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Biomedical subjects

S E Silvis

Publications and source records attributed to S E Silvis.

At least 19 recordsLinked to original sources
PubMed1979

Gastrinoma associated with common bile duct obstruction and the ectopic production of ACTH.

A case of adrenocortical hyperfunction due to ectopic production of ACTH by a gastrin-producing tumor of the pancreas is described. Cushing's syndrome preceded the appearance of the overt Zollinger-Ellison syndrome by 2 years and was treated by bilateral adrenalectomy. The Zollinger-Ellison syndrome was initially treated with cimetidine, which successfully reduced the secretion of gastric acid. Because the pancreatic gastrinoma continued to grow, causing obstruction of the common bile duct, biliary diversion and total gastrectomy were performed. There is evidence that the pancreatic gastrinoma was the source of the ectopic production of ACTH and possibly secretion. The role of Histamine-2 blocking agents as therapy in the Zollinger-Ellison syndrome is discussed.

Adrenocorticotropic Hormone↗
PubMed1979

Significance of the nonopacified gallbladder in endoscopic retrograde cholangiography.

Failure to visualize the cystic duct and gallbladder during endoscopic retrograde cholangiography, while obtaining satisfactory opacification of the rest of the biliary system, is a radiographic sign of undetermined meaning. The diagnostic implication of this finding was analyzed in 63 patients with pathologically proven diagnoses. One patient was normal at surgery. Three groups of abnormal patients had: (1) obstructing lesions of the distal common bile duct (35 patients); (2) primary lesions of the cystic duct or gallbladder (19 patients); or (3) obstructing lesions about the common hepatic/cystic duct junction (8 patients). The results indicate that obstructing lesions of the distal common bile duct may cause stasis of bile within the biliary system, increased biliary pressure, and sludge formation that prevent the flow of contrast material through the cystic duct and into the gallbladder, which can cause nonopacification. If the extrahepatic biliary system is of normal caliber without evidence of an obstructing process, nonfilling of the cystic duct and gallbladder is highly predictive of pathology.

Biliary Tract Diseases↗
PubMed1978

The normal cholangiogram.

This paper describes the measurements of the normal cholangiogram as demonstrated by endoscopic retrograde cholangiopancreatography. Two groups of patients were studied. There were 49 patients who had normal livers and no evidence of biliary tract disease. In addition, there were 25 patients with known liver disease and an apparent normal extra-hepatic biliary tract. The extrahepatic bile duct was measured in three regions: (1) the common hepatic duct (above the cystic duct and below the bifurcation); (2) the prepancreatic portion (below the cystic duct and above the pancreas); and (3) the interpancreatic portion (bile duct within the pancreas). These measurements ranged from 2.1 to 9.2 mm. Although the common bile ducts were generally quite uniform in caliber, there were instances where each portion was the largest diameter in an individual case. There was slight increase in bile-duct caliber with age. This study showed somewhat smaller measurements than previously reported and may relate to case selection in this or previous studies.

Adolescent↗
PubMed1978

Cholangiographic abnormalities in patients with inflammatory bowel disease.

Twenty patients with inflammatory bowel disease, abnormal liver function tests and abnormal endoscopic retrograde cholangiograms were found to have a spectrum of abnormalities affecting the intra- and extrahepatic biliary trees. The intrahepatic systems were abnormal in all patients and demonstrated ductal stenosis, ectasia, decreased arborization and major duct obstruction. The extrahepatic systems were abnormal in 75 percent of cases with stenosis, diverticula formation and mural irregularity being the most frequent abnormalities. The value of endoscopic retrograde cholangiography in this patient group is to exclude extrahepatic obstruction, establish a nonoperative diagnosis, and assist in determining the method of treatment.

Adenoma, Bile Duct↗
PubMed1978

The treatment of hemorrhagic gastritis with cimetidine.

Thirteen patients in whom bleeding from hemorrhagic gastritis was not controlled by a variety of therapeutic modalities were treated with cimetidine. Twelve of the 13 patients stopped bleeding. Three subsequently rebled, two of whom required an operation to control the bleeding. The average amount of blood transfused per patient before treatment with cimetidine was 16 units and after cimetidine, 1.6 units. Nine of the 13 patients died, but only one of them died of hemorrhage. The remaining eight patients died of a combination of sepsis and multiple organ failure. We observed no adverse side-effects after the administration of cimetidine. Cimetidine is a safe and reliable means to control bleeding from hemorrhagic gastritis. Once the diagnosis of hemorrhagic gastritis is established, treatment with cimetidine should be begun and continued until the underlying stress which initiated the bleeding is controlled.

Cimetidine↗
PubMed1978

Effects of renal failure on blood levels of cimetidine.

