Search PubMed⌕ Search

Biomedical subjects

D Y Graham

Publications and source records attributed to D Y Graham.

610 records · Page 34Linked to original sources
PubMedDate not supplied

Endoscopic needle biopsy: a comparative study of forceps biopsy, two different types of needles, and salvage cytology in gastrointestinal cancer.

One of the goals of gastrointestinal endoscopy is to diagnose whether a lesion is malignant. The desire to improve the sensitivity of biopsy-sampling techniques prompted us to compare prospectively the reliability and accuracy of obtaining tissue by forceps biopsy, needle biopsy (21 gauge 13-mm long metal needles versus 18 gauge 20-mm long plastic needles), and salvage cytology in patients with endoscopically suspected malignancy. Samples were obtained in the order of needle biopsy (the order of metal and plastic needle biopsy was randomized), forceps biopsy, followed by salvage cytology. Needle biopsies were obtained by puncturing the lesion under direct vision while aspirating with a syringe. Twenty-three patients with gastrointestinal malignancy were studied (7 esophageal, 4 gastric, and 12 colonic). Forceps biopsies were positive in 18 of 23 (78%), missing 1 gastric and 4 colon malignancies. Metal needle biopsy was positive in 16 of 19 (84%), plastic needle biopsy in 17 of 22 (77%), and salvage cytology in 20 of 22 (91%). Accuracy was increased by a combination of techniques. Endoscopic needle biopsy is a simple and rapid method to evaluate lesions seen at endoscopy and is especially useful in evaluation of submucosal lesions.

Biopsy, Needle↗
PubMedDate not supplied

Sclerotherapy-associated esophageal ulcers: lessons from a double-blind, randomized comparison of sucralfate suspension versus placebo.

We undertook a double-blind randomized trial to assess whether sucralfate suspension would accelerate healing of sclerotherapy-associated esophageal ulcers. Consecutive patients who underwent sclerotherapy were evaluated. Patients were prospectively endoscoped 4 days (range, 3 to 5 days) after sclerotherapy. Those with ulcers greater than 5 mm in diameter were randomized to receive sucralfate suspension, 4 g/day (10 ml four times a day), or placebo. Endoscopic evaluations were done weekly for the 4 weeks of therapy. Nineteen patients survived long enough to be evaluated; complete ulcer healing was scored as success. Nine patients (13 ulcers) received sucralfate and 10 patients (17 ulcers) received placebo. At the end of 4 weeks, 78% of ulcers in sucralfate-treated patients had healed compared with 40% in the placebo group (p = not significant). Large ulcers were found to heal more slowly (p = 0.03, life table analysis) and small ulcers were disproportionally represented in patients receiving sucralfate (67% compared with 40% in the placebo group). When ulcer size was taken into account, the possible drug advantage disappeared; ulcer size appears to be a major determinant of rate of healing of sclerotherapy-associated esophageal ulcers. A large multicenter trial will be required to identify whether sucralfate accelerates postsclerotherapy esophageal ulcer healing.

Clinical Trials as Topic↗
PubMedDate not supplied

Comparison of biopsy sites for the histopathologic diagnosis of Helicobacter pylori: a topographic study of H. pylori density and distribution.

The histologic demonstration of characteristic curved, spiral bacilli on the gastric mucosa is considered the gold standard for the diagnosis of Helicobacter pylori infection. However, in some cases the urea breath test or serologic tests may be positive, yet gastric biopsy specimens fail to reveal H. pylori. The objectives of this study were (1) to analyze the density and distribution of H. pylori in different regions of the stomach, (2) to ascertain which area of the stomach is a preferential site for obtaining biopsy specimens, and (3) to determine whether the presence of neutrophils or lymphoid aggregates correlates with the presence of detectable organisms in the same biopsy specimen. Eighty-nine patients with H. pylori infection underwent gastric mapping. The density of H. pylori, neutrophils, and lymphoid follicles was assessed semi-quantitatively in each biopsy site. The likelihood of getting a false-negative result was also calculated for each biopsy site. All biopsy specimens from the antral lesser curvature, at or near the incisura, had detectable H. pylori. Scores for this area and the cardia were higher than scores for the gastric corpus, but most differences were not significant. Fewer than 3% of antral biopsy specimens were false-negative, compared to between 6% and 9% of those from the corpus (p = 0.02). Neutrophils were present in more than 94% of all antral biopsy specimens, compared to 60% to 86% of specimens from the corpus (p < 0.01). Lymphoid follicles were detected in approximately two-thirds of antral biopsy specimens but in fewer than half of those from the corpus.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMedDate not supplied

Prevention of diarrhea caused by enterotoxigenic Escherichia coli: lessons learned with volunteers.

The effectiveness of bismuth subsalicylate in the prevention and treatment of diarrhea induced in volunteers by a single strain of enterotoxigenic Escherichia coli and a standard inoculum size was evaluated. Bismuth subsalicylate (500 mg in a solid dosage form) was administered 8 hours and 2 hours before and 2 hours and 4 hours after the E. coli challenge; treatment was continued four times a day for three additional days. Volunteers experiencing diarrhea were re-randomized to receive placebo or bismuth subsalicylate (300 mg every 30 minutes, for a total of 2.4 g of bismuth subsalicylate, in eight doses). Diarrhea occurred in nine (56%) of the 16 volunteers receiving placebo and in two (13%) of the 15 volunteers receiving bismuth subsalicylate (P less than .03). In vitro studies revealed that bismuth subsalicylate and its components each were bactericidal at concentrations possibly attained during the clinical trial. The effect of the dosage form (solid vs. liquid), the relation of drug administration to meals, and how these variables might greatly influence the effectiveness of bismuth subsalicylate prophylaxis for travelers' diarrhea were considered.

Bismuth↗
PubMedDate not supplied

Molecular biology and immunology of rotavirus infections.

Rotaviruses were first recognized about 15 years ago in association with diarrhea in children and animals. Since then, rotaviruses have been determined to be the most important viral agent that causes clinically significant diarrhea in children and a need for an effective vaccination program has been recognized. This article reviews the progress which has been made in understanding the molecular biology of rotaviruses and summarizes information on the immune responses to rotavirus infections obtained in a new animal model in rabbits. This model is useful to systematically evaluate active protective immunity following infection of seronegative animals.

Animals↗
PubMedDate not supplied

Nonsteroidal anti-inflammatory drug use in dentistry: gastrointestinal implications.

Pain management long has been an important consideration in dental care. Nonopioid analgesics such as aspirin, acetaminophen, and many of the nonsteroidal anti-inflammatory drugs (NSAIDs) generally provide predictable outcomes for control of dental pain because of their analgesic and anti-inflammatory properties. The anti-inflammatory action of NSAIDs also is being investigated in treatment of periodontal disease when used as an adjunct to non-surgical management. Since NSAID use by dental patients is high, gastrointestinal complications may arise, affecting long-term use of these agents. Systemic considerations of NSAID use are reviewed, as are complications frequently resulting in ulceration of the gastric mucosa.

Aged↗