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Biomedical subjects

I N Marks

Publications and source records attributed to I N Marks.

At least 127 records · Page 7Linked to original sources
PubMed1983

Changing concepts in the presentation, diagnosis and management of the Zollinger-Ellison syndrome.

Nine patients with the Zollinger-Ellison syndrome seen at a single referral centre between 1976 and 1981 are presented to highlight changes in the recognition, diagnosis and management of the condition. Less well recognized manifestations such as diarrhoea and features of the multiple endocrine neoplasia (MEN) type I syndrome are described, and the simplification of the pre-operative diagnosis by the use of both the serum gastrin estimation and the secretin provocation test considered. The problem of tumour localization is discussed with special reference to the newer techniques such as ultrasound, endoscopic retrograde cholangiopancreatography (ERCP) and CAT scanning, and the value of arteriography confirmed. The striking advances in management during the past few years are stressed with special reference to the role of the H2-receptor blocking drugs. Despite their profound inhibitory effect on both acid secretion and symptoms, all patients with the exception of those with proven metastases or the MEN type I syndrome underwent laparotomy to exclude a resectable lesion. If no resectable lesion was found truncal vagotomy was performed to facilitate acid secretory control post-operatively and H2-receptor blocking drugs continued in a dose necessary to maintain basal acid secretion under 5 mmol/hr.

Adolescent↗
PubMed1983

Immunoproliferative small-intestinal disease: follow-up of an alpha-chain negative, lymphoma-free group.

Six patients had the clinical and pathological features of immunoproliferative small-intestinal disease (IPSID). All were female with malabsorption or growth retardation in whom testing for alpha-heavy chains was repeatedly negative. They were followed for a mean of 7.5 years, during which time no significant alteration in the jejunal biopsy appearances of five patients has occurred, none have developed lymphomas.

Adolescent↗
PubMed1983

Relapse rates following initial ulcer healing with sucralfate and cimetidine.

The relapse rate following successful short-term therapy with sucralfate or cimetidine was studied in a group of 86 patients with recently healed duodenal or gastric ulcer. The patients were endoscoped on clinical relapse or, routinely, at 6 weeks, 6 months and one year. Patients whose ulcers had healed on cimetidine relapsed earlier than did those whose ulcers had healed on sucralfate (p less than 0.05 at 12 weeks), but the cumulative relapse rate by the end of one year was of the order of 70% in both treatment groups. The mean duration of remission in patients who developed a recurrence was significantly greater in patients treated initially with sucralfate than in those treated initially with cimetidine - 7.3 and 4.6 months, respectively (p less than 0.01).

Aluminum↗
PubMed1983

Maintenance sucralfate and duodenal ulcer relapse--an interim report.

Fifty-four patients with recently healed duodenal ulcers were entered into a single-blind 1 year follow-up study to assess the value of sucralfate in preventing relapse and to establish the lowest dose required to achieve this. To date, 35 patients have completed a 6-month follow-up period. Endoscopic recurrences were found in 1 of 9 patients randomised to sucralfate 1 g bd, in 3 of 14 on sucralfate 1 g nocte, and in 7 of 12 of the controls. The relapse rates in the sucralfate treated groups were significantly lower than in the control group, but the small number of patients at this stage of the study precludes firm conclusion as to whether a maintenance dose of 1 g nocte is as effective as a dose of 1 g bd.

Aluminum↗
PubMed1983

The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients.

The records of 88 patients with radiation-induced proctosigmoidosis seen over an eight year period were reviewed. Eighty-four (95 per cent) had been irradiated for a gynaecological malignancy. The peak incidence of bleeding occurred after a latent period of nine months from the time of irradiation. Twenty-five subjects (28 per cent) had associated injury to the urinary tract. A wide spectrum of radiological abnormalities found on barium enema is described. Twenty-four patients (27 per cent) underwent operations for radiation-induced injury to the colon and urinary tract. Operations on the bowel were attended by a high complication rate (79%). A clinical classification based on bowel symptoms is presented. Those whose only symptom was low grade rectal bleeding (Group I) had the most favourable outcome and of these, 35 per cent stopped bleeding spontaneously by six months. Patients who required frequent transfusions (Group II) had an increasing mortality rate with the passage of time. Patients whose predominant symptoms were pain and bowel dysfunction (Group III) had the highest death rate but some did well after an operative procedure.

