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Biomedical subjects

F B Thomas

Publications and source records attributed to F B Thomas.

At least 19 recordsLinked to original sources
PubMed1995

Primary linitis plastica carcinoma of the colon and rectum.

Primary linitis plastica of the colon or rectum is a rare entity. Only 85 cases of this type cancer have been reported in the English medical literature. We report two cases, including the oldest known patient presenting uniquely with a sigmoid volvulus and another patient presenting with fecal incontinence and perianal pain. Linitis plastica of the colon or rectum is characterized by presentation in younger patients and is associated with metastatic disease, a high mortality, and insidious growth, often making detection difficult. A high degree of suspicion must therefore be held; a low threshold for endoscopic and echoendoscopic diagnostic intervention also should be maintained. Endoscopic ultrasound provides a unique view of its circumferential infiltrating pattern for diagnosis and staging, but further experience is necessary to establish whether the early use of endoscopic ultrasound favorably impacts mortality.

Aged↗
PubMed1987

Early surgical treatment of gastrinoma.

Medical treatment of the Zollinger-Ellison syndrome has been generally accepted because of the proven efficacy of the histamine (H2)-receptor antagonists in achieving symptomatic relief, and because of early reports indicating that few, if any, gastrinomas were resectable for cure. Gastrin radioimmunoassay (RIA) has made earlier and more certain diagnosis possible, and therefore reevaluation of the surgical management of gastrinomas is necessary. Experience with 60 gastrinoma patients is reported. Comparison between the pregastrin RIA years (before 1970) and post-gastrin RIA years was made to determine whether there was evidence to support the continuation of medical treatment without attempts to resect the gastrinoma. Twenty-five cases were diagnosed in the pre-RIA years. Age at diagnosis ranged from 17 to 68 years (median, 45 years). All patients were operated on. Metastases were found in 56 percent. No tumor was identified in 8 percent. Tumor was resected for "cure" (normal fasting gastrin levels for two years postoperatively) in one patient. Seventeen patients have died, and tumor was the cause of death in 70 percent. The five-year survival rate was 44 percent; the 10-year survival rate was 40 percent. Thirty-five cases were diagnosed after 1970. Age at diagnosis ranged from 39 to 61 years (median, 46 years). Thirty patients were operated on. Metastases were identified in 23 percent and no tumor was found in 17 percent. Tumor was resected for "cure" in 30 percent of patients. Seven patients have died and tumor caused death in 42 percent. The five-year survival rate was 82 percent; the 10-year rate was 64 percent. Advances in diagnosis and surgical technique since 1970 have made early operative treatment applicable in patients with gastrinoma. Because death in most cases is caused by progression of the tumor, an aggressive surgical approach to resect the tumor is advised soon after the diagnosis of Zollinger-Ellison syndrome is established.

Duodenal Neoplasms↗
PubMed1984

Additional chenodiol therapy after partial dissolution of gallstones with two years of treatment.

During the National Cooperative Gallstone Study, therapy with chenodiol, 750 or 375 mg/d, for 2 years resulted in confirmed, complete gallstone dissolution in 14% and 5% of patients, respectively, and partial dissolution (greater than 50%) in 27% and 18%. The present study was done to determine the frequency with which complete dissolution occurs in patients having partial dissolution of gallstones who receive additional therapy. Eighty-six of one hundred thirty-eight eligible patients continued to receive 750 mg/d (61 patients) or 375 mg/d (25 patients) of chenodiol for 1 year. Patients whose oral cholecystogram at the end of the year showed further (greater than 50%) dissolution continued to receive chenodiol, (28 patients at 750 mg/d and 11 patients at 375 mg/d) for a second year (total duration of therapy, 4 years). A final oral cholecystogram was taken at the end of the fourth year. Complete dissolution occurred in 23% and 16% of patients receiving chenodiol, 750 or 375 mg/d, respectively, for an additional 1 or 2 years.

Chenodeoxycholic Acid↗
PubMed1982

Piroxicam, aspirin, and gastrointestinal blood loss.

A study to compare the effects of three piroxicam regimens and aspirin on fecal blood loss (FBL) was conducted among 39 healthy men. Fourteen of the subjects also underwent prestudy and poststudy gastroscopy. There was an increase in FBL after aspirin, 972 mg 4 times a day, whereas piroxicam, 20 mg once a day, 5 mg four times a day, and 20 mg four times a day induced no observable increase in fecal blood loss. There was gastroscopic evidence of irritation in the aspirin group, but not in any of the piroxicam groups.

