Biomedical subjects

E M Ward

Publications and source records attributed to E M Ward.

At least 37 records · Page 2Linked to original sources

PubMed1998

Underlying and multiple cause mortality in a cohort of workers exposed to aromatic amines.

BACKGROUND: The National Institute for Occupational Safety and Health (NIOSH) has previously conducted studies of bladder cancer incidence and mortality at a synthetic dye plant that manufactured beta-naphthylamine from 1940 through 1979. This report extends the period of mortality follow-up 13 years and analyzes both underlying and nonunderlying causes of death. METHODS: The vital status of each cohort member, as of December 31, 1992, was determined by using the National Death Index and information from the Internal Revenue Service and the U.S. Postal Service. The NIOSH life table analysis system (LTAS) was used to generate person-year-at-risk and the expected numbers of death for 92 categories of death, using several referent rates (U.S. underlying, Georgia underlying, U.S. multiple cause). RESULTS: There were three bladder cancer deaths listed as underlying cause, yielding a standardized mortality ratio (SMR) based on U.S. rates of 2.4 (95% confidence interval (CI) = 0.5, 7.0) and a total of eight bladder cancers listed anywhere on the death certificates (SMR based on multiple cause referent rates = 5.6; 95% CI = 2.4, 11.1). Mortality from esophageal cancer, which had been significantly elevated in the previous study, was no longer significantly elevated (SMR = 2.0; 95% CI = 0.8, 4.1). Mortality from all causes was significantly higher than expected (SMR = 1.5; 95% CI = 1.3, 1.6). CONCLUSIONS: The elevated bladder cancer risk in this cohort was detected by the multiple cause, but not the underlying cause, analysis. Elevated mortality from other causes of death, especially among short-term workers, may be related to regional and lifestyle factors.

Amines↗

PubMed1997

Industries and cancer.

Epidemiologic evidence on the relationship between selected industries and cancer is reviewed. This article will focus on several industries which have not been covered elsewhere in this volume, briefly describe current research on cancer in the agricultural and construction industries, and discuss surveillance data on cancer mortality in relation to industry listed on US death certificates. Employment in the rubber industry has been associated with bladder cancer, leukemia, stomach, and lung cancer and is considered by the International Agency for Research on Cancer (IARC) to have 'sufficient evidence of carcinogenicity in humans.' Studies of workers exposed to polychlorinated biphenyls (PCBs) have reported excess mortality from gastrointestinal neoplasms, hematologic neoplasms, and skin cancer (specifically malignant melanoma); IARC considers that the evidence for carcinogenicity in humans is 'limited.' Employment in the boot and shoe industry has been associated with nasal adenocarcinomas in England and Italy ('sufficient'). Hairdressers and barbers have been found to have excess bladder cancer and less consistent evidence for several other sites ('limited'). Workers exposed to wood dust have excess mortality from cancer of the nasal sinuses and paranasal cavities; there is less consistent evidence for excess laryngeal cancer ('sufficient'). Workers employed in the petroleum industry have limited evidence for excess leukemia and other lymphatic and hematopoietic neoplasms, and skin cancer (particularly malignant melanoma) ('limited').

Adenocarcinoma↗

PubMed1996

Mortality study of workers employed in 1,3-butadiene production units identified from a large chemical workers cohort.

The IARC has given the designations of "sufficient evidence" of carcinogenicity of 1,3-butadiene in experimental animals and "limited evidence" of carcinogenicity in humans. To investigate the carcinogenic effect in humans, a cohort mortality study was conducted among 364 men who were assigned to any of three 1,3-butadiene production units located within several chemical plants in the Kanawha Valley of West Virginia, including 277 men employed in a U.S. Rubber Reserve Plant which operated during World War II. The butadiene production units included in this study were selected from an index developed by the Union Carbide Corporation which listed for each chemical production unit within their South Charleston and Institute plants all products, by-products and reactants. Departments included in the study were those where butadiene was a primary product and neither benzene nor ethylene oxide was present. A total of 185 deaths were observed; the standardized mortality ratio (SMR) for all causes of death was 91, reflecting lower mortality among the study population than the U.S. population. The study found a significantly elevated standardized mortality ratio (SMR) for lymphosarcoma and reticulosarcoma based on four observed cases (SMR = 577; 95% confidence interval (CI) = 157-1480), which persisted in an analysis using county referent rates. An excess of lymphosarcoma and reticulosarcoma among all workers and among workers with routine exposure to 1,3-butadiene was also observed in the only other cohort of 1,3-butadiene production workers previously studied. A statistically non-significant excess of stomach cancer was observed in the overall cohort (five cases; SMR = 243; CI = 79-568) that was most pronounced among workers employed in the Rubber Reserve plant for 2 or more years (five cases; SMR = 657; CI = 213-1530). We conclude that the results of this study add to the weight of evidence suggesting that butadiene is carcinogenic in humans.

