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W Putnam

Publications and source records attributed to W Putnam.

8 recordsLinked to original sources
PubMed1995

Cyclosporin use in the precolectomy chronic ulcerative colitis patient: a community experience and its relationship to prospective and controlled clinical trials. Pacific Northwest Gastroenterology Society.

OBJECTIVE: To define what effect seminal and controlled clinical trials have on practice patterns within a gastroenterological community. To define whether these practice patterns reproduce reported treatment methods and whether results comparable with those reported in such trials are noted within a community practice setting. METHODS: Mailed surveies, with telephone follow-up, were sent to all members of the Pacific Northwest Gastroenterology Society. Respondents were queried regarding cyclosporin use in the precolectomy chronic ulcerative colitis (CUC) patient. Data collected included patient demographics, disease duration and extent, pre-treatment use of steroids, method, dosage, and duration of cyclosporin therapy, side effects, and short-term and subsequent clinical results. RESULTS: Twenty-one percent of 81 respondents had used cyclosporin for precolectomy CUC, approximately one-half using constant infusion and one-half using parenteral bolus therapy. Side effects attributed to the cyclosporin were noted in eight of 30 patients (27%), and acute colectomy was avoided in 17 patients (57%). Subsequent colectomy was required in an additional nine patients (73% total) within a 6-month follow-up period, a significantly higher colectomy rate than that reported in prospective trials. CONCLUSIONS: Potential reasons precluding cyclosporin use within the gastroenterological community may include lack of knowledge about cyclosporin therapy for CUC, lack of opportunity, skepticism, fear of medication side effects, survey sampling error, or treatment philosophy. Potential reasons for failure to duplicate the results reported in controlled trials are more complex but may include inadequate treatment duration the learning curve associated with the use of a new medication, or acceptance of colectomy as the treatment of choice in patients with acutely or chronically debilitating disease.

Adolescent↗
PubMed1991

Bile duct diverticula and webs: nonspecific cholangiographic features of primary sclerosing cholangitis.

Biliary tree diverticula and webs are considered by several authors to be specific cholangiographic features of primary sclerosing cholangitis (PSC). Our experience suggested that these findings can be seen in patients without PSC. The purpose of this study was twofold: to establish whether diverticula and webs are indeed specific for PSC and to assess whether PSC can be accurately diagnosed without reference to diverticula or webs. We retrospectively reviewed 861 consecutive ERCP studies and found 32 cases of webs and/or diverticula. Using accepted cholangiographic, clinical, and histologic criteria, we diagnosed PSC in nine patients and excluded it in 21, with two instances of uncertain diagnoses. Webs and diverticula seen in PSC were cholangiographically indistinguishable from those in the group without PSC. All 21 patients without PSC had other biliary abnormalities, and were grouped by the predominant abnormality or finding believed to be associated with diverticulum or web formation: common duct stones or cholangitis (n = 11 patients), postoperative stricture (n = 4), bile duct stent and balloon dilatation (n = 3), malignant stricture (n = 2), and choledochoduodenostomy (n = 1). To assess cholangiographic diagnosis of PSC in these patients, a blinded reviewer studied the radiographs of the 30 patients with diverticula and/or webs who had confirmed diagnoses. By using established radiologic criteria alone (ignoring diverticula and webs), the correct diagnosis was made in 27, yielding a sensitivity of 89% and specificity of 91%. We conclude that the presence of diverticula and/or webs on a cholangiogram is a nonspecific finding and may be due to inflammation or trauma to the bile duct wall. Further, PSC can be distinguished from other abnormalities on the basis of findings other than diverticula and webs.

Bile Ducts↗
PubMed1984

Insulin's effect on bile flow and lipid excretion during euglycemia and hypoglycemia.

Mongrel dogs were prepared by cholecystectomy, ligation of the lesser pancreatic duct, and insertion of modified Thomas cannulas into the stomach and duodenum. When the dogs had recovered from surgery, studies were performed on them, conscious and unanesthetized after an overnight fast. The common bile duct was catheterized through the opened duodenal cannula for collection of hepatic bile. Bile flow was stabilized by the intravenous infusion of sodium taurocholate. After 2 hr of taurocholate infusion, insulin was added to the infusion and continued for the duration of the experiment. Glucose was administered intravenously during the first 120 min of insulin administration to maintain euglycemia; then the glucose was discontinued. The intravenous infusion of insulin during euglycemia maintained by glucose infusion caused a significant increase in bile flow and a decrease in bile salt concentration, but no change in bile salt output. There was a decrease in cholesterol concentration and output and in phospholipid concentration, but no significant change in phospholipid output. When glucose infusion was discontinued and hypoglycemia occurred, there was a further significant increase in bile flow, but no other change. These studies demonstrate that the choleretic action of insulin is not dependent upon hypoglycemia and that intravenously administered insulin may cause increased bile secretion without increase in serum glucagon concentration. These experiments also confirm that insulin choleresis may be associated with a decline in cholesterol output.

Animals↗
PubMed1982

Physician practice profiles for CME: four investigations into sampling methods.

Sampling physicians' patient contacts to produce a practice profile forms the basis of three present individualized CME programs. The practical and statistical adequacy of these sampling procedures was examined and found to be seriously lacking. Samples were compared to a 6-month continuously coded data base on 16 family physicians. Following analysis of the 6-month data base for significant sources of variance, two new sampling procedures were proposed and tested against a 12-month continuously coded data base. Results indicate both practical acceptability and adequate representation by these two sampling procedures.

Canada↗
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