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Biomedical subjects

D L Carr-Locke

Publications and source records attributed to D L Carr-Locke.

At least 127 records · Page 7Linked to original sources
PubMed1984

Endoscopic pancreatic and biliary manometry in pancreatic, biliary, and papillary disease, and after endoscopic sphincterotomy and surgical sphincteroplasty.

Endoscopic manometry was used to measure pancreatic duct, common bile duct, pancreatic duct sphincter and bile duct sphincter pressures in 43 healthy volunteers and 162 patients with a variety of papillary, pancreatic and biliary disorders. Common bile duct pressure was significantly raised after cholecystectomy, with common bile duct stones and papillary stenosis but pancreatic duct pressure only in papillary stenosis. After endoscopic sphincterotomy mean common bile duct pressure fell from 11.2 to 1.1 mmHg and pancreatic duct pressure from 18.0 to 11.2 mmHg. Distinct pancreatic duct sphincter and bile duct sphincter zones were identified as phasic pressures of 3-12 waves/minute on pull-through from pancreatic duct and common bile duct to duodenum. Pancreatic duct sphincter pressures were higher with common bile duct stones and stenosis whereas bile duct sphincter pressures were higher in pancreatitis and stenosis. Bile duct sphincter activity was present in 60% of patients after surgical sphincteroplasty but 21% of patients after endoscopic sphincterotomy. Endoscopic manometry facilitated the diagnosis of papillary stenosis, has allowed study of papillary pathophysiology and has shown a functional inter-relationship between the two sphincteric zones.

Adult↗
PubMed1984

Cimetidine therapy does not prevent rebleeding from peptic ulceration.

One-hundred and five patients admitted to hospital with symptoms of acute upper gastrointestinal haemorrhage shown at endoscopy to be due to peptic ulceration were entered into a prospective double-blind controlled trial of cimetidine versus placebo therapy. The trial therapy was commenced within 12 hr of admission and continued for 7 days. Cimetidine therapy made no difference to the transfusion requirements, rebleeding rate or number of operations performed in patients with either gastric or duodenal ulcers, nor was it of benefit in patients aged over 65 years of age.

Aged↗
PubMed1983

Effects of exogenous glucagon on pancreatic and biliary ductal and sphincteric pressures in man demonstrated by endoscopic manometry and correlation with plasma glucagon.

An endoscopic manometric technique was used to investigate the effects of glucagon on pancreatic duct, common bile duct, pancreatic duct sphincter, and bile duct sphincter pressures in 20 healthy volunteers. Glucagon was given by intravenous infusion at rates of 0.016, 0.0625, 0.25, 1.0, 4.0, and 16.0 micrograms/kg/hr and also as an intravenous bolus of 1 mg. Plasma glucagon was measured by radioimmunoassay. Glucagon significantly reduced peak bile duct sphincter pressure from 49.1 +/- 3.7 mm Hg (mean +/- SD) to 37.8 +/- 2.9 mm Hg (P less than 0.01) at a rate of 0.016 microgram/kg/hr, reaching a maximum effect at rates of 0.25 microgram/kg/hr and above. Reduction in pancreatic duct sphincter, pancreatic duct, and bile duct pressures; slowing of sphincter wave frequency; and shortening of wave duration occurred at infusion rates of 1.0 microgram/kg/hr or greater when plasma concentrations were supraphysiological. We conclude that glucagon has a physiological action on the bile duct sphincter but that all other effects on this area are pharmacological.

Adolescent↗
PubMed1983

Radiological demonstration of colonic aphthoid ulcers in a patient with intestinal tuberculosis.

The case is described of a young Asian woman with massive rectal haemorrhage during and after pregnancy. Barium radiology showed aphthoid ulcers in the colon and changes in the ileum suggesting tuberculosis. Colonoscopy revealed hyperplastic ulceration in the terminal ileum and culture of biopsies from this area grew Mycobacterium tuberculosis. The patient made a full and rapid recovery on anti-tuberculous therapy. Colonic aphthoid ulceration has not previously been recorded, radiologically, in intestinal tuberculosis.

