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Biomedical subjects

M J Phillips

Publications and source records attributed to M J Phillips.

At least 217 records · Page 12Linked to original sources

Iatrogenic nondiabetic hyperosmolar states.

Four cases of the iatrogenic nondiabetic hyperosmolar state are presented. The clinical presentation, biochemical findings and management are discussed. No hypertonic solution should be infused at a rate above the level of patient tolerance; irrigation of a hollow viscus with a hypertonic solution should be avoided, and salt should not be used as an emetic. Patients under stress are particularly prone to this condition, largely because of the high circulating cortisol levels. The use of corticosteroids, salt-containing solutions in excess of patient requirements, water depletion and intravenous nutrition in the absence of careful biochemical monitoring, are all factors which may precipitate the hyperosmolar state in the critically ill.

Acid-Base Imbalance↗

Dissolution of human cholesterol gallstones in vitro with bile salts. A scanning and stereoscanning electron microscopic study.

This report deals with the in vitro dissolution of cholesterol gallstones by bile salts, as observed with the scanning electron microscope. Scanning electron microscopic techniques permit excellent visualization of the substructure of these stones and hence allow insight into the structural basis of gallstone dissolution. The small faceted, mixed cholesterol gallstone was used since this is the most common type clinically. Scanning electron microscopy revealed that the gallstone has four structurally different zones; an outer surface, a cortex of compactly layered cholesterol plates, an inner layer of cholesterol mixed with other components, and a center or nidus. The cortex is of particular importance in terms of gallstone dissolution with bile salts, since the interior of the stone remains unaffected until this zone is removed. The speed and completeness of dissolution of the stone depends mainly upon the thickness of the cortex and in part upon the content of noncholesterol components in the interior of the stone. Chenodeoxycholate and cholate behave similarly in terms of the dissolution process as observed by scanning electron microscopy. The solubilization process is very similar to that observed in vitro with solvents such as ether and ethanol. Stones treated with 400 mM cholate were completely solubilized in 3 weeks. The process described in this paper is probably similar to that which occurs in vivo in spontaneous gallstone dissolution in man and in patients treated with bile salts for gallstone dissolution.

Chenodeoxycholic Acid↗

Periampullary tumours: advances in diagnosis and surgical treatment.

Forty-five carcinomas of the region of the ampulla of Vater were resected at the Toronto General Hospital during a 16-year period. In 26 the presenting symptom was pain and in 32 it was jaundice. The most useful means of investigation was endoscopic retrograde cholangiopancreatography. Angiography was of value in determining resectability prior to operation, and percutaneous aspiration biopsy allowed a preoperative diagnosis in the case of large pancreatic tumours. In 39 patients who had a Whipple procedure the operative mortality was 8%. Total pancreatectomy performed in two patients and local excision of ampullary carcinoma in four patients were attended by no operative deaths. Long-term survival was best in patients with ampullary carcinomas and worst in those with pancreatic cancer.

Ampulla of Vater↗

Cholesterol gallstone formation and prevention by chenodeoxycholic and ursodeoxycholic acids. A new hamster model.

Prior animal models of cholesterol gallstone formation have been criticized for their dissimilarity to the conditions of humans with gallstones. We present a new hamster model of cholesterol cholelithiasis that more closely approximates the human situation. Sixty female Golden Syrian hamsters (average weight 83.2 +/- 3.4 g) were allocated to six groups of 10 animals each. Groups were fed standard diet (containing 0.8 gm cholesterol/g of food) or increased cholesterol diet (containing 2.4 mg cholesterol/g of food), with or without ethinyl estradiol, 15 micrograms/kg/d. Two groups receiving both increased cholesterol and ethinyl estradiol also received either chenodeoxycholic acid or ursodeoxycholic acid, 20 mg/kg/d. The animsl were sacrificed at 12 wk. Cholesterol gallstones (78.3 +/- 5.0% cholesterol by weight) formed in 30% of the animals fed ethinyl estradiol, 50% of those fed increased cholesterol, and 90% of those fed the combination of both. Bile was saturated in all three groups, with the saturation index of the combination group (2.08 +/- 0.17) being the highest. In both groups receiving bile acid therapy, no gallstones were found, and the bile remained unsaturated. For the bile acid-fed groups, both hepatic HMG-CoAR and hepatic cholesterol 7 alpha-hydroxylase activities were reduced (P less than 0.01) when compared to the group fed standard diet and to the grou fed the combination. Thus, a new animal model of cholesterol gallstone formation has been developed in which chenodeoxycholic acid and ursodeoxycholic acid therapy prevented gallstone formation through mechanisms similar to those reported in cholesterol gallstone patients.

