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Biomedical subjects

C H Scudamore

Publications and source records attributed to C H Scudamore.

84 records · Page 5Linked to original sources
PubMed1985

Acalculous cholecystitis: its role as a complication of major burn injury.

The authors present four cases of acute acalculous cholecystitis complicating major burn injury and review the recent literature on acalculous cholecystitis. All patients were men and ranged in age from 22 to 40 years. The mean extent of the burn was 50% of the total body surface area, with an average 29% third-degree component. All four patients survived. Because of their severity, major burn injuries expose patients to many risks, including acute acalculous cholecystitis. Recent experimental evidence supports a vascular insult through the activation of Factor XII pathways as the initial event. A diagnosis is made on clinical grounds, supported by laboratory and ultrasonographic findings, in a patient with a burn covering more than 30% of the total body surface area and who has signs of acute cholecystitis. Cholecystectomy is the treatment of choice; tube cholecystostomy is reserved for critically ill patients.

Acute Disease↗
PubMed1983

Plasma lysosomal enzymes in experimental and clinical endotoxemia.

Endotoxins, which are lipopolysaccharide complexes derived from the cell walls of gram-negative bacteria, have been implicated in the pathogenesis of gram-negative septic shock. One possible mechanism of endotoxin-induced damage may involve an action at cell surface membranes resulting in cell injury and lysosomal enzyme release. In our experiments, the administration of purified E. coli endotoxin (2 mg/kg intravenously) to guinea pigs produced elevations in the plasma activity of the lysosomal hydrolases glucosaminidase, acid phosphatase and Cathepsin D of approx. 2-, 3- and 4-fold, respectively, at 5 h following endotoxin injection. Animals haemorrhaged to produce sustained hypotension that was greater than the reduction in blood pressure seen with endotoxin treatment, exhibited an elevation only in plasma Cathepsin D activity that was, however, significantly lower than the increase associated with endotoxemia. The three lysosomal hydrolases were also measured in man, including a control group, patients with gram-negative septic shock, other shock, gram-positive and gram-negative septicaemia without shock. Plasma Cathepsin D activity was significantly elevated (26-fold above control) in the group with gram-negative septic shock as compared to all other groups. Patients in the gram-negative septic shock group and the other shock group both had significantly greater glucosaminidase activity than controls. Our results suggest that plasma Cathepsin D measurements may be of diagnostic and prognostic value in the clinical management of gram-negative septic shock.

Animals↗
PubMed1983

Effects of small bowel transection, resection, or bypass in 1,2-dimethylhydrazine-induced rat intestinal neoplasia.

The incidence, distribution, size, and histopathology of rat small and large bowel tumors induced by sequential administration of 1,2-dimethylhydrazine followed by either small bowel resection, 50% jejunoileal resection, or 50% jejunoileal bypass were examined in addition to measurements of transit times and beta-glucuronidase activities in large bowel contents. The results indicate that even limited small bowel resection or bypass promotes intestinal neoplasia, particularly in the large bowel, and this effect seems independent of the chronic injury imposed by suture lines. Although no differences in transit times were observed, increased beta-glucuronidase activities in both cecum and distal colon of resected but not bypassed rats was detected. Moreover, an apparent subsite redistribution of small bowel tumors to ileum and large bowel tumors to more proximal colon in bypassed rats suggests that the mechanisms involved for tumor enhancement differ substantially from those in resected rats.

1,2-Dimethylhydrazine↗
PubMed1982

Management of duodenal diverticula.

Duodenal diverticula are not uncommon. Uncomplicated diverticula require no treatment. In the period 1970 to 1980, 104 patients with symptoms presented at the Vancouver General Hospital and the Swedish Hospital in Seattle. Of these, 26% presented with pain and 24% with anemia. Malabsorption and benign tumours were noted infrequently. Fifteen patients were treated surgically for pain, perforation, hemorrhage, tumour, blind loop syndrome and obstruction of the duodenum, biliary tract or pancreatic duct. Two patients died. The second part of the duodenum was involved in 82% and the third part in 10%. Anatomical variations are common in the area of the ampulla; these should be anticipated before operation. Surgical procedures in the area may be technically demanding and associated with high mortality and morbidity. The choice of procedure depends on the urgency and nature of the complication of the diverticulum. Endoscopic retrograde cholangiopancreatography can play a role in evaluating the possible significance of the diverticulum and the anatomy of the area. In some cases endoscopic sphincterotomy may be possible. In some situations diverticulectomy is contraindicated.

