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Biomedical subjects

I S Benjamin

Publications and source records attributed to I S Benjamin.

At least 55 records · Page 3Linked to original sources
PubMed1993

Intravenous cholangiography revisited.

The efficacy and safety of IVC with the new agent has not, in our opinion, been firmly established. In these circumstances we do not feel its routine use preoperatively in patients being considered for laparoscopic cholecystectomy is justified. We remain uncertain about its ultimate safety and are unconvinced that it is able, reliably, to demonstrate ductal anomalies which might increase the risk of iatrogenic injury. If imaging of ductal anatomy is important then it is best to obtain it intraoperatively. The radiologist often acts as an essential guide to the surgeon; as interventionist he frequently actually usurps the surgeon's role; and occasionally has to come to his rescue. In our opinion, he should not be asked to perform a procedure of unproven efficacy and uncertain safety in order to allow the surgeon willfully to abandon good surgical practice.

Bile Ducts↗
PubMed1992

Phosphorus-31 magnetic resonance spectroscopy of the human liver using chemical shift imaging techniques.

Phosphorus-31 magnetic resonance spectroscopy of the human liver was undertaken in 28 healthy adult individuals and in 49 patients with liver disease of varying aetiology. Data localised to the liver were obtained using chemical shift imaging techniques. The mean (+/- 1 S.D.) of the peak area ratio phosphomonoesters (PME)/phosphodiesters (PDE) in healthy adult individuals, from spectra obtained with pulse angle 45 degrees and repetition time 1 s, was 0.24 +/- 0.07. The intra-examination variability of this ratio was 20%, the intra-subject variability 27% and the inter-subject variability 32%. An increase in the PME/PDE was observed in the 31P hepatic MR spectrum from primary or secondary tumours in all 17 patients studied, which invariably represented an increase in PME/ATP and, in some cases, a reduction in PDE/ATP. The spectra did not show aetiological characteristics. A non-specific elevation in PME/PDE was also observed in the 31P hepatic MR spectra of 10 (40%) of 25 patients studied who had diffuse liver diseases, such as cirrhosis and infiltrating malignancies. The spectral pattern did not distinguish between diseases of varying aetiologies, but there was a linear correlation between increasing PME/PDE and a reduction in plasma albumin concentrations (p = 0.03). In three patients with hepatic malignancy and abnormal hepatic 31P-MRS, marked spectral changes were observed after successful treatment to debulk the tumour. Only minor changes were observed in the abnormal spectrum of a fourth patient in whom treatment was unsuccessful. Hepatic 31P-MR spectroscopy may prove useful for monitoring disease processes and treatment effects in well characterised patient populations.

Adenocarcinoma↗
PubMed1992

Radiation stricture of the biliary ducts: an emerging new entity?

Two patients with stricture of the extrahepatic biliary tree are described. Both patients presented with a clinical picture of obstructive jaundice one to two years following radiotherapy for a malignant condition. As no recurrent tumour was detected in either of the patients the strictures were considered to be the result of radiation therapy. Bilio-enteric decompression was performed in both patients who are well at follow up one and ten years after the procedure.

Adult↗
PubMed1991

Cytodiagnosis in the management of extrahepatic biliary stricture.

A total of 117 patients presenting with extrahepatic biliary strictures between 1981 and 1989 had 206 cytological examinations of the bile duct or bile (153 non-operative, 53 intraoperative) to establish the presence of malignancy. A final diagnosis of cholangiocarcinoma was made in 88 patients, with 29 patients having benign biliary strictures. The cytological techniques used were fine needle aspiration (n = 102) or brushing (n = 24) of the bile duct, or exfoliative cytology of bile (n = 80). Forty one patients with malignancy had two or more examinations with differing results between samples in 20 cases. The overall sensitivity was 72%. There was only one false positive result, giving a patient predictive value of positive cytology of 98%. Intraoperative cytology was more sensitive than non-operative examination (80% v 42%). Overall, the sensitivity of fine needle aspiration (67%) was greater than that of brush cytology (40%) or exfoliative cytology (30%). No complications were encountered. Cytodiagnosis of extrahepatic biliary strictures is a safe procedure which is not technically demanding, and as it has a high sensitivity and predictive value for positive cytology, cytological confirmation of malignancy should be sought in all clinically and radiologically suspicious cases.

Adenoma, Bile Duct↗
PubMed1991

Self-expandable stainless steel endoprostheses for treatment of malignant bile duct obstruction.

The Wallstent biliary endoprosthesis is a mesh of stainless steel that is delivered percutaneously over a 7-French catheter but expands to achieve a 1-cm lumen when released across a bile-duct stricture. The small transhepatic track required makes insertion easier, less painful, and probably safer when compared with plastic stents, and the large internal lumen reduces the rate of occlusion by encrusted bile. Wallstent endoprostheses were inserted under local anesthesia in 41 consecutive patients with malignant obstructive jaundice. Biliary drainage was considered the treatment of choice in all of these patients. The diagnosis was based on biopsy results in 32 patients and on radiologic appearances in nine. The patients were followed up in outpatient clinics for 16 months and had repeated radiologic examinations only if they had symptoms suggesting stent occlusion. No cases of hemobilia due to damaged hepatic vessels occurred. Two patients had septicemia treated with antibiotics. Three patients had recurrent jaundice due to growth of tumor below or above the stents. Endoprosthesis migration was not seen. No cases of stent occlusion due to encrustation of bile occurred. The median survival of patients was 105 days (range, 10-545 days). Our experience shows that Wallstent endoprostheses can be inserted with little discomfort for the patient and with relatively few complications. They provide good palliation in patients with malignant obstructive jaundice.

Adult↗
PubMed1991

Pathologic and hemodynamic sequelae of unilobar biliary obstruction and associated liver atrophy.

A patient is presented with unilobar biliary obstruction associated with marked liver atrophy and compensatory hypertrophy. Characteristically she was not jaundiced and had no portal hypertension. Quantitative measurements of the degree of hepatocyte hyperplasia showed that over 50% of cells in the hypertrophied lobe were hyperplastic. Surprisingly, a similar percentage of cells in the atrophied lobe were also hyperplastic. No difference was found in the size of hepatocytes between the two lobes or among the hepatocyte subpopulations in the atrophied lobe. The findings in this case suggest (1) lobar atrophy induces a hyperplastic response in more than one half of the cells of the contralateral lobe; (2) the development of atrophy consequent on biliary obstruction is likely the result of destruction of whole cells rather than cytoplasmic loss; (3) the development of a hyperplastic response within the atrophied lobe is a new finding and is consistent with the hormonal theory of hepatic regeneration; and (4) striking compensatory hypertrophy of the liver is associated with normal portal venous pressure.

Atrophy↗
PubMed1991

Human lymphocyte responsiveness is not enhanced by relief of biliary obstruction: an in-vitro study.

Imparied cell-mediated immunity has been described in obstructive jaundice and has been attributed to depressant serum factors or to depressed intrinsic T-cell function. The authors studied lymphocyte responsiveness to phytohemagglutinin stimulation, the in-vitro correlate of T-cell function, in 11 patients with biliary obstruction. Peripheral-blood mononuclear cells and serum were obtained before (mean serum bilirubin level 302 mumol/L) and after (mean serum bilirubin level 23 mumol/L) treatment of the biliary obstruction. Simultaneous cell culture of all samples disclosed no evidence of a serum depressant factor in patients with obstructive jaundice, and crossover incubation studies failed to suggest that there is a depression of intrinsic T-cell responsiveness that can be reversed by biliary drainage.

Aged↗