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Biomedical subjects

D R Cave

Publications and source records attributed to D R Cave.

At least 37 records · Page 2Linked to original sources
PubMed1996

Complete intraoperative small-bowel endoscopy in the evaluation of occult gastrointestinal bleeding using the sonde enteroscope.

OBJECTIVE: To review our experience with intraoperative small-bowel Sonde enteroscopy in evaluating occult bleeding in the small intestine. DESIGN: Retrospective study with 100% follow-up. SETTING: University-affiliated, tertiary-care teaching hospital. PATIENTS: Sixteen consecutive patients referred with occult gastrointestinal bleeding in whom esophagogastro-duodenoscopy , push enteroscopy, and colonoscopy had failed to identify the source of bleeding. Fourteen of the 16 patients had required one or more transfusions. MAIN OUTCOME MEASURE: Completeness of visualization, diagnostic accuracy, and complications of the procedure and follow-up for recurrent bleeding. RESULTS: In all 16 patients, intraoperative Sonde enteroscopy allowed visualization of the entire small bowel. In 14 of the 16, it revealed the cause of bleeding, which was ileal angiodysplasia in three patients, ileal ulcers in six patients, neoplasia in two patients, and ileal ulcers caused by Crohn's disease, small-intestinal enteropathy and varices caused by portal hypertension, and radiation stricture in one patient each. Two patients had normal small bowel mucosa. The patients with mucosal disease underwent small-bowel resection or oversewing of bleeding sites. Two surgical complications occurred: prolonged postoperative ileus (one patient) and small-bowel obstruction that resolved without surgery (one patient). Two of the patients with angiodysplasia had recurrent bleeding postoperatively. CONCLUSIONS: Intraoperative Sonde enteroscopy is safe and effective in localizing small-intestinal bleeding sites, providing complete visualization of the small-bowel mucosa without enterotomy while avoiding the trauma that can be caused by push endoscopy. It is the diagnostic assessment of choice in selected patients with occult gastrointestinal bleeding of presumed small-bowel origin.

Adult↗
PubMed1996

One-stage retrograde approach to Nd:YAG laser palliation of esophageal carcinoma.

BACKGROUND AND STUDY AIMS: The aim of the present study was to determine the safety, efficacy, and feasibility of a one-stage retrograde approach to Nd:YAG laser palliation of esophageal carcinoma carried out under general anesthesia. PATIENTS AND METHODS: Endoscopic Nd:YAG laser therapy was used on 150 occasions in 62 consecutive patients with advanced malignant obstruction of the esophagus. All procedures were carried out under general anesthesia. The lesion was first dilated using a Savary-Gilliard dilator or balloon technique, and the endoscope was then passed beyond the lesion. Laser energy was applied to the lesion in a circumferential manner as the scope was withdrawn along the length of the lesion, until an adequate lumen was established. RESULTS: Ninety-three percent of the patients had symptomatic improvement, defined as reduction in the subjective dysphagia grade, and only 14% of the patients required repeat procedures within 30 days. Fifty percent of the patients experienced effective palliation with only one procedure over the entire course of their illness. In patients with recurrent dysphagia, the mean time between procedures was 100 days. Seventy-six percent of the patients were discharged on the day following the procedure. Complications included the development of pneumomediastinum or subcutaneous emphysema in five cases, and esophageal perforation in two cases. All cases of pneumomediastinum or subcutaneous emphysema or perforation were managed by conservative therapy. Hemorrhage requiring transfusion occurred in two cases. There were three apparently procedure-related deaths occurring within 30 days of the initial procedure. CONCLUSIONS: Effective palliation of obstructing esophageal carcinoma can be achieved in one session using a one-stage retrograde approach with the Nd:YAG laser under general anesthesia. When compared to other palliative modalities, this method produces a longer dysphagia-free interval, and patients with a terminal illness are therefore able to spend more time out of hospital.

Adult↗
PubMed1996

Intraoperative enteroscopy. Indications and techniques.

This article reviews the role on intraoperative enteroscopy (IOE) in the management and evaluation of patients with chronic transfusion-dependent gastrointestinal bleeding who have not responded to standard diagnostic and therapeutic techniques. Intraoperative enteroscopy may be performed with a standard or pediatric colonoscope, push enteroscope, or a sonde enteroscope at the time of laparotomy. IOE techniques as well as indications, diagnostic and therapeutic capabilities, and complications of this procedure are discussed.

Diagnosis, Differential↗
PubMed1995

Rabbit and ferret parietal cell inhibition by Helicobacter species.

We tested sonicates of Helicobacter pylori, H. mustelae, and H. felis for inhibition of acid secretion in rabbit and ferret isolated gastric glands. Three H. pylori strains, two of three H. mustelae strains, and two H. felis strains significantly inhibited acid secretion in rabbit cells by 95.2-93.3%, 55.9% and 96.4%, and 83.4-96%, respectively. All Helicobacter strains examined inhibited acid secretion by ferret cells by 65.3-76.8%, 89.1-97.6%, and 85.8-92.8%. H. pylori inhibited acid secretion after stimulation with histamine and isobutylmethylxanthine or with 8-bromo-cyclic adenosine monophosphate (P < 0.05 for all tests). These findings demonstrate that acid inhibition is a property common to the three Helicobacter species tested. It occurs independently of the mammalian origin of the parietal cell, and it does not involve blockade of histamine-2 receptors.