Adult↗
PubMed1982

Broncho-oesophageal fistula: a late complication of endoscopic variceal sclerotherapy.

A case is reported of delayed broncho-oesophageal fistula presenting several weeks after fibreoptic injection sclerotherapy for oesophageal varices in a patient with chronic active hepatitis who eventually died from bronchopneumonia. Such serious complications of injection sclerotherapy should be kept in mind with the increasing popularity of this method of early treatment of bleeding oesophageal varices.

Bronchial Fistula↗
PubMed1982

Sulfasalazine-induced lupus syndrome in a patient with Crohn's disease.

The case is described of a young woman with Crohn's disease of the rectum and terminal ileum in whom systemic lupus erythematosus syndrome was diagnosed after 3 yr of symptoms and 4 yr treatment with sulfasalazine. Polyarthralgias and pleuritic chest pains resolved and leucopenia, anemia, and high titers of antinuclear and DNA antibodies returned to normal after withdrawal of the drug. No HLA antigen association was found but a slow acetylation phenotype was present. Consideration should be given to this complication of sulfasalazine therapy in patients with inflammatory bowel disease in whom arthropathy or other features of lupus syndrome appear after treatment is instituted.

Adolescent↗
PubMed1982

Massive bleeding from the ileum: a late complication of pelvic radiotherapy.

Recurrent massive hemorrhage from the ileum as a late complication of radiotherapy has not previously been documented. We describe two patients with a history of pelvic radiotherapy 18 months and 11 yr before, in whom the source of melena was localized to the small bowel preoperatively. Characteristic serosal appearances of ileal radiation injury were present at laparotomy and resection of the terminal ileum controlled the hemorrhage. Pathological study revealed no ulceration but multiple telangiectatic vessels in the tips of mucosal villi. This cause should be considered in patients with obscure gastrointestinal bleeding previously exposed to pelvic radiotherapy.

Aged↗
PubMed1981

Endoscopic manometry of pancreatic and biliary sphincter zones in man. Basal results in healthy volunteers.

An endoscopic manometric technique was applied to the study of intraductal biliary and pancreatic pressures and sphincter activity in normal subjects. A perfused system using a modified endoscopic retrograde cholangiopancreatography catheter was tested and found to provide reliable ductal and phasic recordings. Twenty-five healthy volunteers, aged 19-37, underwent endoscopic manometry under diazepam sedation. Distinct zones of high-pressure phasic activity were identified on pull-through from the pancreatic duct and common bile duct at mean distances of 4.5 and 5.0 mm, respectively, from the papillary orifice with frequencies of 7.0 +/- 1.8 (mean +/- SD) and 5.6 +/- 2.4 waves/min, respectively. These were considered to represent separate pancreatic duct and bile duct sphincters. Peak pancreatic duct sphincter pressure (47.6 +/- 8.2 mm Hg) and bile duct sphincter pressure (57.2 +/- 10.7 mm Hg) were similar. Pancreatic duct pressure was 11.4 +/- 3.0 mm Hg and common bile duct pressure was 3.0 +/- 2.5 mm Hg. Values were adjusted to duodenal pressure as zero reference. The ductal and sphincteric pressures reported in this study provide a basis for the assessment of physiological, pharmacological, pathophysiological, and surgical effects on this area.

Adult↗
PubMed1981

Importance of common bile duct stricture associated with chronic pancreatitis. Diagnosis by endoscopic retrograde cholangiopancreatography.

Twenty-one patients with common bile duct strictures associated with chronic pancreatitis are described in whom ERCP was the principal diagnostic method used. In 5 of the 11 patients who had had previous pancreatic or biliary surgery, a common bile duct stricture was overlooked. Nine patients had one or more attacks of cholangitis which were severe in seven and caused death in one. Endoscopically aspirated bile cultures showed heavy gram-negative infection in four patients with previous cholangitis. Two patients developed stones above the strictures, and in one this led to obstruction of a previous cholecystjejunostomy. Although strictures may be discovered at an asymptomatic stage, there should be careful follow-up to detect the appearance of any symptoms or objective signs of stricture progression, when surgery should be offered without delay. Direct biliary-enteric anastomosis is the procedure of choice when possible to relieve symptoms and prevent the potentially life-threatening complications of cholangitis and septicemia.