Adult↗
PubMed1982

Preoperative external biliary drainage in obstructive jaundice. A prospective controlled clinical trial.

57 patients with obstructive jaundice were randomly allocated to surgery with preoperative external biliary drainage (29 patients) and without preoperative external biliary drainage (28 patients). 22 patients ultimately underwent laparotomy after a mean of 11.7 days of drainage and 25 had surgery without preoperative drainage. The postoperative complication rate was low and similar in both groups but complications associated with the drainage procedure were substantial. Perioperative mortality was 4/28 (14%) in the drainage group and 4/27 (15%) in the non-drainage group. There seems to be no advantage associated with routine preoperative external biliary drainage before surgery for obstructive jaundice.

Acute Kidney Injury↗
PubMed1982

Ranitidine heals duodenal ulcers.

A double-blind placebo-controlled study of ranitidine 150 mg given twice daily for 4 weeks was carried out in 80 ambulant patients with endoscopically proven duodenal ulceration. Fifteen patients were withdrawn because of poor compliance or default. Of the remaining 65 patients, endoscopic healing (with or without residual erosion) was noted in 28 of the 34 ranitidine-treated patients (82%) and in 14 of the 31 placebo-treated patients (45%) (P less than 0.005). Twenty-three patients whose ulcers were unhealed after 4 weeks of ranitidine therapy or placebo were then given ranitidine for a further 4-week period. Four of these patients were withdrawn, but ulcer healing was achieved in 16 of the remaining 19 patients (4 out of 5 (80%) initially treated with ranitidine and 12 of 14 (86%) initially treated with placebo). No significant clinical, biochemical or haematological adverse reactions were noted in either treatment group. It is concluded that ranitidine is a safe and effective therapy in patients with duodenal ulceration and that initial unsuccessful treatment with placebo does not appear to influence the subsequent response to ranitidine.

Adult↗
PubMed1982

Ranitidine in the treatment of gastric ulceration.

Seventy-two patients with endoscopically proven gastric ulcers were entered into a prospective controlled trial to assess the efficacy of ranitidine and cimetidine in ulcer healing. All patients were biopsied on entry and at subsequent endoscopies. After exclusion of 7 patients during the first month of treatment, the remaining 65 patients, 47 males and 18 females, mean age 48.2 +/-1.5 years, at 1 month had a healing rate of 47% and 52% respectively. The non-healers continued their treatment for a further 4 weeks. This increased the healing rate to 77% and 76% respectively. If the defaulters and poor compliers are withdrawn the healing rate rises to 58% and 57% at 4 weeks and to 91% and 79% at 8 weeks respectively. There was no significant difference between the two groups as regarded initial ulcer size and severity of dyspepsia. Antacid tablet consumption during the study was comparable. The initial size of the ulcers which failed to heal after 4 weeks of treatment tended to be larger than those which healed (P less than 0.05), but smoking did not appear to influence ulcer healing. No obvious side-effects or evidence of dysplasia were found. The study shows that ranitidine is at least as effective as cimetidine in gastric ulcer healing.

Aged↗
PubMed1982

Relapse rates after initial ulcer healing with sucralfate and cimetidine.

The relapse rate after successful short-term therapy with sucralfate (Sc) or cimetidine (Cm) was studied in a group of 86 patients with recently healed duodenal or gastric ulcers. The patients were endoscoped on clinical relapse or, routinely, at 6 weeks, 6 months, and 1 year. Patients whose ulcers had healed with Cm relapsed earlier than did those whose ulcers had healed with Sc (p less than 0.05 at 12 weeks), but the cumulative relapse rate by the end of 1 year was of the order of 70% in both treatment groups. The mean duration of remission in patients who developed a recurrence was significantly greater in patients treated initially with Sc than in those treated initially with Cm--7.3 and 4.6 months, respectively (p less than 0.01).

Aluminum↗
PubMed1982

Gastric mucosal prostaglandin E levels in patients with gastric ulcer disease and carcinoma.

