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Biomedical subjects

J E Mullens

Publications and source records attributed to J E Mullens.

30 records · Page 2Linked to original sources

Cell mediated immunity to corn starch in starch-induced granulomatous peritonitis.

Two patients with histologically diagnosed starch induced granulomatous peritonitis (SGP) have been shown to have cell mediated immunity to corn starch using the techniques of macrophage migration inhibition and lymphocyte DNA synthesis. Control groups of normal subjects, patients with uncomplicated laparotomy, and patients with Crohn's disease were negative in both tests. Lymphocytes from two patients with band adhesions, one of whom had biopsy evidence of a granulomatous reaction to starch, were sensitized to starch. Cell mediated immunity to starch may contribute to the pathogenesis of SGP, and some band adhesions may be a chronic low grade manifestation of this disorder.

Adolescent↗

Correlation of endoscopy and double-contrast radiography in the early stages of ulcerative and granulomatous colitis.

Early radiological changes in ulcerative colitis include (a) finely granular mucosa due to hyperemia and edema, (b) mucosal stippling due to adherence of barium to superficial ulcers, and (c) coarsely granular mucosa due to ingrowth of granulation tissue. In granulomatous colitis, early changes include discrete, superficial ulcers, often against a background of normal mucosa, seen best en face. All of these changes can be demonstrated by the double-contrast technique. The radiological and endoscopic findings were in agreement in 95% of the examinations in the authors' series. The importance of the technical aspects of the examination is stressed.

Colitis, Ulcerative↗

The radiological demonstraction of colorectal polyps undetected by endoscopy.

In a consecutive series of 800 routine double contrast studies of the colon, 119 polyps were diagnosed radiologically in 78 patients. Follow-up studies were available in 46 patients with 72 polyps. Ultimately, 56 of these polyps were confirmed (55 by endoscopy and 1 by repeat radiology). Six of these polyps had been missed on the initial endoscopic examination. The missed polyps are usually located in the rectum behind a valve of Houston or in any area of the colon where there is sharp angulation. Radiologists and endoscopists should be aware of these as potential endoscopic blind spots. These cases illustrate the importance of higg quality radiological study of the colon and the complementary nature of radiology and endoscopy in the detection of colorectal polyps.

Adult↗

Endoscopic retrograde cholangiopancreatography in the management of pancreatic and biliary disease.

Endoscopic retrograde cholangiopancreatography is a new and valuable technique in the diagnosis of jaundice, pancreatic disease and obscure upper abdominal pain. Endoscopic sphincterotomy of the sphincter of Oddi and the extraction of stones from the common bile duct are an extension of this procedure already in use in several high-volume centres. Cannulation of the bile ducts and pancreatic ducts in tests of secretion and cytology will become increasingly common applications of the technique. In order to provide dependability and cost-effectiveness, specialists in this procedure must maintain a high volume, necessarily limiting it to a few practitioners. Use of a trained endoscopic technician, a radiologist trained in endoscopy, or an endoscopist trained in fluoroscopy and spot-filming may decrease the manpower costs of this procedure.

Adult↗

Biliary-bronchial fistula demonstrated by endoscopic retrograde cholangiography.

Endoscopic retrograde cholangiography is valuable in the evaluation of biliary tract disorders. A 50-year-old Italian woman developed biloptysis 1 year after cholecystectomy because of intrabiliary rupture of a hydatid cyst with secondary infection, which resulted in intrathoracic rupture and communication with the bronchial tree. Endoscopic retrograde cholangiography showed the cause and pathway of the fistulous tract by outlining the biliary tree, abscess cavity and communication with the right upper lobe bronchus. This technique appears to be well suited to the investigation of patients with biliary-bronchial fistula.

Biliary Fistula↗

The diagnostic accuracy of barium studies of the stomach and duodenum--correlation with endoscopy.

Radiologic and endoscopic diagnoses were compared in 240 patients. In 175 patients examined by a standard barium contrast technique there were 39 radiological errors (22%). The most common causes of error were failure to detect an abnormality on the radiograph and prominent mucosal folds which could either mask or simulate small lesions. In 65 patients examined by a formal double contrast technique using effervescent pills and a thick barium suspension, there were 4 radiological errors (6%). In addition, superficial gastric erosions were demonstrated in 7 patients. Double contrast radiography appears to offer the potential for significant improvements in diagnostic accuracy.

Barium Sulfate↗

Demonstration of superficial gastric erosions by double contrast radiography.

Superficial gastric erosions were found in 30 of 267 patients undergoing esophagogastroduodenoscopy. In 13 of these patients, and in 7 others not submitted to endoscopy, superficial gastric erosions were demonstrated radiologically by the double contrast technique. These may appear as flat, linear streaks, as dots of barium, or as target-like lesions with a central fleck of barium surrounded by a radiolucent halo. In 1 patient, a ring-shaped density was demonstrated due to a small blood clot adherent to a gastric erosion. Although patients presenting with acute hemorrhagic gastritis should still be examined first by endoscopy, double contrast radiography has been of value in patients presenting after the cessation of bleeding and in patients with vague digestive complaints. Because of our experience with the diagnosis of standard methods, and because of the Japanese experience with diagnosis of superficial gastric carcinoma, it is recommended that this technique be applied more widely to facilitate the detection of early and small lesions in the stomach.

Barium Sulfate↗

Clinical usefulness of gastric acidity studies.

Tests of gastric secretion are seldom diagnostic in the investigation of gastric and duodenal ulceration, but they can provide evidence that is helpful in arriving at a diagnosis. Common tests include basal acid output, pentagastrin-stimulated maximal and peak acid output, and the Hollander test. There is some evidence that they may be useful in selecting the type of operation for peptic ulceration. Indications for performing these tests relate to the Zollinger-Ellison syndrome, duodenal ulcer, recurrent dyspepsia after operation for duodenal ulcer, and decisions concerning the choice of operation for peptic ulcer. In order to perform these functions they must be properly conducted and interpreted; they are simply an adjunct to clinical judgement, and complementary to other laboratory tests.

Adenoma, Islet Cell↗

Suppurative thyroiditis: an unusual case caused by Actinomyces naeslundi.

A case of suppurative thyroiditis due to A.naeslundi is recorded. The clinical features (including the difficulty in establishing a clinical diagnosis) have been noted. This is the first instance of A.naeslundi being considered the etiological agent of actinomycosis of the thyroid. It is also the first report incriminating A.naeslundi as a pathogen, since up to now it was considered only a saprophyte.The etiological role of A.naeslundi in this case of suppurative thyroiditis is strongly supported by the following findings:1. A.naeslundi was isolated without the presence of other pathogenic micro-organisms.2. A sulphur granule was demonstrated in the caseous pus after incision of the abscess.3. There was a favourable response to specific antibiotic therapy.

Actinomyces↗