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Biomedical subjects

D Westaby

Publications and source records attributed to D Westaby.

At least 91 records · Page 5Linked to original sources
PubMed1984

Selective and non-selective beta receptor blockade in the reduction of portal pressure in patients with cirrhosis and portal hypertension.

To elucidate the mechanisms by which beta receptor blockade leads to a reduction of portal pressure, 18 patients with cirrhosis and portal hypertension were given comparable doses of propranolol or metoprolol. The fall in portal pressure was more marked with propranolol together with a significant reduction in hepatic blood flow, which was not seen with metoprolol. No correlation between the reduction in cardiac output and the decrease in portal pressure or changes in hepatic blood flow could be elicited in each group, but there was a direct relationship between the decrease in hepatic blood flow and fall in portal pressure in the propranolol treated patients. The difference observed may be related to blockade of beta 2 vasodilator receptors in the splanchnic circulation which will occur only with propranolol and lead to a greater fall in splanchnic blood flow than will be produced by a reduction in cardiac output alone. Metoprolol, by maintaining effective hepatic blood flow, may be preferable to propranolol in patients with severely impaired liver function.

Cardiac Output↗
PubMed1984

Injection sclerotherapy for oesophageal varices: a prospective randomised trial of different treatment schedules.

A prospective randomised study to compare the efficacy and complications of injection sclerotherapy carried out at intervals of one week and three weeks up to the time obliteration of varices was achieved, was undertaken in 55 patients (48 cirrhosis, six portal vein thrombosis, one nodular regenerative hyperplasia). The number of courses of injection required for obliteration of the varices was not different in the two groups and despite a shorter time scale for obliteration in the weekly treated patients the frequency with which further episodes of bleeding occurred before that was not significantly less. Mucosal ulceration during the period required for obliteration was observed at endoscopy more frequently in the weekly treated patients but was not associated with a greater frequency of postinjection pain, dysphagia or of long term stricture formation.

Clinical Trials as Topic↗
PubMed1984

Follow-up study after sclerotherapy.

In a prospective study, 200 patients with variceal bleeding (179 cirrhosis, 21 noncirrhotic) who were treated by long-term sclerotherapy were followed for periods up to 6 years. Varices were obliterated in 162 (81%) with a median of four courses of injection. 'New' varices developed in 99 cases and were a cause of bleeding in 28, of whom 3 died. The recurrence of varices was almost always observed within 12 months of initial obliteration. A median of two courses of sclerotherapy were required to again achieve obliteration. In 20 patients a second recurrence of varices occurred with bleeding in 8 cases but no associated deaths. Based on these observations we recommend regular follow-up endoscopy after obliteration, particularly in the 1st year, to detect and treat varices before they are a cause of bleeding.

Follow-Up Studies↗
PubMed1983

Androgen related primary hepatic tumors in non-Fanconi patients.

Three cases of androgen related primary hepatic tumor in non-Fanconi patients are described in whom detailed information is available concerning histologic changes and clinical course over long periods. Two patients presented with hepatic rupture and hemoperitoneum requiring surgical intervention. In one case histologic assessment showed a hepatic adenoma which has almost completely regressed over four years since androgen withdrawal. In two patients there was a degree of nuclear pleomorphism not seen in 'spontaneous' adenomas and following androgen withdrawal there has been no evidence of progression or of metastases although the tumor has not regressed over a follow-up period of two years.

Adult↗
PubMed1982

Increased long-term survival in variceal haemorrhage using injection sclerotherapy. Results of a controlled trial.

Analysis of 107 patients with cirrhosis and recent variceal haemorrhage included in a prospective randomised trial of endoscopic injection sclerotherapy showed that in the sclerotherapy group 22 (43%) of the 51 patients had episodes of haemorrhage during the period of treatment, but in only 4 did bleeding occur after the varices had been obliterated. This contrasts with episodes of bleeding in 42 (75%) of the 56 patients receiving standard medical management-a highly significant difference. The overall risk of bleeding per patient-month of follow-up was reduced threefold with sclerotherapy. Of 22 patients followed up for at least one year after obliteration of varices, 14 had no evidence of reappearance of varices within this period and, by means of cumulative life-analysis tables, survival was shown to be significantly improved in the sclerotherapy group.

Clinical Trials as Topic↗
PubMed1980

Liver biopsy as a day-case procedure: selection and complications in 200 consecutive patients.

The selection of 200 consecutive patients who underwent liver biopsy as a day-case procedure and subsequent complications were reviewed, In 59 patients a diagnosis of cirrhosis was confirmed by histological examination. Six patients developed minor complications attributable to the procedure and had to stay longer in hospital, and another returned with abdominal pain the evening after the biopsy. With careful selection of patients, liver biopsy may be safely undertaken on a day-case basis.

Adolescent↗
PubMed1980

Prospective controlled trial of injection sclerotherapy in patient with cirrhosis and recent variceal haemorrhage.

64 patients with cirrhosis and recent variceal haemorrhage were studied in a prospective randomised trial of injection sclerotherapy by means of a flexible oesophageal sheath. 12 (33%) of the 36 patients in the sclerotherapy group, suffered further bleeds from varices compared with 19 (68%) of the 28 patients receiving standard medical treatment. The risk of bleeding per patient-month of follow up decreased more than threefold with sclerotherapy and the number of patients rebleeding after 2, 6, and 12 months was significantly reduced (p < 0.05). 1-year survival without further bleeding improved significantly with sclerotherapy (46% compared with 6%, p < 0.02), although the difference in overall survival assessed by cumulative life-table analysis was not statistically significant. The main complication of the technique was the development of oesophageal ulcers in some patients.

