Monophyletic origin of animals: a shared ancestry with the fungi.
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Animals↗
Biomedical subjects
D J Patterson
Publications and source records attributed to D J Patterson.
Endoscopic retrograde cholangiopancreatography after laparoscopic cholecystectomy.
We assessed the use of endoscopic retrograde cholangiopancreatography (ERCP) after laparoscopic cholecystectomy (LC) at our hepatobiliary referral center. This assessment included patients from outside institutions with post-LC problems. Between May 1990 and September 1992, we performed 522 LCs and 1,723 ERCP examinations. There were 78 patients who underwent 143 ERCP examinations after LC, 65% of whom were referred. ERCP findings were categorized as follows: normal results (8%), problems inherent to stone disease (65%), and iatrogenic injury (27%). The types of inherent problems were common bile duct (CBD) stones, pancreatitis, and papillary stenosis/microlithiasis. Within the CBD stone group, 5 of 26 patients also had papillary stenosis, and, within the pancreatitis group, 9 of 11 patients also had papillary stenosis, making papillary stenosis the most frequent observation (55%). Almost all of these patients (96%) required endoscopic papillotomy for successful treatment. The iatrogenic injury group was comprised of 21 patients, 16% of whom had cystic duct leak and 84% of whom had CBD injury. These patients required a variety of endoscopic procedures including endoscopic papillotomy (67%), CBD endoscopic stenting (76%), percutaneous drainage of biloma (29%), and percutaneous transhepatic biliary drainage (24%). Open surgical procedures after endoscopic assessment or treatment were required in only three patients in the iatrogenic group and in none in the inherent group. At this time, long-term follow-up is not possible with regard to biliary stricture. We conclude that the majority of problems after LC are either due to papillary stenosis/microlithiasis with or without CBD stones or to biliary injury. Both can be successfully diagnosed and treated with endoscopic techniques.
Cholangiopancreatography, Endoscopic Retrograde↗
An incarcerated peristomal gastric hernia causing gastric outlet obstruction.
A 77-year-old woman had had several 3-day episodes of nausea and vomiting for 3 years. Upper endoscopy led to findings consistent with pyloric outlet obstruction, and barium studies demonstrated an incarcerated peristomal gastric hernia. This is taken to be the third description of this diagnosis. We discuss the pathophysiology of gastric hernias.
Aged↗
Prospective comparison of congo red and sham feeding testing to determine vagal innervation of the stomach.
The purpose of this study was to validate Congo red (CR) testing as a means of determining the status of vagal innervation of the stomach after gastric surgery by comparing it with the sham feeding test (SF). Twenty-six patients with previous gastric operations were studied prospectively. The operations were vagotomy/antrectomy (n = 14), vagotomy/antrectomy/Roux-en-Y anastomosis (n = 4), proximal gastric vagotomy (n = 3), vagotomy/pyloroplasty (n = 2), and antireflux (n = 3). In each case, the CR test was performed prior to the SF test so that the endoscopist was unbiased. The CR test solution was sprayed on the gastric mucosa through a wash catheter and immediately aspirated. A two-dimensional map of the endoscopist's conception of the red and black mucosa was drawn, and areas were calculated using a computerized scanner. The SF test was performed as described previously, with sham/peak ratios (sham feeding stimulated acid output [SAO]/peak acid output [PAO]) greater than 0.1 indicating a positive test, or incomplete vagotomy. The CR test was negative in 11 patients and positive in 15 patients. SF was negative in 16 patients (SAO/PAO of less than 0.1) and positive in 10 patients. The results correlated in 18 of 26 (69%) patients (p = not significant). Positive sham feeding tests and negative Congo red tests were more reliable, whereas negative sham feeding tests and positive Congo red tests were less reliable. Except patients with Roux-en-Y anastomosis, patients with negative or weakly positive CR tests did not have recurrent ulcers or other symptoms attributable to acid hypersecretion. The CR test was easier to perform and preferred by the patients. We conclude that both tests provide valuable clinical information and that both tests should be available in the evaluation of postgastrectomy patients.
Anastomosis, Roux-en-Y↗
Evaluation of a melengestrol acetate and prostaglandin F(2)alpha system for the synchronization of estrus in beef heifers.
