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Biomedical subjects

R E England

Publications and source records attributed to R E England.

26 records · Page 2Linked to original sources
PubMed1995

Cystic duct patency in malignant obstructive jaundice. An ERCP-based study relevant to the role of laparoscopic cholecystojejunostomy.

OBJECTIVE: This endoscopic retrograde cholangiopancreatography-(ERCP)based study estimates the potential role of laparoscopic cholecystojejunostomy for palliation of patients with malignant obstructive jaundice. SUMMARY BACKGROUND DATA: Traditional treatment of malignant obstructive jaundice has used a standard bilioenteric anastomosis. Laparoscopic biliary bypass via a gallbladder conduit currently is an established technique; it provides a low initial morbidity alternative to open procedures, similar to endoscopic stenting. No study has specifically addressed anatomic factors relevant to cholecystojejunostomy, such as prior cholecystectomy, stricture location in reference to the hepatocystic junction, and cystic duct patency in patients with malignant obstructive jaundice. METHODS: Retrograde cholangiograms were reviewed from consecutive patients with malignant obstructive jaundice and a control group without biliary disease who underwent ERCP during a 2-year period. Patients with either prior biliary surgery or hilar tumors were excluded. The presence of gallbladder or cystic duct filling was assessed. In patients with patent cystic ducts, the distance from obstruction to the cystic duct takeoff was classified as either greater or less than 1 cm. RESULTS: Nearly half the patients with malignant obstructive jaundice were ineligible for cholecystojejunostomies because of prior biliary surgery (29%) or hilar tumors (17%). Half (50 of 101) of the remaining potential candidates had patent hepatocystic junctions. Patients with ampullary carcinoma and patent hepatocystic junctions (5 of 9) were all ideal candidates for cholecystojejunostomies, having biliary obstruction more than 1 cm from the cystic duct takeoff. Two thirds of the remaining eligible patients (28 of 45) had obstructions less than 1 cm from patent hepatocystic junctions. CONCLUSIONS: Palliation of malignant obstructive jaundice by laparoscopic cholecystojejunostomy should only be attempted after direct cholangiography demonstrates a patent hepatocystic junction that is well separated from the malignant stricture. The majority of patients with malignant obstructive jaundice are ineligible for cholecystojejunostomies because of prior cholecystectomies, hilar obstructions, or tumor involvement of the hepatocystic junction. Nonoperative treatments will continue to be indicated for the majority of patients with malignant obstructive jaundice.

Aged↗
PubMed1995

Case report: bleeding gastric varices secondary to splenic vein thrombosis successfully treated by splenic artery embolization.

Splenic vein thrombosis is a complication of pancreatic carcinoma or pancreatitis. It may lead to gastric varices which are difficult to treat and splenectomy may be required to stop variceal bleeding. A case of bleeding gastric varices secondary to splenic vein thrombosis and successfully treated by splenic artery embolization is reported. Embolization was performed by transcatheter deposition of four Gianturco coils into the splenic artery. This resulted in reduced blood flow through the spleen with partial splenic infarction and cessation of variceal bleeding. There has been no recurrence of bleeding in the 6 months since the procedure. Literature review confirms that experience of using this treatment is very limited and it should therefore be restricted to patients at high risk from surgery.

Embolization, Therapeutic↗
PubMed1995

Endoscopic therapy of sclerosing cholangitis.

