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Biomedical subjects

I C Roberts-Thomson

Publications and source records attributed to I C Roberts-Thomson.

At least 109 records · Page 6Linked to original sources
PubMed1985

Spontaneous improvement in pancreatic function in chronic pancreatitis.

Three women with chronic pancreatitis who were observed for 4-29 years showed spontaneous improvement in exocrine function as assessed by symptoms and by reduction in fecal excretion of fat. One patient had a reduction in the severity of diabetes mellitus, while another showed a progressive increase in the maximum bicarbonate concentration in duodenal juice after the intravenous injection of secretin. Improvement in pancreatic function followed cessation of alcohol in two patients in whom chronic pancreatitis was associated with alcohol abuse.

Adult↗
PubMed1985

Manometric disorders in patients with suspected sphincter of Oddi dysfunction.

Sphincter of Oddi (SO) manometry was conducted in 48 subjects who had previously undergone cholecystectomy. Ten of these subjects had no detectable biliary or pancreatic disease and served as controls. The other 38 patients were presumed to have SO dysfunction and had presented with episodes of severe biliary-type pain with either dilatation of the bile duct on a retrograde cholangiogram, transient changes in liver function tests, or both of these abnormalities. A triple-lumen low-compliance manometric system was used to record the SO basal pressure, SO phasic contraction amplitude, SO wave frequency, direction of wave propagation, and SO response to intravenously administered cholecystokinin-octapeptide 20 ng/kg. Satisfactory manometric recordings were obtained from 32 of 38 patients and of these, 25 patients showed one or more abnormalities when compared with data from the 10 controls. The abnormalities included excess of retrograde contractions (12), high frequency of SO phasic contractions (11), elevation of the SO basal pressure (8), and paradoxical cholecystokinin-octapeptide response (10). The study has demonstrated a spectrum of manometric abnormalities in the SO of patients with suspected SO dysfunction.

Adult↗
PubMed1985

Is endoscopic sphincterotomy for disabling biliary-type pain after cholecystectomy effective?

Between 1979 and 1983, 50 patients were treated by endoscopic sphincterotomy for disabling biliary-type pain after cholecystectomy. Forty-six patients were seen at regular intervals for at least 12 months after the procedure and of these, pain resolved in six (13%), decreased in severity and/or frequency in 22 (48%), and continued unchanged in 18 (39%). Patients with bile duct dilation on a retrograde cholangiogram had a similar outcome to those with a bile duct of normal caliber. Twenty-five patients had a morphine-neostigmine test and endoscopic manometry of the sphincter of Oddi prior to the procedure, and the outcome appeared to be independent of results from these investigations. Subgroups of patients who benefit from sphincterotomy will be determined only by prospective studies in which criteria for inclusion are carefully defined so as to avoid heterogeneity within study groups.

Anal Canal↗
PubMed1985

High serum levels of alkaline phosphatase are associated with cancer in cholestatic jaundice.

In a prospective study of liver function tests in cholestatic jaundice, the median serum level of alkaline phosphatase (ALP) in 129 patients with cancer involving extrahepatic ducts and liver (556 IU/1) was significantly higher (P less than 0.001) than that in 121 patients without cancer (264 IU/1). Of patients with an ALP level of greater than 10 X N, 88% had cancer whereas serum levels of ALP of less than 3 X N were observed in only 9% of patients with cancer but in 45% of those without cancer, most of whom had bile duct stones. A high serum level of ALP is associated with cancer involving extrahepatic ducts and liver.

Aged↗
PubMed1985

Abnormal responses to morphine-neostigmine in patients with undefined biliary type pain.

The occurrence of pain and changes in serum concentrations of liver enzymes and amylase were investigated after challenge with intramuscular morphine (0.12 mg/kg) and neostigmine (0.012 mg/kg) in 25 control subjects and 80 patients with undefined biliary type pain, both with and without prior cholecystectomy. Peak enzyme concentrations were reached at four hours after the injection of morphine-neostigmine. When compared with controls, patients who had pain after cholecystectomy and a dilated bile duct and/or spontaneous changes in liver enzymes, had a higher frequency of drug induced pain and a higher frequency of rise (greater than 2 X N) in serum concentrations of aspartate aminotransferase (AST) and amylase; postcholecystectomy patients with pain but without bile duct dilatation, and patients with pain without prior cholecystectomy, had a higher frequency of drug induced pain but did not have a higher frequency of enzyme rise. Increases in liver enzymes after morphine-neostigmine were abolished by endoscopic sphincterotomy. Thirty three patients with a dilated bile duct and/or spontaneous changes in liver enzymes were also studied by endoscopic manometry of the sphincter of Oddi: similar frequencies of enzyme changes were observed in patients with normal manometry as in those with various manometric disorders. Increases in serum concentrations of liver enzymes after morphine-neostigmine may be explained by high biliary pressures resulting from an exaggerated motor response in the sphincter of Oddi.

Alanine Transaminase↗
PubMed1984

Endoscopic sphincterotomy of the papilla of Vater: an analysis of 300 cases.