Adult↗
PubMed1982

Spontaneous bacterial peritonitis associated with acute viral hepatitis.

Spontaneous bacterial peritonitis (SBP) occurs most frequently in patients with cirrhosis and preexistent ascites; SBP has not been previously recognized in association with acute liver disease. We report two patients with acute hepatitis B infection who developed SBP. Patient 1 had Streptococcus pneumoniae peritonitis and bacteremia, but did not have ascites until after the peritoneal infection was evident. Subsequent liver biopsy and follow-up studies confirmed the clinical diagnosis of acute hepatitis. Patient 2 had submassive hepatic necrosis due to hepatitis B and developed ascites before Streptococcus fecalis SBP. Although the association of SBP with acute hepatic injury is rare, these two patients illustrate that the syndrome of SBP does occur with acute liver disease.

Adolescent↗
PubMed1982

Activation of the alternative complement pathway in ascitic fluid during spontaneous bacterial peritonitis.

We studied complement and immunoglobulin profiles on the serum and ascitic fluid of a patient before and during gram-negative spontaneous bacterial peritonitis (SBP). During the infection, activation of the alternative complement pathway in ascitic fluid was manifested by a 35% reduction in functional activity and depression of both properdin and factor B concentrations to nondetectable levels. Activation of the complement cascade was also demonstrated by a 50% reduction in the C3 concentration and depression of total hemolytic complement. There was no evidence of complement activation of a functionally intact complement system in the ascitic fluid of cirrhotic patients. Complement consumption in ascitic fluid may predispose the cirrhotic to SBP.

Ascitic Fluid↗
PubMed1982

Pancreatic cystadenoma in Von Hippel-Lindau disease: an unusual cause of pancreatic and common bile duct obstruction.

Pancreatic cystadenoma is an unusual lesion of the pancreas, typically occurring as an isolated lesion in a middle-aged woman with abdominal pain or an asymptomatic epigastric mass. Jaundice is unusual. Two types of pancreatic cystadenoma are distinguished: microcystic and mucinous; the latter has a tendency to malignant degeneration. A patient with Von Hippel-Lindau disease and pancreatic cystadenoma developed jaundice due to common bile and pancreatic duct obstruction. Cystic and adenomatous lesions of the pancreas are common in Von Hippel-Lindau disease, but jaundice due to common bile duct obstruction has not previously been reported.

Angiomatosis↗
PubMed1982

Effects of amino acids and gastric inhibitory polypeptide on insulin release in dogs.

Insulin release following intravenous administration of an amino acid solution with and without a simultaneous infusion of varying amounts of porcine gastric inhibitory polypeptide (GIP) was studied in dogs. Group I received a 10-amino acid mixture (300 mosmol/kg iv) at 16.6 ml/min for 1 h; group II, amino acid mixture plus 0.5 micrograms.kg-1.h-1 porcine GIP; group III, amino acid mixture plus 1.0 micrograms.kg-1.h-1 of GIP; group IV (a and b) received either 0.5 or 1.0 micrograms.kg-1.h-1 of GIP alone. Compared to group I, groups II and III had a greater insulin response during the first 30 min of the infusion. Group] IV (a and b) showed no insulin release. Glucose concentrations showed no significant change in all groups. From these results, it is concluded that insulin release after intravenous infusion of an amino acid mixture plus GIP is greater than after amino acids or GIP alone. It appears that this effect is more pronounced in the early phase of insulin release.

Amino Acids↗
PubMed1982

Pretreatment biliary lipid composition in white patients with radiolucent gallstones in the National Cooperative Gallstone Study.

