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Biomedical subjects

F B Keane

Publications and source records attributed to F B Keane.

At least 55 records · Page 3Linked to original sources
PubMed1989

Yersinia infections in surgical practice.

This article reviews the clinical manifestations of Yersinia bacteria emphasizing their recent rise in incidence and describing how Yersinia infection presents to the general surgeon. Geographical variations, patterns of disease, pathogenicity and the problems in diagnosis and management are discussed. This common but often unrecognized infection is usually self-limiting but the very young, the very old and the immunocompromised are at greater risk and prompt treatment is required to save lives.

Gastroenteritis↗
PubMed1989

Malignant melanoma lately diagnosed.

To assess the clinical impression that patients in Dublin were presenting with late, deep, poor prognosis lesions, a 10 year retrospective review of patients with malignant melanoma was performed. The pathological data on 186 patients was examined and clinical follow-up obtained on 151 of these (80%). The mean period of follow-up was 35 months. Females predominated in a ratio of 3:1. Incidence figures for the two five year periods (1976-80) and (1981-85) indicated a rise in the latter period of over 100%. There was a marked delay in presentation after the onset of symptoms i.e. new pigmented lesions or changes in pre-existing lesions (mean = 21 months). Only 45% of lesions were less than 1.5mm in depth. Females presented with a higher percentage of good prognosis lesions reflected in a superior five year survival figure of 70% compared with 43% for males. The results of this study suggest an increase in incidence and mortality from malignant melanoma in this country. Patients appear to be unaware of the significance of pigmented lesions, presenting late with deep poor prognosis tumours.

Adolescent↗
PubMed1987

Yersinia infection and acute abdominal pain.

In 194 patients presenting with acute abdominal pain from whom sequential serum samples were taken, the frequency of yersiniosis, established serologically, was significantly higher (23%) than in 320 control subjects (2%). Yersiniosis occurred in 31% of patients with acute appendicitis. Acute-phase serum samples only, obtained in a further 307 patients, yielded a falsely low frequency of yersiniosis (4%). Y pseudotuberculosis was five times more common than Y enterocolitica, and Y pseudotuberculosis type IV was the most common serotype, accounting for 43% of Yersinia infections. Yersinia may play a more important part in the aetiology of acute abdominal pain, and particularly acute appendicitis, than has been previously appreciated. Antibody titres to both Y enterocolitica and Y pseudotuberculosis frequently rise late in infections causing abdominal pain. Consequently analysis of acute-phase serum samples alone leads to underdiagnosis of yersiniosis.

Abdomen↗
PubMed1986

Influence of intraperitoneal drains on subhepatic collections following cholecystectomy: a prospective clinical trial.

In this prospective randomized study, the influence of an intraperitoneal drain on the incidence and clinical significance of subhepatic collections occurring in patients after acute or elective cholecystectomy was assessed by ultrasound examination. A total of 112 patients entered the study, of whom 54 received a drain. There was no significant difference between the drainage and the non-drainage groups with respect to mean age or sex distribution, the number of patients in whom the gallbladder bed was formally closed (27 versus 21) nor in the number of acute cholecystectomies performed in either group (12 versus 13). Ultrasound detected 10 (18 per cent) collections in the drainage group and only one (1.8 per cent) in the non-drainage group (P less than 0.01, chi 2 test). None of the collections required any further treatment and no morbidity occurred that was directly attributable to the presence of the retained fluid. These results suggest that rather than preventing fluid collections, suction drains may predispose to the development of subhepatic collections after cholecystectomy.

Bile↗
PubMed1984

Oesophageal manometry. A comparison of hydraulic and syringe catheter infusion systems using a simple hydrostatic bench model.

A simple hydrostatic bench model is described which can be used to validate oesophageal intraluminal manometry measurements. Conventional syringe pump infusion was compared with the hydraulic capillary infusion system using this model. Accurate recording of pressure changes was achieved on the low compliance hydraulic system at infusion rates of 1 X 10(-8) m3 s-1 (0.6 ml min-1). To achieve comparable accuracy with syringe pump infusion, undesirably rapid infusion rates of 10.35 X 10(-8) m3 s-1 (6.2 ml min-1) were required. We believe that the hydrostatic bench model is a useful tool for checking the accuracy of infused catheter systems.

Animals↗
PubMed1983

The relationship between technetium 99m pertechnetate gastric scanning and gastric contents.

In order to elucidate the gastric handling of 99Tcm, we performed scintiscanning under basal and stimulated conditions while simultaneously monitoring gastric outputs of water and sodium, hydrogen and 99Tcm pertechnetate ions in six healthy fasting volunteers. Our results showed that gastric scintiscanning correlated well with gastric luminal 99Tcm activity (r = 0.99). However, clearance of 99Tcm from plasma into the gastric lumen showed only a poor correlation with hydrogen ion output (r = 0.68) and no correlation with sodium output. Explanation of these results on a cellular basis can be achieved by assuming a two-component mechanism for 99Tcm secretion, with both the parietal cells (H+ ion secretory) and non-parietal cells (Na+ ion secretory) contributing to 99Tcm gastric output. The relative contribution of each cell type to total 99Tcm secretion is dependent on the degree of gastric stimulation, with non-parietal 99Tcm secretion dominating in the basal state and parietal 99Tcm secretion dominating in the stimulated state. It is concluded therefore, that gastric scintiscanning with 99Tcm pertechnetate should stand only as an empirical test of gastric function and not as a means of measuring acid output.

