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Biomedical subjects

R W Burt

Publications and source records attributed to R W Burt.

At least 73 records · Page 4Linked to original sources
PubMed1988

Duodenal polyposis and malignancy in a case of familial polyposis coli.

Familial polyposis coli is characterized by progressive adenomatosis with ultimate progression to colon cancer. It is becoming clear that these patients also have a high incidence of upper gastrointestinal adenomatous polyps, with some developing periampullary malignancies similar to those seen in Gardner's syndrome. This has led to recommendations for periodic endoscopic screening of asymptomatic polyposis patients. We report a patient with familial polyposis coli who developed an adenocarcinoma in the distal duodenum. This case points out the importance of screening the upper gastrointestinal tract in patients at risk.

Adenocarcinoma↗
PubMed1988

The adenomatous polyp and the hereditary polyposis syndromes.

Adenomatous polyps are the benign precursors of colorectal adenocarcinoma. Colonic adenomas occur commonly in adults in Western countries. There is recent evidence that inheritance may play an important role in the etiology of these adenomatous polyps. Colonic adenomatous polyposis (numerous colonic adenomas) is the central feature of several rare inherited syndromes that give rise to colorectal cancer. There also appears to be a risk of gastrointestinal and other malignancies in the rare inherited syndromes of hamartomatous polyposis.

Adenomatous Polyposis Coli↗
PubMed1988

Combined bone scintigraphy and indium-111 leukocyte scans in neuropathic foot disease.

It is difficult to diagnose osteomyelitis in the presence of neurotrophic osteoarthropathy. We performed combined [99mTc]MDP bone scans and indium-111 (111In) leukocyte studies on 35 patients who had radiographic evidence of neuropathic foot disease and clinically suspected osteomyelitis. The [111In]leukocyte study determined if there was an infection and the bone scan provided the anatomic landmarks so that the infection could be localized to the bone or the adjacent soft tissue. Seventeen patients had osteomyelitis and all showed increased [111In]leukocyte activity localized to the bone, giving a sensitivity of 100%. Among the 18 patients without osteomyelitis, eight had no accumulation of [111In]leukocytes, seven had the [111In]leukocyte activity correctly localized to the soft tissue, two had [111In]leukocyte activity mistakenly attributed to the bone, and one had [111In]leukocyte accumulation in a proven neuroma which was mistakenly attributed to bone. These three false-positive results for osteomyelitis reduced the specificity to 83%. Considering only the 27 patients with a positive [111In]leukocyte study, the combined bone scan and [111In]leukocyte study correctly localized the infection to the soft tissues or bone in 89%. Uninfected neurotrophic osteoarthropathy does not accumulate [111In]leukocytes. We found the combined bone scan and [111In] leukocyte study useful for the detection and localization of infection to soft tissue or bone in patients with neuropathic foot disease.

Adult↗
PubMed1988

Comparison of purified indium-111 granulocytes and indium-111 mixed leukocytes for imaging of infections.

Several methods have been proposed for the separation and labeling of white blood cells for the diagnosis of suspected infection. We retrospectively compared 105 patients imaged with 111In purified granulocytes (GRAN) to 106 patients imaged with 111In mixed leukocytes (MIX). We found that in acute infection the sensitivity of GRAN and MIX were both high and not statistically different. In chronic infections the sensitivities were lower than for acute infections. Again, there was no significant difference between GRAN and MIX with the borderline significant exception of MIX being superior to GRAN in chronic soft tissue infections (p = 0.06). We then had independent observers blindly grade the degree of lesion visualization. We found that delayed images visualized the lesions better than early images (p = 0.0001) and acute infection was better visualized than chronic infection (p = 0.03). We concluded that, in routine clinical practice, MIX is probably the agent of choice for three reasons: (a) easier preparation, (b) comparable sensitivity in acute infection and, (c) borderline superior sensitivity in chronic infection.

Acute Disease↗
PubMed1987

Villous adenoma of the duodenal papilla presenting as necrotizing pancreatitis in a patient with Gardner's syndrome.

