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Biomedical subjects

G Glazer

Publications and source records attributed to G Glazer.

At least 19 recordsLinked to original sources
PubMed2001

Neutrophil activation and hyperamylasaemia after endoscopic retrograde cholangiopancreatography: potential role for the leukocyte in the pathogenesis of acute pancreatitis.

BACKGROUND AND STUDY AIMS: Hyperamylasaemia occurs in up to 60% of patients following endoscopic retrograde cholangiopancreatography (ERCP), and in a small proportion of patients (1-5%) acute pancreatitis may develop. We evaluated the role of the neutrophil in post-ERCP hyperamylasaemia and acute pancreatitis by measuring circulating CD11b adhesion receptor expression--an indicator of leukocyte activation. PATIENTS AND METHODS: A total of 43 patients undergoing elective ERCP were studied. Peripheral blood measurements of amylase activity and neutrophil CD11b content (by flow cytometry) were made immediately before ERCP (baseline), and at 2 and 24 hours after the procedure. RESULTS: ERCP induced an increase in amylase level above baseline in 41 of 43 patients. The 2-hour and 24-hour post-ERCP amylase levels were directly related (R = 0.9, P < 0.01). Baseline CD11b receptor status was positively correlated with post-ERCP amylase activity (R = 0.4, P < 0.05), and this relationship was stronger when pancreatography had been performed (R = 0.67, P < 0.01). Three patients (7%) developed clinical acute pancreatitis, with post-ERCP amylase levels persistently elevated above 1000 IU/l. Multiple linear regression identified CD11b expression as the most significant explanatory variable for amylase level after ERCP (multiple R = 0.74, P < 0.01). CONCLUSIONS: The findings from this pilot study indicate an association between neutrophil activation and hyperamylasaemia following ERCP, and suggest a role for this leukocyte in the pathogenesis of pancreatitis. Further study of neutrophil characteristics may allow identification of individual susceptibility to ERCP-induced pancreatic injury.

Acute Disease↗
PubMed2001

Nursing interventions revisited.

Medication administration is one of the most highly contested tasks delegated by registered nurses to others. Readers are encouraged to complete this brief survey asking about which nursing interventions must be performed by an RN versus those that can be safely delegated.

Humans↗
PubMed2000

Elevated tumour marker CA19-9: clinical interpretation and influence of obstructive jaundice.

AIMS: The tumour marker CA19-9 has been promoted as a reliable test for the detection of pancreatobiliary malignancy, yet its diagnostic role remains poorly defined. In this study the clinical interpretation of a raised serum CA19-9 level has been evaluated, with particular reference to obstructive jaundice. METHODS: One hundred and sixty-four patients with a CA19-9 level above 33 U/ml were studied. Serum CA19-9 was compared with clinical diagnosis and correlated with serum bilirubin level. In a subgroup of jaundiced patients (16 benign and 15 malignant cases), follow-up CA19-9 levels were determined 2 weeks after biliary drainage. RESULTS: The median CA19-9 level was lower in benign cases (102 (IQR 50-264) U/ml) than those with pancreatobiliary tumours (910 (IQR 263-6170) U/ml; P<0.01), although the overlap was substantial. In benign jaundiced cases, a positive correlation was observed between bilirubin and CA19-9 elevation (R=0.41, P<0.01). Relief of jaundice was associated with a fall in CA19-9 level in all benign cases and in nine of the 15 with malignancy. CONCLUSION: Confident discrimination between benign and malignant disease could not be made on the basis of a solitary elevated CA19-9 measurement. Hyperbilirubinaemia was associated with a further deterioration in specificity and caution is warranted when interpreting the results in jaundiced patients. Overall, only one half of patients with an elevated CA19-9 level ultimately proved to harbour a malignancy.

Adult↗
PubMed2000

Electronic publishing: the movement from print to digital publication.

This article provides an overview of electronic publishing, describes how information increasingly is being exchanged within the scientific community, and discusses the scholarly qualifications of electronic venues. The following content is included: a.definition of electronic publishing; b.uses and types of electronic publishing; c.uses of electronic journals in nursing and health care; d.advantages and disadvantages of electronic journals; e.advantages and disadvantages of print journals; and f.the authors' projections for the future. Hotlinks to a variety of Internet resources on electronic resources are integrated throughout the article.

Delivery of Health Care↗
PubMed2000

Prerequisites and priorities for nursing research in Israel.

