PubMed Health⌕ Search

Biomedical subjects

E Leen

Publications and source records attributed to E Leen.

At least 37 records · Page 2Linked to original sources
PubMed1999

Liver-specific imaging with SHU 563A: diagnostic potential of a new class of ultrasound contrast media.

The purpose of this study was to evaluate the imaging properties and diagnostic potential of the novel polymeric ultrasound contrast agent SHU 563 A. After i. v. injection, the agent circulates in the blood pool for about 10 min and is then subsequently sequestered by the RES cells predominantly in the liver. The acoustic emission capabilities enable a very sensitive detection during the blood pool phase and after uptake in the RES cells, contributing to differential diagnosis as well as detection of liver lesions. During a multicenter study, 28 patients with liver lesions were examined. In all patients the results were compared to baseline ultrasound and Contrast enhanced Spiral CT. With respect to lesion size and location, very good agreement between SHU 563 A ultrasound and Spiral CT was achieved. Additional lesions could be shown in the RES phase by SHU 563 A enhanced ultrasound. 26 further patients were examined in other indications. The results in all 54 patients indicate good safety and tolerance of SHU 563 without limitations for diagnostic use. SHU 563 A enhanced ultrasound adds significantly to the detection and delineation of focal liver lesions by improving conspicuity due to RES based contrast after uptake.

Adenocarcinoma↗
PubMed1999

The detection of occult liver metastases of colorectal carcinoma.

Despite undergoing an apparently curative surgery, over 50% of colorectal cancer patients will die within 5 years, the majority within the first 2 years from disseminated disease. Occult liver metastases are reported to be present in approximately 30% of patients and they predominantly determine the likelihood of dying from disseminated disease. The question is how to detect these occult hepatic metastases. This article reviews some of the alternative techniques, such as dynamic scintigraphy, functional computerized tomography, and duplex colour Doppler sonography (DCDS), which have been developed to predict which patients harbor these occult metastases. More recently, DCDS measurements of the Doppler perfusion index (DPI: ratio of hepatic arterial to total liver blood flow) have been shown to be highly accurate in the detection of these occult liver metastases. In addition, irrespective of Dukes stage, patients with abnormal DPI were shown to have a very poor outcome while for those with normal DPI, the prognosis was excellent. If the data are reproduced, the administration of adjuvant chemotherapy should be based on DPI status rather than Dukes stage.

Adenocarcinoma↗
PubMed1999

The effect of sibutramine on resting energy expenditure and adrenaline-induced thermogenesis in obese females.

BACKGROUND: Sibutramine, an inhibitor of serotonin and noradrenaline uptake, reduces appetite to cause weight loss. This study tested the hypothesis that an increase in energy expenditure also contributes to this weight loss. In addition, the effects of sibutramine on adrenaline induced changes in heart rate and cardiac output were determined METHODS: Nineteen obese females randomly received either sibutramine 15 mg daily or placebo for 12 weeks along with dietary advice. Resting energy expenditure (REE) was measured and then energy expenditure was measured during a 30 min infusion of adrenaline (25 ng/min/kg IBW). Cardiac output and heart rate, measured by Duplex Colour Doppler ultrasonography, were similarly measured in the basal state and post adrenaline. All measurements were recorded at baseline and then after 12 weeks. RESULTS: Ten patients who received sibutramine reduced their weight by 8.1+/-3.8% while 9 placebo treated subjects reduced their weight by 5.1+/-4.4%, P=0.13. In absolute terms, REE decreased in placebo subjects from 1500+/-201 kcal/24 h to 1357+/-231 kcal/24 h (9.4+/-9.9%) and in sibutramine subjects from 1540+/-184 kcal/24 h to 1444+/-128 kcal/24 h (5.3+/-12.0%), P=0.77. The increased weight loss in the sibutramine group was associated with an increase in the FFM adjusted REE (2.2+/-16.1%) unlike the expected decrease (5.8+/-9.5%) in the placebo group (P=0.11). There was some suggestion (P=0.09) that the usual positive correlation between loss of weight and decline in REE was lost in the sibutramine group (r=-0.30) compared with placebo (r=0.35). There was a negative correlation between loss of FFM and decline in REE/kg FFM and (P=0.029) which was not evident in placebo (P=0.83). Adrenaline induced energy expenditure was similar in the two groups at the end of the 12 week period and there were no significant cardiovascular changes between the two groups. CONCLUSIONS: Sibutramine limits the decline in REE associated with weight loss, equivalent to about 100 kcal/d. This could allow greater numbers of people to maintain a greater degree of weight loss.