This study was conducted to determine the efficacy of feeding melengestrol acetate (MGA) for 14 days and administering prostaglandin F(2)alpha (PGF) 17 days after MGA to synchronize or induce estrus in yearling beef heifers. The study involved 56 Angus (n = 19), Hereford (n = 15) and Simmental (n = 22) heifers that were assigned by breed and pubertal status to either MGA+PGF or to control groups. Heifers in the synchronized group were fed 0.5 mg MGA per head per day for 14 days from a grain carrier and were injected with 25 mg, i.m. PGF 17 days after the last daily feeding of MGA. Control heifers were fed from a grain carrier without MGA and were not treated with PGF. Heifers were classified as pubertal when concentrations of progesterono in the serum exceeded 1 ng/ml in 1 of 2 samples collected prior to the initiation of treatments. Blood samples were collected 7 days before and on the day that treatment with MGA or carrier began and 7 days before and on the day that PGF was administered. Progesterone concentrations in the serum were elevated ( > 1 ng/ml) in 61% (17 28 ) of the MGA+PGF-treated heifers and in 61% (17 28 ) of the control heifers prior to feeding MGA. However, concentrations of progesterone in the serum at the time PGF was administered differed (P<0.05) between MGA+PGF and control groups. Concentrations of progesterone in the serum exceeded 1 ng/ml in 100% (28 28 ) of the MGA+PGF-treated heifers and in 71% (20 28 ) of control heifers at the time PGF was administered (P<0.05). All heifers were inseminated 12 hours after the first detected estrus. Twenty-two of 28 (79%) of the MGA+PGF-treated heifers exhibited estrus within 6 days after PGF compared with 9 of 28 (32%) of control heifers (P<0.05). The conception rate at first service did not differ between MGA+PGF and control groups (64% and 67%, respectively). Synchronized pregnancy rates were higher (P<0.05) for MGA+PGF-treated heifers than for control heifers (14 28 , 50% vs 6 28 , 21%). Increased concentrations of progesterone in serum at the time PGF was administered and higher pregnancy rates during the synchronized period among MGA+PGF-treated heifers demonstrate the efficacy of this treatment for use in estrus synchronization. Moreover, this treatment may have a potential effect on inducing puberty in breeding age heifers.
Journal Article↗
Management considerations in heifer development and puberty.
Management of replacement beef heifers should focus on factors that enhance physiological processes that promote puberty. Age at puberty is important as a production trait when heifers are bred to calve as 2-yr-olds and in systems that impose restricted breeding periods. Calving by 24 mo of age is necessary to obtain maximum lifetime productivity. Because the reproductive system is the last major organ system to mature, factors that influence puberty are critical. The influence of environment on the sequence of events leading to puberty in the heifer is dictated largely by the nutritional status of the animal and related effects on growth rate and development. Management strategies have been designed to ensure that heifers reach a prebreeding target weight that supports optimum reproductive performance, and consequences of inadequate or excessive development have been evaluated. Those strategies are based on evidence linking postweaning nutritional development with key reproductive events that include age at puberty and first breeding, conception, pregnancy loss, incidence and severity of dystocia, and postpartum interval to estrus. Management alternatives that ultimately affect lifetime productivity and reproductive performance of heifers begin at birth and include decisions that involve growth-promoting implants, creep-feeding, breed type and(or) species, birth date and weaning weight, social interaction, sire selection, and exogenous hormonal treatments to synchronize or induce estrus. Basic and applied future research efforts should converge to match in a realistic manner the production potential of the animal with available resources. Strategies that incorporate consideration of nutrition, genetics, and emerging management techniques will need to be tested to enable producers to make decisions that result in profit. This review evaluates the current status of knowledge relating to management of the replacement beef heifer and serves to stimulate research needed to enhance management techniques to ensure puberty at an optimal age.
Animal Feed↗
Evaluation of reproductive traits in Bos taurus and Bos indicus crossbred heifers: relationship of age at puberty to length of the postpartum interval to estrus.
