Medical grand rounds from the University of Alabama Medical Center.
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Adult↗
Biomedical subjects
A Coker
Publications and source records attributed to A Coker.
Spontaneous biliary peritonitis in acalculous cholecystitis: fact or misdiagnosis?
It is often speculated that an inflamed gallbladder weeps bile to produce bile peritonitis. This may be so, but more likely the problem is a peritoneal effusion in a jaundiced patient which thus resembles bile. So-called "spontaneous or idiopathic biliary peritonitis" in acute acalculous cholecystitis without a proven cause is a further example of this very rare condition. Spontaneous perforations of the extrahepatic biliary ductal system associated with acalculous cholecystitis are uncommon albeit reported in adults. Most patients present with an acute abdomen and are operated upon urgently without diagnostic iter. A recent experience with such a case prompted a thorough review of 27 similar cases previously reported.
Acute Disease↗
Is mannitol effective against platelet-activating factor (PAF)-induced liver damage in obstructive jaundice?
BACKGROUND/AIMS: Platelet-activating factor, is a unique phospholipid with a broad range of biological activities that may be relevant in the development of inflammatory reactions. Platelet-activating factor has been suspected to play an important role in liver pathophysiology. The cultured Kupffer and endothelial cells produce and release platelet-activating factor in order to facilitate communication between hepatic sinusoidal and parenchymal cells. In this study, in the experimental jaundice model, platelet-activating factor levels were measured in liver tissue and plasma and the possible effects of mannitol on this mediator were assessed. METHODOLOGY: The experimental model consisted of 7 rats in the control group (CG), 7 rats in the sham operation group (ShG), and 7 rats in the obstructive jaundice group (JG) created by ligating the common bile duct. The last group was the mannitol-treated jaundiced group (MJG) and all animals in this group received 20% mannitol in doses of 2 mL/day, intraperitoneally, following common bile duct ligation. A week later all animals were sacrificed and plasma and liver tissue samples were collected. Platelet-activating factor levels were measured by radioimmunoassay technique. RESULTS: Liver tissue platelet activating factor levels (pg/mg tissue protein) were 72 +/- 18 in the CG, 183 +/- 51 in the JG, 84 +/- 17 in ShG, and 124 +/- 36 in MJG. Plasma levels were 460 +/- 13, 1600 +/- 40, 560 +/- 19, and 1200 +/- 23, respectively. In both sample types, MJG and JG values were significantly different from CG and ShG as well. MJG levels were also different from JG. CONCLUSIONS: These results showed that plasma and liver tissue platelet-activating factor levels are increased in experimental obstructive jaundice; and activation of this mediator contributes to the ongoing liver injury. Mannitol may improve or lessen this damage.
Animals↗
Interleukin-1 receptor antagonist (IL-1RN) and interleukin-1B gene polymorphisms in Turkish patients with rheumatoid arthritis.
OBJECTIVE: Interleukin 1 (IL-1) family is composed of two agonists, IL-1alpha and IL-1Beta and IL-1 receptor antagonist, IL-1Ra. The purpose of this study was to determine the relationship between polymorphisms of IL-1 receptor antagonist (IL-1RN), IL-1B promoter and IL-1B exon 5 genes and susceptibility to rheumatoid arthritis (RA) in Turkish population. METHODS: Polymerase chain reaction (PCR) was used to determine the genotype of the IL-1RN for 94 RA patients and 104 healthy controls. Genotyping of IL-1B polymorphisms at positions -511 (C/T) and +3953 (C/T) was detected by PCR followed restriction fragment length analysis. RESULTS: There was no significant difference in IL-1RN genotype and allele distributions between RA and the control groups. In addition, no significant association was observed in the allelic frequency (C or T) of IL-1B promoter (-511) between RA patients and the controls (P = 0,118), but the genotype distribution of 1/2 (C/T) at position -511 showed a significant difference (P = 0,038). Also, 2/2 genotype (T/T); (P = 0,028), and allele 2 (T) distribution (P = 0,011) of IL-1B (+3953) showed significant differences between RA patients and the control groups in the study population. CONCLUSION: These results imply that 2/2 (T/T) genotype or allele 2 (T) of IL-B (+3953) are susceptibility factors for RA in Turkey. Also, 1/2 genotype (C/T) of IL-1 -511 can play a protective role for RA.
