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Biomedical subjects

C J Fagan

Publications and source records attributed to C J Fagan.

At least 19 recordsLinked to original sources
PubMed1992

Cholelithiasis associated with medroxyprogesterone acetate therapy in men.

Five out of forty-five adult men, 50 years of age or less, who had received, for at least six months, medroxyprogesterone acetate (MPA, Depo Provera) IM, 200-400 mg/week, for prevention of sex-offending or genital-mutilating behavior developed symptomatic cholelithiasis. Thirty of these men were studied with gallbladder ultrasound prospectively off MPA and at six-month intervals while taking the medication and then six months off MPA. Gallstones recovered from two patients were found to have very high cholesterol content, suggesting they were formed in cholesterol supersaturated bile. These findings are consistent with the increased incidence of gallbladder disease related to high-progesterone states and suggest that MPA may be a causative agent in cholelithiasis. The physiologic studies on gallbladder contraction and cholecystokinin release in a subset of the patients failed to provide information on a mechanism for the possible increased incidence of gallbladder disease.

Adult↗
PubMed1988

Pseudocyst following splenectomy: impact of CT and ultrasound on its diagnosis and management.

Three cases of pseudocysts occurring after splenectomy are presented. Sonography and computed tomography were helpful in diagnosing the pseudocysts as well as providing guidance for subsequent drainage. Demonstration of a cystic mass adjacent to the tail of the pancreas following splenectomy suggests the diagnosis of postsplenectomy pseudocyst and has important implications for clinical management.

Adult↗
PubMed1987

Correlation of cholecystokinin receptors with gallbladder contractility in patients with gallstones.

The authors have previously identified two groups of patients with gallstones: those whose gallbladders contract the same as those of normal volunteers and show an increased sensitivity to endogenous cholecystokinin (CCK) ("contractors") and those whose gallbladders are relatively unresponsive ("noncontractors"). To define the mechanism responsible for these differences in contractility, the authors have measured CCK receptors on gallbladder muscle of patients with gallstones. Twenty-three patients with gallstones and 10 healthy volunteers (controls) fasted overnight. Simultaneous plasma samples for radioimmunoassay of CCK release and ultrasonographic measurements of gallbladder volume were obtained before and at intervals for 60 minutes after ingestion of Lipomul. Patients with gallstones had cholecystectomy, and CCK receptors were determined on cell membranes from gallbladder specimens by use of radiolabeled analogs of CCK-8-SO4. Histologic sections were graded for the degree of inflammation and scarring. Thirteen patients with gallstones were identified as contractors and 10 as noncontractors. Basal gallbladder volumes were not significantly different between patients in either group. The total integrated output of CCK for contractors was 1.6 +/- 0.2 ng X min/ml compared with 5.5 +/- 1.2 ng X min/ml for controls, while the integrated output for noncontractors was 11.1 +/- 2.1 ng X min/ml. Contractors had a higher number of CCK-binding sites (27.6 +/- 6.8 fmol/mg protein) than did noncontractors (4.8 +/- 1.0 fmol/mg protein). CCK receptors in gallbladders of all patients with gallstones correlated closely with gallbladder motility (y = 1.149, x = 0.624, r = 0.7, p less than 0.001). Although contractors had more mild inflammation and scarring, 40% of noncontractors had mild inflammation and scarring; there was no correlation. A decrease in CCK receptors may be an early event in the pathogenesis of gallstone formation by causing a decrease in gallbladder motility in some patients.

Adult↗
PubMed1987

Potential placenta previa: definition, frequency, and significance.

Sixty-three (5%) of 1239 women studied by sonography during the second trimester of their pregnancies had a diagnosis of placenta previa. Follow-up was available for 51 of the 63 patients; in three of these, the original diagnosis was complete placenta previa, and in the other 48, the first diagnosis was partial or marginal placenta previa. At term, placenta previa was seen in only four patients for an overall frequency of 0.3% (4/1227). In all three of the patients with complete placenta previa, the condition persisted from the second trimester to term; previa persisted in only one of 48 patients with marginal/partial previa. Because of the infrequent persistence of marginal or partial placenta previa to term, we recommend using the term "potential placenta previa" in the second trimester, with follow-up sonography indicated only for vaginal bleeding.

Female↗
PubMed1987

Chronic ectopic pregnancy. A comparison with acute ectopic pregnancy.