Aged↗

PubMed1996

Monitoring of aromatic amine exposures in workers at a chemical plant with a known bladder cancer excess.

BACKGROUND: In April 1991, an excess of bladder cancer cases among workers employed at a chemical manufacturing facility in Niagara Falls, NY, was reported. This excess was primarily confined to 708 workers who had ever been employed in the rubber chemicals manufacturing area of the plant, where the aromatic amines aniline and o-toluidine have historically been used. PURPOSE: An environmental and biological monitoring survey was conducted to evaluate current exposures to aniline and o-toluidine in the rubber chemicals department. METHODS: Personal air sampling for aniline and o-toluidine was conducted with the use of a modified Occupational Safety and Health Administration (OSHA) 73 method. Urine samples were collected before and after work (i.e., pre-shift and post-shift, respectively) and stored at -70 degrees C. Base hydrolysis was used to convert acetanilide and N-acetyl-o-toluidine, metabolites of aniline and o-toluidine present in the urine, to the parent compounds. The parent compounds were extracted from the alkaline urine into butyl chloride and then back-extracted from the butyl chloride into aqueous hydrochloric acid. An aliquot of each acidic extract was subjected to ion-interaction reversed-phase liquid chromatography with coulometric electrochemical detection. Hemoglobin (Hb) was extracted from blood and stored at -70 degrees C. For the measurement of adducts of aniline, o-toluidine, and 4-aminobiphenyl (4-ABP), precipitated Hb was dissolved in 0.1 M sodium hydroxide in the presence of recovery standards, and the hydrolysate was extracted with hexane, derivatized with pentafluoropropionic anhydride, and analyzed by gas chromatography-mass spectrometry with negative chemical ionization. RESULTS: A total of 73 workers, including 46 of 64 exposed workers who were employed in the rubber chemicals department and had the potential for exposure to aniline and o-toluidine and 27 of 52 unexposed workers employed in other departments where aniline and o-toluidine were not used or produced, had data available for both aniline and o-toluidine and Hb adducts; 28 of the workers in the former group also had personal air-sampling data. Personal air sample measurements showed that airborne concentrations of aniline and o-toluidine were well within the limits allowed in the workplace by OSHA. Urinary aniline and o-toluidine levels, however, were substantially higher among exposed workers than among unexposed control subjects. The most striking differential was for post-shift urinary o-toluidine levels, which averaged (+/- standard deviation) 2.8 micrograms/L (+/- 1.4 micrograms/L) in unexposed subjects and 98.7 micrograms/L (+/- 119.4 micrograms/L) in exposed subjects (P = .0001). Average aniline-Hb and o-toluidine-Hb adduct levels were also significantly higher (P = .0001) among exposed workers than among unexposed control subjects. Average levels of adducts to 4-ABP, a potential contaminant of process chemicals, were not significantly different (P = .48), although three exposed workers had 4-ABP levels above the range in unexposed workers. CONCLUSIONS: The adduct data suggest that, among current workers, o-toluidine exposure substantially exceeds aniline exposure and that 4-ABP exposure, if it occurs at all, is not widespread. These data support the conclusion that occupational exposure to o-toluidine is the most likely causal agent of the bladder cancer excess observed among workers in the rubber chemicals department of the plant under study, although exposures to aniline and 4-ABP cannot be ruled out.

Air↗

PubMed1996

Acute and chronic liver toxicity resulting from exposure to chlorinated naphthalenes at a cable manufacturing plant during World War II.