The efficacy of endoscopic treatment in primary sclerosing cholangitis has not been clearly established. This report presents endoscopic intervention in 53 consecutive patients with this disorder. Pertinent data were abstracted from the GI-TRAC database, medical records, and cholangiograms, and clinical follow-up was obtained by telephone interview of the subjects. Assessed treatment outcomes were clinical symptom, liver function test, and cholangiographic appearance. Between 1986 and 1993, 85 patients with primary sclerosing cholangitis underwent successful ERCP, of which 36 men and 17 women underwent 100 therapeutic endoscopic procedures. Forty-three of 50 dilations, 37 of 38 stentings, 8 of 8 nasobiliary tube placements, and 11 of 17 stone extractions were technically successful. These treatments were complicated by cholangitis or pancreatitis in 15 patients. Clinical follow-up was obtained in 50 of 53 patients who had undergone 85 procedures (median follow-up of 31 months): 28 patients felt better, 21 felt the same, and 1 felt worse. Liver function tests obtained within 3 months of the endoscopic treatment were significantly improved compared with pretreatment values (P < .001). Cholangiograms showed improvement in 36% of the patients, no change in 51%, and the effect of therapy could not be assessed in 13%. Overall, 41 of 53 patients (77%) had improvements of their clinical symptoms, liver function tests, or cholangiograms.

Adult↗
PubMed1993

Imaging of dialysis access: a review of 67 failing fistulas investigated by intravenous digital subtraction angiography.

We have reviewed 67 failing haemodialysis fistulas imaged by intravenous digital subtraction angiography (IVDSA). Peripheral venous injection of non-ionic contrast was used in all examinations. No complications relating to peripheral injection, contrast dose or fluid load were experienced. Image quality was poor, owing to inadequate vascular opacification, in 1/67. Image quality was excellent (53/67), or good (13/67) in the remaining 66. 56/66 of these examinations were diagnostic. Diagnoses included abnormalities of feeding arteries, anastomoses, draining veins, and central veins. Multiple abnormalities were demonstrated in 10/56 examinations. Conventional arm venography was performed in addition to IVDSA in five cases where venous images were inadequate owing to anastomotic obstruction (3/5) or poor opacification (2/5). 5/66 examinations were non-diagnostic owing to failure to image the central veins where no cause for fistula failure had been demonstrated. A further 5/66 examinations were non-diagnostic owing to failure to obtain oblique projections of the shunt where vascular details was obscured by overlapping vessels. The authors recommended routine imaging of the dialysis shunt in two planes and central venous imaging in all cases. This would have resulted in reduction of the failure rate from 16% to 1.5% in this series. IVDSA using a peripheral injection technique is simple, free from complications, and provides good quality images of both arterial and venous components of the fistula. Images of vessels not directly involved in fistula formation are routinely obtained and aid the planning of fistula revision.

Angiography, Digital Subtraction↗
PubMed1990

Halothane and isoflurane alter phospholipid transmethylation in rat brain synaptosomes.

The mechanism of action of inhalational anesthetics is unknown, but neuronal membrane alteration is a favored hypothesis. Since phospholipid methylation and translocation play a key role in the transmission of biologic signals across cell membranes, we examined the effect of two commonly used halogenated anesthetics, halothane and isoflurane, on phospholipid methylation in rat brain synaptosomes. Using S-adenosyl-L-[3H-methyl]methionine as a donor, we found a two-fold increase in 3H-methyl incorporation into phospholipids in synaptosomes taken from rats exposed to concentrations that just abolish pain response, but not in rats exposed to higher or lower concentrations. Methylation was not increased in rats newly recovered from anesthesia. Halothane added to synaptosomes taken from rats not previously exposed to anesthetics stimulated 3H-methyl incorporation over a wide range of concentrations. Enhancement of phospholipid methylation by halothane and isoflurane may effect an alteration of neural signal transduction that results in the anesthetic state.

Animals↗
PubMedDate not supplied

Endoscopic and percutaneous intervention in malignant obstructive jaundice.

Most patients with malignant obstructive jaundice have inoperable disease at presentation. There is debate regarding the best approach to palliate these patients, i.e., surgical versus endoscopic versus percutaneous drainage. The purpose of this article is to review the current literature in an unbiased fashion, and to present a rationale for management. A multi-disciplinary approach is needed if we are to provide the best care for patients with standardization of definitions, complications, and outcomes between specialities such that meaningful comparisons can be made between studies. The need for prospective randomized trials is clear from the currently deficient literature.

Bile Duct Neoplasms↗