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Biomedical subjects

A M Weber

Publications and source records attributed to A M Weber.

15 recordsLinked to original sources
PubMed1992

Serous carcinoma of the peritoneum after oophorectomy.

BACKGROUND: Prophylactic oophorectomy in premenopausal women has been recommended to prevent ovarian cancer. However, serous carcinoma of the peritoneum, which is indistinguishable from ovarian carcinoma, can occur after oophorectomy. CASES: Two cases are reported of serous carcinoma of the peritoneum after oophorectomy. Presentation, management, and outcome are similar to those for ovarian carcinoma. CONCLUSION: More data are needed to quantify the risk of carcinoma after oophorectomy. Such knowledge may change the risk-benefit calculations of recommending prophylactic oophorectomy to premenopausal women at a certain age, and must be discussed with the patient who is considering prophylactic oophorectomy with or without other planned surgery.

Carcinoma, Papillary↗
PubMed1992

Fetal pleural effusion: a review and meta-analysis for prognostic indicators.

We reviewed the literature on fetal pleural effusion to identify prognostic indicators related to outcome. Data on 124 cases from 38 reports were collected and analyzed using chi 2 statistical analysis and stepwise multiple logistic regression. Termination of pregnancy occurred in ten cases, spontaneous resolution occurred in 11 cases with 100% survival, and overall mortality was 46%. Gestational age at delivery of greater than 31 weeks, the absence of hydrops, and the use of antenatal therapy (thoracentesis or shunt placement) were associated with good outcome. Gender of the fetus, hydramnios, extent of effusion as unilateral or bilateral, and mode of delivery were not significantly related to outcome. Recommendations for evaluation include search for other abnormalities and possible causes related to hydrops. Management is guided by gestational age and the presence of hydrops. Antenatal therapy is recommended if hydrops develops, particularly at a gestational age of less than 32 weeks.

Fetal Diseases↗
PubMed1991

Familial biliary atresia in three siblings including twins.

We report a North American Indian family of five children in which dizygotic twin sisters and a third sibling had biliary atresia. This is in contrast to many reports of discordant biliary atresia in twins. Added to 29 previously documented cases of familial biliary atresia, these three cases support the theory that both genetic and acquired factors play a role in the pathogenesis of this disease.

Biliary Atresia↗
PubMed1991

Laparoscopic cholecystectomy during pregnancy.

Cholelithiasis and cholecystitis frequently necessitate cholecystectomy. Laparoscopic cholecystectomy, by avoiding a laparotomy incision, greatly reduces recovery time and thus may reduce postoperative complications. We describe the first reported case of laparoscopic cholecystectomy during pregnancy. This technique should be considered as an alternative to laparotomy in selected patients.

Adult↗
PubMed1990

Effects of bile acids on actin polymerization in vitro.

Bile acids are major determinants of canalicular bile secretion, and there are indications that choleretic bile acids increase bile canalicular contractions, in isolated rat hepatocytes. Therefore, we examined the influence of various bile acids on the rate of actin polymerization in vitro. The free forms of cholic acid, ursodeoxycholic acid, and chenodeoxycholic acid, as well as their taurine and glycine conjugates, were incubated with purified muscle actin, at a concentration of 100-300 nmoles/mg actin. The rate of actin polymerization was measured by viscometry and the fluorescence of the pyrene probe, linked to actin. Results showed that all bile acids slow the rate of polymerization, and that the effect was dose-dependent. However, the reduction by chenodeoxycholic acid was greater than that caused by the other bile acids. The results indicate that bile acids, particularly in high concentrations interact with actin, a finding that may be related to the increased bile canalicular contractility, and altered canalicular membrane morphology, induced by choleretic bile acids.

Actins↗
PubMed1990

Influence of dehydrocholic acid on the secretion of bile acids and biliary lipids in rats.

This study investigated the influence of dehydrocholic acid (DHCA) infusion on the secretion of endogenous bile acids, and biliary lipids in rats in an attempt to explain the reduction of biliary lipid secretion associated with DHCA infusion. DHCA increased bile flow and the bile acids produced during the infusion were composed of three hydroxy-oxo metabolites (83-93%), and cholic acid (6-14%). Very little DHCA was secreted unchanged (less than 2%). The secretions of all the endogenous biliary bile acids were diminished within 30-60 min of infusion. DHCA furthermore reduced the secretion of exogenous cholic acid when co-infused with DHCA. Phospholipid secretion declined to an undetectable amount and cholesterol declined to 10% of the base value by the end of the infusion. The reduction of biliary lipid secretion during DHCA infusion was attributed to the diminished secretion of endogenous bile acids. These data show that DHCA infusion induces choleresis associated with reduced secretion of endogenous and/or exogenous biliary components.

Animals↗
PubMed1990

Development of bile secretory function in the neonatal guinea pig.

Maturation of hepatic bile formation and lipid secretion were examined in neonatal guinea pigs in an attempt to explain the earlier observation that the neonate (15 days old) is less susceptible to lithocholate-induced cholestasis than the adult. Bile flow and bile acid secretion were lowest at 12 h postpartum and increased to attain a maximum at 15 days. Thereafter, values decreased to a level which was not significantly different from that at 3 days of age. Bile acid analysis indicated the presence of chenodeoxycholic acid, 7-ketolithocholic acid and ursodeoxycholic acid in bile at all ages. But, at 15 days ursodeoxycholic acid was a major contributor to total bile acid secretion. Phospholipid and cholesterol secretion increased between the 1st and the 3rd day of age but decreased markedly at 15 days. This indicated an uncoupling of biliary lipid secretion and endogenous bile acids which was related in part to the nature of the bile acids secreted. Serum bile acid levels were markedly increased at 15 days of age. This hypercholanemia may reflect a rapid expansion of the bile acid pool including an enhanced bile acid secretion which could explain in part the resistance to the lithocholate cholestasis by increasing the secretory capacity for the toxic bile acid.

