Biomedical subjects
Publications and source records attributed to W Appel.
The Grand Round was held at the Christie Hospital on the 26 November 2001. It followed a talk by Professor Kate Vallis of the Princess Margaret Hospital in Toronto on, "A functional genomics approach to understanding normal issue response and ionizing radiation".
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The analytical performance of the three analytical systems Reflotron, Ektachem DT60 and Seralyzer III was studied according to ECCLS guidelines (1) and partly according to a protocol of the Société Francaise de Biologie Clinique (SFBC) (2) in a multicentre evaluation involving four laboratories. The determination of 11 analytes led to more than 180,000 data. With the Ektachem DT60, imprecision was acceptable for all analytes except for sodium. With the Reflotron, imprecision for glucose and creatinine was wider than the acceptable limits. With the Seralyzer III, imprecision for glucose, uric acid, cholesterol, creatinine and potassium was not within acceptance limits. The recovery of system assigned control sera values was acceptable for all analytes, except for glucose, creatinine and sodium with the Ektachem DT60 system, and for all but glucose and cholesterol with the Reflotron. On the Seralyzer III, the limits of acceptance were exceeded only with the creatinine assay. The recovery of the reference method values with Kontrollogen L caused problems with all three systems and for all analytes. Only 30% of the mean values of Kontrollogen L measured with the Ektachem and with the Seralyzer III were within the limits of acceptance. 40% of the mean values determined with the Reflotron were inside these limits. The upper limits of linearity as claimed by the manufacturers were obtained with all analytes and systems with the exception of cholesterol on all systems and the creatinine assay on the Seralyzer III. The systems under test and several different comparison methods showed good agreement for the analysis of patient samples, except in one laboratory for the analysis of sodium and aspartate aminotransferase with the Ektachem system and potassium with the Seralyzer III. Turbidity showed no significant influence on the measurements of all analytes and all systems. Haemolysis, hyperproteinaemia, and bilirubinaemia affected several methods on all three systems. A start time delay of up to 60 s did not affect the results of the Reflotron, except in the case of the triacylglycerol assay, which was affected by start time delays greater than 45 s. The results of 4 assays on the Seralyzer III were decreased considerably by a delayed start time (triacylglycerols and creatinine above 5 s, aspartate aminotransferase above 35 s and creatine kinase above 15 s). For reliable results from all the assays in each of the three analytical systems, it was necessary to use the prescribed sample volume within certain limits. The practicability of all analytical systems tested was found to be very good. A field study was conducted with the Reflotron system. The analyte concentration was determined in venous blood from various patients. In 25 out of 30 experiments, the results of the "field" laboratories showed a greater spread about the fitting line than those obtained in the "expert" laboratories.
In recent years, accurate preoperative diagnosis has been increasingly emphasized as an important therapeutic aspect of urinary incontinence in women. One of the diagnostic modalities employed is the lateral urethrocystogram. 25 patients with recurrent stress induced urinary incontinence were subjected to a dura-sling operation. The median duration of incontinence-related problems until secondary surgery (loop surgery) was 2.6 years. Radiological investigations before and after loop surgery showed, that this operation produces good morphological results, if the preoperative diagnosis is accurate. In 84% of the patients the continence obtained was verified by clinical evidence and radiologic findings.
In four cases of hyperinsulinism proven clinically and by blood chemistry the value of intraoperative sonography of the pancreas is emphasized. An insulinoma could be localized preoperatively in two patients. In one of these two cases intraoperative sonography detected additional insulinomas. In the remaining two patients the negative preoperative examinations and surgical palpation was confirmed by using this method: diffuse islet cell hyperplasia was the final diagnosis in both cases.
Diseases of the gastrointestinal tract accompanied by a thickened bowel wall have become more accessible to ultrasonic detection during the last years. In most of the cases, however, the sonographic pattern has no characteristic feature for any disease. In this paper we present the rare case of a phlegmon of the colon and discuss its differential diagnosis.