Historical records were used to reconstruct an outbreak of chlorance and acute liver toxicity due to chlorinated naphthalene exposure at a New York State plant which manufactured "Navy cables" during World War II. A cohort mortality study was conducted of the population (n = 9,028) employed at the plant from 1940 to 1944. Vital status was followed through December 31, 1985. The study found an excess of deaths from cirrhosis of the liver [observed (OBS) = 150; standardized mortality ratio (SMR) = 1.84; 95% confidence interval (CI) = 1.56-2.16]; cirrhosis deaths were elevated to a similar degree in the 460 individuals who had chlorance (OBS = 8; SMR = 1.51; CI = 0.65-2.98). The SMR for "non-alcoholic cirrhosis" (OBS = 83; SMR = 1.67; CI = 1.33-2.07) was similar to the SMR for "alcoholic cirrhosis" (OBS = 59; SMR = 1.96; CI = 1.49-2.53). There was no evidence for increased alcoholism in the overall cohort based on mortality from alcohol-related causes of death other than cirrhosis (SMR for esophageal cancer = 1.01 and for deaths from alcoholism = 0.99). We conclude that the excess mortality from cirrhosis of the liver observed in this cohort is due to the chronic effect of chlorinated naphthalene exposure.

Acute Disease↗

PubMed1996

Barium enema: detection of colonic lesions in a community population.

OBJECTIVE: The purposes of this study were to assess the prevalence of colonic lesions detected at barium enema in a community practice, to compare the findings at barium enema between patients who are asymptomatic and have no known risk factors for colorectal cancer (screening group) and patients who have symptoms of colonic disease or have known risk factors, and to determine if a questionnaire about symptoms and risk factors is an appropriate screening tool. SUBJECTS AND METHODS: A self-administered questionnaire about colorectal symptoms and risk factors was given to 1779 patients scheduled for barium enema examination. On the basis of their responses, patients were divided into three groups: screening group (asymptomatic, without risk factors), symptomatic, and asymptomatic with risk factors. Each patient underwent a fluoroscopic barium enema. We then compared the results (number, histologic type, size of lesion(s), location in the colon, and Patient's age) and risk factors among the three groups. RESULTS: At least one lesion within the colorectum was found in 166 (9%) of 1779 patients at combined proctosigmoidoscopy and barium enema. The prevalence of lesions in the 111 patients with at least one lesion above the rectum at barium enema was 4% (32 of 738) for the screening group, 8% (38 of 476) for asymptomatic patients with risk factors, and 7% (41 of 565) for symptomatic patients (p = .015 when comparing the prevalence in the screening group with the prevalences in the other two groups). Twenty-nine percent of all colonic lesions were found in the screening group. Among the asymptomatic patients, risk factors that included a history of colorectal polyps and advanced age were associated with a significantly higher prevalence of colonic polyps found at barium enema. In the symptomatic group, if patients with histories of polyps were excluded, we were unable to identify other risk factors that led to a significantly higher prevalence of polyps. CONCLUSION: Asymptomatic patients without known risk factors have a significantly lower prevalence of colonic polyps than either symptomatic patients or patients with risk factors alone. Despite this lower prevalence, 29% of all lesions in our series were in the screening group. Assessment of risk factors through a patient questionnaire was not helpful in identifying a group of patients with a higher prevalence of lesions--except for a history of polyps. Management decisions based on a patient questionnaire should be approached with caution. When low-risk patients are denied screening examinations, a significant number of lesions will be missed.

Aged↗

PubMed1995

Mortality study of workers in 1,3-butadiene production units identified from a chemical workers cohort.

The International Agency for Research on Cancer has given the designations of "sufficient evidence" of carcinogenicity of 1,3-butadiene in experimental animals and "limited evidence" of carcinogenicity in humans. To investigate the carcinogenic effect in humans, we conducted a cohort mortality study among 364 men who were assigned to any of three 1,3-butadiene production units located within several chemical plants in the Kanawha Valley of West Virginia, including 277 men employed in a U.S. Rubber Reserve Plant which operated during World War II. The butadiene production units included in this study were selected from an index developed by the Union Carbide Corporation, which listed for each chemical production unit within their South Charleston, West Virginia and Institute, West Virginia, plants all products, by-products, and reactants. Departments included in the study were those where butadiene was a primary product and neither benzene nor ethylene oxide was present. A total of 185 deaths were observed; the standardized mortality ratio (SMR) for all causes of death was 91, reflecting lower mortality among the study population than the U.S. population. The study found a significantly elevated standardized mortality ratio (SMR) for lymphosarcoma and reticulosarcoma based on four observed cases (SMR = 577; 95% CI = 157-1480), which persisted in an analysis using county referent rates. An excess of lymphosarcoma and reticulosarcoma among all workers and among workers with routine exposure to 1,3-butadiene was also observed in the only other cohort of 1,3-butadiene production workers previously studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1995

