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Biomedical subjects

J N Thompson

Publications and source records attributed to J N Thompson.

At least 127 records · Page 7Linked to original sources
PubMed1988

Hemobilia. A disease in evolution.

Ten patients with hemobilia were treated over a six-year period. Six cases resulted from iatrogenic injury (percutaneous invasive procedures, four; surgical trauma, two); the others were caused by gallstone disease (two), liver trauma (one), and vasculitis (one). Five patients were treated successfully by selective arterial embolization. In the other five patients, embolization was not possible due to previous surgical and/or radiologic procedures, or it was contraindicated, and thus, surgical treatment was undertaken. One of these patients died. There were no long-term sequelae in the remaining nine patients followed up for 12 to 66 months. Selective hepatic arterial embolization is the treatment of choice for hemobilia. Inappropriate embolization or surgery frequently fails to control the bleeding and may also prevent later successful embolization.

Adult↗
PubMed1988

Endotoxemia in obstructive jaundice. Observations on cause and clinical significance.

Perioperative endotoxemia was detected in 24 of 40 patients who underwent operation for obstructive jaundice (bilirubin level greater than 5.8 mg/dl). Endotoxemia was associated with an increased admission serum bilirubin level (p less than 0.05) and white blood cell count (p less than 0.05) and a decreased hematocrit value (p less than 0.05), but there was no significant association with other established preoperative risk factors. Patients with preoperative endotoxemia had a decreased immunoglobulin M anti-J5 endotoxin titer (p less than 0.05) and a decreased serum bile acid concentration (p less than 0.05). Preoperative endotoxemia was associated with reduced creatinine clearance before and after operation (p less than 0.05). There was no association between endotoxemia and clinical sepsis, gram-negative infection, or small-bowel colonization. Patients who died had increased preoperative serum fibrin degradation products (p less than 0.05).

Cholestasis↗
PubMed1988

Management of injuries from liquid lye ingestion.

The simultaneous admission of nine youths to our institution following their ingestion of concentrated sodium hydroxide (which had been mistaken for wine) provided us with a unique opportunity to manage corrosive esophageal injuries ranging in severity from second-degree oral mucosal injury alone to full-thickness hypopharyngeal, esophageal, and gastric injury. The severity of injury was graded first on the basis of symptoms and physical examination of the mouth, and then in the operating room by rigid esophagoscopy. This procedure provided a logical approach to management. Three patients with second-degree oral burns required no surgery. Six patients required laparotomy with gastrostomy and/or chimney feeding jejunostomy, one required immediate esophagogastrectomy, and three required immediate total or subtotal gastrectomy. There were no deaths. Three patients have subsequently required esophageal replacement and three others have required repeated dilatations. At 2-year followup, all nine maintain their nutritional status orally, and all except for the previously mute patient can phonate. Ingestion of liquid lye requires a much more aggressive diagnostic and therapeutic approach than is currently recommended for ingestion of caustics in general. On the basis of our experience with these nine patients, we suggest the following for esophageal liquid lye injury: 1) early evaluation of the esophagus by esophagoscopy; 2) with esophageal burns, urgent laparotomy to assess gastric damage and gastrostomy to pass a string for subsequent retrograde dilatations; 3) adequate resection of stomach for gastric burns; 4) with deep esophageal burns, early esophagectomy.

Adolescent↗
PubMed1988

Progressive roentgenographic appearance of caustic esophagitis.

We observed progressive roentgenographic changes in five patients who had caustic esophagitis after accidental ingestion of a liquid alkali. Initial endoscopic examination showed moderate caustic esophagitis in all patients, and esophageal atony and poor distension were early roentgenographic observations. Esophageal strictures developed 13 to 44 days after caustic ingestion in all patients. Intramural pseudodiverticula complicated stricture formation in two patients. Esophageal diverticula developed in two cases, three months to one year after caustic ingestion. In summary, moderate caustic esophagitis is associated with esophageal dilatation, atony, and peristaltic abnormalities initially, and with eventual stricture formation.

Adult↗
PubMed1988

Diagnosis of feline GM1 gangliosidosis by enzyme assay of cultured conjunctival cells.