Adult↗
PubMed1982

An assessment of dynamic gastric scanning with 99Tcm-pertechnetate.

Following intravenous injection, technetium-99m (99Tcm) is selectively taken up by the stomach, and this uptake, which is stimulated by pentagastrin, may be quantified using a gamma camera. Using this property of 99Tcm as a means of assessing gastric function, we found that the mean rate of 99Tcm uptake was significantly greater in 24 duodenal ulcer patients than in 10 healthy controls (P less than 0.01). Scanning values did not correlate with BAO of MAO which were measured on a separate day. Both vagotomy (n = 10) and cimetidine infusion (n = 5) significantly reduced the rate of uptake of 99Tcm (P less than 0.01). Thus, although 99Tcm reflects a function of the stomach which is similar to acid secretion, scanning did not give a good estimate of acid secretion in this group of subjects.

Adult↗
PubMed1982

Acute and chronic management of esophageal varices by injection sclerotherapy.

Of 29 consecutive patients with acute bleeding from esophageal varices, 27 were treated by injection sclerotherapy. Bleeding was controlled by injection in 25 patients. Long term injection therapy was undertaken in these 25 patients. Obliteration of the varices was achieved in five, two of whom had re-canalization and rebleeding. Patent varices remained in 20 patients, with 11 instances of rebleeding and seven deaths due to hemorrhage. All patients with alcoholic cirrhosis had rebled while receiving long term injection sclerotherapy.

Adolescent↗
PubMed1981

Interdigestive canine pancreatic juice composition and pancreatic reflux and pancreatic sphincter anatomy.

Canine and human exocrine pancreatic secretion into the duodenum during fasting is cyclical and related to intestinal motility. To characterize the composition of pure pancreatic juice during the cyclically recurring sequence of propagated motor events (interdigestive motor complex) and to establish whether pancreatic reflux occurs, dogs were prepared with three permanent indwelling duodenal catheters and a pancreatodochal cutaneous catheter. The duodenal catheters were used to record duodenal pressures and measure pancreatic secretion of trypsin, lipase, and bicarbonate, based on the recovery of a constantly perfused marker, [14C]PEG. Pancreatic duct pressures or pancreatic juice concentrations of [14C]PEG, trypsin, lipase, or bicarbonate (done separately in each of five dogs throughout one interdigestive cycle on 4 different days) were related to duodenal motor activity. Finally, the pancreatic duct orifice of freshly sacrificed dogs was examined by light and electron microscopy. During fasting, (1) pancreatic volume secretion increased 10-fold during phases II, III, and IV (P less than 0.001), and bicarbonate concentration increased during phases III and IV (P less than 0.05) compared with phase I, while trypsin and lipase concentrations did not change; (2) reflux of duodenally perfused [14C]PEG into the pancreatic duct occurred in two of five dogs and was minimal (less than 0.1%); and (3) a positive mean pressure gradient from duodenum to pancreatic duct occurred only during phase III (7.4 +/- 4.1 cm H2O). Anatomic studies of the pancreatic duct opening showed a specialized papillary mucosa and an independent crescentic sphincter muscle. We conclude that during fasting, pancreatic juice composition is intimately linked to the different phases of interdigestive intestinal motor activity and that an efficient antireflux mechanism exists.

Animals↗
PubMed1981

Duodenogastric reflux in humans: its relationship to fasting antroduodenal motility and gastric, pancreatic, and biliary secretion.

Duodenogastric reflux may have pathophysiologic importance, but its mechanism is poorly understood. We propose that duodenogastric reflux and periodic changes in motor and secretory activity of the upper gut during fasting may be related. Therefore we determined the relationships between duodenogastric reflux and interdigestive motor-secretory cycles in a group of 6 healthy individuals, on each of whom we performed three 7-h studies in random order on separate days. In all studies gastric intubation and antral pressure recordings were performed. However, in design 1 we used a slow duodenal perfusion rate of [14C]PEG in saline (0.25 ml/min) while in design 3 we used a fast perfusion rate (3.0 ml/min). Duodenal pressures were also recorded during these designs. In design 2 no transpyloric tubes were present. Our study shows that, in humans, fasting duodenogastric reflux of bile and pancreatic juice is cyclic and closely related to the interdigestive migrating motor complex. Reflux is highest during late phase II (when secretory activity is also on the rise) and lowest after phase III. One of the important functions of the migrating motor complex in humans may be to clear the stomach of refluxed duodenal secretions.

Adult↗