Single-pass CT of hepatic tumors: value of globular enhancement in distinguishing hemangiomas from hypervascular metastases.

OBJECTIVE: The purpose of this study was to evaluate the sensitivity and specificity of globular enhancement for differentiating hepatic hemangiomas from hypervascular metastases on single-pass, contrast-enhanced CT scans. Globular enhancement was defined as enhancing nodules less than 1 cm seen within a lesion. MATERIALS AND METHODS: Fifty CT examinations were retrospectively evaluated in a blinded fashion by two independent reviewers. The CT studies were done with nonhelical technique after the IV injection of 150 ml of contrast material. The series included 25 patients with histologically proven hypervascular hepatic metastases (carcinoid, islet cell carcinoma, and leiomyosarcoma) and 25 patients with clinically proven hepatic hemangiomas. Patients with hemangiomas were clinically stable for at least 2 years after the CT studies. A single lesion was isolated from the first-pass, contrast-enhanced portion of each examination; the remainder of the examination was excluded from the review to minimize reviewer bias. Each lesion was evaluated for (1) the presence or absence of globular enhancement (defined as enhancing nodules less than 1 cm seen within a lesion), (2) the density of globular enhancement relative to that of the aorta, (3) the degree of border definition (well or poorly marginated), and (4) the presence or absence of a hypodense halo. A diagnostic impression was then recorded for each lesion. RESULTS: Globular enhancement was 88% sensitive and 84-100% specific for differentiating hepatic hemangiomas from hypervascular metastases (p < .001). A mean of 62% of hemangiomas showed globular enhancement isodense relative to that of the aorta; none of the metastases showed globular, isodense enhancement. The majority of the metastases showed nonglobular enhancement (mean, 92%). The reviewers showed 84% agreement in the identification of (1) globular enhancement in hemangiomas, (2) lack of globular enhancement in metastases, and (3) globular enhancement in the combined set of all lesions. Neither the presence of a hypodense halo nor the degree of border definition was significant in distinguishing between the two groups of lesions. The reviewers showed 96% agreement in the categorization of metastases and 76% agreement in the categorization of hemangiomas. There was 86% agreement in the categorization of all lesions. Overall, reviewers diagnosed a mean of 89% of lesions correctly. A mean of 98% of metastases and a mean of 80% of hemangiomas were diagnosed correctly. CONCLUSIONS: Globular enhancement is highly sensitive (88%) and specific (84-100%) for differentiating hepatic hemangiomas from hypervascular metastases on single-pass, contrast-enhanced CT scans.

Adult↗

PubMed1995

Imaging after laparoscopic cholecystectomy.

Imaging for laparoscopic cholecystectomy involves preoperative imaging of the gallbladder and bile ducts, usually by sonography. Post-operative imaging is usually necessary only for suspected surgical complications. Cross-sectional imaging identifies most patients with postoperative complications. Cholangiography is needed to characterize all biliary abnormalities. Interventional radiologic techniques are helpful to aspirate or drain abdominal fluid collections, provide temporary biliary drainage, or cure cystic stump leaks or treat complications of choledochojejunostomy.

Bile Ducts↗

PubMed1994

Protection from high pressure induced hyperexcitability by the AMPA/kainate receptor antagonists GYKI 52466 and LY 293558.

