Search PubMed⌕ Search

Biomedical subjects

R E Sampliner

Publications and source records attributed to R E Sampliner.

At least 127 records · Page 7Linked to original sources
PubMed1990

Lack of impact of therapy on extent of Barrett's esophagus in 67 patients.

Sixty-seven patients with Barrett's esophagus have been prospectively followed over an average of 36 months (range 6 to 76 months) with standardized endoscopic observation and biopsies of the length of columnar epithelium. The initial length of Barrett's epithelium ranged from 1 to 16 cm, mean 5.5 cm. Specialized columnar epithelium was present in 64 of the 67 patients. Patients were treated predominantly with H2-receptor blocker therapy to relieve symptoms. Eighty-two percent of patients had less than a 1-cm change in length per year. The mean rate of change of length was -0.093 cm per year. These results confirm in a relatively large, prospective study that standard antireflux therapy for Barrett's esophagus does not result in consistent reduction in the extent of Barrett's epithelium over a three-year interval.

Adult↗
PubMed1989

Discordance between flow cytometric abnormalities and dysplasia in Barrett's esophagus.

Eighty-six specimens from 25 patients with Barrett's epithelium were analyzed by both histology and flow cytometry. Of these, 73 were without dysplasia and 13 had dysplasia (7 low grade, 6 high grade). Eight of the nondysplastic specimens were aneuploid and another 15 had increased G2. Among the dysplastic specimens, two were aneuploid and two had increased G2. These data were grouped into four classifications: type 1 (65 specimens), specialized columnar epithelium (Barrett's) without dysplasia and no aneuploidy; type 2 (8 specimens), Barrett's epithelium without dysplasia and an aneuploid cell population; type 3 (11 specimens), Barrett's epithelium with dysplasia and no aneuploidy; and type 4 (2 specimens), Barrett's epithelium with dysplasia and aneuploidy. Distribution by type was 76%, 9%, 13%, and 2%, respectively. We conclude that histologic dysplasia and aneuploidy are often discordant. They may identify separate subgroups at risk, or when concordant, may reflect an increased cancer risk in that population. Further study will define the role of histology and flow cytometry in the screening and management of patients with Barrett's esophagus.

Adult↗
PubMed1989

Limitations of combined flexible sigmoidoscopy and double contrast barium enema in patients with rectal bleeding.

Eighty-seven outpatients with non-massive rectal bleeding or asymptomatic positive fecal occult blood were evaluated with 35 cm flexible sigmoidoscopy, double contrast barium enema (DBCE) and colonoscopy. 82% had hemorrhoids and 35% harbored colorectal neoplasia. The combination of flexible sigmoidoscopy and DCBE missed none of 7 malignant lesions. However, 36% of benign polyps greater than or equal to 1 cm and 60.25% of those less than 1 cm were not detected by this combination. The presence of hemorrhoids should not prevent a search for colon neoplasia and colonoscopy is the preferred method.

Adult↗
PubMed1989

Management of high-grade dysplasia in Barrett's esophagus.

When Barrett's esophagus is complicated by adenocarcinoma, surgery is indicated in appropriate patients. Until now, high-grade dysplasia in Barrett's esophagus has been managed in a similar fashion. We explore this approach and review reported cases of high-grade dysplasia to suggest guidelines for collection of data to make future clinical decisions more rational.

Adenocarcinoma↗
PubMed1988

Ornithine decarboxylase and polyamine levels in columnar upper gastrointestinal mucosae in patients with Barrett's esophagus.

