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Biomedical subjects

D J Clement

Publications and source records attributed to D J Clement.

27 records · Page 2Linked to original sources
PubMed1993

Serum alanine aminotransferase (ALT) elevation in asymptomatic US Air Force basic trainee blood donors.

The purpose of this study was to determine the etiology of elevated alanine aminotransferase (ALT) in a population of asymptomatic volunteer blood donors. Subjects with an ALT value > 2.25 sd above norm (> 55 IU/liter) from the donated unit, were prospectively evaluated over a six-week interval. The subjects consisted of blood donors (78% male, 22% female) beginning basic military training at Lackland Air Force Base. Of 44,160 individuals screened, 19,877 (45%) voluntarily donated blood, 99 (0.5%) of which had confirmed ALT elevation. Of these (90 male/9 female), an associated condition or explanation was made in 12%: four with acute hepatitis B, four positive for anti-HCV, two with autoimmune disease, one with cholelithiasis and one associated with acute appendicitis. In 87 the ALT elevation could not be explained using available testing methods but may represent individual variation from a non-Gaussian distribution, be of nonhepatic origin (muscle), or of hepatic disease not detected by the diagnostic algorithm used. To increase the diagnostic yield, it is suggested that at least two elevated ALT values be established in this population over a period of time (yet undefined), before an extensive hepatic investigation is pursued.

Acute Disease↗
PubMed1992

Pilot trial of prophylactic ursodiol to decrease the incidence of veno-occlusive disease of the liver in allogeneic bone marrow transplant patients.

Ursodiol is a hydrophilic, non-hepatotoxic bile salt indicated for the medical treatment of cholesterol gallstones. This pilot study explored the use of prophylactic ursodiol in an attempt to decrease the incidence and severity of veno-occlusive disease (VOD) of the liver following allogeneic bone marrow transplantation (BMT). Between February 1991 and January 1992, 22 consecutive patients undergoing BMT for hematologic malignancies received the BU(4)/CY(2) preparative regimen and CSA/MTX for GVHD prophylaxis. Ursodiol, 600-900 mg daily by mouth was begun at least 1 day prior to beginning the preparative regimen. Results for this pilot group were compared to a control group of 28 consecutive patients transplanted between June 1989 and January 1991 with the same regimen without ursodiol. There were no significant differences in disease or clinical status between the groups pretransplant. However, mean baseline AST levels were significantly higher in the ursodiol group, 28.0 U/l vs 18.1 U/l in the control group (p = 0.001). The median maximum bilirubin observed post-transplant was 2.35 mg/dl (range 0.9-45) in the ursodiol group, and 5.05 mg/dl (range 0.7-29.4) in controls. The incidence of VOD was 2/22 (9.1%) in the ursodiol group and 18/28 (64.3%) in controls (p = 0.0001). Death due to VOD occurred in 1/22 patients (4.5%) in the ursodiol group and in 6/28 (21.4%) controls (p = 0.12). Our data suggest that ursodiol may decrease the incidence of VOD in allogeneic BMT patients.

Adolescent↗
PubMed1985

Upper gastrointestinal endoscopy--how far does the endoscope go?

Two adult-size endoscopes (Olympus GIF-K2 and ACMI TX-8) were compared for extent of duodenal intubation by the endoscopist's estimate of location and x-ray position in 55 patients. The endoscopes were not different in duodenal position when separately analyzed for the endoscopist's estimate or x-ray location. Combining the results for both endoscopes showed the endoscopist's estimate to differ significantly from x-ray location in 47% of patients (p = 0.02). When incorrect, the endoscopist overestimated 62% of the time and underestimated 38% of the time. X-ray evaluation of insertion depth confirmed that the second portion of the duodenum was reached in 96%, third portion in 51%, and fourth portion or beyond in 38% of patients. We conclude that fluoroscopic confirmation may be necessary when endoscopically assessing distal duodenal segments for pathology.

Adult↗
PubMed1984

Call to quarters.

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Adolescent↗
PubMed1984

Comparison of colon cleansing methods in preparation for colonoscopy.

Colonoscopy cleansing regimens were evaluated in 197 patients randomized in two study phases to one of four methods: group 1 (64 patients), 3-day clear liquid diet; group 2 (40 patients), 3-day minimum-residue diet; group 3 (44 patients), 1-day minimum-residue diet; group 4 (49 patients), Golytely. Groups 1-3 also received laxatives and enemas before colonoscopy. Physician assessment by endoscopists unaware of the method of colon cleansing favored group 4 (p less than 0.001), with good to excellent preparations achieved in 69% of group 1, 80% of groups 2 and 3, and 92% of group 4. Group 4 patients also experienced less abdominal distress (p less than 0.01). Breath hydrogen and methane levels were measured in groups 3 and 4 both before and after preparation. The decrease in pre- to postprep levels of hydrogen and methane were not significantly different between the groups and postprep gas concentrations were below combustible levels in both groups. There were no clinically significant differences between the four groups for any of the other measured hematologic or biochemical parameters. It is concluded that Golytely is a safe, effective method of colon cleansing, well tolerated by patients.

Adult↗
PubMedDate not supplied

A prospective evaluation of successful terminal ileum intubation during routine colonoscopy.

This study prospectively evaluated a dedicated effort to intubate the terminal ileum in an unselected population of patients undergoing colonoscopy in conjunction with our training program. The influence of the visual appearance of the terminal ileal mucosa on patient management was assessed subjectively. The cecum was reached in 270/295 (91%) patients, with successful terminal ileal intubation being accomplished in 213/270 (79%) examinations. The time required to intubate the terminal ileum (x = 3.4 minutes; range, 30 seconds to 10 minutes) was not significantly different (p < 0.05) between the several levels of training in our fellowship program. The terminal ileum was considered to be visually abnormal in 4 cases, but only 1 of these was abnormal on histologic examination. In this unselected population, routine ileoscopy was unrewarding for finding an incidental positive diagnosis; however, brief attempts at terminal ileal intubation may be useful to improve or maintain endoscopic skills, especially in a training setting.

Adult↗