Aging↗
PubMed1989

High incidence of upper gastrointestinal tract involvement in children with Crohn disease.

This retrospective study of Crohn disease in 230 children and adolescents with a mean age of 12.5 years at the time of diagnosis and an average follow-up of 6.6 years showed that 30% had lesions of the esophagus, stomach, and duodenum. Three patients had Crohn disease isolated to the upper gastrointestinal tract. The 169 patients with both small and large bowel disease were at greater risk (33%, P less than .05) of having upper gastrointestinal lesions than the 37 with isolated small bowel disease and the 21 with disease limited to the colon and/or rectum. An aggregate of symptoms and signs more likely present in those with upper gastrointestinal involvement included: dysphagia, pain when eating, nausea and/or vomiting, and aphthous lesions of the mouth. Furthermore, weight loss was more severe and hypoalbuminemia more frequent. Because upper gastrointestinal series x-ray studies failed to detect upper gastrointestinal lesions in 13 patients of 69 of those with upper gastrointestinal disease, endoscopy should be considered in all children and adolescents in whom a diagnosis of Crohn disease is entertained. Endoscopy and biopsy of the upper gastrointestinal tract should be done in any patient with symptoms suggestive of proximal involvement. Finally, in view of the fact that endoscopy established the diagnosis of Crohn disease in five patients previously thought to have chronic ulcerative colitis, the procedure should routinely be performed in all patients with chronic ulcerative colitis or indeterminate colitis before surgery is performed.

Adolescent↗
PubMed1977

Abnormal biliary lipid composition in cystic fibrosis. Effect of pancreatic enzymes.

Because of the increased incidence of gallstones in cystic fibrosis we compared biliary lipid composition in 26 patients with cystic fibrosis, seven children with cholelithiasis but no cystic-fibrosis and 13 controls. Eighteen of the cystic fibrosis group had cholecystograms, and only one had gallstones. In 14 patients with cystic fibrosis who had stopped taking pancreatic enzymes for one week molar percentage of lipid composition accounted for by cholesterol (mean +/- S.E., 16.3 +/- 2.9) and saturation index (2.0 +/- 0.3) were comparable to values of the cholelithiasis group and higher (P less than 0.01) than those of controls. In 12 patients with cystic fibrosis taking pancreatic enzymes, molar percentage of cholesterol (8.6 +/- 1.7) and saturation index (1.0 +/- 0.1) did not differ from those of controls; in cystic fibrosis there was a preponderance of cholic over chenodeoxycholic acid both off (1.7 +/- 0.2) and on (1.9 +/- 0.3) therapy as compared to the cholelithiasis (0.7 +/- 0.1) and control (0.8 +/- 0.0) groups. The glycine/taurine ratio of conjugated bile acids were lower in enzyme-treated patients with cystic fibrosis (3.7 +/- 0.6) than in patients off treatment (6.4 +/- 1.0), but was higher (P less than 0.01) than in controls (1.8 +/- 0.2). Bile is lithogenic in untreated cystic fibrosis and responds to pancreatic enzymes.

Bile↗
PubMed1977

Pseudomembranous enterocolitis in childhood.

Pseudomembranous enterocolitis is reported in five children. The clinical syndrome, characterized by the acute onset of profuse diarrhea, occurred postoperatively in 2 patients. All the patients had received or were taking antibiotics (penicillin, ampicillin, clindamycin). The disease was severe in 4 persons who presented with hypoproteinemia. Related complications were edema, ascites, pleural effusion, septicemia and/or shock. The diagnosis was made on the basis of typical rectosigmoidoscopic findings. Despite intensive therapy 2 children died. The use of parenteral nutrition is advocated in severe cases with exudative enteropathy. When profuse diarrhea occurs postoperatively or does not rapidly subside with discontinuation of antibiotic therapy, a high index of suspicion should be maintained, even in children, for the possibility of pseudomembranous enterocolitis. An emergency rectosigmoidoscopy should be done in order to make an early diagnosis.

Ampicillin↗
PubMed1976

Relationship between bile acid malabsorption and pancreatic insufficiency in cystic fibrosis.

Bile acid loss (mg/m2 24h) in the stools of 43 cystic fibrosis (CF) children with pancreatic insufficiency was 751-1 +/- 48-3, while that of six without clinical evidence of pancreatic disease (133-4 +/- 15-9) did not differ from values in 25 controls (109-8 +/- 9-8). There was a good correlation between the degree of bile acid (BA) and fat sequestration. Concomitant changes in bile acid and fat loss were observed in the one group of six patients studied on and off pancreatic enzymes as well as in a second group of seven children treated with pancreatic supplements and maintained on a normal diet followed by a low fat diet supplemented with medium chain triglycerides. Administration of NA bicarbonate led to a significant decrease in fat loss (15-8 +/- 2-7 leads to 10-3 +/- 1-9) without any simultaneous change in bile acid excretion (533-1 +/- 58-3 leads to 500-4 +/- 58-6). Qualitative bile acid patterns in controls, in infants after an ileal resection, and in patients with CF or with coeliac disease showed that the percentage of primary BA followed closely the total amount excreted except in situations where antibiotics were administered. The exact mechanism for the increased loss of BA in CF is unknown. It is found in all age groups and is related to the presence and degree of pancreatic insufficiency. The possibility that unhydrolysed triglycerides may interfere with the intestinal absorption of bile acid needs further confirmation.

Adolescent↗