Biomedical subjects
Publications and source records attributed to A B Lumsden.
A 60 year old female with a carcinoid tumour of the ampulla of Vater is presented. The importance of considering this diagnosis in localized lesions of common bile duct or ampulla of Vater and thus avoiding more radical surgery is stressed.
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Polyamine levels (putrescine, spermidine and spermine) in colorectal cancers (n = 25) were measured in order to assess their importance as markers of cellular proliferation. Colonic mucosa from healthy resection margins of patients with diverticular disease (n = 5) was used as control material. Polyamine levels (expressed as nanomoles per 100 mg tumour) in cancers ranged from 0.8 to 7.9 for putrescine (mean: 2.3 +/- 0.7), from 6.5 to 22.8 for spermidine (mean: 13.9 +/- 0.9) and from 13.0 to 37.5 for spermine (mean: 22.1 +/- 1.3). Mean spermidine and spermine content of cancers was more than three times mean spermidine (3.92 +/- 0.8), and more than four times mean spermine (5.0 +/- 1.2), content of normal colonic mucosa (P less than 0.01). Polyamine content of colorectal cancers was independent of tumour site, Dukes' stage, histological grade and the presence of palpable liver metastases at laparotomy. Because colorectal cancers contain such high levels of spermidine and spermine, polyamines may play an essential role in the regulation of their growth.
The goblet cell and Clara cell populations of human distal airway epithelium were examined. The bronchioles, terminal bronchioles, and respiratory bronchioles of 16 smokers and four non-smokers were studied by both light and electron microscopy in surgically resected specimens. A very significantly (p less than 0.001) greater number of goblet cells were found in the bronchioles of smokers compared than in those of non-smokers but no such difference was evident in terminal/respiratory bronchioles. Clara cell numbers in contrast were lower in the bronchioles (p less than 0.01) and terminal and respiratory bronchioles of smokers (p less than 0.01). Both of these alterations in cell frequency may adversely affect small airway function in smokers.
A total of 108 patients with mammary duct ectasia have been reviewed. Patients who presented with breast pain or a lump were significantly younger than those with nipple retraction. A histological review of the 88 patients who underwent biopsy showed severe periductal inflammation around non-dilated ducts occurred in younger patients and was associated with the symptom of breast pain or a lump, whereas older patients had duct dilatation as the most prominent feature, frequently associated with nipple retraction. These findings suggest periductal mastitis precedes duct dilatation and is the initial disorder in this condition. Data on parity and breast feeding for the 108 patients with duct ectasia were compared with age-matched groups of 505 patients with breast cancer, 199 with fibroadenoma, 240 with cysts and 912 'normals'. There were no differences in parity or breast-feeding history between the patients with duct ectasia and any other group, indicating that neither parity nor breast feeding is an important aetiological factor in this condition.
Endotoxin concentrations were measured in the portal, hepatic and peripheral venous blood of two groups of patients with cirrhosis using a limulus-based chromogenic assay. The high sensitivity of chromogenic detection allowed measurement of endotoxin as low as 10 to 15 pg per ml, an order of magnitude greater than previously possible by gelation studies. Group 1 consisted of 56 patients with cirrhosis undergoing angiographic evaluation. In this group, there was wide variability in hepatic venous concentration [73 +/- 110 pg per ml (mean +/- S.D.)] and peripheral venous concentration [31 +/- 58 pg per ml]. However, paired t test showed peripheral venous concentration was significantly (p less than 0.001) lower than hepatic venous concentration. Neither hepatic or peripheral venous endotoxin levels correlated significantly with a variety of clinical, biochemical or radiological parameters. Group 2 consisted of 21 patients with cirrhosis undergoing shunt surgery. Endotoxin levels again showed a wide range, with portal venous concentration (142 +/- 167 pg per ml) and simultaneous peripheral venous concentration (82 +/- 150 pg per ml). Paired t test in this group showed a significant (p less than 0.001) portal to peripheral venous gradient. This study showed the feasibility of measuring endotoxin in plasma to low concentrations by a chromogenic assay technique. It supports the concept of relatively high levels of endotoxin in the portal circulation. In the presence of liver disease, systemic endotoxemia occurs, which is augmented by stressful situations.
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BACKGROUND: Division of incompetent perforating veins has long been regarded as an appropriate approach for treatment of venous stasis ulcers. The development of endoscopic techniques using standard laparoscopic instrumentation has permitted the application of this therapy without the need for long open incisions, fraught with complications. METHODS: We report our experience with 20 cases of subfascial endoscopic perforator surgery (SEPS) in 19 patients. Seventeen limbs had active ulceration at the time of operation. A gas insufflation technique with two 10 mm ports was used in most cases. RESULTS: An average of four perforating veins were divided in each case. Mean operating time was 1.5 hours. At a mean follow-up of eight months, initial complete healing occurred in 14 of 17 ulcers, three ulcers improved, and three healed ulcers at the time of SEPS have remained healed. One patient developed a small area of recurrent ulceration after initial healing. There were no thromboembolic complications. One procedure was technically unsuccessful because of morbid obesity. One patient developed a wound infection, and one patient required re-exploration for a subfascial hematoma. CONCLUSION: SEPS is a safe, minimally invasive procedure which should become an important part of the surgical armamentarium in treating patients with venous ulcers.