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Biomedical subjects

G L Cullingford

Publications and source records attributed to G L Cullingford.

10 recordsLinked to original sources
PubMed2000

Pancreatic vasoactive intestinal polypeptide-oma as a cause of secretory diarrhoea.

A 42-year-old woman presented with a 4-year history of worsening diarrhoea that was watery, profuse and confirmed to be secretory in nature. She had tested positive for phenolphthalein on urinary laxative screening but continued to deny laxative usage. Her vasoactive intestinal polypeptide (VIP) level was subsequently found to be markedly elevated. Despite a normal abdominal ultrasound, a computed tomography scan revealed a 5-cm pancreatic tail mass. Octreotide scanning was used to exclude metastatic disease and she went on to have surgical removal of a localized pancreatic vasoactive intestinal polypeptide-oma which resulted in the complete resolution of her diarrhoea.

Adult↗
PubMed1994

Distribution of heat-stable enterotoxin/guanylin receptors in the intestinal tract of man and other mammals.

The human intestinal tract, as well as that of several eutherian and metatherian mammals, was examined for the distribution of heat-stable enterotoxin (ST)/guanylin receptors. These receptors were confined to the intestinal epithelium lining the lumen and forming the intestinal glands throughout the length of both the small intestine and colon of all species examined. In man and most other mammalian species, there appeared to be a decrease in receptor density distally along the longitudinal axis of the small intestine. ST/guanylin receptors were not observed in other strata forming the gut wall. Along the vertical axis of the human small intestine (villus/crypt unit), as well as that of most other mammals, receptor density was greatest in enterocytes located near the base of villi and in those forming the proximal portion of the intestinal glands. ST/guanylin receptors were for the most part confined to the region of the plasmalemma forming the microvillus border. In the colon of man and the other species examined, receptor density was greatest in enterocytes forming the proximal region of the intestinal glands. Receptors were present in the intestinal epithelium lining the lumen of the colon, but generally were fewer in number. The distribution of cellular cGMP accumulation responses to E. coli ST and guanylin in the opossum (Didelphis virginiana) and raccoon (Procyon lotor) revealed that proximal small intestine had greater magnitudes of cGMP responses than did the distal small intestine. Proximal colon had greater cGMP responses than distal colon, which had no significant cGMP responses to either ST or guanylin.

Animals↗
PubMed1993

Cholangiocarcinoma and familial adenomatous polyposis.

A case of cholangiocarcinoma occurring in a patient with familial adenomatous polyposis--only the fourth such case reported--is presented. Evidence suggests that tumours of the extrahepatic biliary tree may also be an extra-colonic manifestation of familial adenomatous polyposis.

Adenomatous Polyposis Coli↗
PubMed1992

Irritable bowel syndrome: can the patient's response to colonoscopy help with diagnosis?

The irritable bowel syndrome (IBS) is a common disorder estimated to affect up to 20% of adult Caucasians, with only a small percentage requiring investigation. This prospective study was performed to substantiate the impression that patients with IBS experience more pain during endoscopic examination of the colon than do patients with other conditions. Patients with IBS were observed to experience significantly more pain during colonoscopy than did patients without IBS (median observed pain scores 46 and 9, respectively), p < 0.001. The intensity of the pain perceived during examination was significantly higher for patients with IBS than for those without IBS (median 52.5 and 23.5, respectively), p < 0.001. Within the groups, there was no significant difference between flexible sigmoidoscopy and colonoscopy in observed or perceived pain. 64% of the patients with IBS said that the pain experienced at colonoscopy was identical to their presenting pain. This study supports the hypothesis of a lower colonic pain threshold with colonic hyperalgesia in patients with IBS. We have found that hypersensitivity to the endoscopic examination of the colon is a useful clinical adjunct in the diagnosis of the IBS in those selected to undergo colonoscopy.

Colonic Diseases, Functional↗
PubMed1991

Severe late postsplenectomy infection.