Biliary lipid classes (bile acids, phospholipids, cholesterol) as well as individual biliary bile acids were measured in duodenal bile samples obtained before treatment from 284 white men and 264 white women participating in the National Cooperative Gallstone Study. The patients had radiolucent gallstones present in visualizing gallbladders. Calculated biliary cholesterol saturation was significantly higher in women (143 +/- 43, mean +/- SD, vs. 132 +/- 39 for men). Chenodeoxycholic acid was the major biliary bile acid in both sexes (40.0 +/- 9.9 in men; 38.8 +/- 9.3 in women, NS). Cholic acid was the second most common bile acid, constituting 32.9 +/- 8.8 in men and 31.8 +/- 8.9 in women (NS). When other demographic and clinical characteristics, including serum lipids, were related with biliary lipid composition, only percent ideal body weight correlated significantly. The partial correlation coefficient adjusted for percent ideal body weight indicated that the proportion of chenodeoxycholic acid correlated negatively with the mole fraction of cholesterol in bile in men, but not in women. Multiple regression analyses showed that bile saturation could not be predicted reliably from any clinical, chemical, or radiologic measurement in either sex. Published data for biliary lipid composition in individuals with biliary disease showed considerable overlap with the National Cooperative Gallstone Study data reported here, suggesting that cholesterol gallstone disease is not caused solely by increased biliary cholesterol saturation.

Adult↗
PubMed1982

Kaposi's sarcoma: endoscopic observations of gastric and colon involvement.

Kaposi's sarcoma is a multisystem neoplastic disease in which skin manifestations are usually seen first. Visceral involvement is frequent and the gastrointestinal tract is the most common location. We report a patient with Kaposi's sarcoma in whom the typical violaceous skin lesions were the sarcoma in whom the typical violaceous skin lesions were the only overt clinical manifestations, but the patient had multiple macular angiodysplastic-like lesions on colonoscopy. In contrast to the uniform appearance of the colonic lesions, polypoid, volcano, and maculopapular lesions were seen in the stomach on endoscopy. This report provides probably the first endoscopic description of the colonic lesions of Kaposi's sarcoma and contrasts them with the typical upper gastrointestinal lesions. A thorough gastrointestinal survey should be performed in all patients with Kaposi's sarcoma to delineate involvement, since appropriate treatment will be dictated by the presence or absence of visceral involvement.

Aged↗
PubMed1981

Endoscopic retrograde cholangiopancreatography. Its use in the evaluation of nonjaundiced patients with the postcholecystectomy syndrome.

Forty-two patients with the postcholecystectomy syndrome were studied by endoscopic retrograde cholangiopancreatography (ERCP). Both the biliary ductal system and pancreatic duct were well visualized in all patients. The ERCP was abnormal in 22 patients (52%). Abnormal findings included choledocholithiasis, papillary stenosis, pancreas divisum, pancreatic carcinoma, sclerosing cholangitis, incomplete cholecystectomy, and chronic pancreatitis. The results of one or more standard liver function tests and/or other noninvasive tests were abnormal in 36 patients; however, none reliably predicted the presence or specific anatomical type of pancreaticobiliary tract disease. Our data indicate that ERCP is essential in the diagnosis and management of the postcholecystectomy syndrome. The high yield of abnormal findings amenable to surgical correction in patients with recurrent biliary tract symptoms following cholecystectomy justifies the use of this procedure in all such patients.

Adult↗
PubMed1981

Idiopathic acute pancreatitis: the value of endoscopic retrograde cholangiopancreatography.

Acute pancreatitis is classified as idiopathic when an underlying cause cannot be identified through a careful history and appropriate noninvasive tests. Unless a cause can be identified, recurrent attacks cannot be effectively prevented. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 35 patients considered to have idiopathic recurrent acute pancreatitis, and an anatomic abnormality of either the pancreatic or biliary ductal system was demonstrated in 16. Ten underwent appropriate surgical procedures based on the results of ERCP, and 80% had no further episodes of acute pancreatitis. ERCP established the precise nature of potentially correctable anomalies and thereby facilitated precise preoperative planning. The wider use of ERCP in these patients may lessen the number of cases of acute pancreatitis considered to be idiopathic and lead to appropriate surgical therapy.

Acute Disease↗
PubMed1980

Inhibitory effect of coffee on lower esophageal sphincter pressure.

