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Biomedical subjects

T V Taylor

Publications and source records attributed to T V Taylor.

At least 19 recordsLinked to original sources
PubMed1996

Wernicke's encephalopathy after vertical banded gastroplasty for morbid obesity.

Thiamine deficiency is known to lead to certain neurological sequelae including Wernicke- Korsakoff encephalopathy. Signs attributable to this condition include ataxia, ophthalmoplegia, nystagmus, and mental confusion. Recognised predisposing conditions include alcoholism gastric carcinoma, pyloric obstruction, hyperemesis gravidarum, and prolonged intravenous feeding. We have recently encountered two cases of Wernicke's encephalopathy after vertical banded gastroplasty for morbid obesity . Other neurological sequelae are recognised after vertical banded gastroplasty, including Guillain-Barre syndrome, psychosis, and pseudoathetosis, but the causes are multifactorial.

Adult↗
PubMed1995

The challenge of therapy for pancreatitis-related common bile duct stricture.

BACKGROUND: Opinions regarding the appropriate clinical management of pancreatitis-related common bile duct (CBD) stricture vary considerably. PATIENTS AND METHODS: Nineteen patients with chronic pancreatitis and proven stricture of their CBD were included in this study. Their mean duct diameter was 16 mm, bilirubin was 8.4 mg/dL, and alkaline phosphatase was 784 mIU/mL. RESULTS: Five patients initially treated with endoscopic biliary stent placement are doing well at a mean follow-up of 7 months with only 1 patient requiring a biliary-enteric bypass. Four patients underwent a pancreaticoduodenectomy and the other 10 patients underwent a biliary-enteric bypass. Mean bilirubin and alkaline phosphatase at 13 months after therapy were 0.9 mg/dL and 144 mIU/mL. CONCLUSION: An endoscopically placed biliary stent will relieve obstruction due to the stricture for several months and allow the inflammatory process to follow its natural course. In patients with long-standing permanent biliary stricture, pancreatitis limited to the head of the pancreas, duodenal obstruction, or suspected pancreatic head carcinoma, pancreaticoduodenectomy is the operation of choice. Biliary-enteric bypass in association with gastric or pancreatic bypasses should be reserved for patients with severe inflammatory changes preventing a safe pancreaticoduodenectomy.

Adult↗
PubMed1994

The effects of low-level direct current therapy on a preclinical mammary carcinoma: tumour regression and systemic biochemical sequelae.

Low-level direct electric current has been shown to be capable of destroying tumour tissue. Using an early-passage subcutaneous murine mammary carcinoma, the relationships between the volume of tumour destruction, charge and polarity have been examined. The results revealed a direct correlation between charge passed and absolute volume regression when the intratumoral electrode was made either an anode or a cathode. Tumour destruction for a given charge was significantly greater following anodic than cathodic treatment. A direct correlation was also observed between the percentage volume of prompt treatment-induced regression and the in situ end point of tumour growth delay. During the course of these experiments, a highly reproducible toxic effect was discovered, which has not been previously reported for this modality. An anodic charge greater than 10.6 coulombs or a cathodic charge greater than 21.6 coulombs resulted in 100% mortality at 24-72 h, while lower charges had no influence on mortality. Quantitative assays of a number of blood parameters showed that mortality was associated with serum electrolyte imbalances and appeared to be the result of the metabolic load of tumour breakdown products. These effects are similar to the tumour lysis or surgical crush syndromes and should not constitute a significant problem in clinical practice, where the tumour mass to total body mass ratio will normally be much smaller.

Animals↗
PubMed1994

Ablation of neoplasia by direct current.

The application of low-voltage direct electrical current (DEC) has been studied in animals and humans for the ablation of anal condylomata, oesophageal cancer and Kaposi's sarcoma. Twenty milliamps of DEC passed through multiple 6 cm x 1 cm, flat-plate longitudinal electrodes into the squamous mucosa of the oesophagus of healthy dogs for periods ranging from 10 min to 2 h resulted in denudation and necrosis of the oesophageal mucosa at the site of application of the current. In humans, the application of DEC to two patients with benign anal condyloma acuminata, three patients with inoperable obstructing oesophageal cancer and one patient with disseminated Kaposi sarcoma resulted in striking necrosis of tumour tissue that was confirmed by macroscopic and microscopic studies. These initial findings imply promising therapeutic potential for the use of DEC as a simple, effective, safe, low-cost alternative for ablation of neoplasia.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Pelvic ileo-anal reservoirs: a lectin histochemical study.