The majority of patients with Gardner's syndrome and familial polyposis coli develop duodenal adenomatous polyps. Duodenal cancer sometimes arises in this setting, but nonmalignant problems from duodenal polyps have not been described. This report presents a patient with Gardner's syndrome who developed hemorrhagic pancreatitis and was found to have a villous adenoma encasing the pancreatic duct at the duodenal papilla. The case is important because it suggests that patients with polyposis coli may be at risk for significant nonmalignant problems from duodenal polyps, particularly if polyps exhibit villous histology and occur at the duodenal papilla.

Adenoma↗
PubMed1986

Colonic mucosal dissection following electrocautery or laser polypectomy.

Mucosal proctectomy and ileoanal anastomosis is being increasingly performed on patients with familial polyposis, many of whom have undergone previous subtotal colectomy followed by endoscopic surveillance and polypectomy with monopolar electrocautery (MPEC) or, more recently, argon laser (AL). Our aim was to compare the ease of mucosal dissection following polypectomy with MPEC or AL in the canine colon. At celiotomy, two groups of fifteen 5- to 7-mm sessile polyps were surgically created in the descending colon of five mongrel dogs. Six weeks later, each animal underwent flexible colonoscopy and polyp fulguration with MPEC (15 polyps) and AL (15 polyps). Fulguration was performed weekly for 2-3 weeks until all polyps had been obliterated. Ten weeks later, mucosal dissection was performed with the operating team unaware of prior treatment. Mucosal dissection was scored for dissectability (1 to 4; 1 = facile, 4 = difficult), blood loss, operating time, and number of mucosal perforations with the last three parameters normalized to 100 cm2 of mucosa. AL and MPEC were equally effective at polyp obliteration; however, more AL-treated polyps required retreatment than MPEC-treated polyps (P less than 0.05). After AL treatment, mucosal dissection was more facile [dissectability index (mean +/- SEM): 1.4 +/- 0.2 vs 2.6 +/- 0.2; P less than 0.05] and could be performed more quickly (15.1 +/- 2.4 min vs 23.6 +/- 2.7 min; P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

The histopathology of fundic gland polyps of the stomach.

To assess the histopathologic features of fundic gland polyps (FGP) of the stomach, 83 specimens from 25 patients were examined. In nine patients, FGP were associated with an inherited adenomatous polyposis syndrome; the other 16 patients had nonsyndromic FGP. FGP were microscopically characterized by the presence of fundic glands with variably disordered architecture, a feature not previously emphasized. Disordered architecture, found in 80 of 83 specimens (96%), comprised a spectrum of abnormalities, ranging from prominent glandular and cellular budding, found in 51 biopsies (61%), to irregular tortuous glands, noted in 61 biopsies (75%), to microcysts lined by fundic epithelium, seen in 72 biopsies (87%). The continuous range of these changes suggested that FGP arise through progressive formation and unfolding of secondary glandular buds, to result in cystic dilatation. No differences were found between syndromic and nonsyndromic FGP with respect to histologic features or mucin histochemistry, including presence of O-acylated sialomucins.

Adenomatous Polyposis Coli↗
PubMed1986

Acetazolamide enhancement of HIPDM brain flow distribution imaging.

Six patients with symptomatic cerebral vascular disease were studied with 133Xe regional cerebral blood flow measurements and HIPDM cerebral imaging after the administration of acetazolamide. The results obtained from this small group suggest this technique may have high sensitivity for detection of cerebral vascular disease.

Acetazolamide↗
PubMed1986

Clinical comparison of indium-111 acetylacetone and indium-111 tropolone granulocytes.

This clinical study compares the efficacy of two 111In white blood cells preparations. Seventy-six patients were imaged after an injection of granulocytes (GRAN) isolated on a Ficoll-Hypaque gradient and labeled with [111In]acetylacetone (ACAC) in saline; 105 patients were imaged after an injection of GRAN isolated on a metrizamide-plasma gradient and labeled with [111In]tropolone (TROP) in plasma. Early (2-4 hr), intermediate (4-6 hr), and delayed (24 hr) images were obtained. The specificity was quite high (94-100%) in both preparations and no statistical differences could be found. The sensitivity for ACAC-GRAN for the early, intermediate, and delayed images were 39%, 63%, and 64%, respectively; for TROP-GRAN it was 80%, 89%, and 92%, respectively. In all cases the TROP-GRAN images were significantly more sensitive than the ACAC-GRAN images obtained at the same time after injection (p less than 0.001 for early and delayed images, 0.01 less than p less than 0.025 for intermediate images). For ACAC-GRAN the intermediate and delayed images were significantly more sensitive than the early images, while no significant difference could be found for TROP-GRAN. In a blinded experiment, the ability of TROP-GRAN to demonstrate a lesion was compared to that of ACAC-GRAN. TROP-GRAN demonstrated the lesions better than ACAC-GRAN, both in the early and late images (p less than 0.001). TROP-GRAN visualization scores at 4-6 hr equaled those obtained 24 hr after injection. In conclusion, GRAN separated and labeled in plasma with TROP are superior to those separated and labeled in saline with ACAC in three ways: higher visualization scores, earlier visualization of the lesion, and greater sensitivity.