Records of age at puberty (AAP) and duration of the postpartum interval to estrus (PPI) for heifers calving first at 2 yr of age were used to determine the relationship between the two reproductive traits. The study from which these records were obtained was designed in a 2 x 2 x 2 factorial arrangement of treatments. Angus x Hereford (AH; n = 148) and Brahman x Hereford (BH; n = 148) heifers were allotted within breed after weaning by weight into light (LW) and heavy (HW) weight blocks. Heifers were assigned by age to different levels of energy (low or high) in diets calculated to reach a target weight of 55% (LE) or 65% (HE) of their projected mature weight by the onset of the breeding period. Data were analyzed within breed and included only records for which both AAP and PPI were available. Pearson correlation coefficients for AAP to PPI were r = -.12 (P = .20) and r = .05 (P = .71) for AH and BH, respectively. Eliminating animals that experienced dystocia from the analyses yielded correlations of r = -.27 (P = .02) and r = .06 (P = .65) for Ah (n = 69) and BH (n = 51), respectively. When energy level, weight block, and energy level x weight block were included in the model for PPI, analyses of variance indicated that PPI among AH heifers was influenced most by the weight at which heifers began the trial after weaning (P = .01) but not by energy level (P = .23) or the interaction of energy level x weight block (P = .48).(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Reproductive response of yearling beef heifers to a melengestrol acetate-prostaglandin F2 alpha estrus synchronization system.
A study was designed to evaluate estrus response and fertility after treatment with melengestrol acetate (MGA) and prostaglandin F2 alpha (PGF2 alpha) in yearling beef heifers. Three hundred four heifers at three locations were allotted to one of two treatments: Treatment 1 served as a nonsynchronized control (CON); and heifers in Treatment 2 received .5 mg of MGA.animal-1.d-1 for 14 d and 25 mg of prostaglandin F2 alpha (PGF2 alpha) 17 d after MGA (MGA-PGF). Heifers in CON and MGA-PGF groups were artificially inseminated 12 h after observed estrus for 21 and 6 d after PGF2 alpha, respectively. Blood samples were collected from each heifer 10 d before and on the day MGA feeding began and 10 d before and on the day PGF2 alpha was administered. Heifers with concentrations of serum progesterone greater than 1 ng/mL on either date before administration of MGA or PGF2 alpha were considered pubertal. More (P = .02) prepubertal heifers that received MGA attained puberty by initiation of breeding than did CON heifers (72 vs 45%, respectively). The proportion of heifers that displayed estrus within 6 d after PGF2 alpha was greater (P less than .001) for MGA-PGF than for CON heifers (77 vs 25%, respectively) but was also influenced by location (P = .03). Conception rate at first service for MGA-PGF heifers that attained puberty during MGA feeding and before PGF2 alpha was not different (P = .50) from that of CON that attained puberty during the same period.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Pancreaticoenteric fistula: no longer a surgical disease?
We report our experience with eight patients with severe persistent pancreatitis associated with peripancreatic fluid collections requiring placement of drainage catheters who subsequently developed pancreatic fistula. The fistulas were diagnosed by endoscopic retrograde cholangiopancreatography, contrast tube study, or Hypaque enema at a mean of 13 weeks after diagnosis of pancreatitis and drain placement. These fistulas involved the duodenum in five patients and colon in three patients. Six patients had fistula resolution with medical therapy (after removal of percutaneous drainage catheters in three and with drain removal in conjunction with transpapillary stenting of a disrupted pancreatic duct in another three). We conclude that in patients with ongoing pancreatitis, pancreaticoenteric fistulas are probably caused by erosion of percutaneous drainage catheters. Such fistulas resolved with conservative treatment in six of eight patients.
Catheters, Indwelling↗
Endoscopic approach to pancreatic duct calculi and obstructive pancreatitis.
Twelve patients with chronic pancreatitis and obstructing pancreatic calculi underwent endoscopic retrograde cholangiopancreatography and attempted pancreatic stone extraction. This procedure, utilizing conventional stone baskets and balloons, as well as extracorporeal or laser lithotripsy in a subset, was ultimately successful in 11 of 12 patients. Nine of the 10 patients with relapsing pancreatitis have not had a symptomatic flare at a mean follow-up of 17 months. In contrast, neither of the patients who presented with chronic pain had convincing symptomatic improvement. The authors conclude that endoscopic removal of pancreatic duct calculi deserves further investigation in the treatment of relapsing attacks of chronic pancreatitis.
