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Biomedical subjects

D J Allison

Publications and source records attributed to D J Allison.

At least 91 records · Page 5Linked to original sources
PubMed1983

Role of hepatic arterial embolisation in the carcinoid syndrome.

Eighteen patients with severe symptoms of the carcinoid syndrome were assessed for hepatic embolisation. Four were too ill, and one had mild symptoms; thus 13 received a periembolisation regimen of cyproheptadine, fenclonine, aprotinin, methylprednisolone, tobramycin, flucloxacillin, and metronidazole. Embolisation was not performed in one patient with an occluded portal vein and was unsatisfactory in two others, in one because she was moribund and in the other because the hepatic artery had been ligated. Dramatic improvement in symptoms occurred in the nine patients in whom embolisation was successfully carried out, with abolition of flushing, severe abdominal pain, and wheeze and reduction in diarrhoea from 10.5 (SD 7.6) to 1.6 (0.9) stools/day. Urinary excretion of 5-hydroxyindole acetic acid fell from 1048 (716) to 289 (184) mumol/24 h (200 (137) to 55 (35) mg/24 h). Complications included one death from septicaemia, a hepatic abscess requiring surgical drainage, abdominal pain in three patients, pleural effusion in two, and transient encephalopathy in one. Relief of symptoms lasted for one to 24 months, and second embolisation in two patients produced further remissions of four to six months. Five patients died, one to 40 months after embolisation, in four cases because of metastases or heart failure. Hepatic embolisation is the treatment of choice for symptoms of the carcinoid syndrome resistant to medical treatment.

Adult↗
PubMed1983

Role of venous sampling in locating a phaeochromocytoma.

Selective venous sampling was performed in 31 patients in whom the diagnosis of phaeochromocytoma was suspected on clinical and biochemical grounds. Data from samples assayed for their adrenaline and noradrenaline content using a radioenzymatic technique were used to confirm or refute the suspected diagnosis. In 19 of the 31 patients a phaeochromocytoma was subsequently removed surgically, and the remaining 12 patients are now thought not to have tumours (mean follow up period: four years). Analysis of the assay data shows that selective venous sampling correctly identified the presence of a tumour in all 19 patients, and correctly excluded the diagnosis in 11 of the 12 remaining patients--an overall success rate of 97%. Success rates of 88% for arteriography and 84% for computed tomography were recorded, though these investigations were not performed in all patients. Ultrasound and intravenous urography were much less accurate. On the basis of this study a sequence of investigation is proposed for patients with a suspected phaeochromocytoma. Computed tomography occupies a central role in this sequence with venous sampling (and occasionally other techniques) being used only as complementary investigations when specific indications for their use exist.

Adolescent↗
PubMed1983

Non-surgical management of post-cholecystectomy haemobilia.

Therapeutic embolization of the hepatic artery was performed in two patients actively bleeding from aneurysms resulting from previous surgical damage to the artery at cholecystectomy. The advantages of embolization over surgical ligation of the hepatic artery are discussed.

Adult↗
PubMed1983

Carcinoma of the proximal extrahepatic biliary tree radiologic assessment and therapeutic alternatives.

Preoperative cholangiography and angiography have been used in a series of 37 patients with hilar cholangiocarcinoma investigated over a 17-month period in a single specialist unit. Twelve lesions were judged to be irresectable on the basis of the cholangiographic findings: this was confirmed at laparotomy in nine patients and at autopsy in one. Angiography was performed in 21 patients, and suggested irresectability in eight: this was confirmed by laparotomy in seven. The eighth patient had compression of the left portal vein which had been interpreted as tumor invasion on angiography, and it was possible to perform a curative extended right hepatic lobectomy. Of the 13 potentially resectable patients, three were unfit for major resectional surgery. Five were found to be irresectable at laparotomy because of vena cava involvement in two and distant metastases in three. Five patients underwent resection with histologically clear margins. The combined use of cholangiography and angiography is recommended as a means of selecting appropriate therapy for patients with hilar cholangiocarcinoma.

Adenoma, Bile Duct↗
PubMed1983

Action of almitrine bismesylate on pulmonary vasculature in the dog: preliminary report.

The effects of almitrine bismesylate on the pulmonary circulation have been investigated in anaesthetized dogs, paralysed and artificially ventilated. An i.v. bolus of almitrine bismesylate (10 micrograms X Kg-1) caused a 35% increase in specific pulmonary vascular resistance under normoxic or hyperoxic conditions but only a 2% increase when pulmonary vessels were constricted by hypoxia (13% inspired O2). With local hypoxia, confined to the retrocardiac lobe, almitrine bismesylate caused lobar vasodilation (specific vascular conductance increased by 10%) while at the same time conductance fell by 38% in the rest of the lung which was hyperoxic. The almitrine-induced vasoconstriction was not abolished by alpha- or beta blockade, indomethacin, vagotomy or bilateral clamping of both common carotids in the neck. With constant ventilation, no rise of arterial PO2 occurred following almitrine bismesylate . In the presence of local hypoxia, the drug by virtue of its inhibition of local hypoxic vasoconstriction caused PaO2 to fall slightly. In conclusion, almitrine bismesylate constricts pulmonary vessels in normoxia and dilates them when they are constricted by hypoxia. The mechanism is unknown but it is likely to be an intra-rather than an extrapulmonary site of action.

Almitrine↗
PubMed1982

Angiography in gastrointestinal bleeding.

160 selective visceral angiograms were performed in 145 patients with gastrointestinal bleeding. In 52 studies done as emergency procedures (group A) 87% were positive, and in 108 elective procedures (group B) 74% were positive. The commonest lesion demonstrated in group B was angiodysplasia (43 patients) and most of these cases had previously undergone various investigations which had proved to be negative. Angiodysplasia is clearly an important cause of obscure gastrointestinal bleeding that may go unrecognised for many years. In addition to its diagnostic value angiography also proved extremely successful as a therapeutic measure in appropriate cases. Embolisation was performed in 36% of group A patients with positive angiograms, and in 10% of corresponding group B patients.

Acute Disease↗
PubMed1982

Angiodysplasia and Meckel's diverticulum: a congenital association?

Five patients under the age of 21 years are described in whom a Meckel's diverticulum was found in association with angiodysplasia of the caecum or ascending colon. Angiodysplasia has only been observed previously in patients over the age of 35 years and its demonstration in 5 young patients with Meckel's diverticulum points not only to an association between the two disorders, but suggests that angiodysplasia may have a congenital aetiology.

Adolescent↗
PubMed1982

Facial swelling: a complication of transvenous pacing.

A case of progressive venous thrombosis involving the superior vena cava is reported following implantation of a permanent transvenous pacemaker. Acute symptoms in the arm appeared after 18 months, but the symptoms of superior vena caval obstruction developed gradually, three years after pacemaker insertion. The diagnosis was confirmed by cavography and symptoms resolved with heparin therapy. Long-term anticoagulation is indicated when thrombosis is responsible for this uncommon but important complication of transvenous pacing.

Aged↗