Ornithine decarboxylase (ODC) activity was elevated in the premalignant metaplastic columnar epithelium (mean activity, 0.13 unit/mg protein, N = 18 individual samples from 18 patients), compared to either adjacent gastric (mean activity, 0.02 unit/mg protein, N = 9) or small intestinal (mean activity, 0.02 unit/mg protein, N = 9) epithelium in patients with Barrett's esophagus. Enzyme activity ranged from 0 (less than detectable) to more than 0.5 unit/mg protein in the metaplastic tissue. However, neither putrescine, spermidine, spermine (as individual parameters), nor total polyamine contents were related to ODC activity in the individual patient biopsies. Spermidine/spermine ratios ranged from 0.38 to 2.18 and were also not related to enzyme activity in any apparent manner. Nevertheless, cell strains derived from the metaplastic tissue were growth inhibited by alpha-difluoromethylornithine, an enzyme-activated, suicide inhibitor of ODC. In two different cell strains derived from Barrett's epithelium, growth was affected with drug concentrations as low as 0.05 mM. While the mechanism responsible for the elevation in enzyme activity is unknown, the regulation of polyamine metabolism appears to be altered in this premalignant tissue. The growth inhibition of Barrett's epithelium-derived cell lines by ODC inhibitors suggests a potential role for these compounds in the treatment of this disease.

Barrett Esophagus↗
PubMed1988

False-positive secretin-KABI provocation test associated with achlorhydria.

Two patients with chronic abdominal pain and fasting hypergastrinemia had increases in serum gastrin of 440 and 300 pg/ml after injection of 2 U/kg Secretin-KABI. Both subsequently proved to have pentagastrin-fast achlorhydria. Intragastric instillation of 0.1 N HCl suppressed serum gastrin concentration by greater than 60%. In both, the pancreas was normal by sonography or computed tomography (CT) scan and at laparotomy in one. Both are currently asymptomatic 12 and 18 months later. We conclude that achlorhydria may be associated after injection of Secretin-KABI with a false-positive rise in fasting serum gastrin concentration of greater than 200 pg/ml and that gastric analysis for hypochlorhydria should be performed before secretin provocation testing.

Achlorhydria↗
PubMed1988

Squamous mucosa overlying columnar epithelium in Barrett's esophagus in the absence of anti-reflux surgery.

Seven of 45 patients with Barrett's esophagus prospectively followed with yearly endoscopy had histological evidence of squamous mucosa overlying Barrett's epithelium. This histological finding has previously been identified as a rare sequela of anti-reflux surgery. All seven patients had specialized columnar epithelium. No evidence of the overlying mucosa was recognized at endoscopy. Only one patient had previous anti-reflux surgery. During the observation interval, three patients had a decrease, and four had no change in the length of Barrett's epithelium. Squamous mucosa overlying columnar epithelium in Barrett's esophagus is not infrequent, and prior anti-reflux surgery is not a necessary precondition.

Aged↗
PubMed1987

Synchronous neoplasms in patients with diminutive colorectal adenomas.

The distribution of synchronous neoplasms was retrospectively analyzed in 220 patients undergoing initial colonoscopic evaluation for colorectal neoplasms. In 159 of the 220 patients, an index neoplasm was present in the rectosigmoid region. Of these 159 patients, 32 had an index rectosigmoid adenoma less than 5 mm in diameter (diminutive), 105 had an index rectosigmoid adenoma greater than or equal to 5 mm in diameter and 22 had an index rectosigmoid adenocarcinoma. Among these patients with different index neoplasms the frequency of synchronous neoplasms was 34%, 53%, and 73%, respectively. The synchronous neoplasm was an adenoma greater than or equal to 5 mm in diameter in 13%, 40%, and 64%, respectively. The synchronous neoplasm was a carcinoma in 0%, 7%, and 5%, respectively. Two or more synchronous neoplasms occurred in 9%, 34%, and 41% of the index neoplasm groups, respectively. Finally, symptoms providing an indication for colonoscopy were present in 31%, 75%, and 86%, respectively. It is concluded that patients with diminutive index adenomas had fewer and smaller synchronous neoplasms (P less than 0.025) than patients with larger adenomas or invasive carcinoma as the index lesion. Thus, total colonoscopy does not appear to be necessary in asymptomatic patients with only diminutive adenomas found at flexible sigmoidoscopy.

Adenoma↗
PubMed1987

Significance of isolated antibody to hepatitis B core antigen determined by immune response to hepatitis B vaccination.