Adult↗
Portal colopathy: prospective study of colonoscopy in patients with portal hypertension.
Twenty patients with portal hypertension related to a variety of causes prospectively underwent colonoscopy for hematochezia (n = 10), hemoccult positive stool and anemia (n = 9), or polyp found with screening flexible sigmoidoscopy (n = 2) (includes 1 patient with anemia/heme-positive stool). Twelve patients (60%) had previously undergone a course of sclerotherapy, and 10 (50%) had endoscopic evidence of congestive gastropathy. Colonoscopic findings included mucosal abnormalities resembling multiple vascular ectasias in 14 (70%), 4 of whom also had endoscopic features suggesting a mild, chronic colitis. Neither signs of chronic liver disease nor stigmata suggestive of more severe portal hypertension correlated with the colonoscopic findings. Two patients required heater probe therapy for actively oozing lesions resembling vascular ectasias and an additional two patients sclerotherapy for bleeding midrectal varices. Although likely an overestimate of the frequency, this study suggests that portal colopathy can occur in portal hypertension. Vascular ectasialike lesions in such settings may be associated with acute as well as chronic gastrointestinal bleeding and may require pharmacological, directed endoscopic, or portal decompressive therapy. Additional studies are required to determine not only the pathophysiology but also the true frequency of this entity.
Capillaries↗
Evaluation of reproductive traits in Bos taurus and Bos indicus crossbred heifers: effects of postweaning energy manipulation.
Reproductive traits were evaluated in Bos taurus and Bos indicus crossbred heifers that were fed different diets during the postweaning period. The study was designed in a 2 x 2 x 2 factorial arrangement of treatments. Angus x Hereford (AH; n = 148) and Brahman x Hereford (BH; n = 148) heifers were sorted after weaning by body weight into light (LW) and heavy (HW) weight blocks. Heifers in each weight block were assigned to diets calculated to reach a target weight of 55% (LE) or 65% (HE) of their projected mature weights by the start of the breeding season. Puberty was determined after a 160-d observation period and characterized by the following criteria: 1) behavioral estrus, 2) presence of a palpable corpus luteum (d 6 to 10; estrus = d 0), and 3) rise in serum progesterone above 1 ng/ml (d 6 to 10). A higher (P = .01) proportion of AH heifers than of BH heifers reached puberty by the breeding season (93% vs 67%). Interactions of breed x weight block and energy level x weight block also contributed to this difference. Weight at puberty was heavier (P = .001) among HE than among LE heifers and greater for heifers in HW than for those in LW blocks (P = .02). Differences in prebreeding weight, body condition, average daily gain, hip height, and pelvic area were influenced selectively by breed, energy level, or weight block. Pregnancy rates were higher (P = .01) among AH than among BH heifers. Incidence and severity of dystocia was influenced by the breed x energy level interaction (P = .01). Brahman x Hereford heifers had less (P = .01) dystocia than AH heifers, HE heifers had less (P less than .02) dystocia than LE heifers, and HE-AH heifers had less (P less than .01) dystocia than LE-AH contemporaries. Subsequent duration of the postpartum interval to estrus was shorter (P = .002) among AH than among BH females. Pregnancy rates at the end of the 2nd yr were higher (P = .02) among LW than among HW females and weights were heavier (P = .001) at weaning among calves weaned from BH dams.
Animal Feed↗
Disposable endoscopic biopsy forceps: comparison with standard forceps of sample size and adequacy of specimen.
Disposable biopsy forceps have recently been introduced into the field of endoscopy. We have analyzed biopsy size and histologic interpretation of samples obtained with the disposable forceps and compared them to those obtained with reusable forceps. In the 18 patients studied, 49 samples were collected with the reusable forceps and 47 samples with the disposable. Biopsy sites included the colorectum in 50%, esophagus in 22%, small bowel in 17%, and stomach in 11% of the patients. We found that statistically smaller samples were collected by the disposable biopsy forceps than by the reusable (2.48 +/- 1.11 mm versus 1.99 +/- 0.55 mm, p = 0.006). The smaller biopsy size with disposable forceps was not clinically important since all but one of 47 specimens were interpreted as adequate for histologic diagnosis. The convenience, potential cost savings, and prevention of the spread of communicable agents afforded by disposable biopsy forceps make them a possible alternative to conventional forceps in some clinical settings.