Serial blood samples for determination of drug levels were obtained after intravenous administration of 300 mg of cimetidine. Sixteen patients with varying degrees of renal failure were studied. There was a prolongation of drug half-life in patients with renal insufficiency compared with that in normal controls (P less than 0.001). A significant inverse relationship between the half-life and the creatinine clearance was noted (r= 0.69; P less than 0.01). The effect of hemodialysis was studied in 12 patients. Cimetidine was found to be dialyzable. This was demonstrated both by a shortening of the half-life of the drug during dialysis and by measurement of dialysance. This suggests that the dose schedule should be modified for patients with renal insufficiency and for those on hemodialysis. A single intraveno us dose of cimetidine was well tolerated by the patients. One patient developed an urticarial skin rash, believed to be allergic in nature. There was a transient, mild (but significant) rise in blood urea nitrogen and serum creatinine concentration in 5 patients with moderate renal failure.

Adult↗
PubMed1977

Endoscopic retrograde intrahepatic cholangiogram: radiographic findings in intrahepatic disease.

Endoscopic retrograde intrahepatic cholangiograms were evaluated in 107 patients and correlated with intrahepatic diagnoses determined by liver biopsy. Included were normal livers (six), cirrhosis (38) portal fibrosis (14), cholangitis (22), metastases (11), and miscellaneous diagnoses (16). Results suggest that differentiation of the normal from the abnormal intrahepatic biliary system using the endoscopic retrograde intrahepatic cholangiogram is possible, and that certain patterns of abnormality prevail within given disease categories. The cholangiogram in cirrhosis is marked by ductular stenosis, diminished arborization, tortuosity, and approximation of the intrahepatic ducts. Sclerosing cholangitis demonstrates focal stenoses with concomitant ectasias and frequent similar involvement of the extrahepatic system. Chronic cholangitis and portal fibrosis are frequently associated with extrahepatic obstructing lesions and increased intrahepatic ductal caliber, but demonstrate no distinguishing intrahepatic characteristics. Intrahepatic metastases, polycystic liver disease, and primary hepatic neoplasm produce mass effects consisting of ductal displacement, narrowing, and obstruction. The potential of endoscopic retrograde intrahepatic cholangiography in evaluating the intraheptic biliary tree is significant; specifically in separating normal from abnormal, in distinguishing between intrahepatic processes, and as an adjunct to liver biopsy in determining the extent and location of intrahepatic abnormalities.

Bile Ducts, Intrahepatic↗
PubMed1977

Influence of age and stomach function on serum vitamin B12 concentration.

Serum vitamin B12 (B12), maximal gastric acid output (MAO), and B12 absorption were determined in 82 subjects, age 32 to 85 years, who had normal absorption of radiocyanocobalamin. In 46 of the patients the gastric intrinsic factor (IF) was also measured. Serum B12 concentration and MAO varied widely in all age groups from abnormally low to definitely normal. The mean values for serum B12 and MAO, however, declined very similarly with advancing age owing to an increased incidence of low values for these two measurerment in the aged. There was no significant fall in the mean B12 absorption or IF secretion as a function of old age. Achlorhydric and hypochlorhydric patients invariably had lower mean serum B12 concentrations than those with adequate MAO. Conversely, patients with normal MAO all had normal serum B12 levels. Serum B12 concentration, although correlating with both MAO and IF secretion, showed a closer relationship to the former than to the latter. These findings suggest that the stomach, aside from producing the IF, plays an important role in maintaining a normal serum B12 concentration.

Adult↗
PubMed1977

Pancreatic scanning using retrograde injection of technetium-99m-labeled compounds.

With increased clinical availability of endoscopic retrograde pancreatography, a method for retrograde injection of radionuclides into the pancreas became available. A dog model was developed to evaluate resolution and toxicity of retrograde imaging prior to human use. Two groups of technetium-99m-labeled compounds were used. The first included ionic carriers--pertechnetate and pyrophosphate--and the second included particulate carriers--sulfur colloid and albumin microspheres. Parenchymal visualization, absorption patterns, and toxicity in dogs were studied. The results suggest that pyrophosphate, sulfur colloid, and albumin microspheres would all be feasible technetium carriers for use in humans.

Animals↗
PubMed1976

Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey.

Esophagogastroduodenoscopy (211,410 examinations) had a complication rate of 1.3/1,000 cases. Duodenoscopy with cannulation was performed 3,884 times and had a complication rate of 21.6/1,000 examinations. Diagnostic coloscopy (25,298 examinations) had a complication rate of 3.4/1,000. Polypectomies during coloscopy (6,124 cases) had a complication rate of 23.3/1,000 cases. Esophageal dilations (13,139 cases) had a complication rate of 4.25 with mercury bougies, and in 9,431 cases metal olives produced a complication rate of 6.1/1,000 treatments. Dilation for achalasia in 1,224 patients produced a complication rate of 18.4/1,000 procedures. Peritoneoscopy (4,404 examinations) produced a complication rate of 5.4/1,000 patients. The value of these diagnostic and therapeutic procedures is now well established but must be weighed against a potential risk of complications.

Endoscopes↗