The immune response to hepatitis B vaccine was studied in 14 individuals with isolated, high-titer antibody to hepatitis B core antigen (anti-HBc) and examined as an indicator of this serologic pattern's significance. Four subjects demonstrated a low-titer antibody to hepatitis B surface antigen (anti-HBs) on repeated testing, and three in this subgroup had anamnestic responses (anti-HBs, 82 to 140 ratio units) after vaccination. Compared with 22 seronegative controls, the remaining ten had significantly higher anti-HBs response rates (78% vs 22%, P = .003) and median anti-HBs titers (4 vs 0 ratio units, P = .008) two weeks after vaccination. One of ten subjects had an anamnestic response, while another exhibited no response. The general pattern of anti-HBs responsiveness observed in those subjects with isolated, high-titer anti-HBc was intermediate between seronegative and anti-HBs-positive groups and may indicate a state of waning immunity after natural infection. Hepatitis B vaccination with follow-up anti-HBs testing should be done for those patients with isolated, high-titer anti-HBc to help exclude chronic infection and boost protective immunity.

Adult↗
PubMed1987

Hepatitis B virus DNA in asymptomatic HBsAg carriers: comparison with HBeAg/anti-HBe status.

Sera of 17 HBeAg positive and 104 anti-HBe positive asymptomatic HBsAg carriers from two cohorts were tested for HBV DNA. HBV DNA was found in 13 of 17 HBeAg positive carriers (76.5%) and in only 7 of 104 of anti-HBe positive carriers (6.7%). Eleven of the 17 HBeAg positive carriers were retested for HBV DNA over a period of 7 to 36 months after the initial test. HBV DNA disappeared from the serum in 2 patients in spite of persistence of the HBe antigen. Of the 104 anti-HBe carriers, 89 were retested for HBV DNA over a period of 6 to 52 months after the initial test. HBV DNA disappeared from the serum in 5 of the 7 who were previously positive for HBV DNA, and persisted in 2. These findings indicate that there is an inconstant relationship between the time of seroconversion of HBeAg to anti-HBe and the disappearance of HBV DNA. In one HBeAg positive patient, HBV DNA, which was absent in the serum on first testing, was present on retesting. This suggests that the presence of HBV DNA in the serum of some patients may be intermittent. The presence of HBV DNA in the serum of some anti-HBe positive carriers accounts for the finding that they may be infective. All but one of the HBV DNA positive anti-HBe carriers were born outside North America, most in Asia. HBV DNA were found more frequently in the serum of anti-HBe positive carriers who had biochemical and histological evidence of liver disease than in carriers without such evidence.

Antibodies, Viral↗
PubMed1986

Chronic liver disease following community-acquired non-A, non-B hepatitis.

Chronic non-A, non-B hepatitis occurring in an urban American population was identified in 23 patients followed for more than six months after the onset of acute hepatitis. Eight of the 23 patients subsequently developed normal aminotransferase levels a mean of 12.3 months after the onset of hepatitis. Liver biopsies were obtained from 9 of the remaining 15 patients. Eight biopsies revealed abnormalities consistent with chronic persistent hepatitis. One revealed chronic active hepatitis. The probable source of hepatitis included blood transfusions in 4%, intravenous drugs in 43%, personal contact in 4%, and no known source in 48%. Normalization of aminotransferase activity could not be predicted by initial symptoms, physical findings, or laboratory values. This study suggests that the chronic liver disease following community-acquired non-A, non-B hepatitis is frequent and may have a benign course.

Chronic Disease↗
PubMed1986

Identification of alcohol abuse and alcoholism with biological parameters.

The prevalence and incidence of heavy alcohol consumption are major problems which have been increasing in many countries in recent years. It is crucial for physicians to consistently identify early drinking problems as well as the various end disease states in order to minimize suffering and maximize recovery. This paper reviews the evolutionary development of clinical tools for detection of alcohol abuse. The focus is primarily on clinical/biochemical indicators of alcohol abuse, emphasizing but not limited to changes in hematological characteristics, liver enzyme activity, lipids, immune function factors, hormones, neurological factors, and some physically based tests. Use of test combinations and sophisticated statistical analysis of pattern changes in test batteries evidence increased diagnostic efficiency.

Alcoholism↗