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Biomedical subjects

E B Keeffe

Publications and source records attributed to E B Keeffe.

At least 145 records · Page 8Linked to original sources
PubMed1986

Serum gamma-glutamyl transpeptidase activity in patients receiving chronic phenytoin therapy.

To better define the incidence and range of elevated gamma-glutamyl transpeptidase (GGT) activity in patients taking a drug known to induce hepatic microsomal enzymes, GGT was measured in the sera of 58 patients before and after six months of phenytoin therapy. Enzyme activity at six months was greater than baseline in 52 of 58 patients (90%). GGT activity (normal, 0-50 units/liter) was 45.2 +/- 9.9 (mean +/- SEM) at baseline and 135.8 +/- 18.1 after six months of therapy, a mean threefold increase (P less than 0.001). Of the 45 patients with normal baseline GGT activity, some had marked elevation of serum GGT activity with values rising over 200 units/liter in eight patients and over 300 units/liter in four patients. Mean serum GGT activity remained significantly elevated at 12 and 24 months. This elevation in GGT activity was not influenced by age, sex, or additional anticonvulsant drug therapy. Both baseline and six-month GGT activity was lowest in patients who drank no alcohol, higher in patients who drank 0-1 pint/week, and greatest in patients who drank greater than 1 pint/week. All 13 patients with elevated baseline GGT activity were regular users of alcohol and/or taking other enzyme-inducing drugs. In conclusion, increase in serum GGT activity occurs in 90% of patients on long-term phenytoin therapy, most often to moderate but occasionally to high levels, and this rise in GGT activity is accentuated by regular consumption of alcohol.

Adult↗
PubMed1986

Clinical approach to viral hepatitis in homosexual men.

The prevalence of both hepatitis A and hepatitis B is increased in homosexual men. On an annual basis, 5% to 7% of homosexual men will acquire hepatitis A. Risk factors for HAV infection include length of homosexual activity, number of sexual contacts, and oral--anal sexual contact. The HBsAg carrier rate of homosexual men is 5% to 6%, and another 50% have evidence of previous HBV infection with a positive anti-HBs. HBeAg is present in a higher precentage of HBsAg-positive homosexual men (38% to 75%) than in general population carriers (3% to 30%). The annual incidence for HBV infection in homosexual men is 16% to 28%, higher than that for hepatitis A. Transmission of HBV infection in homosexual men is facilitated by a large number of sexual partners, high HBsAg carrier rate, high infectivity of carriers (positive HBeAg), and the specific sexual practices of oral--anal and anal--genital contact with exposure to HBV on open mucosal surfaces. The prevalence of non-A, non-B and delta infection in homosexual men is probably somewhat increased, but the importance of these viruses in the development of hepatitis in this population remains uncertain. Prevention of hepatitis A and B in homosexual men will ultimately be achieved by vaccination of susceptible individuals, which currently is feasible only for hepatitis B. Appropriate use of immune globulins for postexposure prophylaxis and knowledge of specific sexual practices that transmit disease may reduce the incidence of hepatitis A and B.

Hepatitis A↗
PubMed1986

Adenomatous polyp arising in Barrett's esophagus.

A 40-year-old woman with chronic symptoms of gastroesophageal reflux had a 1.5-cm filling defect in the distal esophagus on esophagogram. Endoscopy revealed distal esophagitis and, immediately above a hiatal hernia, a pedunculated polyp on a short stalk, which was removed by snare cautery. The polyp was an adenoma composed of tubular glands and covered by intestinal-type epithelium. Serial distal esophageal biopsies confirmed Barrett's metaplasia with areas of specialized columnar epithelium with goblet cells. These findings suggest that the full expression of neoplasia in Barrett's esophagus includes the development of adenomatous polyps as well as dysplasia and adenocarcinoma.

Adenoma↗
PubMed1986

Treatment of severe reflux esophagitis with cimetidine and metoclopramide.

