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Biomedical subjects

D Westaby

Publications and source records attributed to D Westaby.

95 records · Page 6Linked to original sources
PubMedDate not supplied

Use of propranolol to reduce the rebleeding rate during injection sclerotherapy prior to variceal obliteration.

In a prospective, randomized controlled trial, 53 patients with variceal hemorrhage from portal hypertension, including 44 with cirrhosis, were allocated, after initial control of the bleeding, to treatment by sclerotherapy alone, or by this together with oral propranolol in a dose sufficient to reduce resting pulse rate by 25% during the period up to the time when varices were obliterated. Eight of the 27 patients undergoing sclerotherapy alone rebled during this period as compared to 7 of the 26 patients in the additional propranolol group (p greater than 0.80), two patients from each group dying from uncontrollable variceal hemorrhage. Propranolol precipitated encephalopathy in one patient and complicated resuscitation following bleeding in a second, and as there was no evidence in this study that use of the drug reduced the frequency or severity of the variceal bleeding, its administration cannot be recommended during the period prior to obliteration of varices by sclerotherapy.

Clinical Trials as Topic↗
PubMedDate not supplied

Hepatobiliary and pancreatic manifestations of cystic fibrosis: MR imaging appearances.

Magnetic resonance (MR) imaging and MR cholangiopancreatography are useful, noninvasive techniques for the assessment of pancreatic and hepatobiliary complications in cystic fibrosis. Abnormalities of the pancreas in cystic fibrosis are typically characterized by fat deposition, which has increased signal intensity on T1-weighted MR images, and pancreatic fibrosis, which has low signal intensity on both T1- and T2-weighted images. Pancreatic cysts are a relatively common finding; these cysts are typically quite small but are well demonstrated at MR imaging and MR cholangiopancreatography. Pancreatic duct abnormalities are also occasionally seen. Hepatic manifestations range from hepatomegaly and diffuse fatty infiltration to severe cirrhosis with fibrotic change, regenerative nodules, and portal hypertension. Splenomegaly is often characterized by siderotic nodules that manifest as multiple focal areas of abnormal low signal intensity within the spleen. Biliary manifestations include cholelithiasis, stricturization, and narrowing or dilatation of intra- and extrahepatic bile ducts. Gallbladder abnormalities including microgallbladder are also readily demonstrated. MR cholangiopancreatography can be used to help determine the presence and severity of biliary complications without resorting to more invasive procedures and, in conjunction with MR imaging, may prove useful in the assessment of patients with cystic fibrosis who present with abdominal symptoms that suggest hepatobiliary involvement.

Cholangiography↗
PubMedDate not supplied

A critical review of the medical treatment of portal hypertension.

There are three distinct phases during which treatment might influence the outcome in patients with portal hypertension and variceal bleeding: treatment of the active bleeding episode, the prevention of recurrent haemorrhage and perhaps most controversially the use of prophylactic therapy to avert the first bleeding episode. For the treatment of active haemorrhage injection sclerotherapy is almost certainly the treatment of choice when the expertise is available. In the absence of such, vasoconstrictor therapy continues to be widely adopted as a temporizing measure. The efficacy of vasopressin as a single agent has been limited by associated cardiovascular complications. The addition of nitroglycerin to a vasopressin regime has recently been shown to reduce such complications and to improve overall efficacy. Somatostatin represents an alternative vasoconstrictor with increasing evidence of efficacy in the absence of serious complications. Long-term injection sclerotherapy is widely accepted as the first line treatment to prevent recurrence of variceal haemorrhage although early rebleeding, prior to the obliteration of varices, represents an important limitation of therapy. Alternative local endoscopic therapy using tissue adhesives or banding of varices are under evaluation. The major claims of benefit initially attributed to oral propranolol for the prevention of rebleeding have now been considerably modified and a specific role remains to be defined. Both injection sclerotherapy and B-adreno-receptor have been proposed as prophylactic therapy to prevent the first variceal haemorrhage. Two extremely positive reports of prophylactic sclerotherapy have received little further support and there are now few protagonists of this approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Alcohol and the liver.

Alcohol remains the most common cause of cirrhosis in the Western world. This article reviews the increased understanding of the mechanisms by which alcohol damages the liver, why individuals differ in their susceptibility to alcohol, current treatments available and those which may have a role to play in the future.

Acetaldehyde↗