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Biomedical subjects

B R Parry

Publications and source records attributed to B R Parry.

14 recordsLinked to original sources
PubMed1992

Serum tumour necrosis factor alpha and insulin resistance in gastrointestinal cancer.

Cancer cachexia may be mediated by endogenous peptides such as tumour necrosis factor alpha (TNF-alpha). Insulin resistance occurs in these patients, and is also seen experimentally with TNF-alpha administration. In this study, insulin sensitivity and energy metabolism were measured in 11 patients with gastrointestinal cancer and ten controls, using the euglycaemic glucose clamp and indirect calorimetry. Patients with cancer were significantly more insulin resistant than controls (P < 0.01) and in such patients insulin resistance correlated with serum TNF-alpha level (rs = 0.74, P < 0.01). Fasting insulin levels also correlated inversely with insulin sensitivity (rs = -0.62, P = 0.003). These results suggest a possible association between endogenous TNF-alpha production and insulin resistance in patients with gastrointestinal cancer.

Aged↗
PubMed1992

Methylxanthines in surgery: a bright future?

Methylxanthines have been used in clinical practice for over 100 years, and although understanding of their mechanisms of action is growing their effects are not fully understood. Nevertheless the knowledge to date has brought about a general upsurge of interest in methylxanthines and the development of novel derivatives. Methylxanthines are poised to escape the confines of their traditional role as these agents are applied in novel ways to surgical illnesses such as septic shock, the adult respiratory distress syndrome, cancer cachexia and functional neutrophil disorders. Methylxanthines, alone or in combination with other compounds, may well become part of the surgeon's future stock-in-trade.

Humans↗
PubMed1992

Validation of subjective measures of fatigue after elective operations.

OBJECTIVE: To find out if it was possible to evaluate postoperative fatigue by questionnaire. DESIGN: Open study. SETTING: University hospital. SUBJECTS: 23 patients about to undergo elective general surgical operations. INTERVENTIONS: A questionnaire was filled in before, and 2-46 days after, operation. MAIN OUTCOME MEASURES: Six measures of fatigue were derived from the questionnaire and validated objectively with changes in body weight, exercise tolerance (n = 10), or grip strength (n = 21). RESULTS: The six measures all showed a significant increase after operation. The changes in fatigue correlated well, but there were differences in sensitivity to changes in perceived weakness compared with perceived tiredness. Each measure correlated significantly with either body weight, exercise tolerance or grip strength. CONCLUSION: Questionnaires can provide reliable results in the assessment of postoperative fatigue.

Adult↗
PubMed1992

Peritoneal fine structure of inguinal hernia: a transmission electron microscope study.

Fine structure of normal human parietal peritoneum served as control data for recording changes in the fine structure of the peritoneum of hernial sacs. In these sacs, mesothelial cells retracted, rounded up and some of them eventually separated altogether to give rise to wide open intercellular spaces thus creating unhindered passageways (stomata) between the subserosal connective tissue and the cavity of the sacs. There was a considerable collagen build-up in the subserosal fibrous tissue of hernial sacs. Occurrence of this fibrosis is at variance with an accepted surgical concept which suggests a defect in collagen synthesis as the cause of herniation. In some sacs mesothelial nodules and/or peritoneal adhesions were present. Certain cytological changes in the mesothelial cells of hernial sacs showed features in common with cells of malignant tumours in general, and features mimicking malignant mesotheliomas in particular. This is in spite of the fact that thorough gross and light microscopic examination of operative specimens and cytological evaluation of peritoneal effusion failed to reveal any evidence of malignancy. Pathologists should be aware of the consummate ability of mesothelial cells to mimic carcinomas in order to avoid possible diagnostic errors. In this report, an electron micrograph of peritoneal adhesion is being published for the first time in the literature. A syncytium-like firm bond between adjoining mesothelial cells constituted the adhesion which is obviously an irreversible process.

Epithelial Cells↗
PubMed1991

Tumour necrosis factor-alpha immunodetection in blood monocytes and serum: preliminary findings in weight-losing cancer patients.

The peptide tumour necrosis factor-alpha (TNF-alpha) is a central mediator of the host response. Identifying where and when TNF-alpha is produced may give insights into its potential role in various pathophysiological states. This paper describes a quantitative analysis of TNF-alpha expression in peripheral blood monocytes (PBM) at the single cell level. A pilot study has been undertaken, using this method to assess TNF-alpha expression in PBM from healthy volunteers and cancer patients. We also report mildly elevated serum TNF-alpha levels in the cancer patients, using an immunoradiometric assay (IRMA) sensitive to 1 pg/mL of recombinant TNF-alpha. The results of this preliminary investigation suggest that TNF-alpha production may be altered in cancer patients.