Animals↗

Selection of operation in patients with bleeding esophageal varices.

The results of surgical treatment of bleeding esophageal varices over an 8-year period in 155 patients are reviewed. Primary treatment of bleeding was conservative, with intravenous administration of vasopressin and balloon tamponade. Emergency operations were carried out after 48 hours in persons with persistent bleeding who were surgical candidates. Operative mortality was higher in this group (40%) than in those undergoing elective or urgent operations (each 10%). Postoperative encephalopathy occurred in 35% of patients and was correlated closely to late death after establishment of a shunt. The mesocaval shunt is no better than the portacaval but appears to be a good alternative in an emergency. In a controlled trial the distal splenorenal shunt was found to be associated with a lower rate of postoperative encephalopathy than the portacaval shunt, but thus far the long-term survival rates have not differed.

Blood Vessel Prosthesis↗

Evidence for microfilament involvement in norethandrolone-induced intrahepatic cholestasis.

An experimental study of norethandrolone (NED)-induced intrahepatic cholestasis was made. NED was infused via a portal vein catheter into rat liver in vivo, and measurements were made of bile flow. Liver specimens were taken at intervals for light microscopy and for transmission and scanning electron microscopy. Bile-canalicular-rich membrane fractions were prepared. The effects of NED were also examined in isolated hepatocytes in suspension culture. NED infusion induced total cholestasis by 3 hours. Canalicular alterations commonly associated with cholestasis were found in in vivo infused liver and in isolated hepatocytes. Pericanalicular microfilament changes were also noted in both, with loss of filament structure and replacement by a granular zone. In isolated canalicular membrane fractions prepared from NED-treated animals, the normal investment of pericanalicular filaments was no longer present. Loss of the bile canalicular ruthenium red surface coat was also noted. In view of the identical findings in isolated hepatocytes and in in vivo liver, obstruction and mechanical factors can be excluded as possible causes. The results raise the possibility that the mechanism of NED-induced cholestasis may be related to disaggregation and/or detachment of microfilaments from the canalicular membranes.

Animals↗

Ethanol metabolism, oxygen availability and alcohol induced liver damage.

The rates of ethanol oxidation in various species are linked to the rates of general metabolism, and more specifically that of O2 utilization by the liver. After chronic ethanol administration, increased oxidation of ethanol is accompanied by increased total hepatic O2 utilization, as studied in the whole animal, the perfused liver, and isolated liver slices. The correlation is particularly striking in the spontaneously hypertensive rat. This linkage makes the liver of the chronically ethanol-consuming rat abnormally vulnerable to hypoxic damage. Exposure to 5% oxygen atmosphere for 6 hours produced major elevations of SGOT and SOCT activities and marked centrilobular necrosis, in alcohol-treated animals but not in controls. The same differential susceptibility was found to acute anemia produced by bleeding. The possible relation of these findings to alcoholic liver damage in humans is discussed.

Alcoholism↗

Bile canalicular membrane pathology in cytochalasin B-induced cholestasis.

The mechanism of cytochalasin B-induced intrahepatic cholestasis was examined using electron cytochemical techniques. Since previous studies suggested that the earliest lesions were in hepatic canaliculi, markers were used for three canalicular membrane components, namely ruthenium red for the glycoprotein-rich surface coat, the Mg2+-ATPase reaction as an example of a membrane-bound protein, and uranyl acetate en bloc and ruthenium red staining for the canalicular membrane-associated microfilaments. In rat liver infused in vivo with cytochalasin B, reduction in bile flow correlated with bile canalicular dilation, loss of the ruthenium red-positive surface coat from the canalicular membrane, and loss of demonstrable Mg2+-ATPase activity. In addition, structural alterations in microfilaments with widening of the ectoplasmic zone were noted. In isolated liver cells in vitro, identical changes were found. Bile canaliculi isolated from the in vivo cytochalasin B-infused rat liver lacked their normal investment of microfilaments. Detachment of the filaments from the bile canalicular membrane may be involved in the mechanism of cytochalasin B-induced cholestasis.

Adenosine Triphosphatases↗

Emergency open lung biopsy.

Twenty-eight patients underwent open lung biopsy on an emergency basis. The clinical course in each case was deteriorating rapidly, and all were in respiratory failure. The correct diagnosis was established in 96% of the biopsies (27 of the 28 patients). The clinical diagnosis prior to biopsy was in error or incomplete in 15 (55%) of the patients. Specific therapy was lifesaving in 12 of the 28 patients. The value of the procedure outweighed the complications. Thrombocytopenia and positive end-expiratory pressure ventilation were not contraindications to biopsy.

Adult↗