Pelvic ileo-anal reservoir (ileal pouch) formation is now a common surgical approach to the management of long-standing inflammatory bowel disease. The ileal mucosa in this new environment responds with changes in morphology and histochemical reactivity, as shown by conventional techniques. In this study, pre-pouch ileum and pouch ileal mucosa from 20 patients have been examined with a large panel of lectins using an avidin-biotin-peroxidase technique, with appropriate negative controls and sugar-inhibition studies. Changes were noted between pre-pouch ileum and the pouch mucosa which were complex, and no single alteration was seen in every case. Most variations related to saccharide sequences near the non-reducing termini of O- and N-linked glycans. Many of these were seen with lectins having requirements for terminal fucosyl residues, and to a lesser extent for galactosyl sequences, and were most obvious in the epithelium. Some of the changes occurred with such frequency as to suggest a direct response to surgery, but many of the variations were likely to be adaptive responses, possibly related to inflammation or infection. The changes in glycans were largely additive and could not be explained as a consequence of the actions of bacterial glycosidases. These alterations suggest that reservoir mucosa undergoes an adaptive response to the new intraluminal environment, without frank colonic metaplasia, and some changes occur to a greater degree in patients with pouchitis.

Adult↗
PubMed1993

Benign cystic peritoneal mesothelioma.

The well defined but rare entity of benign cystic mesothelioma is reported. The aetiology of this neoplasm remains obscure. The presenting features make a precise preoperative diagnosis difficult; information provided by computed tomography and cytology may help. A firm diagnosis can only come from electron microscopic or immunohistochemical examination of the tumour. Diagnostic accuracy and diligent follow up are essential because, although the tumour is considered benign, it does tend towards local recurrence.

Cysts↗
PubMed1993

Carcinoma of the breast at the site of migrated pacemaker generators.

We report two patients in whom breast malignancy developed in the proximity of 'migrated' pacemaker generators. These cases and the similar ones reported in the literature raise concerns whether this association is merely coincidental or whether the pacemaker generator is responsible for the occurrence in some inexplicable manner. We urge for a routine, careful examination in all patients with implanted pacemaker generators at follow-up visits. This would help in (a) timely detection of migration of the pacemaker generators and (b) earlier diagnosis of any mass developing close to the migrated generators.

Aged↗
PubMed1992

Use of the de Pezzer catheter to facilitate endoanal pull-through during ileal pouch-anal anastomosis.

Ileal pouch-anal anastomosis is now the treatment of choice for selected patients requiring proctocolectomy for benign mucosal disease of the large intestine. Pelvic sepsis continues to be a major postoperative complication. This is often subsequent to the technical complexity of the intestinal pull-through and ileal pouch-anal anastomosis. We report the use of the de Pezzer catheter to facilitate this often difficult reservoir pull-through during restorative proctocolectomy. This is an inexpensive and simple aid which has consistently helped to decrease operative difficulty, especially where pelvic access is restricted. By enabling the avoidance of clamps and tissue forceps, it has reduced the incidence of contamination and tissue trauma. It has enabled pull-through without undue tension on the reservoir and has facilitated postoperative drainage of the reservoir.

Catheterization↗
PubMed1992

Adenocarcinoma of the pancreas with osteoclast-like giant cells: a case report with immunocytochemistry.

Histological examination of a tumor centered in the body of the pancreas of a 65-year-old Iranian man revealed it to have a substantial component in which osteoclast-like giant cells were set within a stroma of pleomorphic mononuclear cells though other areas were composed of conventional adenocarcinoma. Immunocytochemistry was used to investigate the differentiation of the various component cells of the tumor. The carcinoma cells of the usual type expressed epithelial antigens (EMA and cytokeratin). The giant cells expressed vimentin and showed membrane staining with anti-LCA, in common with examples of cells originating from the mononuclear phagocytic system, including normal osteoclasts. The accompanying stromal cells expressed vimentin only. This implies that the giant cells are likely to have their origin in the bone marrow, whereas the mononuclear stromal cells that separate them may represent tumor cells that have lost their epithelial phenotype. The giant cells are therefore an unusual tissue response to the presence of the carcinoma.