We examined the effect of 150 ml of caffeinated instant coffee at two pHs, 4.5 and 7.0, on lower esophageal sphincter pressure in 20 normal volunteers and 16 patients with reflux esophagitis. When ingested alone coffee at pH 4.5 and 7.0 caused a decrease in basal sphincter pressure in normal volunteers from 19.4 +/- 1.5 to 13.7 +/- 1.0 mmHg (P ¿ 0.01) and from 18.7 +/- 1.5 to 16.0 +/- 0.8 mmHg (P < 0.05) respectively. When coffee at pH 4.5 was drunk with a mixed nutrient test meal, the resting sphincter pressure in normal subjects fell after 30-60 min with the nadir, 11.2 +/- 1.0 mmHg, being recorded at 60 min (P < 0.01). Coffee at pH 7.0 with the test meal resulted in a fall in pressure to 14.3 +/- 1.5 mmHg (P < 0.02) at 60 min. In patients with reflux esophagitis, coffee at pH 4.5 lowered lower esophageal sphincter pressure from 9.1 +/- 1.0 to 5.5 +/- 0.6 mmHg (P < 0.005); coffee at pH 7.0 decreased lower esophageal sphincter pressure from 8.5 +/- 1.1 to 6.9 +/- 0.7 mmHg (P < 0.05). In these patients, mean basal pressure, 9.2 +/- 0.8 mmHg, decreased to 5.2 +/- 0.7 mmHg (P < 0.001) 45 min after drinking coffee at pH 4.5 with the test meal. Coffee at the neutral pH caused a fall in pressure from 8.8 +/- 1.1 to 6.5 +/- 0.7 mmHg at 60 min after the test meal. Thus, coffee at either pH 4.5 or 7.0 caused a decrease in fasting and postcibal lower esophageal sphincter pressure in normal volunteers and patients with reflux esophagitis. The magnitude and the duration of the effect were greater after coffee at the lower pH. These data support the clinical belief that coffee may cause or aggravate heartburn by decreasing lower esophageal sphincter pressure.

Adult↗
PubMed1978

Selective release of gastric inhibitory polypeptide by intraduodenal amino acid perfusion in man.

Intraduodenal amino acids are known to stimulate the release of gastric inhibitory polypeptide and cholecystokinin. In order to separate and quantitate gastric inhibitory polypeptide secretion selectively, 12 normal subjects received an intraduodenal perfusion of a mixed amino acid solution (158 mM) containing either methionine, phenylalanine, tryptophan, and valine (perfusate 1), or an amino acid solution containing arginine, histidine, isoleucine, leucine, lysine, and threonine (perfusate 2). Serum concentrations of gastric inhibitory polypeptide and insulin were significantly greater in the group receiving perfusate 2 (P less than 0.001). In contrast, after administration of amino acid perfusate 1, there was only a slight increase in serum gastric inhibitory polypeptide concentration and insulin secretion increased only slightly. Mean trypsin and bilirubin outputs in the group receiving perfusate 1 were nearly 3 times greater than the outputs of the group receiving the other amino acid mixture. This study expands the importance of intraduodenal amino acid mixtures in stimulating secretion of gastric inhibitory polypeptide and insulin and quantitatively separates gastric inhibitory polypeptide release from release of hormones that stimulate pancreatic enzyme secretion, such as cholecystokinin.

Adult↗
PubMed1978

Effects of caffeine and coffee on fluid transport in the small intestine.

Although caffeine is known to stimulate small intestinal water secretion in man, no available studies have examined the effect of coffee on small intestinal fluid transport. We have studied the effect of both coffee and caffeine on jejunal sodium and water transport by the triple lumen intestinal perfusion technique. Both caffeine and coffee solutions had equivalent caffeine concentrations, approximating the caffeine concentration in one cup of coffee. Control and coffee perfusion resulted in net absorption of 0.9 +/- 0.2 and 1.1 +/- 0.3 ml per min per 30 cm, respectively, whereas caffeine perfusion resulted in net water secretion of 2.4 +/- 0.4 ml per min per 30 cm (P less than 0.02). Net sodium absorption was observed with control and coffee solutions with a mean absorption of 190 +/- 32 and 184 +/- 40 muEq per min per 30 cm, respectively. Net sodium secretion of 334 +/- 25 muEq er min per 30 cm was observed during caffeine perfusion (P less than 0.02). We conclude that coffee perfusion has no significant effect on sodium and water transport in the jejunum in spite of the marked secretory effects of caffeine solutions. The results of this study yield further support to the suggestion that the effects of caffeine may not be similar to the effects of caffeine-containing compounds such as coffee.

Adult↗