Alleles↗
Patients as subjects for research: ethical dilemmas for the primary care clinician-investigator.
BACKGROUND: Past studies suggested an association between human papillomavirus (HPV) and cervical intraepithelial neoplasia (CIN). In 1987, University of North Carolina (UNC) Hospitals Family Practice Center clinicians were approached for a control population to study this association. METHODS: One hundred five patients attending the UNC Hospitals Neoplasia Clinic with biopsy-proven CIN 2 or 3 and 268 control patients attending the UNC Family Practice Center for a routine Papanicolaou smear were enrolled in this case-control study. Case and control patients consented to having an additional cervical specimen taken and to being interviewed. The cervical specimens were classified by the Southern blot and polymerase chain reaction techniques for HPV. RESULTS: Early results suggested the control patients who had HPV were at high risk of developing CIN. Interventions were made to inform these patients of this risk and need for closer follow-up, causing a wide range of patient reactions. The final results showed no association of HPV with CIN, indicating the early interventions were premature. CONCLUSIONS: Physicians engaged in research need to be prepared to deal with the discovery of health risks in the otherwise "normal" control patient. They bear the ethical responsibility of scrutinizing study design and methods and planning communication with patients from the inception of a study.
Adult↗
The serum levels of soluble interleukin-2 receptor levels in patients with obstructive jaundice.
BACKGROUND/AIMS: Increased susceptibility to infection in patients with obstructive jaundice is well recognized. Depression of reticuloendothlial system phagocytic function and suppression of cellular immunity suggested by in vivo studies have been postulated as the cause. It has been shown that increased serum soluble interleukin-2 receptor (sIL-2R) levels are the marker of immune system activation, especially T cell activation. The purpose of this study was to evaluate cellular immune system activation by measuring serum sIL-2R levels in 18 patients with obstructive jaundice (11 with choledocholithiasis, 7 with malignant obstructive jaundice), 10 patients with liver cirrhosis and 10 healthy subjects. MATERIAL AND METHODS: Serum sIL-2R levels were measured by using ELISA (Boehringer Manheim). Lymphocyte subgroups were determined by flowcytometry. Serum immungolubulins (IgG, IgA, IgM) and autoantibodies such as antinuclear antibody, rheumatoid factor, anti-thyroglobulin and anti-microsomal antibody were measured. RESULTS: The levels of serum sIL-2R were found to be 47.1-121.2 (mean 77.3, SD +/- 20.1) pmol/l in healthy subjects, 82.8-199.2 (mean 150.9 +/- 32.2) pmol/L in patients with liver cirrhosis and 32.6-172.5 (mean 121.7 +/- 40.6) pmol/L in patients with obstructive jaundice. Serum sIL-2R levels were significantly higher in patients with liver cirrhosis or obstructive jaundice than in healthy subjects (p < 0.01 and p < 0.05 respectively). There is a significant difference in levels between patients with choledocholithiasis and with malignant obstructive jaundice (p < 0.01). Serum sIL-2R levels were measured higher in patients with liver cirrhosis than those in patients with obstructive jaundice (p < 0.059). CONCLUSIONS: In patients with obstructive jaundice, and to a lesser extent in those with liver cirrhosis, in vivo activation of immune system may be considered possible.
Aged↗
Esophagocoloplasty in the management of postcorrosive strictures of the esophagus.
BACKGROUND/AIMS: Esophageal replacement therapy has developed an increasing role in the management of severe esophageal strictures due to caustic ingestion. The aim of this study is to discuss methods of reconstruction and results of them in corrosive esophagitis at our Institute. METHODOLOGY: Thirty-three patients underwent 34 esophagocoloplasties for benign strictures of the esophagus over a 17-year period. The left colon was used in 8 patients, the right colon in 3 patients, and the right colon with the terminal ileum in 23 patients. RESULTS: Three patients died in the first postoperative month, and there was an overall mortality rate of 9%. The most severe complication was graft necrosis (2 patients). The remainder of the patients survived without any deleterious complications. CONCLUSION: Esophageal replacement therapy using the right colon with the terminal ileum is superior to the modalities in terms of the continuity of peristalsis of the interposed bowel segment with an intact ileocecal valve, which decreases the hazard of regurgitation from the colon. It is also easier to perform an anastomosis between the ileum and the cervical esophagus from the point of view of surgical manipulation.
Adolescent↗