Adenocarcinoma↗
PubMed1992

Complications of percutaneous endoscopic enterostomy tubes.

Percutaneous endoscopic gastrostomy and jejunostomy tubes have been used clinically for approximately 10 years. They have been used predominantly in patients who cannot sustain their weight by oral intake, such as individuals with abnormalities of swallowing or intestinal peristalsis. The percutaneous endoscopic method of placement confers some advantages over classical surgical placement, especially in poor risk cases. Although several types of tube are commercially available, a substantial complication rate is still directly attributable to the tubes. In some series, complications are reported in 70% of cases. This report describes two complications of endoscopically introduced jejunostomy tubes used in patients with Roux-en-Y reconstructions after previous multiple gastric surgical procedures.

Adult↗
PubMed1991

Intragastric device for weight loss. Effect on energy intake in dogs.

It remains unclear whether or not intragastric devices promote weight loss. To elucidate if an intragastric balloon reduces energy intake by a placebo effect of inducing satiety, five free-feeding dogs had balloons inserted via a gastric cannula. Meal intake was assessed with the balloons inflated to 200 and 500 ml with saline and compared with intake during a control period when the animals maintained stable weight. Average energy intake during the control period was 0.3 MJ/kg/day. Inflation to 200 ml had no significant effect on intake (0.31 MJ/kg/day), whereas inflation to 500 ml significantly reduced energy intake to 0.14 MJ/kg/day (P less than 0.0001). An intragastric balloon does create aversion to feeding, presumably by producing satiety, but the effect is volume dependent.

Animals↗
PubMed1991

Sex differences in gallstone pancreatitis.

From a computerized database comprising 28 pertinent items in each of a consecutive series of 664 patients with cholelithiasis, differences were studied between men and women. In 52 patients there was a documented attack of acute pancreatitis (7.8%). Twenty-five of 174 men had pancreatitis, compared with 27 of 490 women (p less than 0.0001). Men developed gallstones later in life than women, but suffered gallstone pancreatitis earlier in life and in the course of their gallstone-related disease. A history of flatulent dyspepsia, chronic cholecystitis, and biliary colic was less common in men than in women with pancreatitis (p less than 0.0001). Men with pancreatitis had fewer stones in their gallbladders than did women (p = 0.0002). The cystic duct and the common bile duct in the pancreatitic patient were more likely to be dilated (p less than 0.0001). In the nonpancreatic group, these ducts were larger in men. Pancreatic duct reflux on operative cholangiography was more common both in patients with pancreatitis 62% cf 14% (p less than 0.0001), and in men (p less than 0.001). Predisposition to pancreatitis relates to duct size rather than stone size per se. Men are more susceptible to gallstone migration at an early stage of their disease. In addition they have a larger diameter duct system and possibly a different anatomic disposition of the sphincter of Oddi, which predisposes them to a higher incidence of pancreatitis than women. The data suggest that it is cystic duct size that is critical in the pathogenesis of gallstone pancreatitis.

Acute Disease↗
PubMed1991

A somatostatin analogue is protective against retrograde bile salt-induced pancreatitis in the rat.

Despite the proposal that somatostatin or its stable analogue, octreotide (SMS-201,995), may exert an ameliorating effect on acute pancreatitis, data concerning its beneficial effect in this situation are conflicting. This study examines the effects of octreotide on acute pancreatitis, resulting from the retrograde injection of a bile salt (taurocholate) plus saturating trypsin into the common bile-pancreatic duct of the rat. Octreotide given before the induction of pancreatitis significantly reduced the levels of serum amylase and lipase, ascites amylase concentration, degree of leukocyte infiltration, and focal areas of pancreatic tissue necrosis. In contrast, administration of octreotide as soon as 5 min following induction had no demonstrable ameliorating effects on the pancreatitis. These results indicate that octreotide may have application to prophylaxis of acute pancreatitis in cases where bile salts may play a role in pathogenesis, but may not be beneficial in established acute pancreatitis.

Acute Disease↗
PubMed1990

Antireflux surgery.

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Gastroesophageal Reflux↗