The neurophysiological effects of 2 novel AMPA/kainate receptor antagonists, GYKI 52466 and LY 293558, on the high pressure neurological syndrome have been investigated in the rat and baboon (GYKI 52466) and rat (LY 293558). Rats were exposed to increasing ambient pressures of helium and oxygen at 3 ATA/min, on one occasion each. GYKI 52466 at 20 mumol/kg i.v. immediately before, followed by 70 mumol/kg/hr i.v. during compression delayed tremor by 85% and myoclonus by 30%, compared with control vehicle, and no side effects were observed. Seizure activity was not affected by any of the doses used. LY 293558 at 36 mumol/kg i.p. delayed tremor and myoclonus (44% and 12%), LY 293558 72 mumol/kg additionally delayed seizure activity (21%). Side effects, principally tranquilization at the higher dose, were also noted. Six baboons were exposed to a maximum pressure of 91 ATA at 0.3 ATA/min, in the same environment, on two occasions. One exposure was treated with an i.v. infusion of GYKI 52466 15.2 mumol/kg/hr, the other with the same volume of control vehicle. Limb and face tremor and myoclonus were delayed and the severity of signs reduced. No seizures were observed in the drug treated group before 91 ATA. EEG changes associated with exposure to pressure were not affected. It is concluded that antagonism at the AMPA/kainate receptor by GYKI 52466 and LY 293558 beneficially alters HPNS signs but in a manner which is dependent on both the drug and species being studied.

Animals↗

PubMed1994

Lack of effect of lamotrigine against HPNS in rodent and primate models.

The neurophysiological effects of the novel anticonvulsant lamotrigine on the high pressure neurological syndrome, HPNS, were investigated in the rat and nonhuman primate Papio anubis. Rats were exposed to pressure at a rate of 3 ATA per min in a helium/oxygen environment. They were pretreated with either lamotrigine isethionate 15, 30, or 60 mg/kg IP or control vehicle. After 15 and 30 mg/kg there were no changes in onset pressures for any of the grades of tremor or myoclonus. After 60 mg/kg, tremor was much slower, at 7-9 Hz, than the 15-20 Hz seen in controls. Four baboons were exposed to pressure at 0.33 ATA per min in the same environment and treated with lamotrigine isethionate at 7.5 mg/kg/h i.v. Each animal underwent a control and a drug-treated exposure. No changes in the onset or severity of HPNS behavioural signs were observed. However, an increase in alpha wave amplitude of the EEG was almost prevented. In both species sustained myoclonic jerking occurred at pressures similar to those at which seizure activity was observed in control exposures. It is concluded that although lamotrigine is protective in several models of neuronal excitation, it is ineffective in protecting against behavioural signs associated with high atmospheric pressure.

Animals↗

PubMed1994

Cancer mortality patterns among female and male workers employed in a cable manufacturing plant during World War II.

A cohort mortality study was conducted among 9028 (3042 women, 5986 men) workers potentially exposed to chlorinated naphthalenes (chloracnegens structurally similar to dioxins) and asbestos in the manufacture of Navy cable during World War II. Based on mortality through December 31, 1985, standardized mortality ratios (SMRs) for all cancers was 1.03 in women (95% confidence interval [CI] = 0.9 to 1.17) and 1.18 in men (95% CI = 1.10 to 1.26). There were no significant elevations in causes of death hypothesized a prior to be associated with chlorinated naphthalene exposure (malignant neoplasms [MN] of connective tissue, liver, and lymphatic and hematopoietic organs). An excess of MN of the connective tissue was suggested for workers with over 1 year of exposure and 25 years of latency (SMR = 3.54; 95% CI = 0.97 to 9.07). Among cancer sites not hypothesized to be related a priori, three showed concordant excesses among both genders (MN of stomach; rectum; and trachea, bronchus, and lung). No significant elevations occurred in hormonally related cancers among women. Cancer mortality among 460 individuals with chloracne (431 men, 29 women) was similar to that of the entire cohort, although the chloracne subcohort showed significant excesses in two rare causes of death (MN of esophagus, SMR = 3.26; "benign and unspecified neoplasms," SMR = 4.93). Use of county referent rates decreased SMRs for stomach, rectal, and buccal cavity cancer, suggesting a role for nonoccupational risk factors. It is difficult to draw conclusions about carcinogenicity of chlorinated naphthalenes because of study limitations, most importantly, concomitant asbestos exposure and the relatively short duration of exposure to chlorinated naphthalenes among most of the cohort.

Acne Vulgaris↗

PubMed1994

Cancer mortality in female and male dry-cleaning workers.