Adult↗
PubMedDate not supplied

Intraductal papillary carcinoma of the pancreas.

We report a case of intraductal papillary adenocarcinoma of the distal pancreatic duct. Although a rare subgroup of exocrine pancreatic tumors, their diagnosis is an important one in view of their favorable prognosis with pancreatectomy. Because of the established behavior of villous tumors of the colon, to which they are similar histologically, these tumors should be resected, even if biopsy shows benign disease. Patients should be followed radiologically for recurrence or the development of new adenoma following resection.

Carcinoma, Intraductal, Noninfiltrating↗
PubMedDate not supplied

Surgical management of dyslipidemia: clinical and experimental evidence.

Coronary artery disease (CAD) is still a major cause of mortality in developed countries, and dyslipidemia is one of its major causes. In an attempt to reduce both mortality and morbidity from CAD, several dietary, pharmacological, and surgical approaches have been used to reduce plasma cholesterol levels. In this brief review, we summarize the evidence for cholesterol-lowering effects and safety of partial ileal bypass (PIB) procedure in both human and animal studies. The results of the Program on the Surgical Control of the Hyperlipidemias (POSCH), which involved a total of 838 subjects with myocardial infarction, are promising. A 5-year follow-up of this study revealed significant reductions of up to 27% in total cholesterol (TC) and up to 42% in low-density lipoprotein (LDL) cholesterol levels along with an increase of up to 8% in high-density lipoprotein (HDL) cholesterol levels as compared to controls. These changes were associated with other benefits such as increased HDL/TC and HDL/LDL ratios, and a significant decrease in apolipoprotein (apo) B100 and increase in apo AI levels. Similar results were also demonstrated by other studies. PIB surgery is one of the most effective methods for reduction of plasma cholesterol levels, particularly in patients with heterozygous familial hypercholesterolemia. This procedure is also applicable to treatment of sitosterolemia, a rare genetic disorder in which the absorption of plant sterols is abnormally high. Although no major complications of this method have been reported, more extensive studies are required to evaluate its long-term effects on renal and hepatic function. Similarly, long-term impact of this procedure on progression/regression of atherosclerotic lesions must be documented. Finally, indications for this procedure should be carefully considered, particularly in view of availability of other treatments of dyslipidemia.

Animals↗
PubMedDate not supplied

Obscure gastrointestinal bleeding from an ampullary tumour in a patient with a remote history of renal cell carcinoma: a diagnostic conundrum.

Metastasis of renal cell carcinoma to the ampulla of Vater is a rare occurrence. The outlined case, which presented as an upper gastrointestinal bleed, is only the eighth such reported case in the English-language literature. This case is the longest reported time interval between surgical nephrectomy to presentation with ampullary metastasis at 17.5 years. The ampullary source of bleeding in this case was initially obscure and missed by conventional gastroscopy. Diagnosis was made with a side-viewing endoscope, emphasizing the usefulness of this instrument in the investigation of active bleeding from a small bowel source.

Aged↗
PubMedDate not supplied

Stapler technique for extrahepatic vascular control during hepatic resection.

A technique is described for extrahepatic division of the hepatic veins and portal structures to be resected utilizing a vascular stapler. The authors have employed this technique in more than 200 consecutive cases of hepatic resection. No major hepatic venous bleeding has been identified.

Hepatic Veins↗
PubMedDate not supplied

Liver tumor ablation techniques.

Despite advances in surgical technique, patients with primary and secondary liver tumors remain a difficult management problem, as most tumors are unresectable at presentation. Alternative therapies, involving the in situ destruction of liver tumors, have recently come under scrutiny as palliative options. Percutaneous ethanol injection and cryosurgery have been advocated, but both have associated technical difficulties and adverse effects. Novel liver tumor ablation techniques have recently been developed that work via the induction of localized hyperthermia. There is mounting evidence to support a hypothesis that cancer cells are more selectively sensitive to heat than are normal cells, due to the poor blood supply of neoplastic tissue and the decreased vasodilatation capacity of the neovascular bed. These ablative modalities induce a variable degree of tumor necrosis in unresectable tumors, and therefore may provide useful palliation. Clinical trials are needed to determine the true nature and degree of any palliative benefit. In addition, the determinants of treatment efficacy and the predictability of the necrotic zone must be better understood before these techniques can be contemplated as alternatives to liver resection for cure.

Cryosurgery↗