Reflux esophagitis may be unresponsive to standard medical therapy with an H2-receptor antagonist drug. Twenty-five patients with chronic reflux esophagitis, refractory to cimetidine treatment alone, were randomly assigned in a double-blind design to receive cimetidine (1200 mg/d), in combination with metoclopramide (40 mg/d) or placebo. Nine of twelve patients receiving cimetidine with metoclopramide had significant symptomatic improvement at the end of the 8-week study period, compared with 3 of 12 patients receiving cimetidine with placebo (p less than 0.02). Endoscopic appearance improved in 9 patients receiving metoclopramide and in 4 patients receiving placebo (p less than 0.05). Neither group had significant improvement in lower esophageal sphincter pressure, 24-hour esophageal pH recordings, and esophageal histologic findings. Side effects were common with cimetidine and metoclopramide but were rarely disabling. This combination is efficacious in the management of chronic reflux esophagitis but, because of frequent side effects, should be reserved for patients refractory to treatment with cimetidine alone.

Biopsy↗
PubMed1986

Screening flexible sigmoidoscopy by primary care physicians. Effectiveness and costs in patients negative for fecal occult blood.

A total of 252 consecutive screening flexible sigmoidoscopies were done by two community-based general internists on asymptomatic patients with stool negative for occult blood. Neoplastic lesions were found in 26 patients (10.3%), including 27 adenomatous polyps, 2 with carcinoma-in-situ and 1 carcinoid tumor. No complications resulted from flexible sigmoidoscopy. Nineteen patients with positive screening sigmoidoscopy underwent colonoscopy, and additional adenomatous polyps were found in six patients (31.6%), but no additional malignancy. Total cost for screening flexible sigmoidoscopy and additional studies was $30,359 ($1,168 per patient with a polyp or malignancy and $10,119 per patient with a malignant lesion). Screening flexible sigmoidoscopy can be safely done by community-based general internists in asymptomatic patients with a diagnostic yield comparable with that reported by subspecialists; total costs are acceptable.

Colonic Neoplasms↗
PubMed1985

Peanut shell colitis.

A 40-year-old physician experienced abdominal pain, loose stools, hematochezia, and anal discomfort with defecation associated with the daily consumption of 15 to 30 whole peanuts, including the shells. Thorough evaluation revealed only nonspecific colitis of the distal portion of the sigmoid colon and inflamed hemorrhoids. Discontinuation of whole peanut ingestion was associated with symptomatic, endoscopic, and histological resolution. In this patient, undigested peanut shells seem to have caused a nonspecific colitis, perhaps as the result of mechanical abrasion of the colonic mucosa.

Adult↗
PubMed1984

Recurrent obstructive jaundice caused by fibrolamellar hepatocellular carcinoma.

A 24-year-old man with hepatocellular carcinoma presented with recurrent obstructive jaundice caused by bile duct invasion and distal migration of necrotic tumor fragments. After resection of an isolated left lobe tumor, he was well for 2 years until he again presented with obstructive jaundice caused by necrotic tumor and clot in the common bile duct. Analysis of his tumor revealed the fibrolamellar histologic variant of hepatocellular carcinoma. This case is unique in that the hepatocellular carcinoma was of the fibrolamellar variant and presented both initially and when recurrent 2 years later with obstructive jaundice caused by invasion of the common bile duct.

Adult↗
PubMed1984

Severe and prolonged oral contraceptive jaundice.

Oral contraceptives frequently produce mild hepatocellular dysfunction, but only rarely cause jaundice. The syndrome of oral contraceptive jaundice is usually mild, with rapid resolution upon withdrawal of the drug. We describe a patient who had a severe illness with marked jaundice after one cycle of oral contraceptives. Her symptoms progressively worsened and serum bilirubin increased for almost 3 months after discontinuation of oral contraceptives. Full recovery ultimately occurred. Her severe and prolonged course demonstrates the wide spectrum of oral contraceptive jaundice.

Adult↗
PubMed1984

Gastrointestinal symptoms of marathon runners.

A survey of 707 participants in the 13th Annual Trail's End Marathon in Seaside, Oregon, showed a high incidence of gastrointestinal disturbances, predominantly of the lower tract, associated with long-distance running. The urge to defecate, both during and immediately after running, occurred in over a third of runners. Bowel movements (35%) and diarrhea (19%) were relatively common after running, and runners occasionally interrupted hard runs or races for bowel movements (18%) or diarrhea (10%). Lower gastrointestinal disturbances were more frequent in women than in men and in younger than in older runners. Awareness of the frequency and nature of gastrointestinal symptoms documented by this survey will assist physicians in evaluating abdominal complaints in runners.

Adolescent↗
PubMed1983

Clinical outcome after percutaneous transhepatic obliteration of esophageal varices.