Adult↗
PubMed1999

Fatal phenytoin hypersensitivity syndrome.

The phenytoin (hydantoin) hypersensitivity syndrome is rare but potentially fatal. Often, as in this case, it presents with non-specific symptoms and signs, requiring a high degree of clinical suspicion for diagnosis.

Aged↗
PubMed1998

Assessment of the role and reliability of sonographic post-prandial flow response in grading Crohn's disease activity.

PURPOSE: To investigate the value of pre and post prandial Duplex colour Doppler sonographic (DCDS) measurement of superior mesenteric artery (SMA) flow in the assessment of Crohn's disease activity, and its response to treatment. MATERIALS AND METHODS: SMA volume flow rates before and after a food challenge (200 ml of Ensure Plus) were recorded over 60 min in 11 controls, and 25 patients with proven Crohn's disease. Peak flow rates and the time interval to peak flow were recorded. Eleven patients with active disease were monitored longitudinally and their response following the introduction of systemic steroids was assessed. RESULTS: The time interval from food challenge to peak SMA flow rate was significantly lower in patients with untreated active disease (median 20 min, range 14.5-21.25) compared to inactive patients (median 33 mins, range 28.75-40.5, P = 0.0006). Longitudinal follow-up of active disease demonstrated prolongation of time to peak flow following clinical remission (P = 0.0024) CONCLUSIONS: This technique is useful in offering an immediate, noninvasive means of assessing disease activity. Further longitudinal follow up data is necessary to determine its utility in assessing response to treatment.

Adult↗
PubMed1998

Hepatic blood flow changes in chronic hepatitis C measured by duplex Doppler color sonography: relationship to histological features.

Our aim was to determine if portal vein and hepatic artery blood flow indices are a noninvasive index of severity of liver disease in chronic hepatitis C. The effect of interferon-alpha treatment on liver blood flow was also studied. Liver blood flow measurements were recorded by duplex Doppler color sonography in 39 patients with chronic hepatitis C, 50 healthy controls, and a single patient with hepatocellular carcinoma. Doppler perfusion index (DPI) (calculated as the ratio of hepatic artery flow to total hepatic flow) and the congestive index of the portal vein (area/velocity) were calculated. Liver biopsies were scored for hepatic inflammation and fibrosis. Hepatic arterial flow (415.7+/-329.1 ml/min vs 195.1+/-103.5 ml/min) and DPI (0.27+/-0.14 vs. 0.17+/-0.06) were elevated in chronic hepatitis C patients compared to controls (P = 0.0002 and 0.0003, respectively) while portal vein flow and total hepatic flow were similar. Portal vein congestive index was similar in chronic hepatitis C (0.106+/-0.05) compared to controls (0.125+/-0.08) P 0.52. Hepatic blood flow indices were not related to the grade of hepatic inflammation or the stage of hepatic fibrosis. Twelve weeks of treatment with interferon-alpha had no effect on liver blood flow. In conclusion, patients with chronic hepatitis C have elevated hepatic artery blood flow. Hepatic blood flow indices have no relationship to the severity of histological liver injury in chronic hepatitis C, and these flow indices are unaffected by a 12-week course of interferon-alpha.

Adult↗
PubMed1998

Influences on adrenaline-induced thermogenesis in obese women and relationship to cardiovascular responses.

1. In order to evaluate factors influencing thermogenesis in obesity, energy expenditure was measured before and during an adrenaline infusion (25 ng min-1 kg-1 ideal body weight for 30 min) in 22 obese females. 2. Thermogenic responses were related to body morphology, age and biochemistry. In addition, thermogenic responses were related to cardiovascular responses by simultaneously measuring blood pressure, pulse rate and cardiac output using Doppler sonography. 3. Resting energy expenditure was predicted by body weight, lean body mass and fat mass. 4. Adrenaline-induced thermogenesis was predicted by fasting insulin, low basal respiratory quotient and body fat. 5. There was a significant relationship between the cardiac output and thermogenic responses to adrenaline (r = 0.63 P < 0.015) but there was no relationship to the heart rate or blood pressure responses. For every 1% increase in energy expenditure, there was a 5% increase in cardiac output. 6. In conclusion, the factors predicting resting energy expenditure and adrenaline-induced thermogenesis are different. Increased lipid oxidation and central fat distribution (with hyperinsulinaemia) are associated with a greater thermogenic response. The proportionately greater cardiac output responses may have implications for thermogenic agents designed to induce weight loss.