A prospective study of the results of fibrinolytic therapy in 87 patients was carried out with particular reference to the type of fibrinolytic agent. The primary success rate using urokinase was 78%, which was markedly greater than the 44% success rate when using streptokinase. An attempt was also made to evaluate the effect of other factors, such as the extent and duration of the occlusion. Long term results, as might have been expected, were directly related to the primary success rate. If fibrinolytic therapy resulted in fairly normal vasculature, the long-term results were satisfactory in 79%, whereas unsatisfactory reconstruction of the vascular bed produced a satisfactory long-term result in only 30%.
Percutaneous removal of centrally located, embolized, intravascular foreign bodies is essential. A technique was developed to shift fixed foreign bodies into a position where they may be grasped and eventually removed with a snare or Dormia basket. It involves insertion by bilateral femoral vein puncture of a curved-end catheter and a second catheter attached to a Dormia basket set. A wire passed through the first catheter is grasped with the Dormia basket, and the foreign body is mobilized by means of traction on both catheter systems.
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Surgical treatment of Crohn's disease and ulcerative colitis is standardized today, despite several unresolved problems. Cooperation between gastroenterologist and surgeon is essential to establish the indication for surgery in emergency situations and during the chronic phase, as well. The surgical procedures aim for maximum preservation of function; in Crohn's disease salvage of bowel by means of limited resections and strictureplasty has priority, whilst in ulcerative colitis the preservation of sphincter function is the paramount goal, wherever possible, by means of ileorectostomy and ileal pouch procedures.
A review on the peptide hydrolase chymotrypsin gives some characteristics concerning the structure, specificity, mechanism of activation from its precursor and catalytic activity. Problems of the active sites, allosteric alterations, changes of conformation, different behaviour against types of substrates, and suggested kinetics are shown in some detail. Finally, the diagnostic role of this serine proteinase is mentioned.
A photometric method to determine chymotrypsin in stool, equivalent to the titrimetric analysis, was developed. The chymotrypsin concentrations found in healthy children and those with gastrointestinal and pancreatic disease permit the same clinical conclusions as the titrimetrically determined results. In view of its lower technical requirements, this method is suitable for the identification of maldigestion in pediatric and general practice.
This is a report on a rare case of a recurring abscess in the pituitary gland. Diagnosis was extremely difficult to establish preoperatively. This is demonstrated via various radiological methods. Anamnesis and clinical disease pattern are important assisting factors in diagnosis.
58 patients with peritonitis and acute renal failure (ARF) were treated either by haemodialysis (HD, n = 22), continuous arteriovenous haemofiltration (CAVH, n = 9), or continuous pump-driven haemofiltration (CPDHF, n = 27). In contrast to HD, which led to severe hypotension in 31.9% of procedures and to cardiac arrest in 3 cases, CPDHF caused neither haemodynamic nor metabolic alterations. Control of uraemia was most effective in the CPDHF group, too. Mean daily BUN and creatinine values fell significantly (p less than 0.005) and remained at 60 mg % and 2.0 mg %, respectively, whereas during HD no significant changes were found. During CAVH serum creatinine showed an insignificant decline, whereas BUN even increased. Despite higher costs CPDHF seems to be a promising alternative to HD or CAVH for treatment of ARF in septic patients, as mortality was lower in the CPDHF group and recovery of renal function occurred in 48.2%, whereas during HD only 27.3% recovered from ARF.
Fecal chymotrypsin (FCT) was determined in stool specimens of healthy children and those with gastro-intestinal disease, by a new photometric method. The values are comparable with chymotrypsin concentrations found by pH-stat method. The new test is cheap, reliable and easy to perform. For this reasons and for the sensitivity of all tubeless pancreatic function tests (NBT-PABA, FDL, FCT) is rather low (60-70%), the FCT-test may be preferred as diagnostic marker for differential diagnosis of exocrine pancreatic insufficiency.
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The clinical and radiological features of primary adenocarcinoma of the duodenum are demonstrated by seven histologically confirmed cases. Clinically, obstruction develops following a prolonged uncharacteristic prodromal stage. The radiological findings resemble those of a carcinoma in any other part of the gastro-intestinal tract: polypoid filling defects, ulcers, mural thickening and loss of elasticity. The radiological method of choice is hypotonic duodenography. Sonography and CT are complimentary methods and are of use in postoperative follow-up.