This article describes prerequisites and priorities for nursing research in Israel. The historical development of nursing research in Israel details shifts in types of research by decade from the 1960s through 1990s. The four phases of development and evaluation of nursing research are explored. Prerequisites for the development and growth of nursing research in Israel, as is true worldwide, include individual, professional, institutional and federal commitments. Priorities for Israeli nursing research include the development of a master plan which reflects its unique culture and geography.

History, 20th Century↗
PubMed1999

Surgical intervention in acute pancreatitis: indications, techniques and complications.

Acute pancreatitis is a disease with a significant morbidity and mortality. It has been reported as the principal diagnosis in 2% of hospital admissions with abdominal pain in the UK. The incidence is in the range of 200 to 300 cases per million population per year, but it is probably increasing. The overall mortality rate is 10 to 12%. The management of the disease and its complications requires close co-operation between surgeon, radiologist and gastroenterologist. There have been a number of improvements in the management of acute pancreatitis in the last decade.

Journal Article↗
PubMed1997

Perforated colonic carcinoma presenting as epididymo-orchitis and Fournier's gangrene.

Epididymo-orchitis is a relatively common diagnosis in elderly men, often related to prostatic outflow obstruction. A 70-year-old man presented with a 4-day history of swelling and pain in the scrotum, fevers, dysuria and frequency. He had severe symptoms of prostatic hypertrophy. Physical examination and urine microscopy confirmed the diagnosis of left epididymo-orchitis and antimicrobial therapy was commenced. Subsequently, however, he developed severe necrotizing fasciitis (Fournier's gangrene) of the scrotum requiring surgical debridement, and at laparotomy, a perforated carcinoma of the sigmoid colon was found at the level of the left deep inguinal ring. Despite further radical surgery the gangrene extended, his condition deteriorated and he died. There has been no other similar case reported in the literature, and thus, although rare, intra-peritoneal causes of infection should be considered in patients with Fournier's gangrene.

Aged↗
PubMed1996

Fatal haemorrhage following liver biopsy in patients with HIV infection.

A retrospective review of all 248 liver biopsies performed in patients with HIV infection at two referral centres in London over a 12 year period revealed five cases of major bleeding following biopsy, with four deaths. The risk of major bleeding was 2.0%, and mortality was 1.6% following liver biopsy. The risk of bleeding as much higher than in published series of biopsies done in patients without HIV infection, owing in part to the high prevalence of thrombocytopaenia and clotting abnormalities in patients with HIV infection. HIV infection per se may also increase the risk of bleeding following liver biopsy.

Adult↗
PubMed1994

Multicentre audit of death from acute pancreatitis.

A prospective audit of acute pancreatitis involving nine hospitals in the North-West Thames Region recruited 631 patients over 54 months. There were 57 deaths (9 per cent); a diagnosis had been reached in 50 patients (88 per cent) before death and in seven (12 per cent) at autopsy. Eighteen patients (32 per cent) died within the first week, usually as a result of multisystem organ failure (15 patients). Thirty-nine patients (68 per cent) died after the first week from complications related to infection (26 patients) co-morbid conditions (nine) or non-infective complications (four). Twenty-one patients (42 per cent) had been inadequately evaluated by Ranson's criteria, and only 22 (44 per cent) of 50 with a premortem diagnosis of pancreatitis had undergone computed tomography (CT). Fifteen of 26 patients who died from infection-related complications had CT and only nine underwent necrosectomy or surgical drainage. These data suggest that improved diagnosis, investigation and management of patients with acute pancreatitis is possible, and may result in improved clinical outcome.

Acute Disease↗
PubMed1994

Lack of demonstrated effect of nandrolone on serum lipids.

Numerous prior studies of serum lipid levels during anabolic steroid (AS) use have uniformly demonstrated dramatic adverse lipid profiles (eg, average high-density lipoprotein [HDL] depression of 50%) during administration of 17 alpha-alkylated AS. In contrast, the existing studies of 17 beta-esterified AS have shown mild or absent lipid effects (eg, HDL depression 0% to 16%) with these agents. Thus, the potential effects on serum lipids of individual AS are an important clinical consideration. The present study was therefore designed to investigate the lipid effects of nandrolone, a 17 beta-esterified AS. Twenty-one men and three women had lipid profiles measured before and after administration of nandrolone decanoate 100 mg intramuscularly (IM) once a week for 6 weeks. No significant change was noted in HDL cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol, triglycerides, the total cholesterol to HDL-C ratio, or the LDL-C/HDL-C ratio from nandrolone treatment. Moreover, observed trends toward HDL-C depression (-2.00 +/- 8.83 mg/dL; values reported are for men only unless noted otherwise) and LDL elevation (+5.05 +/- 20.45 mg/dL) were small. In power analysis, HDL-C depressions of 6.3, 7.6, or 8.7 mg/dL during nandrolone were ruled out with powers of 80%, 95%, and 99%, respectively.

