Biomedical subjects
Publications and source records attributed to G M Wilcox.
We describe two patients in whom acute colitis developed during etodolac treatment. Symptoms resolved when etodolac was stopped. In one, symptoms of colitis recurred with reexposure to the drug. The clinical and pathologic findings were consistent with de novo colitis from etodolac.
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We report the case of an 18-yr-old man with quiescent ulcerative colitis complicated by concomitant primary sclerosing cholangitis and rapidly progressive glomerulonephritis. Findings on immunofluorescence microscopy and electron microscopy suggested that glomerular injury occurred secondary to the deposition of circulating immune complexes. Renal disease responded to treatment with corticosteroids. A review of the literature found similar cases of glomerulonephritis and inflammatory bowel disease, but no previous association with sclerosing cholangitis has been recognized. The pertinent clinical, immunological, and pathophysiological aspects of this association are reviewed.
The diagnosis of Whipple's disease in a 58-year-old man was based on the finding of periodic acid-Schiff (PAS)-positive foamy macrophages on duodenal biopsy and demonstration of the typical bacilliform bodies by electron microscopy. The patient also had generalized peripheral lymphadenopathy with lymph node biopsy showing PAS-negative noncaseating granulomas. Electron microscopic examination of the lymph node specimen demonstrated a small number of typical bacilliform bodies with localization specifically to the granulomas in the lymph node. This finding of bacilliform bodies within PAS-negative noncaseating granulomas has not been reported previously. Localization of the Whipple bacillus specifically to noncaseating granulomas suggests that some patients with the disease may manifest a delayed hypersensitivity reaction to the bacillus.
The management alternatives of segmental colonic resection versus follow-up alone for colonic adenomas containing early invasive carcinoma (i.e., polypectomy resection margin free of tumor) were evaluated by decision tree analysis. Using data from the literature, the major variables influencing the decision were as follows: probability of residual disease after polypectomy, operative efficacy (defined as the chance of curing a tumor that would otherwise recur without surgery), and operative mortality. For a hypothetical patient with low operative risk (operative mortality of 0.2%), resection would yield the best outcome in terms of life expectancy as long as the probability of residual disease was greater than 0.5%. Extensive analysis of the impact of changes in assumptions about the parameters characterizing the problem showed this conclusion to be unchanging over wide ranges of operative efficacy and probability of residual disease. However, the decision to do a secondary resection in this situation was still close because surgery was only marginally justifiable on economic grounds. Observation would be preferred in patients with higher operative risk (operative mortality greater than 2%).
The proper treatment of adenomatous colonic polyps containing small foci of invasive cancer is controversial because the metastatic potential of these lesions is not precisely known. This article critically reviews all known English language studies of this lesion. Before the introduction of colonoscopic polypectomy, the estimated incidence of metastasis from this lesion was 10.4% (based on 12 studies containing 347 polyps), with a confidence interval (95% level) of 7.4 to 14.1. The incidence of metastasis estimated from lesions removed via colonoscopic polypectomy was 10.1% (based on 13 studies containing 188 polyps), with a confidence interval of 5.9 to 14.8. Differences in the definitions of the involved lesions, study designs, and indications for resection cause problems with case selection bias and make comparison of studies difficult. These problems are discussed in detail. Most studies had broad confidence intervals for the estimated incidence of metastasis because of small sample size. The histopathologic criteria, as reflected in the literature, for considering polypectomy alone as adequate treatment for this lesion are summarized and discussed.
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In order to estimate the proportion of women who have urinary tract infection, 23 rural primary care private practices agreed to obtain information according to a standard protocol on women over 12 years of age with urinary tract symptoms. Women excluded were those with vaginitis, chronic urinary tract infection, or concurrent confounding diagnoses. The results of the study on 213 women showed that the proportion of ambulatory women with urinary symptoms diagnosed as having urinary tract infection ranged from 31 percent to 71 percent, depending on the diagnostic criteria used. The type of urinary symptoms experienced by the women were not sensitive for cultures of 10(5) or more organisms per milliliter.
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The effects of orthostatic changes on the excretion of urokinase were studied in healthy normal volunteers. Urokinase excretion rose (average +69%) significantly (p less than .005) while urine volume fell (average-59%) significantly (p less than .001) after the subjects had been standing. There was no difference between men and women nor was there an apparent diurnal variation in urokinase excretion of recumbent subjects. A relationship between urokinase excretion and sympathetic nervous system activity is suggested.
Two radiochemical esterolytic assays for urokinase are described. One assay is based on the urokinase-dependent hydrolysis of Nalpha-acetyl-glycyl-L-lysine [3H]methyl ester and the other on the urokinase-dependent activation of plasminogen and assay of generated plasmin with Nalpha-tosyl-L-arginine [3H]methyl ester. The assays are performed in tubes placed in liquid scintillation counting vials. At the end of the experiment generated [3H]methanol is extracted into the liquid scintillation cocktail and counted. Unhydrolyzed substrate largely remains in the aqueous phase and contributes only a small fraction of the counts. This facile separation of 3H-labeled alcohol from the ester substrate allows the simple and highly sensitive assay for urokinase. The assays give results in good agreement with the classical fibrin plate assay.