Esophageal Diseases↗
PubMed1980

A simple method for continuous pericardial drainage.

Needle pericardiocentesis is performed routinely for relief of symptoms in patients with pericardial effusion and cardiac tamponade. In many patients however, reaccumulation of fluid requires further aspiration or surgical drainage, occasionally as a matter of urgency. Both procedures carry significant risks which may be avoided by insertion of an indwelling catheter. The Viggo subclavian cannula proves ideal for prolonged drainage of pericardial effusions and for relief of tamponade in an emergency situation. Introduction into the pericardium is simple, safe, and can be performed quickly without specialised equipment. This procedure is described and illustrated in patients with tuberculous and rheumatoid pericarditis.

Aged↗
PubMed1977

Liver damage from long-term methyltestosterone.

Of 60 patients (42 female transsexuals and 18 impotent males) receiving long-term therapy with methyltestosterone 50 mg three times a day, 19 had abnormal liver-function tests and 33 out of 52 had abnormal liver scans, particularly those who had been treated for more than a year. Liver biopsy specimens showed accumulation of hepatocytes in the liver cords and within the walls of centrilobular veins, and early peliosis hepatis. One patient had a hepatic adenoma. Of the androgens, only 17alpha-alkylated steroids seem to be implicated in the development of cholestatic jaundice, peliosis hepatis, and liver tumours.

Adenoma↗
PubMed1977

Hyperplasia and prolapse of hepatocytes into hepatic veins during longterm methyltestosterone therapy: possible relationships of these changes to the developement of peliosis hepatis and liver tumours.

We report the pathological changes in liver biopsies from 10 patients (four female transexuals and six impotent males) after treatment with 150 mg methyltestosterone daily for periods of up to 3 years, and in a hemihepatectomy specimen from a female transexual who developed a liver adenoma after 37 months of this treatment. Hepatocyte hyperplasia and mild focal sinusoidal dilatation was found in most cases. In some cases there were microcysts and dissociation of hepatocytes. In nine patients there was accumulation of hepatocytes between the endothelium and the supporting collagen of hepatic veins which often resulted in either partial occlusion of their lumina or disruption of their walls. These vascular changes do not appear to have been reported before. It is postulated that a single pathological process-hyperplasia, perhaps related to the anabolic effect of methyltestosterone--could be partly responsible both for the formation of cysts through mechanical obstruction of hepatic veins and for the formation of nodules and tumours.

Adult↗
PubMedDate not supplied

A prospective randomized study of two sclerotherapy techniques for esophageal varices.

In a study designed to compare the efficacy and safety of two techniques of injection sclerotherapy, 40 patients (30 with cirrhosis and 10 with portal vein block) were randomly allocated to the sheath or free-hand technique. Although the former was associated with significantly less bleeding within the first 24 hr of injection (p less than 0.05) but more postinjection pain (p less than 0.05) and esophageal stricture, there was a trend toward earlier obliteration of varices. This was most marked over the first three courses of injection, and although frequency of rebleeding was not significantly less, none of the 11 episodes in the sheath group were fatal, compared to 5 of 15 bleeds in those injected by the free-hand technique (p less than 0.05).

Clinical Trials as Topic↗
PubMedDate not supplied

Improved survival following injection sclerotherapy for esophageal varices: final analysis of a controlled trial.

Long-term follow-up (median: 37 months; range: 19 to 68) of the 116 patients (56 sclerotherapy, 60 control group) entered into a controlled trial of endoscopic variceal sclerotherapy has shown a total of 18 deaths in the sclerotherapy group, including five from variceal bleeding compared with 32 deaths in the control group (p less than 0.01), of which 25 were from variceal hemorrhage (p less than 0.001). Survival as assessed by cumulative life analysis was significantly better in those treated by sclerotherapy (p less than 0.001). Both the cumulative proportion of patients rebleeding and the total number of episodes of variceal hemorrhage were also significantly less in the sclerotherapy group (p less than 0.01). Recurrence of varices was observed in 27 of 45 patients in whom variceal obliteration was initially observed at a median of 11 months (range: 2 to 27) later, although in only 12 of these did bleeding recur and was the cause of death in one.

Adolescent↗
PubMedDate not supplied

A randomized trial of vasopressin and vasopressin plus nitroglycerin in the control of acute variceal hemorrhage.

A randomized trial was undertaken to determine efficacy of nitroglycerin when added to a vasopressin infusion in both reducing the complication rate and giving improved control of acute variceal hemorrhage. Seventy-two bleeding episodes in 57 patients were included, with vasopressin being used on 34 occasions and vasopressin plus nitroglycerin on 38 occasions, for an infusion period of 12 hr. At the end of the 12-hr period, hemorrhage had been controlled significantly more frequently in those receiving combined therapy (26 of 38; 68%) than in those given vasopressin alone (15 of 34; 44%, p less than 0.05), although this difference was not statistically significant if those patients in whom therapy was discontinued due to drug complications were excluded from the analysis [hemorrhage controlled in the combined group (68%) and vasopressin alone (48%); chi 2 = 2.4, p greater than 0.05]. Major complications requiring cessation of therapy were significantly less common in those given nitroglycerin--one occasion compared to seven in those given vasopressin alone (p less than 0.02). Thus, the addition of nitroglycerin to a vasopressin infusion results in a lower rate of complications and is more effective in controlling variceal hemorrhage.

Blood Transfusion↗