Adult↗
Endoscopic transpapillary therapy for disrupted pancreatic duct and peripancreatic fluid collections.
Eighteen patients with active pancreatic ductal disruptions, including 14 with definable fluid collections, were treated with transpapillary pancreatic duct drains or stents. Twelve of these patients had undergone a previous percutaneous or surgical pancreatic drainage procedure or both, and 8 had long-term drainage tubes in chronic fistulous tracts. Transpapillary catheters could be placed across the ductal disruption or directly into the fluid collection in each case, and 16 of 18 patients had resolution of the disrupted pancreatic duct. Twelve of 14 fluid collections resolved. Complications were limited to mild exacerbation of pancreatitis symptoms in 2 patients and 2 patients who developed subsequent stent occlusion leading to recurrent pancreatitis (1 patient) or recurrent duct blowout with pseudocyst (1 patient). Nine patients had variably significant ductal changes attributable to pancreatic duct stents. At a median follow-up of 16 months, 7 patients ultimately required surgery for ongoing pancreatic pain or residual/recurrent fluid collection. The transpapillary treatment of ongoing pancreatic ductal disruption with or without fluid collection has the potential to obviate surgery in some patients, change an urgent surgical procedure into an elective one, or even assist the surgeon in the performance of intraoperative pancreatography. Further study of this technique appears warranted and must be placed into the perspective of current therapies.
Acute Disease↗
Response of prepubertal Bos taurus and Bos indicus x Bos taurus heifers to melengestrol acetate with or without gonadotropin-releasing hormone.
The effectiveness of treatments to induce estrus in prepubertal beef heifers was evaluated. Angus x Hereford (n = 148) and Brahman x Hereford (n = 148) heifers were sorted after weaning by body weight into light and heavy weight blocks. Heifers were assigned to diets, calculated to reach a target weight of 55% or 65% of their projected mature weight by the start of breeding. Cyclicity was determined after a 160-d observation period and from concentrations of progesterone in serum determined 10 d before and on the day that treatments began to induce puberty. The remaining nonpubertal heifers, with concentrations of progesterone in serum of less than 1 ng/ml (0 or 10 d before treatment), were assigned randomly within breed and nutrition group to either a melengestrol acetate + saline (MGA+S) or MGA + gonadotropin-releasing hormone (MGA+GnRH) treatment. Prepubertal Angus x Hereford heifers (n = 11) and Brahman x Hereford heifers (n = 49) were fed 0.5 mg MGA for 7 d. Forty-eight hours after MGA, heifers were injected with 500 ug s.c. GnRH or 5 ml of saline. Blood samples were collected from all prepubertal heifers every 3 d after GnRH or saline for 30 d. There was no difference between treatments in the proportion of heifers that exhibited estrus by Day 7 after treatment. However, a larger (P<0.05) proportion of MGA+S-treated heifers exhibited estrus within 14 d after treatment than MGA+GnRH-treated heifers (87 vs 63%). Among heifers that exhibited estrus during that time period, the proportion with increased progesterone was higher (P<0.10) for the MGA+GnRH group than for the MGA+S group (71 vs 41%, Day 7; 79 vs 54%, Day 14). There was no difference in conception rate at first service between treatment groups. Thirty-seven and 53%, respectively, of the MGA+S and MGA+GnRH-treated heifers had short estrous cycles after treatment, and 44 and 50%, respectively, of those short cycles were repeated. Pregnancy rates at the end of 45 d were numerically higher for MGA+S heifers than for MGA+GnRH treated counterparts (63 vs 53%).
Journal Article↗
Value of diagnostic upper endoscopy preceding percutaneous gastrostomy.
Percutaneous gastrostomies, placed endoscopically or radiographically, have supplanted their surgical counterparts in many institutions. Although there are few comparative data, a cost advantage is claimed for the radiographic method, as no endoscopy is required. We performed upper endoscopy on 201 patients prior to attempted percutaneous endoscopic gastrostomy (PEG). The medical records of these patients were reviewed. Data collected included endoscopic findings which precluded gastrostomy, necessitated conversion to jejunostomy, or led to changes in medical management. For a total of 73 patients (36%), findings at pregastrostomy endoscopy led to major changes in medical management, including 35 patients with severe reflux esophagitis, 29 patients with peptic ulcers, and two patients with gastric outlet obstruction. Appropriate treatment of such conditions may improve morbidity, mortality, and cost by reducing length of hospital stay. The authors recommend diagnostic upper endoscopy in patients undergoing percutaneous gastrostomy, regardless of placement method.
