Biomedical subjects

H J Sheiner

Publications and source records attributed to H J Sheiner.

At least 19 recordsLinked to original sources

PubMed1986

Liver abscess in Western Australia (1974-1983).

Over the 10 year period 1974-1983, 91 cases of liver abscess presented to the major teaching hospitals in Perth, Western Australia. Amoebic liver abscess (ALA) accounted for 37 (or 41%) of these cases, an incidence inflated by Perth's proximity to south-east Asia where amoebiasis is endemic. This frequent recent history of contact, the availability of sensitive and specific diagnostic serology and a clinical presentation usually suggesting pathology in the right upper quadrant, accounted for the consistently short delay in diagnosis of ALA. There were no deaths from ALA and a low incidence of complications such as secondary infection or rupture into the thorax. On the other hand, pyogenic liver abscess (PLA) commonly presented in a more non-specific manner and in an older age group, contributing to a long delay in diagnosis. Despite improvements in liver imaging techniques and advances in antibiotic and general supportive therapy, mortality for PLA remains high, 20% in this series. Fatal PLA was associated with multiple abscesses not amenable to drainage, increasing age, delay in diagnosis and the presence of septicaemia.

Adolescent↗

PubMed1985

Non-seminomatous germ cell testicular tumours: residual masses after chemotherapy.

Twenty-three consecutive patients with metastatic non-seminomatous germ cell testicular tumours were treated with a combination of cisplatinum, vinblastine and bleomycin. Nineteen had elevated serum tumour marker levels (alpha-fetoprotein and beta-subunit HCG) prior to chemotherapy. In 11 of the 19, residual masses were present on the completion of induction chemotherapy despite normal serum tumour marker levels (residual mass after chemotherapy). The management of these 11 patients was based on a policy of observation rather than routine resection of residual deposits and all are currently alive (32-58 months) with ten free of active disease. Two of the eleven required additional chemotherapy when serial tumour marker levels became elevated during follow-up. Another six have been observed without further intervention and have remained well with stable or diminishing deposits. The remaining three have required resection of residual masses, in each case because of mass enlargement despite persistently negative tumour marker levels. None of the masses showed histological evidence of malignancy. A more selective approach to resection of residual masses after chemotherapy is advocated.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1983

Fine-needle aspiration cytology in the management of breast disease.

The results of a series of fine needle aspiration biopsies of breast lumps were reviewed to evaluate the accuracy of this diagnostic method and its place in the clinical management of breast lesions. A high level of diagnostic accuracy was achieved. There were no false positive diagnoses of malignancy and fewer than 3% of diagnoses were falsely negative. Eighty per cent of carcinomas could be confidently diagnosed by means of cytological investigation. The patient with a benign cytological diagnosis can either be reassured, or her surgical management planned as a day case. For the patient with a cytological diagnosis of malignancy, discussion of the nature of her surgery and subsequent care is possible before operation. In selected cases of carcinoma, mastectomy can be performed without frozen-section confirmation. Diagnostic accuracy is dependent upon experience, especially in aspiration technique, and optimum results are obtained if the pathologist/cytologist also performs the procedure.

Biopsy, Needle↗

PubMed1982

The comparative epidemiology of benign breast lumps and breast cancer in Western Australia.

Totals of 313 patients with breast cancer and 1,283 patients biopsied for benign breast lumps were found in Western Australia in 1978 through review of all histopathological, hospital and cancer registry records. The incidence of breast cancer rose to 146.9 per 100,000 at age 45-54 years and thereafter increased little. The biopsy rate for benign breast lumps rose more sharply to 420.2 per 100,000 at age 45-54 years and then fell. This pattern was mainly due to benign mammary dysplasia (BMD); fibroadenoma showed an earlier peak biopsy rate (30-34 years) and other (mainly non-neoplastic) benign lumps were biopsied at a relatively constant rate throughout adult life. Rates of breast cancer, BMD and fibroadenoma showed similar relationships to the other descriptive variables studied. The rates of each were higher in single than married women, in residents of the Perth area than residents of other parts of the State and in women employed in professional and related occupations than other employed women. They were lower in migrants from Europe (excluding Great Britain) than native-born Australians and in women of low socio-economic status than women of high status. Not all these differences were statistically significant. Rates of other breast lumps did not generally vary in these ways and were conversely related to country of birth, area of residence and socio-economic status. The parallels in descriptive epidemiology between breast cancer, BMD and fibroadenoma suggest that they may share aetiological factors.