GM1 gangliosidosis is characterized by a deficiency in the lysosomal hydrolase beta-galactosidase, progressive nervous system disease and ocular lesions. Diagnosis of GM1 gangliosidosis in humans and cats with the analogous disease has been made by measurement of the enzyme activity in various tissues including brain, liver and cultured skin fibroblasts. The authors report the use of cultured conjunctival cells for this purpose derived from cats with feline GM1 gangliosidosis, a model of the human disease (juvenile GM1 gangliosidosis, Derry's disease). Full thickness conjunctival biopsies from three cats with GM1 gangliosidosis and two normal controls were used to initiate cell cultures. Optimal conditions for beta-galactosidase activity were established with an uncultured conjunctival biopsy from a normal cat. The fluorgen, 4-methylumbelliferyl-beta-D-galactopyranoside was used as substrate. After 2 months in culture, and 2 weeks after subculture, cells from cats affected with GM1 gangliosidosis exhibited specific activities for beta-galactosidase of 10, 9 and 12 nmoles 4MU/hr/mg protein, whereas specific activities for normals were 630 and 469 nmoles 4MU/hr/mg. Enzymatic analysis of cultured conjunctival cells may offer an effective alternative for the diagnosis of GM1 gangliosidosis.

Animals↗
PubMed1988

The management of fistulas of the biliary tract after injury to the bile duct during cholecystectomy.

Twelve of 123 patients who were treated for benign stricture of the bile duct after cholecystectomy presented with an external fistula of the biliary tract. Nine of these patients had undergone multiple operations prior to referral, six having undergone earlier attempts at repair of the bile duct. Two patients initially required urgent laparotomy for drainage of infected abdominal collections. Distal obstruction of the bile duct below the origin of the fistula was present in five patients. Repair of the bile duct was undertaken after careful investigation and correction of nutritional, fluid and electrolyte status in five patients who had little prospect of spontaneous closure of the fistula. The other seven patients were initially treated conservatively; in three, the fistula closed at five to nine weeks without complication, and no further surgical treatment has been required (a range of six to 36 months). The remaining four patients required delayed operation after the development of cholangitis or jaundice. The overall median survival time between development of fistula and operative repair was 3.5 months, and all nine of these patients remained asymptomatic with normal results from liver function tests (a median follow-up period of 17 months). The need for careful initial assessment prior to repair of the bile duct and the possibility of conservative treatment for patients with a postcholecystectomy fistula of the biliary tract are emphasized.

Adult↗
PubMed1987

Hybrid dysgenesis in D. melanogaster is not a general release mechanism for DNA transpositions.

Many spontaneous mutations are caused by the insertion or excision of DNA elements. Since most mutations are deleterious, evolution should favor a mechanism for genetically controlling the rate of movement of transposable elements in most, if not all, organisms. In Drosophila melanogaster a syndrome of correlated genetic changes, including mutation, chromosome breakage, and sterility, is observed in the hybrid progeny of crosses between different strains. This syndrome, which is termed hybrid dysgenesis, results from the movement of P-DNA elements. What is not clear is whether the movement of other types of transposable elements is under the same coordinated control. In this study the ability of hybrid dysgenesis to increase the rate of excision of 12 DNA elements at 16 mutant alleles and to induce insertion-bearing mutations to change to other mutant states was tested. The data show that hybrid dysgenesis caused by P-element transpositions does not act as a general stimulus for the movement of other Drosophila transposable elements.

Animals↗
PubMed1987

Renal impairment following biliary tract surgery.

Postoperative mortality has been directly attributed to renal failure in approximately 5 per cent of patients after surgery for obstructive jaundice. An analysis of 334 patients undergoing biliary tract surgery was undertaken to identify the perioperative factors associated with the development of renal impairment, and to estimate the contribution of renal failure to mortality. Thirty-eight patients (11 per cent) developed postoperative renal impairment (a two-fold increase in serum creatinine postoperatively or a rise of greater than 100 mumol/l). Ninety-three factors were examined in these and 196 control patients. Stepwise logistic regression analysis identified only three factors which were significantly associated with renal impairment: postoperative sepsis (P less than 0.0005), pre-operative serum bilirubin (P less than 0.0005), and pre-operative urea (P less than 0.05). Renal impairment developed at a median 4 days after surgery and was associated with a median of two additional major postoperative complications, particularly sepsis and haemorrhage, for which 17 patients underwent reoperation. Twenty-eight (74 per cent) of the patients with renal impairment died in hospital, but in only one case was the cause of death directly related to renal failure. Twenty patients received specific therapy for renal failure, but only one of these survived. Pre-operative obstructive jaundice and postoperative infection are the major factors associated with renal impairment after biliary tract surgery. Renal impairment appears to be related to postoperative complications rather than directly to the surgical procedure itself. The development of postoperative renal impairment predicts a low chance of survival but appears to be an indicator, rather than a direct cause of a poor prognosis.

Acute Kidney Injury↗
PubMed1987

Specialist investigation of obscure gastrointestinal bleeding.

