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Biomedical subjects

A W Hall

Publications and source records attributed to A W Hall.

At least 19 recordsLinked to original sources
PubMed1992

Presentation of abdominal tuberculosis to general surgeons.

Abdominal tuberculosis (TB) continues to give rise to diagnostic and therapeutic challenges. A total of 24 patients with abdominal TB who presented to general surgeons over a 9-year period have been reviewed. Most (92 per cent) of these patients were Asian; only one had a past history of pulmonary TB. The most common presenting complaint was abdominal pain in 21 patients (88 per cent) with the associated symptoms of weight loss in 18 (75 per cent), anorexia in 15 (62 per cent) and night sweats in 13 (54 per cent). A tissue diagnosis was obtained in 18 patients (75 per cent) and 17 patients (71 per cent) underwent laparotomy. These results show that the diagnosis of abdominal TB is still difficult to establish, and that many patients undergo laparotomy despite the existence of less invasive diagnostic procedures.

Abdominal Pain↗
PubMed1990

Spontaneous benign pneumoperitoneum complicating scleroderma in the absence of pneumatosis cystoides intestinalis.

We describe a 64 year old woman with a 3-year history of scleroderma who presented as an emergency with increasing painless abdominal distention. Radiological investigations revealed a pneumoperitoneum in the absence of either visceral perforation or pneumatosis cystoides intestinalis. This is only the fourth report of spontaneous benign pneumoperitoneum complicating scleroderma without pneumatosis cystoides intestinalis. The possible aetiology of this condition is discussed.

Female↗
PubMed1987

Multicentre clinical trial of low volume fresh frozen plasma therapy in acute pancreatitis.

Fresh frozen plasma (FFP) has been proposed as a specific therapy for acute pancreatitis. Reduced mortality encountered in an uncontrolled clinical study and a controlled experimental study may be attributable to replenishment by FFP of the naturally occurring antiprotease system. To investigate this potential therapy further, 202 patients presenting with acute pancreatitis were randomized to receive FFP (2 units daily for 3 days) or a similar volume of colloid control as part of their intravenous fluid therapy. Clinical progress was monitored and the major serum antiproteases (alpha 1-antiprotease and alpha 2-macroglobulin) were measured on days 1, 3 and 7. There was no significant difference between the two groups in terms of clinical outcome. alpha 1-Antiprotease levels rose significantly from day 1 to day 3 in both groups (P less than 0.0001) and remained elevated at day 7. alpha 1-Antiprotease is an acute phase protein in man and raised serum levels would be anticipated. FFP appears to have no effect on the magnitude of this rise. Serum alpha 2-macroglobulin levels were reduced in both groups on day 1 and continued to fall significantly from day 1 to day 3 in the colloid control group (P less than 0.005) whilst remaining substantially unaltered in patients receiving FFP (P = 0.6527). alpha 2-Macroglobulin plays a central role in the elimination of proteases during acute pancreatitis and the ability of relatively low volumes of FFP to reduce the fall in serum alpha 2-macroglobulin levels seen during the early stages of this disease may have therapeutic implications.

Acute Disease↗
PubMed1987

Treatment and outcome in 52 consecutive cases of ampullary carcinoma.

The results of treatment and outcome in 52 consecutive patients presenting to Leicester from 1972 to 1984 are presented. The number of patients diagnosed increased from two per year before the introduction of duodenoscopy to nearly five per year afterwards. Endoscopic drainage (ED) was attempted in 21 patients with a success rate of 81 per cent. In eight cases ED was used pre-operatively and in the remainder as definitive treatment. Twenty-four patients had a Whipple's resection (12.5 per cent mortality), four patients had a local resection (no deaths), ten patients had surgical bypass (60 per cent mortality) and thirteen patients had ED alone (23 per cent mortality). The major risk factor score was significantly greater in patients undergoing surgical bypass compared with Whipple's resection. Age and risk factor scores were significantly greater in patients who had ED drainage alone than in surgical patients. The 5 year survival rate for resection was 56 per cent versus 13 per cent for drainage procedures (P less than 0.001). Survival in resection cases was directly related to the degree of tumour differentiation and a new staging system. It is proposed that all patients with ampullary tumours should have endoscopic biopsy followed by ED; Whipple's resection remains the surgical treatment of choice.