A 4.5-yr experience with percutaneous transhepatic obliteration of gastroesophageal varices in 49 patients is reviewed with respect to technical success, control of active hemorrhage, rebleeding frequency, survival, and complications to better define clinical guidelines regarding its application. The procedure was successfully completed in 94% (46 of 49) of patients, and complete obliteration of all variceal feeder vessels was achieved in approximately one-half (52%). Variceal hemorrhage was controlled in three-quarters (76%) of actively bleeding patients, and recurrent hemorrhage occurred in 65% of patients at mean follow-up of 33 wk. Complete obliteration of all variceal feeder vessels was found not to be necessary from a technical standpoint, because the frequency of control of active hemorrhage and rebleeding were not significantly different in those patients having partial as compared with complete obliteration. In comparison with the reported outcome following standard medical therapy of bleeding varices, survival after variceal obliteration appears similar, but death from hemorrhage may be reduced. The interval to rebleeding is longer in patients having elective variceal obliteration after medical control of hemorrhage than in actively bleeding patients undergoing urgent obliteration of varices. The complication rate of obliteration was acceptable, but Child's class C patients with uncontrolled hemorrhage were a subgroup that experienced high mortality and derived little benefit from obliteration. Variceal obliteration is most appropriate in the bleeding but medically stabilized patient or the inoperable patient with recurrent bleeding. Active bleeding is most often controlled and recurrent bleeding may be prevented for several months, thus allowing consideration of elective shunt surgery.

Adolescent↗
PubMed1982

Hepatotoxicity to both erythromycin estolate and erythromycin ethylsuccinate.

Two patients experienced hepatotoxicity associated with erythromycin estolate (Ilosone) usage, followed 13 and 15 years later by an hepatotoxic reaction with administration of erythromycin ethylsuccinate (E.E.S.). These cases provide further evidence for erythromycin ethylsuccinate-associated hepatotoxicity and demonstrate erythromycin cross-sensitivity after previous erythromycin estolate liver injury. Hepatotoxicity to both sensitivity after previous erythromycin estolate liver injury. Hepatotoxicity to both estolate and ethylsuccinate preparations of erythromycin stimulates speculation regarding the potentially hepatotoxic moiety of the erythromycin molecule. Furthermore, these cases suggest that all erythromycin preparations should be avoided or used only with careful monitoring in patients with previous erythromycin-associated liver injury.

Adult↗
PubMed1982

Pancreatic insufficiency associated with ulcerative colitis and pericholangitis.

A 19-yr-old woman developed pancreatic insufficiency and pericholangitis associated with ulcerative colitis. Recognized causes of pancreatic insufficiency were excluded. Pancreatic insufficiency has not previously been reported in patients with ulcerative colitis, although interstitial pancreatitis at postmortem examination and pancreatic duct abnormalities by endoscopic pancreatography have been described. Pancreatic insufficiency and ulcerative colitis may have occurred together by chance in this patient, but the time sequence and exclusion of known causes of pancreatitis suggest an association between these two conditions. The literature concerning pancreatic disease in ulcerative colitis is reviewed.

Adult↗
PubMed1981

Isolation of a rat liver plasma membrane fraction of probable canalicular origin. Preparative technique, enzymatic profile, composition, and solute transport.

A technique currently used for isolation of brush border membranes from renal and intestinal epithelium that involves vigorous tissue homogenization and sedimentation of non-luminal membranes in the presence of Mg2+ has been adapted to rat liver. Liver plasma membranes so prepared consisted almost exclusively of vesicles by electron microscopy, showed some contamination with endoplasmic reticulum and minimal contamination with mitochondria or Golgi by marker enzymes, were highly enriched in alkaline phosphatase, Mg2+-ATPase, and 5'-nucleotidase activity compared with homogenate, and showed little enrichment in (Na+, K+)-ATPase. Comparison of this enzymatic profile with cytochemical studies localizing (Na+, K+)-ATPase and alkaline phosphatase to the sinusoidal/lateral and canalicular membranes, respectively, suggested that these membranes were predominantly of canalicular origin. They had a lower (Na+ + K+)-ATPase specific activity, lower lipid content, and higher cholesterol to phospholipid molar ratio than a conventional plasma membrane preparation believed to be enriched in canaliculi. Moreover, it was possible to measure movement of D-[3H]glucose into an osmotically sensitive space bounded by these membrane vesicles.

Adenosine Triphosphatases↗