Prostaglandin E was measured by radioimmunoassay in endoscopic biopsy specimens obtained from 7 normal healthy volunteers, 28 patients with a benign gastric ulcer, and 10 with a malignant gastric ulcer. Biopsy specimens were taken from the antral and body mucosa and from the ulcer edge in patients. The median value in normal antrum specimens was 5.15 (4.44-8.40) ng PGE/mg protein which was more than the body with 3.50 (1.86-9.28), p less than 0.05. In the 28 patients with benign gastric ulcer the ulcer edge contained 2.33 (0.48-7.67) ng PGE/mg protein which was more than the antrum with 1.06 (0.30-4.17) or the body with 0.97 (0.20-7.67), p less than 0.01 respectively. The antral and body levels in patients with gastric ulcers were lower than those found in the normal volunteers, p less than 0.01. There was no difference between the levels found in patients with malignant as opposed to benign gastric ulcer. In patients with gastric ulcer lower levels of PGE were found in body mucosa with atrophic gastritis 0.83 (0.53-2.66) ng PGE/mg protein as compared with histologically normal body mucosa 2.55 (0.63-7.67), p less than 0.05. These results suggest that mucosal PGE levels are reduced in patients with gastric ulcer disease and that this may be due to the presence of atrophic gastritis.

Adult↗
PubMed1981

Intramural rupture of the oesophagus.

Two cases of intramural rupture of the oesophagus are described. In both cases the diagnosis was made endoscopically and confirmed radiologically. Both patients were successfully managed conservatively but were later found to have disordered oesophageal motility. The clinical presentation of severe retrosternal chest pain followed by haematemesis and then dysphagia is stressed, and the diagnostic features on barium swallow examination and endoscopy are described. It is suggested that the diagnosis should be made on clinical presentation and barium swallow, and that the possible hazards of endoscopy in the acute stage should be avoided.

Barium↗
PubMed1981

Gastric ulceration--a follow-up study.

Two hundred and forty-six patients who were diagnosed in 1976 as having either a benign (180) or a malignant (66) gastric ulcer on endoscopy were reviewed between November 1979 and May 1980. Eight patients were lost to follow-up and 7 had died before healing, leaving 165 patients for review. Eighty-eight (53%) healed on medical treatment and 28 (17%) underwent surgery within 3 months of diagnosis. Subsequent medical treatment healed 107 (65%), while 58 (35%) had operations for non-healing of their gastric ulcers. Twenty-six (39%) of those followed up developed a symptomatic recurrent gastric ulcer. Twelve of these patients required surgery, bringing the final surgical rate to 56%. Ten per cent of benign ulcers were incorrectly thought to be malignant at endoscopy, while 12% of malignant ulcers were thought to be benign. All malignant ulcers were diagnosed within 2 months of the initial endoscopy and no further malignant lesion was found during the follow-up period.

Adult↗
PubMed1981

Does progressive pancreatic insufficiency limit pain in calcific pancreatitis with duct stricture or continued alcohol insult?

We studied the pancreatic function, alcohol history, and ERCP findings in 26 patients with painless and 34 patients with painful alcohol-induced calcific pancreatitis (AICP). About 50% of patients in both the painless and painful groups continued to take alcohol, the incidence of duct stricture or obstruction was of the order of 62% in both groups, and the proportion of patients with duct stricture or obstruction and continued alcohol intake was comparable. In all instances the patients in the painless category had significantly greater pancreatic insufficiency, or more impaired function, than patients with pain. This applied to those patients who continued to take alcohol, to those with an obstruction or stricture on ERCP, and to the subgroup with both duct narrowing and continued alcohol intake. We conclude that grossly impaired pancreatic function confers a degree of freedom from painful attacks in AICP in those patients who continue to drink even in the presence of duct obstruction or stricture on ERCP; and that patients with AICP become free of pancreatic pain once gross pancreatic insufficiency supervenes.

Alcoholism↗
PubMed1981

Exocrine pancreatic enzyme and calcium secretion in health and pancreatitis.

Calcium, enzyme, and total protein secretion were measured in secretin stimulated pancreatic juice in health, "early" chronic pancreatitis, and in chronic calcific pancreatitis. Increased concentrations of trypsin, total protein, and calcium, and increased outputs of calcium and protein were shown to be present in the "early" stages of the disease, indicating that an environment conducive to the formation of protein plugs and possibly later calcification already exists.

Calcium↗