In all, 1490 patients underwent splenectomy in Western Australia between 1971 and 1983, giving 7825 person years exposure. Thirty-three patients developed severe late postsplenectomy infection (septicaemia, meningitis or pneumococcal pneumonia requiring hospitalization) and three developed overwhelming postsplenectomy infection. The incidence and mortality rates of severe late postsplenectomy infection were 0.42 and 0.08 per 100 person years exposure respectively and for overwhelming postsplenectomy infection the incidence and mortality rates were 0.04 per 100 person years exposure. There were 628 splenectomies after trauma, giving 3922 person years exposure. Eight patients developed severe late postsplenectomy infection of whom one had overwhelming postsplenectomy infection. Following trauma, the incidence of severe late postsplenectomy infection was 0.21 per 100 person years exposure, with the incidence and mortality rates of overwhelming postsplenectomy infection being 0.03 per 100 person years exposure. Patients undergoing splenectomy have a 12.6-fold increased risk of developing late septicaemia compared with the general population. Splenectomy following trauma gives an 8.6-fold increased risk of late septicaemia. The majority of severe late postsplenectomy infections did not occur within the first 2 years and 42 per cent of severe late postsplenectomy infections occurred greater than 5 years after splenectomy. The low incidence of severe late postsplenectomy infection and overwhelming postsplenectomy infection makes statistical evaluation of the effectiveness of prophylactic antibiotics, vaccination and splenic repair most difficult.

Adolescent↗
PubMed1990

Endoscopic management of intragastric migration of an Angelchik prosthesis.

The Angelchik prosthesis was devised as a simple surgical solution for reflux oesophagitis. Since 1983 there have been increasing reports of complications attributed to the prosthesis, the more serious being transmural erosion through the oesophageal or gastric wall. The majority of these have required repeat surgery, which is not without risks. A case report of an Angelchik prosthesis incompletely eroding into the stomach is presented. The prosthesis was tethered by a 1 cm-thick mucosal bridge which precluded simple extraction. Using an endoscopic sphincterotome, the bridge was divided and the prosthesis removed. Endoscopic methods of extracting intragastric Angelchik prostheses should be considered before surgery is undertaken for this complication.

Aged↗
PubMed1983

Demonstration of functioning heterotopic splenic autografts by scintigraphy.

The use of heterotopic splenic autografts is demonstrated as a means of preserving functioning splenic tissue in 15 patients undergoing splenectomy for trauma. In all patients, functioning splenic autografts could be shown by scintigraphy, using 99mTc-labelled erythrocytes or 99mTc-labelled sulphur colloid, performed 12 weeks after implantation.

Adult↗
PubMedDate not supplied

Preoperative assessment of pancreatic malignancy using endoscopic ultrasound.

BACKGROUND: Endoscopic ultrasound (EUS) has been regarded as the most accurate modality for locoregional staging of pancreatic malignancy. However, several recent studies have questioned this. The current study assessed the accuracy of EUS in determining preoperative resectability of pancreatic neoplasia. METHODS: A retrospective review was performed of patients with pancreatic malignancy who had preoperative EUS and underwent surgery. EUS-predicted resectability was compared with surgical resectability. Where available, accuracies of vascular and nodal staging were also assessed. RESULTS: Forty-five patients were identified (mean age 60 years, age range = 36-79 years). All patients underwent surgical exploration; vascular staging was available in 32 cases and 17 cases underwent surgical resection. The sensitivity, specificity, and accuracy of EUS in determining unresectability were 66%, 100%, and 78% respectively. Overall EUS stage concurred with surgical stage in 56%, greater than surgical stage in 4%, and less than surgical stage in 40%. Vascular staging on EUS had a sensitivity of 69% and a specificity of 100%. Accuracy of nodal staging was 71%. CONCLUSION: EUS had a high specificity for assessing unresectable pancreatic malignancy. This technique should be used to avoid unnecessary surgical exploration of incurable lesions. However, EUS had only a moderate sensitivity, and a proportion of patients staged preoperatively as having resectable disease will not be surgically resectable.

Carcinoma, Pancreatic Ductal↗