Adenocarcinoma↗
PubMed1987

Synthesis of some [N-(2-haloalkyl)amino]tetralin derivatives as potential irreversible labels for bovine anterior pituitary D2 dopamine receptors.

A series of hydroxylated 2-aminotetralins were prepared in the search for irreversible labels for D2 dopamine receptors. N-2-Haloacetyl and N-2-haloalkyl substituents were chosen as potential receptor alkylating groups. Titrimetric studies were carried out on [N-(chloroethyl)-N-methylamino]tetralins 10, 10a, 24, and 26 to demonstrate that aziridinium ions were formed as reactive intermediates from these compounds. This observation was confirmed by 1H NMR studies on compound 10. The majority of the aminotetralins prepared showed reasonably high affinity binding to anterior pituitary D2 dopamine receptors and exhibited agonist properties. Structure-activity results are presented together with preliminary studies designed to identify irreversible receptor binding agents. [N-(2-Chloroethyl)-N-propylamino]-6,7-dihydroxytetralin hydrobromide (18) proved most promising in these studies.

Acylation↗
PubMed1987

Oat cell carcinoma of the bronchus and acute pancreatitis.

A case of small cell carcinoma of the lung presenting with acute pancreatitis is described. We believe this to be the first such case reported, despite the frequency of metastasis to the pancreas from such tumours. We discuss the investigation and management of such cases.

Acute Disease↗
PubMed1986

Guanine nucleotide effects on agonist binding at D2 dopamine receptors in bovine anterior pituitary.

[3H]Spiperone binding to D2 dopamine receptors on bovine anterior pituitary membranes is of high affinity, saturable and unaffected by guanine nucleotides. Antagonist displacement of [3H]spiperone binding is characterised by pseudo Hill coefficients close to one and is unaffected by guanine nucleotides. Agonist displacements show pseudo Hill coefficients less than one and agonist affinities are reduced by guanine nucleotides, although pseudo Hill coefficients are essentially unchanged. Agonist displacement curves may be treated in terms of two agonist binding sites with different agonist affinities, and in the presence of guanine nucleotides the two-binding site model remains the best description of the data.

Animals↗
PubMed1978

Effect of gastrointestinal hormone infusions of lower oesophageal competence of rhesus monkeys.

The lower oesophageal high pressure zone (HPZ) was studied in 5 non-refluxing and 3 refluxing Rhesus monkeys. The changes in HPZ and reflux status in response to infusion of various doses of secretin, cholecystokinin and glucagon were measured in all animals, and, in the 5 non-refluxing monkeys, after oesophagogastrectomy with replacement of the lower oesophagus by a stomach tube. All three hormones consistently produced a transient decrease in the HPZ pressure. The only change in response following oesophagagastrectomy and gastric tube replacement was a significant delay in the response to each hormone. Neither hormone infusion nor operation altered gastro-oesophageal reflux status. It appears that lower oesophageal competence in primates is more dependent on the presence of narrow, muscular, intra-abdominal tube than on a specialized segment of the lower oesophagus.

Animals↗
PubMed1978

Value of laparoscopy in the diagnosis and management of pancreatic carcinoma.

Our experience with laparoscopy in the diagnosis and staging of 23 cases of pancreatic cancer is reported. This endoscopic procedure has proved useful in the diagnosis of the disease, in the assessment of operability, and in the retrieval of material for histological and cytological confirmation of pancreatic cancer. An infra-gastric laparoscopic method for inspection of the body and tail of the pancreas is described and the technique may allow the earlier detection of neoplasms in this region.

Adult↗
PubMed1977

The effect of small bowel resection and subsequent precise antrectomy on lower esophageal function in rhesus monkeys.