Adult↗
PubMed1994

A pilot study of intraperitoneal cisplatin in the management of gastric cancer.

BACKGROUND: This phase II trial was designed to evaluate the feasibility, toxicity, relapse pattern and survival following adjuvant intraperitoneal cisplatin in patients with gastric cancer at high risk of relapse. PATIENTS AND METHODS: Patients who had undergone complete surgical resection of adenocarcinoma of the stomach and who had positive serosa and/or regional lymph nodes and/or peritoneal washings has insertion of either a Tenckhoff catheter or temporary peritoneal dialysis catheter and were treated with cisplatin 60 mg/m2 intraperitoneally every 21 days for 4-6 courses. Peritoneal lavage or cytology was done before each treatment. RESULTS: Eighteen patients were studied. Seventeen patients had serosal involvement, 11 had regional lymph node involvement and 2 had positive peritoneal washings before treatment. The median number of courses of chemotherapy was 4 (range 2-6). Radioisotope tracer studies (6 patients) showed good distribution throughout the peritoneal cavity. No WHO grade 3/4 toxicity was seen. Twelve patients (67%) have relapsed, 6 (33%) intra-abdominally, 4 (22%) with hepatic metastases and 2 (11%) outside the abdominal cavity. The median survival was 17 months. CONCLUSIONS: Cisplatin can be administered safely as adjuvant therapy to patients with gastric cancer, however, as single agent therapy the pattern of relapse and subsequent death was similar to that expected. The occurrence of distant metastases may argue for systemic rather than local adjuvant treatment.

Adenocarcinoma↗
PubMed1994

Resource implications of head injuries on an acute surgical unit.

Head injuries are expensive and demanding in terms of resources. In the UK, most are cared for outside neurosurgical centres. In the absence of specialist rehabilitation services, patients with on-going disability add to those admitted for observation and treatment on acute surgical wards. We audited the workload pattern and financial implications related to head injuries on a general surgical unit in a central London teaching hospital. Data collected prospectively at the time of admission and derived from departmental computerized information systems included clinical outcome, hospital stay and its relationship to severity of injury and other factors. Ward, departmental (accident and emergency (A & E), intensive therapy unit (ITU), radiology, and theatre) and neurosurgical referral costs were derived. Long-term social and rehabilitation costs were not calculated. Over a 6 month period 899 patients with head injuries were treated in the A & E department, of whom 156 were admitted. Of the admitted patients 68% were classified as minor; 22% as moderate; and 10% as severe head injuries. Fifty-one per cent of adult admissions were intoxicated by alcohol. Prolonged hospital stay was related to age, severity of head injury, mechanism of injury, associated injuries and preexisting neuropsychiatric conditions (including alcoholism). Six patients died. The direct cost of these head injuries patients was estimated at 173,500 pounds, during which time they occupied 7.6% of our unit's adult inpatient capacity. Twenty-four hour observation of 76 patients with minor head injuries contributed 9700 pounds (5.6%) to this figure. Associated extracranial injuries cost a further 46,500 pounds.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Radiation-induced squamous carcinoma arising within a seborrhoeic keratosis.

Seborrhoeic keratoses (SK) are common skin tumours. They are benign, and present little difficulty in management. However, rare malignant transformation is recognized. We report a case of a squamous cell carcinoma arising from dysplastic changes within a long-standing SK on the chest wall of a 75-year-old retired radiologist, and consider the role of radiation in inducing malignant change within SKs.

Aged↗
PubMed1993

Use of fine needle aspiration cytology for investigating lymphadenopathy in HIV positive patients.

The cytological diagnoses of 27 lymph node aspirates were compared with the histological diagnoses or clinical outcome in 23 HIV positive patients. There was agreement between the cytological and histological diagnoses in 14 of the 16 surgically biopsied cases. The clinical outcome in the remaining 11 cases was consistent with the cytodiagnosis. Fine needle aspiration (FNA) is a reliable, minimally traumatic, cost effective method with high specificity. It is suitable for an initial rapid diagnosis in HIV positive patients with lymphadenopathy.

Adult↗