Biomedical subjects
Publications and source records attributed to A C Page.
The requirement of immediate and abrupt quitting ("cold turkey") can be an obstacle to the acceptance and accomplishment of abstinence as a long-term outcome. Three alternative "warm turkey" routes to abstinence are discussed: (a) sobriety sampling, (b) tapering down, and (c) trial moderation. Clinical research evidence and case examples are provided in support of these alternative approaches.
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The insertion of Hickman central venous catheters for chronic venous access is a procedure usually conducted in the operating theatre under local or general anaesthesia. In a prospective study over a one year period we have assessed the feasibility of radiologists inserting central venous catheters for long term access. A subclavicular approach to the subclavian vein with prior digital subtraction angiography or video imaging of the vein was the technique of choice. Thirty-one Hickman catheters were inserted in 21 patients. All but two patients had a haematological malignancy. Ages ranged from 19 to 77 years. The mean time for insertion was 43 min (range 20-80 min). The catheters remained in situ for between 2 days and 242 days with a mean of 86 days. There was one documented line infection; nine patients had episodes of septicaemia with identified organisms, and a further six had pyrexias of unknown origin during the line indwelling period. There were four documented line and or ipsilateral subclavian vein thromboses, and one death occurred within 36 hours of the procedure. We conclude that radiological placement is an excellent alternative to 'blind' surgical placement. Screening during insertion provides immediate facilities for correction of malposition and monitoring of immediate complications. The time taken for catheter insertion did not impede the usual patient throughout in the interventional radiology suite.
Chronic intussusception is a rare but completely correctable cause of failure to thrive in infants and children. The presenting features differ from acute intussusception. We present the case of a 16 month old boy presenting with a three week history of anorexia, diarrhoea, and weight loss with subsequent delayed diagnosis.
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An association between arachnoid cysts of the middle fossa (ACMF) and complicating subdural haematoma (SDH) has been previously noted. More recently it has been hypothesized that ACMF may predispose to SDH formation. The Plymouth Neurosurgical Unit has treated twenty patients with ACMF between 1976-1985, seven of these being complicated by SDH. There was an age range of 11-56 years in those with SDH. Six of the seven patients with ACMF and SDH gave no significant trauma history. Four of these were males aged 11 to 20 years. The presenting histories, clinical findings and subsequent management of these patients were compared with the age-matched males with SDH alone (twelve patients). In the SDH alone group 100% suffered major skull trauma and 80% had demonstrable skull fractures. In addition the patients with ACMF were compared with patients presenting with other supratentorial arachnoid cysts in Plymouth. Only ACMF were associated with the development of SDH in our study. Three patients demonstrated total masking of the ACMF by isodense intracystic haematoma on computed tomography. In two of these patients the presence of an ACMF was suspected due to plain radiographic and CT enlargement of the middle fossa. It is advocated that with special reference to young males, in the absence of major skull trauma an ACMF should be suspected as a predisposing factor to SDH. Postoperative CT scans for at least one year are advisable in young patients with SDH as demonstration of the presence of an ACMF and SDH affects future management.
Haemangiopericytoma, a rare mesenchymal tumour infrequently found within the thorax, is described in a patient who presented with a pleural mass following a lower respiratory tract infection. Specific radiological features leading to a diagnosis have previously been suggested; however, these are challenged in view of the findings in this case. Haemangiopericytoma ought to be considered in the differential diagnosis of an asymptomatic enlarging pleuropulmonary soft tissue mass.
The objective of this study was to determine the kinetics of absorption, distribution, and elimination of DBCP after intravenous (iv) administration in plasma, and after oral administration in water or corn oil, to conscious, fed, male Fischer 344 rats. Rats were prepared with an external jugular vein cannula and were dosed with 0.1, 1, or 10 mg/kg DBCP into the penile sinus or orally as a solution in water or in corn oil (1 mg/kg only). Blood was sampled at various times up to 12 hr, concentrations of DBCP were determined by gas chromatography, and data were evaluated by classical pharmacokinetic techniques. After oral administration in water, absorption of DBCP was rapid, and the distribution and elimination phase was biexponential. There did not appear to be any saturation of DBCP absorption, distribution, or elimination at the high oral or iv dose. After oral administration of DBCP in a corn oil vehicle, absorption was prolonged, suggesting retention of DBCP in the stomach; this could contribute to the toxic effects of DBCP on the forestomach when chronically administered in corn oil. The areas under the blood concentration/time curve were similar regardless of vehicle, suggesting that systemic toxicity might be independent of the vehicle.
The major urinary metabolite of 14C-epichlorohydrin, after oral administration to rats, was identified previously (Gingell et al. 1985) to be N-acetyl-S-(3-chloro-2-hydroxypropyl)-L-cysteine (ACPC) at 36% of the administered dose. In a similar study reported here, 1,2-dibromo-3-chloropropane (DBCP) was metabolized to at least 20 radioactive urinary metabolites. ACPC was only a minor metabolite (4%) of DBCP. Epichlorohydrin was metabolized in vitro by rat liver microsomes to alpha-chlorohydrin, but DBCP was not metabolized to epichlorohydrin or alpha-chlorohydrin under similar conditions. Covalent binding of radioactivity to liver microsomal proteins occurred for both substrates, but was less for 14C-epichlorohydrin than for 14C-DBCP. Addition of 3,3,3-trichloropropylene oxide, an inhibitor of epoxide hydrolase, increased the extent of protein binding of epichlorohydrin, but decreased the amount of 14C-DBCP which was bound. The data indicate the epichlorohydrin is not a significant in vivo nor in vitro metabolite of DBCP in the rat, and is unlikely to be responsible for the toxicity of DBCP.
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The radial head-capitellum view, a radiographic projection of the elbow to show the lateral components, has been advocated for routine use in the investigation of acute elbow trauma. Retrospective and prospective studies in an Accident and Emergency Department were conducted to determine objective benefits in primary diagnostic rate and treatment. None were found, and thus it is suggested the view be for specialized use only when indicated.
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A comprehensive disposition and metabolism study of epichlorohydrin (ECH) has not been previously reported. In this study, male Fischer 344 rats were dosed (6 mg/kg) orally with [2-14C]ECH (98% radiochemically pure) as an aqueous solution and killed after 3 days. Approximately 38% of the radioactive dose was exhaled as CO2, 50% was excreted as metabolites in the urine, and 3% was present in the feces. Radioactivity in tissues accounted for the remainder of the administered dose. When expressed per gram of tissue, radioactivity was highest in liver, kidney, and forestomach. The half-life of initial elimination of radioactivity in both the urine and exhaled air was about 2 hr, indicating that ECH was rapidly absorbed and metabolized. The major metabolites in the urine were identified as N-acetyl-S-(3-chloro-2-hydroxypropyl)-L-cysteine and alpha-chlorohydrin, about 36 and 4% of the administered dose, respectively. Finding these metabolites, which have not been previously reported, is consistent with the initial metabolic reactions being conjugation of the epoxide with glutathione and hydration of the epoxide.