Adolescent↗

PubMed1980

Massive pancreatic serous effusions.

The condition of massive pancreatic serous effusion is being increasingly recognized as a specific complication of pancreatitis. It occurs as a result of leakage of pancreatic juice into the pleural or peritoneal cavity after disruption of the duct system. Five such cases are described. The difficulties in making the diagnosis are mainly due to the absence of symptoms of pancreatitis, and most patients present because of the effects of the effusion. Once suspected, the diagnosis is confirmed by the demonstration of a grossly elevated amylase level in the fluid. A rational surgical approach is usually successful, and depends on the demonstration of a leak from a pseudocyst or disruption of the pancreatic duct system.

Amylases↗

PubMed1978

Operative biopsy of the pancreas using the Trucut needle.

The results of 14 operative biopsies of the pancreas using the Trucut technique are presented. There was no significant complication attributable to the biopsy, and in all cases an adequate tissue specimen was obtained, facilitating either frozen or paraffin section histological diagnosis. One false negative result was obtained which was due to sampling error. This technique is recommended as a good alternative when operative pancreatic biopsy is required. It is technically simple, has an acceptably low sampling error, provides a good tissue specimen for histological examination, and has few complications.

Adenocarcinoma↗

PubMed1977

The initial phase of gastric emptying before and after vagotomy and pyloroplasty.

The initial phase of gastric emptying of solid food was monitored with the use of a gamma camera and on-line computer facilities. In normal subjects a consistent pattern was seen comprising an early delay in the onset of emptying ("plateau"), followed by an exponential decay curve. After vagotomy the plateau was lost, and the exponential pattern of emptying commenced once the stomach was full. There was no evidence of sudden "dumping" of contents from the stomach. The overall rates of emptying as measured by the half emptying time (T 1/2) were the same in normal and postvagotomy subjects.

Duodenal Ulcer↗

PubMed1976

Drug therapy for postragotomy gastric stasis.

An unusual but well-recognized complication of truncal vagotomy with a drainage procedure is severe gastric stasis (atony). In 6 patients presenting with this problem drug therapy was initiated after mechanical obstruction of the gastric outlet was excluded by radiology. Bethanechol chloride was successful in stimulating gastric peristalsis in all the patients, with consequent improvement of symptoms in 5 out of the 6 subjects. Metoclopramide alone was of no value in starting peristalsis but of pssible benefit once gastric motility had begun.

Adult↗

PubMed1976

Multiple hyperplastic inflammatory polyps complicating quiescent ulcerative colitis.

A patient with well-controlled and currently asymptomatic ulcerative colitis had II unusually large polypoid lesions in his colon demonstrated by barium enema X-ray examination and colonoscopy. Previous histological descriptions of inflammatory polyps did not adequately describe their morphology, and the term "hyperplastic inflammatory polyp" is suggested.

Adult↗

PubMed1976

Continuous monitoring of the effect of pentagastrin on gastric emptying of solid food in man.

By continuous monitoring of a solid meal labelled with a radiopharmaceutical it has been possible to determine the effects of drugs on gastric emptying and motility during a single study. Predictably hyoscine delayed, and bethanechol increased, the rate of gastric emptying. Pentagastrin initially produced marked antral activity resulting in a physiological stricture and subsequent delay in the overall rate of gastric emptying. Fundal motility was unaffected though reflux from the antrum occurred.

Gastrointestinal Motility↗

PubMed1976

Gastric emptying in control subjects and patients with duodenal ulcer before and after vagotomy.

The emptying of a solid meal labelled with Indium 113mDTPA from the stomach was studied with a gamma camera in 26 normal subjects, 27 patients with duodenal ulcer, on 41 occasions after truncal vagotomy and pyloroplasty and 38 times after highly selective vagotomy. Applying the method of principal component analysis to the results, differences were detected between control and duodenal ulcer subjects and two probable subgroups of duodenal ulcer were observed. Half emptying times did not reveal these patterns. After vagotomy, delayed emptying was general at one week. At one month, patients after highly selective vagotomy had a more normal result than those with truncal vagotomy and pyloroplasty (TV), but by six months no significant difference in overall emptying rate was found, although changes in the pattern of gastric emptying persisted in some patients after TV.

Adult↗

PubMed1975