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Biomedical subjects

P McMaster

Publications and source records attributed to P McMaster.

At least 181 records · Page 10Linked to original sources
PubMed1990

Primary hepatic malignancy: the role of liver transplantation.

Between January 1982 and April 1989, 134 patients with a suspected liver neoplasm were referred to the liver unit, Queen Elizabeth Hospital, Birmingham. In 105 (78 per cent), a primary hepatic neoplasm was histologically confirmed, and 47 patients (45 per cent) proved to have primary hepatocellular carcinoma. Twenty-nine orthotopic liver transplants were performed in 28 of these patients (27 per cent). Twenty patients (71 per cent) survived 30 days or longer (median 11.5 months; range 2-87 months), of whom nine are currently alive. We retrospectively analysed our data to determine the influence of preoperative evaluation, histological type and staging on outcome. Computed tomography proved to be superior to intraoperative assessment (86 versus 58 per cent) in diagnosing tumour positive nodes. Patients with tumour negative lymphadenopathy had a better prognosis. Postoperative stage I/II had a median survival of 16 months (range 3-87 months) compared with 7.5 months (range 2-20 months) for stage III. Non-cirrhotic patients with hepatocellular carcinoma had the best prognosis; cholangiocellular carcinoma and cirrhotic patients with hepatocelluar carcinoma had the worst outcome with no survivors beyond 1 year. Because of the advanced stage of disease at the time of presentation, the value of liver transplantation in primary liver cancer is limited. For those presenting with advanced disease confined to the liver (stage I/II) in whom conventional hepatic resection is not possible, significant benefit can be achieved in selected cases.

Adenoma, Bile Duct↗
PubMed1990

Assessment of the biliary tract after liver transplantation: T tube cholangiography or IODIDA scanning.

Biliary tract obstruction or anastomotic leakage are common problems following liver transplantation. In a sequential study, 31 patients with a liver transplant were investigated by 99mTc-IODIDA (IODIDA) scanning and T tube cholangiography (TTC) and the results were compared with clinical outcome. Seven patients had an extrahepatic biliary obstruction and one patient had a biliary leak. In the detection of biliary complications TTC and IODIDA scanning were similar in terms of sensitivity (63 per cent for both) but TTC had a better specificity (79 per cent versus 60 per cent) and accuracy (74 per cent versus 60 per cent) than IODIDA scanning. When liver function was taken into account, the diagnostic efficacy of both tests in patients with bilirubin levels of less than 200 mumol/l was similar. With levels greater than 200 mumol/l there was a greater number of false positive results with IODIDA scanning (12 per cent versus 54 per cent). The only significant biliary leak was clearly detected by TTC but not IODIDA scanning. TTC remains the more effective way of evaluating the biliary tract after transplantation. IODIDA scanning has limited value when bilirubin levels are elevated, but may provide additional information about blood supply, hepatocyte function and intrahepatic cholestasis.

Adolescent↗
PubMed1990

Portal hypertension secondary to sigmoid colon arteriovenous malformation.

A case of portal hypertension secondary to an arteriovenous malformation of the sigmoid colon is presented. The importance of mesenteric angiography in the diagnosis of this condition is discussed. The dramatic clinical improvement in this case following surgery emphasizes that arteriovenous malformations of the gastrointestinal tract represent a potentially curable cause of portal hypertension.

Adult↗
PubMed1990

Referral of patients with primary biliary cirrhosis for liver transplantation.

All patients with primary biliary cirrhosis referred to this unit for consideration for transplantation between April 1981 and January 1989 were analysed retrospectively to assess whether disease stage at referral affects the outcome after grafting and whether greater awareness of the benefits of the procedure means that patients are now being referred at an earlier stage. Seventy of the 107 patients have been grafted, with an overall one year actuarial survival of 62%. A better prognosis at the time of referral, as assessed by both serum bilirubin concentration and a mathematically derived prognostic index, was associated with a greater probability of survival after grafting. Patients in the tertile with the best prognosis (median serum bilirubin concentration at referral 84 mumol/l and estimated survival in the absence of transplantation of more than nine months) had a 78% one year actuarial survival after transplantation, whereas those in the tertile with the worst prognosis (median serum bilirubin concentration 467 mumol/l and estimated survival of less than four months) had a one year actuarial survival of only 50%. No trend towards earlier referral of patients, however, was shown using either of these two markers. This retrospective analysis suggests that many patients are being referred too late for an optimal outcome. We recommend that patients with primary biliary cirrhosis who are potential candidates for liver grafting should be referred to a transplant centre before the serum bilirubin concentration approaches 150 mumol/l.

Adult↗
PubMed1990

Cerebral aspergillosis in liver transplantation.

Nine cases of cerebral aspergillosis were identified in a series of 44 brains obtained at necropsy from patients who had undergone liver transplantation. In two of these there was dual infection with Candida albicans. The primary focus of infection was invariably in the lungs. One case of pulmonary Aspergillus infection was found with no evidence of cerebral disease. Infection tended to occur in the period soon after transplantation, was associated with high dose steroids, retransplantation, and showed a significant seasonal incidence. Neurological findings were non-specific and only two cases were diagnosed before death. Aspergillus infection soon after transplantation indicates that this organism is a considerable nosocomial hazard, particularly in the winter and spring months. Positive cultures before death are rarely obtained and antifungal treatment should be started on clinical suspicion alone.

Adolescent↗
PubMed1989

Increasing rate of pneumonia hospitalizations in the Bronx: a sentinel indicator for human immunodeficiency virus.

To describe secular trends in pneumonia hospitalizations in the Bronx, New York City from 1982-1986, we analysed all cases with a discharge diagnosis of pneumonia, excluding Pneumocystis carinii pneumonia (PCP), for Bronx residents by age, sex, neighbourhood, and length of stay (N = 21,822). Hospital deaths from PCP and immune disorders were analysed separately as a non-recurrent indicator of human immunodeficiency virus (HIV) related disease prevalence by age, sex and geographical areas. From 1982 to 1986, pneumonia hospitalizations increased 132% among males and 100% among females aged 25-54, an age group accounting for 90% of adult AIDS cases in the Bronx, as compared to a 21% rise among males and 38% among females in all other age groups (p less than 0.001). Pneumonia rates increased most in those population groups with the highest rates of PCP and immune disorders. An ecological correlation of pneumonia hospitalization with this measure of AIDS prevalence for residents of a small geographical area is evident (r2 = 0.92). The observed increase in pneumonia hospitalizations, believed to be related to underlying prevalence patterns of HIV in this population, accounts for a significant and previously unrecognized burden on the local health care system. From 1983-1986, these 'excess' pneumonias in the Bronx accounted for 14,707 days of hospitalization--equal to 42% of the total days attributed to all hospital admissions for AIDS per se.

Acquired Immunodeficiency Syndrome↗