A cohort study of dry-cleaning workers (1109 women, 592 men) in the mid-1980s revealed significant excess bladder cancer mortality. This article updates vital status through 1990. Significant excesses were seen for bladder cancer (nine deaths, standardized mortality ratio [SMR] = 2.54, 95% confidence interval [CI] = 1.16-4.82), esophageal cancer (10 deaths, SMR = 2.14, 95% CI = 1.02-3.94), and intestinal cancer (26 deaths, SMR = 1.56, 95% CI = 1.02-2.29). In a subcohort exposed only to perchloroethylene (PCE), those with 5 or more years of employment and 20 or more years since first exposure had a significant increased risk of esophageal cancer (four deaths, SMR = 7.17, 95% CI = 1.92-19.82). Women had significant excess esophageal cancer (five deaths, SMR = 3.24, 95% CI = 1.05-7.58) and elevated SMRs for intestinal, pancreatic, and bladder cancer mortality. This study confirms the esophageal cancer risk among dry-cleaning workers seen in another study and suggests an association with PCE. It further documents the risks for intestinal, pancreatic, and bladder cancers in this industry.

Cause of Death↗

PubMed1993

The orally active NMDA receptor antagonist CGP 39551 ameliorates the high pressure neurological syndrome in Papio anubis.

The neurophysiological effects of a novel, orally active, competitive N-methyl-D-aspartate (NMDA) receptor antagonist (DL-(E)-2-amino-4-methyl-5-phosphono-3-pentenoic acid ethyl ester), CGP 39551, on the high pressure neurological syndrome (HPNS) were investigated in the non-human primate Papio anubis. Six animals were exposed to maximum pressures of 81 ATA in a helium and oxygen environment, on two occasions. One exposure was pretreated orally with CGP 39551 100 mg/kg 24 h before compression, the other pretreated with an equivalent volume of vehicle, in this case water. CGP 39551 significantly ameliorated the signs of HPNS, compared with controls, at pressures above 31 ATA and prevented the severe signs from occurring at the higher pressures. Onset pressures of the mild signs at low pressures were, however, unaffected. Among EEG changes, the pressure induced reduction in delta wave amplitude was prevented by CGP 39551, but the increase in the amplitude of the 7-9 Hz band was not. It is concluded that CGP 39551 may play an important role in the prophylactic treatment of HPNS.

2-Amino-5-phosphonovalerate↗

PubMed1993

Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease.

Acute exacerbations of chronic obstructive airways disease (COAD) are a common cause of admission to hospital, and have a high mortality. Nasal intermittent positive pressure ventilation (NIPPV) has been used successfully in patients with respiratory failure due to neuromuscular and skeletal disorders, but the outcome of treatment in patients with COAD is less well known. We carried out a prospective randomised controlled trial of conventional treatment versus conventional treatment plus NIPPV, in 60 patients with acute ventilatory failure due to exacerbations of COAD. For the NIPPV group there was a rise in pH, compared with a fall in the controls (mean difference of change between the groups 0.046 [95% CI 0.06-0.02, p < 0.001]), and a larger fall in PaCO2 (mean difference in change between the groups 1.2 kPa [95% CI 0.45 to 2.03, p < 0.01]). Median visual analogue scores over the first 3 days of admission showed less breathlessness in the NIPPV group (2.3 cm [range 0.1-5.5]) than in the control group (4.5 cm [range 0.9-8.8]) (p < 0.025). Survival rates at 30 days were compared for intention-to-treat and efficacy populations. In the efficacy mortality comparison, mortality in the NIPPV group was reduced: 1/26 vs 9/30 (relative risk = 0.13, CI = 0.02-0.95, p = 0.014). This effect was less in the intention-to-treat analysis: 3/30 vs 9/30 (relative risk = 0.33, CI = 0.10-1.11, p = 0.106). In patients with acute ventilatory failure due to COAD who received NIPPV there was a significant rise in pH, a reduction in PaCO2 and breathlessness, and reduced mortality.

Adrenal Cortex Hormones↗

PubMed1993

Diagnostic features and clinical outcome of ischemic-type biliary complications after liver transplantation.