Adult↗
PubMed1998

Doppler perfusion index: an interobserver and intraobserver reproducibility study.

PURPOSE: To assess the potential of Doppler perfusion index (DPI) measurement as a routine diagnostic tool in the detection of occult colorectal liver metastases. MATERIALS AND METHODS: By using color doppler ultrasound, two independent sonologists performed DPI measurements blindly in 20 patients aged 30-82 years; interobserver reproducibility was assessed. A second group of 20 patients aged 37-88 years were examined to assess the level of intraobserver reproducibility of DPI measurements attained by one sonologist. For each patient in this group, the DPI was measured three times in succession, and the variability between measurements was analyzed. Calculations of the intraclass correlation coefficient and the coefficient of variation (CV) were used to determine the levels of reproducibility. The data were also analyzed by using the Student paired t test, with significance established at P less than .05. RESULTS: The interobserver CV and intraobserver CV were 20% and 16%, respectively. The two sonologists who examined the first group of patients agreed independently on the DPI status in 18 of 20 (90%) patients. CONCLUSION: In this study, both the intraobserver reproducibility and the interobserver reproducibility of DPI measurements were clinically acceptable.

Adult↗
PubMed1997

Doppler index perfusion in the detection of hepatic metastases secondary to gastric carcinoma.

BACKGROUND: The early detection of liver metastases in patients with gastric carcinoma is important for determining the appropriate therapy; however conventional imaging techniques are limited for detecting "occult" liver metastases. Previous studies have shown that the measurement of the Doppler perfusion index (DPI)-ratio of hepatic arterial to total liver blood flow-can detect the presence of even small hepatic tumors. In this study, we compared the measurement of DPI with computed tomography (CT) for detecting gastric liver metastases. METHODS: At presentation, 43 patients with gastric carcinoma underwent CT scanning of the liver and after 12 hours of fasting, DPI measurement was carried out using Doppler sonography. RESULTS: Both techniques detected overt liver metastases in 9 of the 43 patients. Of the 34 remaining patients with an apparently disease-free liver on the basis of CT, laparotomy, or laparoscopy, 14 subsequently develop liver metastases over a follow-up period of 4 years, 13 of which had been predicted by DPI at the time of presentation. CONCLUSION: The data suggest that the measurement of the DPI is more sensitive than a CT scan for detecting liver metastases secondary to gastric carcinoma.

Aged↗
PubMed1996

Intraoperative ultrasound in colorectal cancer patients undergoing apparently curative surgery: correlation with two year follow-up.

Conventional ultrasound (US) and computerized tomography (CT) are well recognized to be limited in the detection of small liver metastases. In this study, we assessed the use of intraoperative ultrasound (IOUS) in the detection of 'occult' liver metastases in colorectal cancer patients undergoing apparently curative surgery of the primary colonic carcinoma. Ninety three colorectal cancer patients undergoing apparently curative surgery on the basis of preoperative US, CT and laparotomy were studied. All patients underwent IOUS examination of the liver. After two year follow-up, 27 of these 93 patients developed overt liver metastases and of these 27, only five had been detected by IOUS examinations at the time of laparotomy. The results suggest that IOUS is relatively insensitive in the detection of occult colorectal liver metastases. Its routine use as a screening tool during primary surgery is therefore not recommended.

Colorectal Neoplasms↗
PubMed1996

Prognostic power of Doppler perfusion index in colorectal cancer. Correlation with survival.

OBJECTIVE: The authors assessed the relative value of Dukes' staging and Doppler perfusion index (DPI) as prognostic indices of early death in patients with colorectal cancer who have had apparently curative surgery. SUMMARY BACKGROUND DATA: Dukes' classification is recognized as the gold standard against which other prognostic factors should be compared; however, its discriminatory power is limited. No established method exists for accurately identifying patients who, despite having undergone an apparently curative resection for colorectal carcinoma, are at high risk. METHODS: Eighty consecutive patients undergoing apparently curative surgery for colorectal cancer were staged using Dukes' classification. In addition, DPI (ratio of hepatic arterial to total liver blood flow) was measured before surgery by means of a duplex/color Doppler sonography. RESULTS: On the basis of 2-year follow-up data, Dukes' classification failed to define clearly those patients who died or who developed recurrent disease. In contrast, DPI clearly identified two groups of patients: 78% of patients with an abnormally elevated DPI value developed recurrent disease or died, whereas 97% of patients with a normal DPI value survived. CONCLUSION: This technique can identify patients at high risk for colorectal cancer, after having undergone apparently curative resection, who would be suitable for adjuvant therapy.