The lower esophageal high pressure zone (HPZ) was characterized manometrically and reflux status determined in eight male rhesus monkeys. The studies were repeated six weeks and six months after 50 per cent distal small bowel resection. At the same time fasting serum gastrin and gastric inhibitory polypeptide values were assayed. In seven animals precise antrectomy with gastroduodenal anastomosis was performed and the studies repeated. HPZ pressure increased from 6.7 +/-0.67 mm Hg (+/-1 SEM) to 10.3 +/- 0.76 mm Hg at six weeks (p less than 0.005). At six months the pressure was 9.3 +/- 1.02 mm Hg (p less than 0.02) and after antrectomy 15.2 +/- 3.1 (not significant from 6 month value, p less than 0.02 from control). Serum gastrin and GIP values showed significant elevations at six weeks, but six month and postantrectomy results were not statistically different from control. Reflux episodes for the group were reduced at six weeks and six months. After antrectomy increased reflux was noted.

Animals↗
PubMed1977

Effect of 50% distal small bowel resection on gastric emptying in Rhesus monkeys.

The effect of bowel resection, sufficient to cause gastric secretory changes, on gastric emptying is unknown. Gastric evacuation was characterized in 8 Rhesus monkeys by a modification of George's double sampling test meal. Fifty per cent distal small bowel resection was then performed. Gastric emptying was again studied at 6 weeks and 6 months. The rate constant fell from -0.00289 +/- 0.000467 (+/-1 SEM) to -0.00232 +/- 0.00106 during the early phase, but role to -0.00308 +/- 0.00186 by 6 months, neither value being statistically different from the preoperative values. T1/2 rose from 125.2 +/- 19.2 mins to 367 +/- 173.4 mins by 6 weeks and to 380.9 +/- 161.6 mins by the end of the experiments. Corresponding values for T were: control period 425.8 +/- 63.2 mins, early phase 1223 +/- 589 mins and late phase 1245.9 +/- 529.6 mins. None of these changes were statistically significant. Alterations in emptying time within each animal were consistent at the two postoperative phases. Although the two animals showing acceleration of evacuation were those with least change in secretion, compensation for the observed increase in output of gastric juice did not materially alter the results.

Animals↗
PubMed1977

Evaluation of a new monkey model for the repeated study of bile secretory physiology.

An unchaired monkey model for the repeated long-term study of biliary secretory physiology is reported. Postoperative management with cholre recorded. Evaluation was performed by repeated measurement, over a period of months, of bile flow and 14C erythritol clearance at three rates of taurocholate infusion given intravenously in a random order. Response to secretin was tested at the final infusion rate of taurocholate for each experiment. The outcomes of 9 monkeys were described of which 5 were repeatedly studied. They demonstrated an increase in bile flow and 14C erythritol clearance with increasing bile salt output. A dramatic choleresis over a wide range of bile salt excretion was noted with secretin and a linear relationship between bile bicarbonate output and bile salt secretion rate was observed. The new model has several major advantages and gives higher bile flows than previously recorded in the chaired model.

Animals↗
PubMed1977

Effect of antrectomy on gastric hypersecretion induced by distal small bowel resection.

Seven male Rhesus monkeys, with demonstrated gastric hypersecretory response to 50% distal small bowel resection, were studied. This increase in gastric acid output had persisted for more than 6 months. Precise, anatomical antrectomy without vagotomy was performed and intestinal continuity restored by gastroduodenostomy. Complete abolition of basal acid secretion and of the secretory response to histamine occurred. These effects could not be reversed by continuous (5 hour) infusions of pentagastrin at 0.2 microgram/kg hr-1 or 2 microgram/kg hr-1. The dose response curve to gastrin pentapeptide was altered; maximum secretion was greatly reduced and occurred at 10 microgram/kg hr-1. Neither basal serum gastrin or basal serum GIP was significantly reduced by antrectomy. These findings indicate that in this animal model the antrum is essential in the genesis of the hypersecretory state. If these findings are relevant to man precise antrectomy may be the procedure of choice for symptomatic acid hypersecretion after small bowel resection or disease.

Animals↗