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Biomedical subjects

D E Tweedle

Publications and source records attributed to D E Tweedle.

At least 37 records · Page 2Linked to original sources
PubMed1989

Cytomegalovirus cholecystitis and colitis associated with the acquired immunodeficiency syndrome.

Cytomegalovirus (CMV) is an important cause of acalculous gangrenous cholecystitis in immunocompromised persons. We report a case of acalculous acute cholecystitis and active colitis associated with CMV in a patient suffering from the acquired immune deficiency syndrome. The condition was treated successfully with surgery and 9-(1,3,-dihydroxy-2-propoxymethyl)guanine intravenously.

Acquired Immunodeficiency Syndrome↗
PubMed1989

The pharmacokinetics of the biliary excretion of ciprofloxacin.

The pharmacokinetics of ciprofloxacin excretion have been studied in 54 patients undergoing biliary and pancreatic operations with and without obstruction of the common bile duct. High concentrations were achieved in common duct bile within 20 minutes of intravenous injection and persisted for over 3 hours after 100 mg and for over 8 hours after 200 mg. The concentration of ciprofloxacin in the bile of functioning gall bladders was much greater than that in the common duct bile. Remarkably, it was identified in therapeutic concentrations in the bile of obstructed ducts. This and the rapid fall from initially high venous concentrations probably reflect diffusion from the circulation as a result of the exceptional tissue penetration. A unique feature of this study was the finding of clinically significant concentrations in the bile of obstructed ducts. Two patients developed wound infection and no side effects were observed. The broad spectrum antibiotic ciprofloxacin has potential as a useful agent for prophylaxis in biliary surgery maintaining biliary and venous concentrations in excess of the MIC90 for most biliary pathogens for more than 8 hours.

Adult↗
PubMed1989

Staging laparotomy in early Hodgkin's disease: a surgical view.

Fifty consecutive patients with early Hodgkin's disease underwent staging laparotomy. There were no deaths and most complications were minor. As a consequence, 17 (34%) patients were upstaged from clinical stage I or II to pathological stage III or IV. Subdiaphragmatic disease was found in five out of 22 patients with nodular sclerosing, seven out of ten with lymphocyte predominant and four out of 13 patients with mixed cellularity histological type. The age, sex, preoperative clinical stage and mediastinal involvement did not correlate with the presence of intra-abdominal disease. Among 15 patients with a normal preoperative computed tomography (CT) scan, nine had intra-abdominal disease at laparotomy and all three patients with suggested subdiaphragmatic involvement by the CT scan examination were clear. The surgeon's ability to diagnose early involvement at laparotomy was also limited. There seems to be a continued need for staging laparotomy to ensure adequate treatment of one-third of patients with early Hodgkin's disease.

Adolescent↗
PubMed1988

Endoscopic removal of retained stones after biliary surgery.

Seventy-three patients with retained stones in the common duct after biliary surgery underwent attempted endoscopic removal at a mean interval of 39 days after surgery. Endoscopic extraction was successful in 63 patients (86 per cent). Complications occurred in 14 patients (19 per cent). The most frequent complication was haemorrhage which occurred in nine patients, four of whom required surgery; two other patients required surgery for complications. The complication rate of endoscopic sphincterotomy in recently operated patients may be higher than in the non-operated patient. Less invasive methods, such as dissolution therapy or T tube track extraction, may be preferable as they are associated with less risk. Endoscopic sphincterotomy should be reserved for patients in whom these alternative techniques fail or are inappropriate.

Aged↗
PubMed1987

Endoscopic management of common duct stones without cholecystectomy.

Endoscopic sphincterotomy was attempted in 81 patients with gallbladders for the primary management of symptomatic common duct stones and was successful in 80. Immediate complications occurred in six (7 per cent) and one patient died (1 per cent). Clearance of the common duct was achieved in 70 (86 per cent). Eight patients required surgery for failed clearance of the duct and suffered no operative mortality. Of 70 patients with cleared ducts, 5 underwent elective cholecystectomy. Four other patients with persistent or recurrent symptoms have required cholecystectomy, also without mortality. Sixty-one patients were reviewed 12-44 months (mean 24; median 22 months) after endoscopic sphincterotomy. Eighteen have died, none from biliary disease. Forty-three patients remain alive and well, free of biliary symptoms since, endoscopic sphincterotomy. When the surgical risk of cholecystectomy and choledocholithotomy is high, endoscopic sphincterotomy is effective and safe. Routine cholecystectomy is not indicated when the common duct has been cleared.

Adult↗
PubMed1987

Enteric cyst of the pancreas.

Enteric duplication cysts (enterogenous cysts) are found most commonly in the distal ileum, the posterior mediastinum, and the third part of the duodenum. Rarely, enteric cysts can occur distant from the gut. This paper describes the clinical and radiologic features of a cystic lesion in the body of the pancreas which was shown on resection to be an enteric cyst.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1984

The aetiology and significance of distal choledochoduodenal fistula.