Digestive System Diseases↗
Long-term survival in patients undergoing percutaneous endoscopic gastrostomy and jejunostomy.
Percutaneous endoscopic gastrostomy (PEG) used to supply enteral nutrition has supplanted surgically placed feeding tubes in many institutions. These tubes are currently placed in: 1) patients with reversible disease with potential for recovery (stroke, Guillain-Barré syndrome); 2) patients with incurable disease with potential for extended survival (head and neck cancer, amyotrophic lateral sclerosis); or 3) patients who are terminal or seriously debilitated (head trauma, systemic malignancies). Few data are currently available regarding long-term survival, survival difference between various patient populations, and incidence of recovery of oral intake with subsequent PEG tube removal. In this study, records of 191 patients in whom PEG tubes were placed were retrospectively reviewed and information collected regarding underlying diseases (malignant vs nonmalignant), survival, and incidence of subsequent tube removal. Of the patients, 68 (36%) had cancer, and 123 (64%) had benign disease (usually stroke or other neurologic disorder). Survival curve analysis demonstrated that one-third of patients were dead within 60 days of PEG placement, and half were dead in the first 6 months. Total deaths were 115 (60%) at a median time of 164 days. No mortality was directly related to acute or subsequent PEG tube complications. Feeding tubes were removed in 41 patients (21%), 10 with cancer (5%), and 31 without (16%, p less than 0.05). These data on limited patient survival and low incidence of recovery of oral intake suggest that facilitation of hospital discharge into a less expensive home care or step-down facility is the most likely goal to be realized after PEG placement. Further, these results raise questions regarding the appropriateness of PEG placement in patients with anticipated early mortality or low likelihood of hospital discharge.
Aged↗
Methotrexate induces clinical and histologic remission in patients with refractory inflammatory bowel disease.
STUDY OBJECTIVE: To determine whether methotrexate has anti-inflammatory activity in refractory inflammatory bowel disease. DESIGN: Nonrandomized, open-label, preliminary trial of methotrexate along with standard medications for 12 weeks. SETTING: Referral-based gastroenterology practice. PATIENTS: Twenty-one patients with refractory inflammatory bowel disease (14, Crohn disease; 7, chronic ulcerative colitis); 17 taking variable doses of corticosteroids and 14 on sulfasalazine or metronidazole. Of the 21 patients, 10 had previously failed azathioprine or 6-mercaptopurine trials. INTERVENTIONS: Sulfasalazine and metronidazole were continued and prednisone dose was tapered according to clinical response. Methotrexate was given as a 25-mg intramuscular injection weekly for 12 weeks, then switched to a tapering oral dose if a clinical and objective improvement was noted. MEASUREMENTS AND MAIN RESULTS: Sixteen of twenty-one patients (11 of 14 patients with Crohn disease, 5 of 7 patients with chronic ulcerative colitis) had an objective response as measured by disease activity indices (modified Crohn's Disease Activity Index, 13.3 to 5.4 [P = 0.0001], Ulcerative Colitis Activity Index, 13.3 to 6.3 [P = 0.007]). Prednisone dosage decreased from 21.4 mg +/- 5.6 (SEM) to 5.5 mg +/- 2.0; P = 0.006 and 38.6 mg +/- 6.35 to 12.9 mg +/- 3.4; P = 0.01, respectively. Five patients with Crohn colitis had colonoscopic healing and 4 had normal histology at 12 weeks. In contrast, none of the 7 patients with ulcerative colitis had normal flexible sigmoidoscopies, despite histologic improvement in 5. Side effects included mild rises in transaminase levels in 2 patients, transient leukopenia in 1, self-limited diarrhea and nausea in 2 patients, and 1 case each of brittle nails and atypical pneumonitis. CONCLUSIONS: Although this pilot study is encouraging, further work is needed before methotrexate can be recommended for inflammatory bowel disease.
Colitis, Ulcerative↗