1-Methyl-3-isobutylxanthine↗
PubMed1991

Use of esmolol to control autonomic instability of tetanus.

Tetanus is often accompained by autonomic instability, rendering hemodynamic management difficult. Death is frequently secondary to an inability to control this instability. A variety of modalities have been used to stabilize the cardiovascular system, but all are not ideal. Esmolol offers theoretical advantages over other modalities. We report a case of severe tetanus in which a continuous infusion of esmolol was effective in controlling the autonomic instability.

Adrenergic beta-Antagonists↗
PubMed1991

Inhibition of acid secretion from parietal cells by non-human-infecting Helicobacter species: a factor in colonization of gastric mucosa?

Helicobacter pylori has been shown to produce a protein that inhibits acid secretion from parietal cells. We have examined other non-human-infecting Helicobacter species for this property by measuring the uptake of [14C]aminopyrine into rabbit parietal cells as an indirect assessment of acid secretion. Helicobacter felis and an isolate from a rhesus monkey were shown to inhibit acid secretion. Isolates of Helicobacter mustelae gave variable responses. Whole bacteria and cell-free sonicates impaired the uptake of [14C]aminopyrine. We also tested other bacteria, including Escherichia coli, Proteus vulgaris, Klebsiella oxytoca, and Campylobacter jejuni. As whole organisms, these control bacteria had little effect on acid secretion, but sonicates caused pronounced inhibition that was partially heat labile. Pronase treatment of H. pylori destroyed its inhibitory effect. These results suggest that most Helicobacter species, but not all isolates, are able to inhibit acid secretion from rabbit parietal cells. This property may be a factor in the establishment of long-term infection by these species.

Aminopyrine↗
PubMed1991

Helicobacter pylori stimulates pepsin secretion from isolated rabbit gastric glands.

In man, type-B gastritis caused by Helicobacter pylori has been associated with both increased serum pepsinogen in the presence of hypochlorhydria and increased levels of gastric pepsin. We investigated the effect of H. pylori on pepsinogen secretion in vitro and found that a sonicated preparation of H. pylori increased pepsinogen secretion from isolated rabbit gastric glands. This increase was significant after 5 min (p = 0.001), and maximum secretion was obtained after 30 min of incubation. The effect was additive to the secretion achieved by stimulation with carbachol at 10(-4) M plus 10(-4) isobutylmethylxanthine or 10(-8) M cholecystokinin. There was no detectable stimulation of pepsinogen synthesis by 2 h. Lactate dehydrogenase (LDH) release was assayed as an index of cell damage, and no significant LDH release was noted. The secretory factor in the H. pylori sonicate is inhibited by boiling, unaffected by heating at 60 degrees C for 30 min, dialysable, and inactivated by pronase. These data suggest that H. pylori stimulates pepsinogen secretion by a mechanism different from that of other tested stimulants. H. pylori-stimulated pepsinogen release may be a factor in the etiology of type-B gastritis and peptic ulcers.

Analysis of Variance↗
PubMed1989

Effect of a Campylobacter pylori protein on acid secretion by parietal cells.

The uptake of [14C]-aminopyrine by rabbit gastric epithelial cells was used as an indirect assay for acid secretion from parietal cells. Campylobacter pylori strains, isolated from the stomachs of 3 patients with chronic gastritis, duodenal ulcer, and near-normal mucosa, respectively, inhibited acid secretion as effectively as 10(-4) mol/l cimetidine. The inhibition occurred with whole organisms and with sonicates. Preliminary characterisation suggested that the inhibition was due to a nondialysable protein. The inhibitor was not toxic to gastric epithelial cells. This bacterial product may explain the hypochlorhydria seen in man acutely infected with C pylori.

Aminopyrine↗
PubMed1989

Response to Simko.

Explore the source record for details and available documents.

Esophageal Neoplasms↗
PubMed1988

Palliative laser therapy of advanced esophageal carcinoma: an alternative perspective.

Endoscopic Nd:YAG laser therapy was used on 91 occasions in 26 consecutive unselected patients with advanced malignant obstruction of the esophagus. Patients were treated predominantly by the retrograde method after initial esophageal dilatation. Laser therapy was effective in restoring esophageal luminal patency. However, luminal patency did not guarantee restoration of adequate oral nutritional intake. Twenty-seven percent of patients required additional nutritional support. Twenty-six percent of procedures were complicated by significant events, predominantly cardiorespiratory. Six deaths occurred within 30 days of laser therapy. Mean survival from time of first laser therapy was 16 wk. We conclude that laser therapy of malignant esophageal obstruction provides effective palliation of dysphasia; however, in older patients with advanced disease, this therapy often results in complications, as do other methods of treatment for this condition.

Adenocarcinoma↗