Thirteen patients undergoing investigation for biliary or pancreatic disease were found at endoscopic retrograde cholangiopancreatography to have unsuspected choledochoduodenal fistula. In only one patient could the presenting symptoms be directly attributed to the fistula. Ten of the thirteen patients had previously undergone exploration of the common bile duct and instrumentation at surgery is postulated as being the most likely cause of these fistulae. Treatment of the uncomplicated fistula appears unnecessary.

Adult↗
PubMed1984

Incidence of synchronous and metachronous colorectal carcinoma.

Two hundred and twenty-three patients with colorectal carcinoma were treated consecutively at the University Hospital of South Manchester from May 1976 to January 1981. Twenty-four patients (10.7 per cent) were found to have more than one colorectal carcinoma. In 18 patients this was recognized either immediately or within 6 months of the initial diagnosis--synchronous carcinoma. In the other six cases a second carcinoma was found at a later time--metachronous carcinoma. The incidence of synchronous, and consequently the combined incidence of synchronous and metachronous carcinoma, was higher than previously documented. The anatomical distribution of the multiple carcinomas and the sex incidence in these patients was similar to that seen in patients with a single carcinoma of the large bowel. A high association of adenomatous polypi with multiple large bowel carcinomas was observed. The possibility of more extensive colonic resection in the younger patient with a favourable carcinoma is discussed.

Adult↗
PubMed1983

A prospective randomized trial of vagotomy in chronic duodenal ulceration: 4-year follow-up.

A total of 153 patients (124 male and 29 female) with uncomplicated chronic duodenal ulceration were studied in a prospective, randomized trial of proximal gastric vagotomy (PGV) and truncal vagotomy and pyloroplasty (TVP), conducted in four Manchester hospitals. Of these, 137 patients have now been followed up for 2.5 to 5.5 (mean 4.1) yr. There have been 15 (21 per cent) recurrent ulcers following PGV compared with 5 (7.5 per cent) after TVP (P less than 0.05). A satisfactory functional result was obtained in 82 per cent of patients after TVP compared with 73 per cent following PGV and there was little difference between the groups with regard to the incidence of dumping, heartburn and vomiting. There was significantly more diarrhoea following TVP (13 per cent) compared to PGV (1.4 per cent) but this represented only a minor clinical problem.

Adult↗
PubMed1983

Venous complications of two diazepam preparations related to size of vein.

The venous complications associated with the administration of two preparations of diazepam, an aqueous (Valium) or a lipid (Diazemuls) preparation were investigated in 100 patients before upper gastrointestinal endoscopy in a double-blind randomized study. No differences in pain during injection or subsequent thrombophlebitis were found when a large vein was used for the injections. In a retrospective study of 78 patients who had received either preparation in a vein on the dorsum of the hand, the frequency of thrombophlebitis was significantly less with the lipid preparation. Both preparations provided effective sedation for endoscopy.

Arm↗
PubMed1983

The pharmacokinetics of cefotetan excretion in the unobstructed biliary tree.

Cefotetan excretion was studied in 17 patients undergoing biliary or pancreatic surgery. The antibiotic was detected in bile taken from the common bile duct within 15 min of a 1 g iv bolus and therapeutic plasma levels were found up to 10 h after administration. Even higher concentrations of cefotetan were measured in the bile from functioning gall bladders, despite the presence of gall stones. Concentrations of cefotetan in bile from the common bile ducts and functioning gall bladders were greater than the plasma concentrations at all times. These concentrations exceed the in-vitro minimum inhibitory concentrations (MIC) for most common biliary tract pathogens.

Anti-Bacterial Agents↗
PubMed1983

Randomized trial of elective highly selective or truncal vagotomy in chronic duodenal ulceration.

Between 1973 and 1976, 153 patients (124 men, 29 women) with uncomplicated, chronic, duodenal ulcer were entered into a prospective randomized trial of highly selective vagotomy (HSV) or truncal vagotomy and pyloroplasty (TVP). The study was conducted in four Manchester hospitals and the operations were performed by consultants or chief registrars. The follow-up was conducted by personal interview using a standardized questionnaire. The medical gastroenterologist did not know which type of operation the patient had had. The patients who had symptoms were referred back to the surgeon who performed the operation. The clinical laboratory and follow-up data were analysed by computer. There were no operative deaths. Three patients died from unrelated causes, 13 were lost to follow-up; 137 (89.5%) were followed up for a mean of 4.1 years (range from 2.5 to 5.5 years). A modified Visick grading was used to assess the results of surgery. The outcome was good in 82% after TVP and 73% after HSV. This difference and those in the incidences of early or late postprandial dumping, bilious vomiting, weight loss, anemia and heartburn were not significant. Diarrhea was more frequent after TVP (13.4%) than after HSV (1.4%); although the difference was significant (p less than 0.025), this complaint did not present a serious clinical problem. Ulcers recurred in 15 (21.4%) patients following HSV and in 5 (7.5%) after TVP; this difference was statistically significant (p less than 0.05).

Adult↗