Adult↗
PubMed1980

The value of the new interpretation of the insulin test in predicting duodenal ulcer relapse after treatment with cimetidine.

Twenty-one patients with duodenal ulcer were treated with cimetidine. After 2 weeks they were submitted to an insulin test and the results were compared with a range of secretion previously established in untreated duodenal ulcer patients (1). The secretion of 13 patients fell within this range and so they were predicted to have a high risk of relapse. The patients whose secretion was below the range had a predicted low risk of relapse. After 4 weeks' treatment repeat endoscopy showed that 4 ulcers had failed to heal. The secretion of 3 of the patients was within the range of the high risk group. The remaining 17 patients were followed up (range 20-23 months): 9 relapsed and 8 remained symptom-free. Eight of the 9 were in the high risk group and 6 of the 8 symptom-free patients were in the low risk group. In all, 11 out of 13 were correctly predicted in the high risk group and 6 out of 8 in the low risk group. The performance of the insulin test in predicting liability to relapse following cimetidine treatment was significant (P = 0.0225).

Cimetidine↗
PubMed1980

Pancreatic juice gamma-glutamyltransferase, alanine transaminase, and alkaline phosphatase in pancreatic disease.

Pancreatic juice gamma-glutamyltransferase (GGT, EC 2.3.2.2) has been proposed as a marker of pancreatic disease. We have collected pancreatic juice endoscopically from 24 control patients and 43 patients with a variety of hepatic, pancreatic, and biliary disorders. Pancreatic juice GGT, alanine transaminase (ALT, EC 2.6.1.2), and alkaline phosphatase (ALP, EC 3.1.3.1) were measured and found to be present in all samples. GGT was significantly higher in patients with pancreatic cancer (range 21-1175 IU/liter, P less than 0.005) compared with controls (range 2-52 IU/liter). Of 17 patients with pancreatic juice GGT concentrations greater than 52 IU/liter, eleven had definite pancreatic disease (seven pancreatic cancer, four chronic pancreatitis) and, in the remaining six, pancreatitis was possible although not proven. Pancreatic juice ALT and ALP provided no useful diagnostic criteria. GGT in pancreatic juice seems to be a nonspecific marker of pancreatic disease and merits further study.

Alanine Transaminase↗
PubMed1980

Serum and pancreatic juice carcinoembryonic antigen in pancreatic and biliary disease.

Serum and pancreatic juice carcinoembryonic antigen (CEA) concentrations were studied in a group of 144 patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) with a variety of benign and malignant pancreatic and biliary diseases. Serum CEA was found to be a poor diagnostic and discriminating marker for pancreatic disorders and was raised in obstructive jaundice from various causes correlating with serum alkaline phosphatase. A pancreatic juice CEA concentration of greater than 106 mcg/l was associated with pancreatic disease but did not distinguish benign from malignant lesions. Criteria derived from pancreatic juice volumes and bicarbonate responses provided additional diagnostic differentiation of normal from pancreatic disease but not cancer from pancreatitis. Pancreatic juice CEA may have a limited application where imaging techniques have failed or are not available and additional study of pancreatic juice biochemistry is required before adequate diagnostic criteria can be established.

Biliary Tract Diseases↗
PubMed1980

Endoscopy and endoscopic retrograde cholangiopancreatography findings in traumatic liver injury and hemobilia.

A case of posttraumatic hemobilia is described in which endoscopy provided the initial diagnosis. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) demonstrated an abnormality in the left hepatic duct considered to be due to a traumatic aneurysm or abscess cavity. Selective angiography confirmed the presence of an aneurysm of the right hepatic artery at the same site as shown on ERCP. Management was conservative despite massive and prolonged episodes of gastrointestinal bleeding in view of the severe initial liver injury sustained.

Adult↗