Humans↗
PubMed1991

Competency and the colonoscopist: a learning curve.

The first 334 consecutive unassisted studies of a trainee colonoscopist were audited to analyse the relationship between experience and a target 90% completion rate of colonoscopy. The cumulative sum (cusum) score was applied to examine the time trend for the attaining of the target 90% completion rate. This technique described a learning curve which showed, in this instance, that approximately 100 studies were necessary before a 90% completion rate was approached. A further 100 studies were required before this target completion rate was achieved consistently. A trend for continued improvement above the 90% completion rate level was also seen after 200 studies. Polypectomy was completed in 117 of the 123 studies where indicated. Cusum analysis may be a useful method for monitoring the progress of the trainee colonoscopist and the attainment of satisfactory competence. Training requirements, therefore, might better emphasize the attainment of an acceptable completion rate rather than an arbitrary quota per se.

Clinical Competence↗
PubMed1990

Tumour necrosis factor in surgical illness.

TNF is a multipurpose molecule which works alongside other cytokines to stimulate and coordinate immune and inflammatory responses to antigenic challenges. It is extremely well conserved throughout all mammal species, and obviously confers considerable survival advantage. There are circumstances, however, in which TNF itself can be a source of tissue injury. This occurs in septic shock when the magnitude of the host response is overwhelming. TNF also initiates the energy substrate mobilization required to meet the heightened fuel demands associated with immunological, inflammatory and wound-healing activities. In chronic infection and malignancy this may lead to severe depletion of host tissues with its own attendant morbidity and mortality. At present our understanding of the host response is expanding rapidly. The challenge for the future will be to manipulate this response selectively, to maximize its influence on the disease while minimizing its negative impact on the host.

Animals↗
PubMed1990

Gardner's syndrome: a case report.

Gardner's syndrome, with characteristic dental abnormalities and osteomas involving the jaws, is described in an adolescent male. The sinister aspect of the syndrome relates to the malignant potential of intestinal polyps and therefore the need for early diagnosis and prophylactic colectomy. The dentist may be the first health professional to have an opportunity to make an early diagnosis and referral of a patient with Gardner's syndrome, and should therefore be aware of the features of the syndrome that affect the teeth and jaws.

Adolescent↗
PubMed1989

In vivo immunohistochemical identification of tumor necrosis factor/cachectin in human lymphoid tissue.

To find an alternative approach to the in vivo detection of tumor necrosis factor/cachectin (TNF alpha), an immunohistochemical method to identify TNF alpha in histologic sections was developed. This method employs the streptavidin-biotin immunoperoxidase technique, and TNF alpha-specific monoclonal and polyclonal antibodies, on cryostat sections of fresh frozen human lymphoid tissue. Staining was evident in most specimens displaying follicular hyperplasia, but was absent from histologically normal tissue. Both tingible body macrophages and follicular dendritic reticulum cells appeared from phenotype analysis in serial sections and by double staining experiments to constitute the main source of TNF alpha. This technique complements other systemically oriented assays that may fail to detect significant in vivo TNF alpha production and activity at a cellular level.

Humans↗
PubMed1985

Catheter-related sepsis in patients on intravenous nutrition: a prospective study of quantitative catheter cultures and guidewire changes for suspected sepsis.

One hundred and ninety-five central venous catheters used for intravenous nutrition in 113 patients were studied prospectively. Catheter-related sepsis (CRS), defined by recovery of the same organism from the catheter tip and peripheral blood cultures, occurred with only 3.3 per cent of catheters or 2.3 per 1000 days of therapy. In contrast, CRS was suspected with 30 per cent of catheters and catheter contamination occurred in 37 per cent. Contamination was defined by a positive catheter tip culture without recovery of the same organism from the blood. CRS was present in 4 of 12 cases (33 per cent) with greater than 1000 colony forming units on the catheter tip but in only 2 of 54 (4 per cent) with fewer organisms. Thirty-eight cases suspected of having CRS were randomized to have catheter removal and later replacement, or replacement over a guidewire. There were no significant differences in the catheter contamination rate but there were significantly fewer problems of insertion in the guidewire group. However, transfer of Klebsiella sp., during the guidewire procedure, resulted in subsequent sepsis in one case. It is concluded that replacement of catheters over a guidewire is a safe and convenient way of establishing whether sepsis is catheter-related. Because organisms may be transferred, the procedure is not an appropriate treatment for catheter-related sepsis.

Adolescent↗