An ectopic tubal pregnancy that undergoes repeated minor ruptures instead of a single episode of rapid bleeding frequently develops into a pelvic hematocele. The hematocele, which contains old blood, clots and gestational tissue, is surrounded by adhesions and is misleadingly called a "chronic" ectopic pregnancy. The term "chronic" describes only the appearance of the pelvic mass and does not necessarily imply chronicity of duration. Its incidence was 28% in our series of 149 ectopic pregnancies. Fifty percent of our patients with chronic ectopic pregnancy had a negative serum beta human chorionic gonadotrophin (HCG). This entity has a sonographic appearance distinctly different from acute ectopic pregnancy.

Acute Disease↗
PubMed1986

Ruptured uterus: sonographic diagnosis.

Sonography was able to suggest a diagnosis of uterine rupture by demonstrating intra- or extraperitoneal hematoma in the correct clinical setting. A pelvic abscess complicating a uterine rupture was seen in one case. Previous uterine scar, use of prostaglandins for induction of labor, trauma with a currette, and cornual pregnancy were the implicated etiologic factors. Although the rupture site was never directly visualized by sonography, the combination of sonographic and clinical findings was strongly suggestive of the correct diagnosis.

Abscess↗
PubMed1986

Indium-111 leukocyte scanning. False-negative study in a renal abscess.

A 33-year-old man had clinical features of a right renal abscess. Results of excretory urography and ultrasonography showed a focal complex mass lesion in the right kidney. An In-111 leukocyte scan failed to detect the right renal abscess, which later was aspirated under CT guidance and explored surgically. The role of In-111 leukocyte imaging in the detection of intra-abdominal abscesses, with limitations of the procedure, is discussed.

Abscess↗
PubMed1986

Sonographic findings in abdominal pregnancy.

The sonograms of 20 proven cases of abdominal pregnancy were evaluated to determine the frequency of specific abnormalities associated with this condition. The most frequent and reliable finding was separation of the uterus from the fetus (90%). Extrauterine placenta (75%) and oligohydramnios (45%) were next in frequency. Other features such as fetal parts close to the maternal abdominal wall (25%), failure to visualize myometrium between the fetus or placenta and maternal bladder (15%), abnormal fetal lie (25%), poor visualization of the placenta (25%), and maternal bowel gas impeding fetal visualization (25%) were noted.

Adult↗
PubMed1986

Sonographic demonstration of bladder-flap hematoma.

A bladder-flap hematoma is generally thought of as a blood collection in a potential space located between the urinary bladder and lower uterine segment (vesicouterine space). These collections can also extend over the bladder and uterus beneath the peritoneal reflection. In this study, ten patients with a bladder-flap hematoma were evaluated for fever, mass, or dropping hematocrit after surgery. No one sonographic appearance is specific for bladder-flap hematoma; however, the diagnosis can be made by finding a mass in the extraperitoneal pelvic space in the postoperative patient.

Cesarean Section↗
PubMed1985

Sonographic diagnosis of bowel obstruction presenting with fluid-filled loops of bowel.

When intestinal obstruction presents with fluid-filled bowel loops instead of air-distended loops, subtle elongated masses representing these bowel loops may be missed on plain abdominal radiographs. In these cases, ultrasound will show sausage-shaped, cystic structures, with uneven margins representing mucosal folds, distributed throughout the abdomen and sometimes accompanied by peristalsis. These features differentiate fluid-filled bowel loops from other cystic structures in the abdomen and help make a diagnosis of bowel obstruction.

Adult↗
PubMed1985

The role of neurotensin in human gallbladder motility.

Gallbladder contraction in response to a fatty meal is thought to be caused by release of cholecystokinin (CCK). We have previously demonstrated a close correlation between circulating concentrations of CCK and contraction of the gallbladder in normal humans and in gallstone patients. Recent studies in animals, however, have shown that other potentially cholecystokinetic hormonal agents are released by a fatty meal, which suggests that other hormones may be involved in postprandial gallbladder contraction. Neurotensin, a 13-amino acid peptide, is released by fat; we have shown it to cause gallbladder contraction in dogs. In the present study, we measured release of neurotensin in seven normal adult volunteers. We determined the effects of infused neurotensin (4 pmol/kg-min) on gallbladder contractility, measured by ultrasonography in 10 adult volunteers, and we evaluated release of neurotensin in eight patients with gallstones. After ingestion of fat, we found significant release of neurotensin in normal volunteers from a mean basal concentration of 15.9 +/- 3.5 pg/ml to a maximum of 34.7 +/- 0.2 pg/ml. In the gallstone patients after fat ingestion, neurotensin rose from a basal of 16.8 +/- 3.1 pg/ml to a maximum of 53.4 +/- 28.1 pg/ml, which was a significantly greater release than in controls. Intravenous infusion of neurotensin produced dilatation of the gallbladder (from a mean basal volume of 13.7 +/- 2.3 cc to 20.0 +/- 1.8 cc). Neurotensin causes relaxation of the gallbladder in humans and, by contributing to stasis, may be involved in the formation of gallstones.