The investigation and treatment of 131 patients with 'obscure' gastrointestinal bleeding has been reviewed. One hundred and six patients were assessed electively for recurrent haemorrhage, 25 presented as emergencies. The major presenting feature was melaena (55 patients), anaemia (35), rectal bleeding (34), haematemesis (six) and ileostomy bleeding (one). The lesions responsible for haemorrhage were colonic angiodysplasia (52 patients), small bowel vascular anomalies (16), Meckel's diverticula (nine), small bowel smooth muscle tumours (seven), gastric vascular anomalies (four), chronic pancreatitis (three), colonic diverticular disease (three) and 16 other miscellaneous lesions. No lesion was found in 21 cases. Lesions were first shown by visceral angiography (69 patients), at laparotomy (23), on endoscopy (11), on gastrointestinal contrast radiological studies (four), and at ERCP (three). Lesions which were undetectable at operation increased markedly with age (p less than 0.0001). Expert visceral angiography is strongly recommended before surgery in patients over 45 years of age and after laparotomy when no cause has been found. Exploratory laparotomy is recommended at an early stage for younger patients, and for older patients after non-diagnostic angiography.

Adolescent↗
PubMed1987

Corrosive esophageal injuries. I. A study of nine cases of concurrent accidental caustic ingestion.

Treatment of corrosive injuries of the esophagus remains largely unsatisfactory, and severe esophageal burns still frequently result in stricture with accompanying morbidity or death. The nine patients presented here with 3-year follow-up accidentally drank a concentrated alkaline solution. All were teenagers or young adults who drank from the same bottle while at a party. The problems encountered in these patients led us to conclude that all patients with moderate to severe corrosive injury of the esophagus should have assessment of the entire esophagus and stomach at the time of initial assessment. Six patients underwent diagnostic laparotomy and one underwent thoracotomy as well for assessment of his esophageal injuries. Had we followed the traditional approach of esophagoscopy only to the level of the first circumferential burn, more severe and potentially life-threatening injuries would have been missed. Early endoscopic evaluation of the esophagus and stomach remains the standard for diagnosis; however, complete assessment may require laparotomy or thoracotomy. Early resection of necrotic tissue in the esophagus or stomach can lead to increased survival.

Accidents, Home↗
PubMed1987

Corrosive esophageal injuries. II. An investigation of treatment methods and histochemical analysis of esophageal strictures in a new animal model.

The unique clinical experience of having to treat simultaneously nine young adults who had ingested the same corrosive substance prompted this investigation in rabbits of the pathophysiology of corrosive esophageal injury and of drugs that might prevent formation of stricture. Treatment of experimental corrosive esophageal injury in these animals consisted of antegrade dilatation and administration of two lathyrogenic drugs, colchicine and penicillamine, in various combinations. This study demonstrated that the rabbit can serve as a suitable animal model for study of corrosive injury of the esophagus, that penicillamine given alone affected wound healing with less severe stricture after such an injury, and that colchicine was associated with delayed wound healing and severe stricture.

Animals↗
PubMed1987

Selective visceral angiography in obscure postoperative gastrointestinal bleeding.

Postoperative gastrointestinal bleeding may be difficult to diagnose and treat. Selective visceral angiography localised the bleeding site in seven out of ten episodes of obscure postoperative gastrointestinal haemorrhage, and in two cases radiological embolisation was used successfully to control the bleeding. Angiography, preferably during an episode of haemorrhage, is recommended whenever possible for patients with undiagnosed postoperative gastrointestinal bleeding.

Aged↗
PubMed1987

Airway obstruction in LeFort fractures.

Airway obstruction associated with fractures of the midfacial skeleton can be life-threatening if not recognized promptly and treated appropriately. One hundred seventeen patients with LeFort fractures were treated between 1978 and 1984. Of the 117 patients, 21 had a LeFort I fracture, 46 had a LeFort II fracture, 14 had a LeFort III fracture, and 36 had various combinations of the three types of LeFort fractures. Thirty-one patients (26.5%) presented with airway obstruction, decreased respiration, or both, requiring either tracheotomy or endotracheal intubation. Of the 31 patients undergoing emergent tracheotomy or endotracheal intubation, 26 (83.9%) had loss of consciousness relating to their injuries. Thirty-nine (33.3%) additional patients had an elective tracheotomy either at the time of surgical repair of their fractures or for prolonged endotracheal intubation. Age and sex of the patients played no role in the incidence of airway complications in patients with LeFort fractures. Patients with LeFort III fractures and those with associated injuries such as mandible fracture, laryngeal and pharyngeal injury, and chest or closed head injury are at greater risk for requiring emergent control of the airway.

Adolescent↗