The clinical significance and outcome of nonanastomotic strictures and dilatations involving only the biliary tree of the graft with a radiological appearance of biliary ischemia is unknown. Therefore we analyzed the grafts of 128 patients to evaluate the biochemical, radiological and histological features that prompted the diagnosis of ischemic-type biliary stricture and the clinical outcome of this complication. Ischemic-type biliary strictures were diagnosed in 25 patients (19%). Initial graft function was similar in all patients, whether or not this complication developed. Most ischemic-type biliary strictures occurred between 1 and 4 mo after orthotopic liver transplantation. However, the appearance of ischemic-type biliary stricture in the month after transplantation was predictive for a poor outcome in all six grafts with early onset of ischemic-type biliary strictures. Eighteen patients (72%) were treated with biliary stents and repeated dilatations. Long-term patency was achieved in 88% of these patients. Repeat transplantation was performed in six patients (24%); five survived. Finally, patients with ischemic-type biliary strictures spent more time in the hospital during the first year after orthotopic liver transplantation than did patients without the complication (62 +/- 27 days vs. 37 +/- 20 days; p < or = 0.001). This was due to repeated hospitalizations and a higher incidence of retransplantation. One-year graft survival was lower in patients with ischemic-type biliary strictures than in patients without ischemic-type biliary strictures (69% vs. 88%; p = 0.006). However, 1-yr patient survival was similar in the two groups (91% vs. 89%). In conclusion, early appearance of ischemic-type biliary stricture features is associated with poor graft prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗

PubMed1993

Imaging of complications of laparoscopic cholecystectomy.

Laparoscopic cholecystectomy has gained widespread acceptance for treatment of cholelithiasis. Because radiologists have a primary role in recognizing and treating complications of this surgical technique, we reviewed the clinical records and imaging studies of 29 patients with complications after laparoscopic cholecystectomy. Complications included bile duct injuries (15 cases), retained common bile duct stones (seven cases), cystic duct stump leak (four cases), bowel perforation (two cases), abdominal abscess (two cases), intraperitoneal gallstones (2), and failure to diagnose malignant bile duct obstruction (one case). Twenty-two patients required reoperation, and one patient with bowel perforation died. Eleven of 15 bile duct injuries were imaged prior to hepaticojejunostomy. Nine of 11 were proximal bile duct injuries within 2 cm of the junction of the right and left bile ducts. Endoscopic retrograde cholangiography (ERC) identified the distal extent of injuries, but transhepatic cholangiography (THC) was necessary to fully evaluate the proximal extent of the bile duct abnormalities. ERC was used for diagnosis and treatment of the seven patients with choledocholithiasis. Abdominal films showed intraperitoneal in one patient with bowel perforation, intraperitoneal stones in a second patient, and intraabdominal abscess in one of two patients in whom abdominal films were performed. Computed tomography (CT), done in three patients with bowel perforation or abscess, showed the one duodenal perforation, and the two abscesses. CT also showed bilomas, intraperitoneal gallstones, and unsuspected malignancy. Imaging studies detected and defined complications after laparoscopic cholecystectomy in all cases.

Bile↗

PubMed1993

Nasal intermittent positive-pressure ventilation in weaning intubated patients with chronic respiratory disease from assisted intermittent, positive-pressure ventilation.

Nasal intermittent positive-pressure ventilation (NIPPV) has been used for domiciliary ventilatory support, and to avoid intubation for acute respiratory failure in patients with chronic airflow limitation (CAL). Its role in weaning patients from assisted ventilation in intensive care has not been defined. We have used NIPPV to wean 14 patients with respiratory disease who were referred either because of predicted difficulty in weaning or failure to wean using standard techniques. Twelve patients were ventilated for acute respiratory failure; eight patients had CAL and four had chest wall or neuromuscular disease. Two further patients with chest disease were difficult to wean following surgery. Weaning was successful in 13 patients. NIPPV corrected hypoxia, reduced hypercapnia and was well tolerated. Weaning from NIPPV was achieved in all patients with CAL, although three patients with chest wall disease later required domiciliary ventilatory support. All but one of the patients survived to leave hospital. NIPPV may have an important role in weaning from assisted ventilation, particularly in patients with underlying chronic respiratory disease. This preliminary report needs to be followed by a controlled study comparing NIPPV with established weaning methods.

Adult↗