Colorectal Neoplasms↗
PubMed1995

Effect of extended ibuprofen administration on the acute phase protein response in colorectal cancer patients.

The regulation of acute phase protein production and the relationship of the acute phase protein response to tumour growth was examined in colorectal cancer patients (n = 9). Ibuprofen (1200 mg/d) was administered for 8-11 days. Following ibuprofen administration there were reductions in circulating concentrations of C-reactive protein (P = 0.01), interleukin-6 (P = 0.06), cortisol (P = 0.04) and also in the platelet count (P = 0.01). There was no significant change in albumin, insulin and carcinoembryonic antigen. These results indicate that ibuprofen administered over a prolonged period substantially reduces acute protein production via its effect on interleukin-6 and cortisol. It remains to be determined whether ibuprofen is useful in moderating tumour growth in colorectal cancer patients.

Acute-Phase Proteins↗
PubMed1995

Generalized endemic Kaposi's sarcoma.

Kaposi's sarcoma (KS) is a multicentric neoplasm thought to arise from both vascular and lymphatic endothelium. It is subdivided into four main categories on the basis of clinical features, course and prognosis. We report a 54-year-old Afro-Caribbean male, living in the UK for the past 26 years, with classic features of generalized endemic KS. Because he has never lived on the African continent, the role of genetic rather than environmental factors is favoured in the aetiology of KS in this individual. This disorder is rarely seen in Afro-Caribbeans living in the UK, who have never actually lived in Africa.

Africa↗
PubMed1995

Detection of colorectal liver metastases: comparison of laparotomy, CT, US, and Doppler perfusion index and evaluation of postoperative follow-up results.

PURPOSE: To assess the value of the Doppler perfusion index (DPI = the ratio of hepatic arterial to total liver blood flow) as measured with duplex and color Doppler sonography (DCDS) in comparison with computed tomography (CT), conventional ultrasound (US), and laparotomy for the detection of liver metastases in patients with colorectal cancer. MATERIALS AND METHODS: DCDS measurement of the DPI and CT, US, and laparotomy were performed in 161 consecutive colorectal cancer patients. Patients who underwent an apparently curative resection were followed up at 3-month intervals with US and at annual CT. RESULTS: Fifty-six patients had histologically proved liver metastases at initial examination. Liver metastases were detected with DPI, CT, US, and laparotomy in 56, 45, 27, and 36 patients, respectively. After a 1-year follow-up, 23 patients had developed liver metastases, all of which were predicted on the basis of an abnormal DPI value. CONCLUSION: Results suggest that DCDS measurement of the DPI is the most sensitive technique in detection of colorectal liver metastases. All studies should attempt to define normal liver on the basis of follow-up results rather than those of laparotomy.

Blood Flow Velocity↗
PubMed1994

Improved sensitivity of colour Doppler flow imaging of colorectal hepatic metastases using galactose microparticles: a preliminary report.

The clinical application of ultrasonographic contrast agents in colour Doppler flow imaging of hepatic tumours is receiving increasing attention. Levovist is a suspension of galactose microparticles that provides reproducible concentrations of stabilized air bubbles with transpulmonary stability. Its effect on colour Doppler imaging was assessed in 26 patients with colorectal cancer and histologically proven hepatic metastases. Colour Doppler flow imaging was performed before and after intravenous injection of 10 ml Levovist 300 mg/ml. At 5-10 s after injection there was significant enhancement of the hepatic lesions with colour Doppler signals in 23 patients, lasting for a mean(s.d.) of 180(45) s. A consistent pattern of colour Doppler signal was observed, with increased enhancement predominantly around the tumour periphery and little or no central enhancement. These data suggest that Levovist may increase the sensitivity and specificity of colour Doppler flow imaging of colorectal hepatic metastases.

Adult↗