Adult↗
PubMed1985

Correlation of in vitro measurements of contractility of the gallbladder with in vivo ultrasonographic findings in patients with gallstones.

The objective of this study was to examine the in vitro responsiveness to cholecystokinin-8 of gallbladder muscle strips from patients with gallstones and to correlate the findings with preoperative ultrasonographic studies of gallbladder contractility. The response of gallbladder muscle strips to cholecystokinin-8 of patients with noncontracting gallbladders was significantly reduced in comparison to that of patients with gallstones whose gallbladders contracted in response to fat.

Cholelithiasis↗
PubMed1985

Effect of aging on gallbladder contraction and release of cholecystokinin-33 in humans.

The objective of this study was to examine the effect of aging on gallbladder contraction and cholecystokinin (CCK) release, as well as on the correlation between the two in humans who are free of gallbladder disease. Twenty-nine human volunteers were divided into a young group of 14 individuals (ages 22 to 42 years, median age 32 years) and an older group of 15 individuals (ages 60 to 84 years, median age 66 years). In the study each person in both groups was given corn oil (Lipomul), 1.5 ml/kg, by mouth after an overnight fast. Blood was collected for measurement of CCK-33 by radioimmunoassay before and at intervals after ingestion of Lipomul. Simultaneous measurements of gallbladder volume were obtained by real-time varian ultrasonography. Both fasting and fat-stimulated concentrations of CCK in plasma were significantly higher in the older individuals than in the younger volunteers. The 60-minute integrated measurement of CCK release was significantly increased in the older people as compared with the young. Both fasting and maximally contracted gallbladder volumes were equal in the older and younger groups. The rate of emptying of the gallbladder was equal in both age groups, but the gallbladders of older people appeared to show an earlier initiation of contraction. The highly significant correlation of gallbladder contraction with levels of CCK was similar in both age groups, but the sensitivity of the gallbladder to CCK in the older people was significantly decreased. In conclusion, both fasting and fat-stimulated plasma levels of CCK increase with aging. The sensitivity of the gallbladder muscle to stimulation by CCK is diminished with age, but this appears, teleologically, to be matched by the increased release of CCK, so the kinetics of gallbladder emptying are little different in the aged.

Adult↗
PubMed1984

Adult Wilms' tumor: clinical and radiographic features.

The clinical and radiographic features of Wilms' tumor in 4 adult patients are described. Wilms' tumors in adults are usually bulky and contain numerous areas of necrosis and hemorrhage, imparting a complex appearance to the lesion on sonography and computed tomography. Angiography reveals the tumor to be hypovascular with some neovascularity. No specific features of the lesion differentiate it from hypernephroma. In contrast to the childhood variety, Wilms' tumors in adults have ill-defined margins and frequently extend into the retroperitoneum. Their treatment is the subject of debate and prognosis is poor.

Adult↗
PubMed1984

Chronic ectopic pregnancy.

A chronic ectopic pregnancy is a form of tubal pregnancy in which there is gradual disintegration of the tubal wall with slow and/or repeated episodes of hemorrhaging leading to the formation of a pelvic mass. A review of 22 pathologically proven cases of this entity revealed the pelvic mass to be a hematocele, or a sealed-off inflammatory mass composed of blood clots, organized hematomas, and surrounding adhesions. Sonographically, the abnormality is manifested by an extrauterine, complex mass in the adnexa(e) and cul-de-sac. The mass may obliterate uterine margins and be confused for pelvic inflammatory disease, endometriosis, or uterine leiomyomas. With an increased awareness of this entity and its mildly symptomatic and protracted clinical course, a preoperative diagnosis should be possible.

Chronic Disease↗