorrhage have been readmitted and entered into a programme of chronic injection sclerotherapy to prevent recurrent variceal haemorrhage. Two hundred and nineteen elective courses of injections were performed at fibreoptic endoscopy with minor complications occurring in six patients. Twenty three patients rebled on 33 occasions but in only five instances did haemorrhage occur following variceal obliteration. With 67 per cent of patients surviving one year, this treatment option offers a satisfactory means of preventing recurrent haemorrhage when variceal obliteration is achieved.

Adult↗
PubMed1984

A double-blind trial of intramuscular stanozolol in the prevention of postoperative deep vein thrombosis following elective abdominal surgery.

Fibrinolytic shutdown may be important in the development of postoperative deep vein thrombosis (DVT). We have previously shown that stanozolol 50 mg, given intramuscularly 24 hr before surgery, prevents the decrease in plasminogen activator activity (PA) seen on the first postoperative day in patients at high risk of DVT. To investigate the role of fibrinolytic shutdown in causation of DVT, sixty patients were randomized in a double-blind controlled trial to receive stanozolol or placebo intramuscularly, and DVT was detected by leg scanning and confirmed by venography. Scan positive DVT occurred in 11 of 31 placebo patients (35%) and 12 of 29 who received stanozolol (41%). A significant decrease in PA was confirmed in the placebo group, while stanozolol caused a significant increase in PA on the first postoperative day. Patients in either group who did not develop DVT showed minimal changes in PA. We conclude that prevention of fibrinolytic shutdown by this regimen of stanozolol does not prevent postoperative DVT, and that further studies are required to clarify the relationship of postoperative fibrinolysis and DVT.

Abdomen↗
PubMed1984

Pre-operative carcino-embryonic antigen and survival in patients with colorectal cancer.

The relationship between pre-operative levels of carcino-embryonic antigen (CEA), resectability of the primary tumour, the extent of tumour spread and subsequent survival was studied in 333 patients with colorectal cancer. Twenty-five per cent of patients undergoing 'curative' resection had elevated CEA levels compared with fifty-six per cent of patients receiving palliative treatment. Twenty-five per cent of patients with Dukes B or C tumours had elevated pre-operative CEA levels compared with seventy per cent of patients with stage D disease. In patients undergoing 'curative' resection there was no correlation between pre-operative CEA levels and subsequent survival. In patients undergoing palliative resection, elevated pre-operative CEA levels were associated with poor survival. Although pre-operative levels of CEA reflect the extent of the underlying disease process, estimations of pre-operative CEA levels are of limited value in predicting patients with a poor prognosis following curative resection for colorectal carcinoma.

Carcinoembryonic Antigen↗
PubMed1984

Advanced gastric cancer: experience in Scotland using 5-fluorouracil, adriamycin and mitomycin-C.

Eighty-four patients with advanced gastric cancer treated in four centres in Scotland between June 1980 and December 1982 were reviewed following treatment with 5-fluorouracil, adriamycin and mitomycin-C (FAM). Eighty-one patients were evaluable. Twenty-eight patients (35 per cent) responded (four complete) with a median duration of response of 10.5 months and median survival of 17 months. Ten are still alive. Response was associated with an improvement in performance status. Eight patients (10 per cent) had stable disease with a median survival of 10 months. Forty-five (55 per cent) had progressive disease with a median survival of 4.5 months; one patient remains alive. Analysis of prognostic variables indicated that the presence of hepatic metastases had a negative influence on response to FAM (P less than 0.001). Treatment was well tolerated on an outpatient basis. FAM offers good palliative therapy in a proportion of patients with this disease, especially those without overt liver metastases.

Adenocarcinoma↗
PubMed1984

Modification of postoperative nitrogen balance with preoperative anabolic steroid.

Thirty six patients undergoing abdominal operations were randomly allocated to receive an anabolic steroid, stanozolol (50 mg) or placebo 24 h before surgery. Patients were fasted during the first four postoperative days. During this period the mean daily nitrogen balance was significantly less negative in the stanozolol group (-8.0+/-3.0 gN/day) than in the control group (-10.9+/-4.1 gN/day), although improvement in nitrogen balance was greater in male than in female patients. Muscle catabolism as measured by 3-methylhistidine excretion was similar in both treatment groups. Significant fluid retention occurred in the stanozolol treated group and was more marked in female patients. Improved nitrogen balance in the absence of a measurable change in muscle catabolism suggests that this anabolic steroid acts by improving protein synthesis in the early period after surgery.

Journal Article↗
PubMed1984

Comparison of three adrenoreceptor blocking agents in patients with cirrhosis and portal hypertension.

The effects of different types of adrenoreceptor blocking agents on portal venous pressure were studied in patients with cirrhosis and portal hypertension. Oral atenolol (selective beta 1 blocker), propranolol (non-selective beta 1 and beta 2 blocker), and prazosin (alpha blocker) were compared in three groups of eight patients. Haemodynamic measurements were made before and after two or three and eight weeks of therapy. The dose of beta blockers was sufficient to reduce the exercise heart rate by more than 25%. Propranolol and prazosin produced a sustained reduction in the mean portohepatic venous pressure gradient of the order of 25% and 18% respectively. The cardiac index was significantly reduced by propranolol but not altered by prazosin. Atenolol produced an early reduction in portohepatic venous pressure which, although not sustained, showed a good correlation with reduction in cardiac index. No such relationship was found with propranolol. All three drugs were well tolerated by these patients with advanced cirrhosis. Therefore propranolol and prazosin have proved to be effective agents for the reduction of portal venous pressure.

Atenolol↗
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↗
PubMed1984

Crystals of cadmium, zinc metallothionein.

Single crystals have been grown of Cd,Zn metallothionein isoform II from rat liver. The space group is P41212(P43212) with unit cell dimensions a = b = 31.0 A and c = 120.0 A, and one molecule in the crystallographic asymmetric unit. The crystals are square bipyramids elongated on the tetragonal c-axis and are grown by repetitive seeding. The crystals are suitable for high resolution structure analysis. Assays of dissolved crystals show that the crystals have the same Cd and Zn content and amino acid composition as the native, as-isolated protein.

Animals↗
PubMed1983

Single crystals of cadmium, zinc metallothionein.

Single crystals have been grown of Cd,Zn metallothionein isoform II from rat liver. The space group is P4(1)2(1)2 (P4(3)2(1)2) with unit cell dimensions a = b = 31.0 A and c = 120.0 A, and one molecule in the crystallographic asymmetric unit. The crystals are square bipyramids elongated on the tetragonal c-axis and are grown by repetitive seeding. The crystals are suitable for high resolution structure analysis. Assays of dissolved crystals show that the crystals have the same Cd and Zn content and amino acid composition as the native, as-isolated protein.

Animals↗