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Biomedical subjects

D A Howell

Publications and source records attributed to D A Howell.

11 recordsLinked to original sources
PubMed1992

Symptomatic choledochoceles in adults. Endoscopic retrograde cholangiopancreatography recognition and management.

During a 2-year interval, we identified 10 patients with symptoms of pancreaticobiliary disorders and small choledochoceles by endoscopic retrograde cholangiopancreatography. Patients ranged from 36 to 89 years of age. Eight were female. Seven presented with recurrent, acute pancreatitis, two presented with biliary colic, and one presented with cholangitis. Dilated common bile ducts were seen in four patients, and no other biliary lesions were demonstrated in any patients. Five patients were shown to have normal gallbladders by ultrasonographic or computed tomographic criteria. Choledochoceles were identified endoscopically as a bulge above or involving the ampulla. Diagnosis was confirmed by cholangiography. All patients underwent successful unroofing of the choledochocele and sphincterotomy of the common bile duct. One pancreatic sphincterotomy was performed for pancreatic ductal obstruction. We encountered no complications. Hospital stays ranged from 1 to 4 days. Follow-up intervals ranged from 2 to 20 months. At this time, no patients have had any recurrence of symptoms, and none has required rehospitalization or surgery.

Adult↗
PubMed1992

Endoscopic management of cystic duct fistulas after laparoscopic cholecystectomy.

Two patients are reported who developed bile ascites as a result of cystic duct fistulas following laparoscopic cholecystectomy. Both patients were successfully treated with endoscopic retrograde cholangiopancreatography, utilizing sphincterotomy and nasobiliary tube placement. Characteristics of this syndrome and advantages of this form of therapy are emphasized.

Adult↗
PubMed1979

Olfactory mucosa in herpes simplex encephalitis.

The olfactory mucosa was examined in three patients dying from herpes simplex encephalitis. It showed changes attributed to infection by the herpes simplex virus. It is suggested that in some patients encephalitis may be a complication of infection of the olfactory mucosa.

Adult↗
PubMed1979

Spinal internuncial neurones in progressive encephalomyelitis with rigidity.

The clinical and pathological features of a fourth patient with progressive encephalomyelitis with rigidity are reported and compared with those previously described. It is suggested that the muscular rigidity, abnormal postures, painful muscular spasms, and myoclonus are a product of excessive and abnormal discharges of alpha motor neurones caused by their release from control by spinal internuncial neurones. A count of neuronal perikarya in the ventral horns confirmed that the disease selectively destroyed small and medium sized neurones, most of which were spinal internuncial neurones. Experimental, clinical, and pathological evidence concerning spinal internuncial neurones is reviewed and found to conform to this theory. The pathogenesis of opsoclonus may be similar.

Astrocytes↗
PubMed1975

Observations on radiation myelopathy.

Three cases of radiation myelopathy are reported. Corticosteroid therapy was associated with worth-while remissions in 2 patients. Two patients showed swelling of the spinal cord in myelograms and in one it extended below the irradiated part of the spinal cord. Demyelination of the dorsal white columns of the spinal cord unaccompanied by vascular abnormality was seen below the irradiated part of the cord. It is suggested that radiation damages the endothelial cell barrier of capillaries and arterioles after a latent interval. Proteinous oedema fluid spreads through the white matter from the capillaries and also into the arteriolar walls narrowing these vessels enough to cause local ischaemia and infarction. It is further suggested that apart from ischaemia and infarction myelin is also damaged by poor nutrition associated with oedema fluid, and that radiation damage to oligodendroglial cells is not the cause of this additional demyelination in patients with radiation myelopathy.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Endoscopic needle aspiration biopsy at ERCP in the diagnosis of biliary strictures.

We have developed a ball-tipped catheter with a retractable 22-gauge, 7-mm long needle to perform endoscopic needle aspiration (ENA) for cytology and compared this technique to brush cytology of malignant-appearing biliary strictures during ERCP. Of 31 patients, 26 had proven malignant strictures involving the common bile duct and 5 had benign lesions. All 31 patients had ENA and 29 were brushed. Positive ENAs were obtained in 16 of 26 patients (61.5%) and positive brushings in 2 of 24 (8.3%). With the addition of two suspicious ENAs for pancreatic adenocarcinoma, 73% of patients had positive or suspicious cytology for malignancy by combined ENA and brush with a specificity of 100%. Although ENA appeared to be more sensitive in diagnosing cholangiocarcinoma, it proved to be most effective in the diagnosis of pancreatic adenocarcinoma when compared with brush cytology. One patient with cholangiocarcinoma in our series was diagnosed by brush cytology only, with a negative ENA, supporting our recommendation of using both endoscopic brushings and ENA for cytology when evaluating biliary strictures.

Adenocarcinoma↗