Adolescent↗
PubMed1985

Dominant inheritance of adenomatous colonic polyps and colorectal cancer.

Except in the rare polyposis syndromes, the contribution of heritable factors to the genesis of colorectal cancer and adenomatous polyps is not well understood. We examined the inheritance of susceptibility to colonic polyps and cancer in a large Utah pedigree with multiple cases of common colorectal cancer but no recognizable inheritance pattern among them. Inheritance was clarified, however, by systematic screening for colonic polyps in pedigree members and spouse controls, using flexible proctosigmoidoscopy. One or more adenomatous polyps were found in 21 per cent of family members (41 of 191) but in only 9 per cent of controls (12 of 132) (P less than 0.005). Pedigree analysis was performed with likelihood methods that compared random occurrence of cancer and polyps with autosomal recessive and autosomal dominant patterns of inheritance. The analysis suggested that the observed excess of discrete adenomatous polyps and colorectal cancers was the result of an inherited autosomal dominant gene for susceptibility, rather than an inherited recessive gene for susceptibility or a chance occurrence. This type of inheritance of colorectal polyps and cancer may be more common than previously recognized.

Adult↗
PubMed1985

Effect of hypoxemia on sodium and water excretion in chronic obstructive lung disease.

To determine the role of hypoxemia in the pathogenesis of impaired sodium and water excretion in advanced chronic obstructive lung disease, 11 clinically stable, hypercapneic patients requiring long-term supplemental oxygen were studied. The renal, hormonal, and cardiovascular responses to sodium and water loading were determined during five-and-a-half-hour studies on a control day (arterial oxygen tension = 80 +/- 6 mm Hg) and on an experimental day under hypoxic conditions (arterial oxygen tension = 39 +/- 2 mm Hg). Hypoxemia produced a significant decrease in urinary sodium excretion but did not affect urinary water excretion. Hypoxemia also resulted in concomitant declines in mean blood pressure, glomerular filtration rate, and filtered sodium load. Renal plasma flow and filtration fraction were unchanged whereas cardiac index rose. On the control day, plasma renin activity and norepinephrine levels were elevated whereas aldosterone and arginine vasopressin levels were normal; none of these four hormones was affected by hypoxemia. Renal tubular function did not appear to be altered by hypoxemia as there was no significant change in fractional reabsorption of sodium. The concurrent decreases in glomerular filtration rate, filtered sodium load, and mean blood pressure at constant renal plasma flow suggest that the reduction in urinary sodium excretion was due to an effect of hypoxemia on glomerular function, possibly related to impaired renovascular autoregulation.

Aged↗
PubMed1985

Polyps: an approach to large bowel cancer detection and prevention.

The evidence that an adenomatous polyp identifies a patient at higher than average risk for colonic cancer seems firm. There is also growing evidence that polypectomy with followup decreases the expected mortality from colonic cancer in patients with adenomatous polyps. Recent studies suggest inheritance of solitary adenomas and colonic cancer in some pedigrees. Further studies of adenoma etiology are suggested; the information to be gained from such studies should be of potential importance to colonic cancer screening efforts.

Colonic Neoplasms↗
PubMed1984

Failure to demonstrate a chromosome 2 deletion in adenomatous colorectal polyposis patients.

A group of researchers recently reported a specific chromosome abnormality consisting of a deletion in the long arm (q) of chromosome 2 in patients with adenomatous colorectal polyposis. Using a high resolution chromosome banding technique and a blind study design, the authors karyotyped two patients with Gardner syndrome, two patients with familial polyposis, and four normal controls. No deletion was found in chromosome 2.

Adult↗