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Biomedical subjects

C E Brady

Publications and source records attributed to C E Brady.

At least 19 recordsLinked to original sources
PubMed1994

Occult celiac sprue masquerading as severe iron deficiency anemia.

Severe iron deficiency was the presenting manifestation in a patient with occult celiac sprue that went unrecognized for a prolonged time. Endoscopic abnormalities and the absence of typical symptoms may contribute to a delay in diagnosis unless a high index of suspicion is maintained.

Anemia, Hypochromic↗
PubMed1991

Secretin provocation test in the diagnosis of Zollinger-Ellison syndrome.

The secretin stimulation test has become the preferred provocative test in suspected cases of Zollinger-Ellison syndrome. A pure secretin preparation, a gastrin-specific radioimmunoassay, and an appropriate sampling sequence are important for the proper interpretation of this test. Gastric acid analysis is necessary in the assessment of hypergastrinemia to confirm acid hypersecretion and exclude achlorhydria. When properly performed and interpreted, the secretin provocation test offers a safe, expeditious, and reliable means of evaluating patients with hypergastrinemia.

Calcium↗
PubMed1989

Healing of severe perineal and cutaneous Crohn's disease with hyperbaric oxygen.

Recurrent perineal Crohn's disease can be an extremely debilitating complication that may be difficult to treat. We report a patient with progressively worsening perineal and biopsy-proven cutaneous Crohn's disease that had been refractory to surgery and medical treatment (sulfasalazine, steroids, 6-mercaptopurine, metronidazole, antibiotics). As the lesions were reminiscent of problem wounds occurring in other situations, hyperbaric oxygen treatment was instituted while the patient was continued on metronidazole. Response was dramatic with almost immediate relief of symptoms and regression within 2.5 mo of wounds that had previously defied therapy for 8 yr. Clinical remission has not been sustained as four subsequent courses of hyperbaric oxygen have been given over a period of 11 mo. However, the patient has been essentially asymptomatic since her initial course and the extent of her cutaneous disease has been minimal compared with that before hyperbaric oxygen. Hyperbaric oxygen treatment is costly and should not be routinely used in every patient with perineal Crohn's disease. However, this case report may herald an advance in the understanding of the pathogenesis of this complication and ultimately, its therapy.

Combined Modality Therapy↗
PubMed1989

Is the gastrin response to secretin provocation a function of antral G-cell mass? Results in the hypergastrinemia of acid hyposecretion.

Some patients with hypergastrinemic achlorhydria may have false-positive secretin provocation as an exaggeration of the normal gastrin response to secretin, presumably related to an increased, or more responsive, antral G-cell mass. To test this hypothesis, we reviewed our experience with secretin provocation in normogastrinemic subjects with presumed normal antral G-cell mass (normal--17, duodenal ulcer--13) and in patients with hypergastrinemia related to changes in antral G-cells (vagotomy--5, hypochlorhydria--7, achlorhydria--10). Basal serum gastrin (mean +/- SEM) was progressively higher for each group; normal (42 +/- 3 pg/ml), duodenal ulcer (53 +/- 4 pg/ml), vagotomy (226 +/- 54 pg/ml), hypochlorhydria (346 +/- 92 pg/ml), achlorhydria (844 +/- 100 pg/ml). On selective analysis of only those with gastrin rises, significant differences (p less than 0.05) in peak gastrin change were found between achlorhydria (93 +/- 21 pg/ml) compared with all other groups and between hypochlorhydria (40 +/- 12 pg/ml) versus normal (6 +/- 1 pg/ml). Linear regression in these responders showed a significant correlation (p less than 0.001) between basal gastrin and peak gastrin change after secretin. There were no false-positive secretin provocation tests, but four achlorhydric patients had gastrin rises greater than 100 pg/ml, whereas no patient in the other categories had rises above 90 pg/ml. Our results support the concept that patients with hypergastrinemic achlorhydria tend to have greater G-cell responsiveness to secretin provocation, which may account for the false-positive results in some such patients.

Achlorhydria↗
PubMed1989

Alterations in oxygen saturation and ventilation after intravenous sedation for peritoneoscopy.

The effect of intravenous sedation on oxygen saturation and ventilation was studied in 11 patients undergoing peritoneoscopy. Oxygen saturation (mean +/- SD) decreased from baseline (94.7% +/- 1.7%) to nadir (78.6% +/- 10.7%) after sedation. Respiratory depression was evident in these patients by concomitant decreases in minute ventilation and tidal volume. Baseline to nadir arterial blood gas changes in eight patients were consistent with hypoventilation and also suggested a superimposed ventilation perfusion mismatch. Mean respiratory rate did not significantly change during peritoneoscopy. Peritoneal gas insufflation stimulated increased ventilation and oxygen saturation, but no further changes in PCO2 or pH. We conclude that serious arterial oxygen desaturation and possibly some ventilation perfusion mismatch occur after sedation with intravenously administered meperidine-diazepam for peritoneoscopy with resultant hypoxemia, hypercarbia, and acidosis.

Adolescent↗
PubMed1989

Colon cleansing for diagnostic and surgical procedures: polyethylene glycol-electrolyte lavage solution.

Recent work has shown that polyethylene glycol-electrolyte lavage solutions provide adequate cleansing in preparation for colonoscopy, barium enema, intravenous pyelography, and colon surgery. It is safe and well tolerated by patients, and seems ideal for those with renal or cardiovascular disease who must undergo colon cleansing. We review the development of polyethylene glycol-electrolyte lavage solution and the clinical experience with various colon-cleansing preparations.

Colon↗
PubMed1988

Acid secretion and serum gastrin levels in individuals with Campylobacter pylori.

Campylobacter pylori may cause gastritis and has been proposed as an etiologic factor in the development of peptic ulcer. However, it may be an acid-sensitive microbe and before it can be implicated in the pathogenesis of peptic ulcer, it should be consistently found in ulcer patients with normal acid secretion. Thirty-six patients with C. pylori by Warthin-Starry stain underwent gastric analysis; 25 were normochlorhydric and 11 hypochlorhydric. Ulcers were present in 19 normochlorhydric patients (10, gastric; 9, duodenal) and 2 hypochlorhydric patients (gastric). Median basal acid output was higher for those with duodenal ulcer (38 mmol/h) than gastric ulcer (28 mmol/h) or miscellaneous endoscopic features (33 mmol/h). The hypergastrinemia seen in 12 patients with negative secretin provocation tests was believed to be due to various nongastrinoma conditions. Campylobacter pylori was found in 6 normogastrinemic patients with elevated acid output and in 1 gastrinoma patient with marked acid hypersecretion. Histologic chronic gastritis was present in all subjects and 29 had active chronic gastritis. Twenty-three patients were taking H2-receptor antagonists at the time of diagnosis which did not seem to interfere with culture results. Using standard acid secretory tests, we conclude that C. pylori can survive in a wide range of acid conditions.

Adult↗