Endoscopic sphincterotomy was performed on 300 patients with biliary and/or pancreatic disease during the period 1978-1983. The most frequent indications were choledocholithiasis after cholecystectomy (59%), choledocholithiasis without cholecystectomy (17%) and presumed motility disorders of the sphincter of Oddi (15%). In choledocholithiasis, stones passed spontaneously or were extracted from the bile duct in 147 of 164 patients (90%) in whom the outcome was determined by cholangiography immediately after stone extraction or by a second retrograde cholangiogram. In presumed motility disorders, only 51% of patients have shown sustained improvement in symptoms. Complications were uncommon (5%) but included bleeding from the margins of the incision, pancreatitis, cholangitis and an entrapped Dormia basket; no patient died. Duodenal diverticula were more frequent (p less than 0.005) in patients with bile duct stones after cholecystectomy (28%) than in patients in whom retrograde cholangiography did not reveal stones (9%) but the presence of diverticula did not influence the outcome of the procedure. Endoscopic sphincterotomy is a safe and effective procedure of particular relevance to elderly patients with choledocholithiasis after cholecystectomy and to high-risk patients with choledocholithiasis without cholecystectomy.

Adult↗
PubMed1983

An examination of differences in serum antibody specificities and hypersensitivity reactions as contributing factors to chronic infection with the intestinal protozoan parasite, Giardia muris, in mice.

After oral administration of cysts of the intestinal protozoan parasite, Giardia muris, young male C3H/He mice are chronically infected, whereas BALB/c mice demonstrate a rapidly resolving pattern of infection. Both strains of mice injected with trophozoites in adjuvant and challenged orally with cysts develop serum antibodies to numerous trophozoite proteins. A limited number of these protein antigens was differentially immunoprecipitated by sera from resistant BALB/c and susceptible C3H/He mice exposed to G. muris. 35S-methionine-labelled protein antigens better recognized by immune BALB/c sera included molecules of relative mobility (Mr) 82,000 and a series of proteins of Mr 25,000 to 32,000. Differential recognition extended to a subset of solubilized trophozoite antigens that bind to the lectin, wheat germ agglutinin (WGA), and that can be radio-iodinated. In particular, a complex of 4 acidic protein antigens of approximate Mr 32,000, and designated collectively as Gm32, was better recognized by immune BALB/c serum than C3H/He serum. Isolated WGA-binding antigens were not able to consistently vaccinate BALB/c mice against subsequent G. muris infection. Moreover, preliminary evidence has been obtained that lack of antibody responsiveness to Gm32 does not segregate strictly with susceptibility to chronic infection in (BALB/c X C3H/He)F2 mice. These data, plus the observation that drug-cured C3H/He mice are highly resistant to reinfection, has led to examination of whether mice differ in the capacity of the intestines to support inflammatory responses. Mast cell deficient Wf/Wf mice, unlike wild-type litter-mates, developed chronic giardiasis although no reconstitution of resistance has yet been achieved with inocula of bone marrow cells from +/+ mice. BALB/c mice injected with the antihistamine and antiserotonin drug, cyproheptadine, also showed prolonged infections with G. muris. The data suggest that analysis of specificity differences in immune responses of mice varying in susceptibility to intestinal parasites must be supplemented by examination of the capacity of the intestine to support induced immune responses.

Animals↗
PubMed1982

Giardiasis in mice: analysis of humoral and cellular immune responses to Giardia muris.

Humoral and cellular immune responses have been evaluated in two inbred strains of mice which differ markedly in their susceptibility to infection with Giardia muris. Serum IgG and IgA antibody levels and IgA levels in intestinal washes were determined by a solid-phase radioimmunoassay using G. muris antigen prepared by sonication of trophozoites, while cell-mediated immunity was assessed by a radiometric ear-assay for delayed-type hypersensitivity. Following infection of BALB/c mice (resistant) and C3H/He mice (susceptible), the IgG and IgA antibody levels in serum progressively increased over the period of study with C3H/He mice having significantly higher titres of IgA antibodies than BALB/c late in the infection. Systemic immunization with G. muris trophozoites resulted in high titres of IgG antibodies in the serum. IgA antibodies were detected in intestinal washes 2 weeks after infection with a subsequent fall in levels in BALB/c mice but a progressive increase levels in C3H/He mice. Prior immunization resulted in IgA antibodies being detected earlier in the intestinal washings after a challenge infection. Delayed-type hypersensitivity to G. muris antigens could not be detected during an infection but a positive response was elicited following antigen priming in mice pretreated with cyclophosphamide. The immune responses evaluated in this study were assessed using a whole G. muris trophozoite sonicate and variations in the quantitative aspects of the responses did not account for observed differences in the course of infection in the two strains of mice.

Animals↗
PubMed1982

Carcinoma of the papilla of Vater.

Carcinoma of the papilla of Vater was diagnosed in 18 patients during the period 1970 to 1980. In ten patients, surgical treatment was facilitated by a preoperative diagnosis based on duodenal endoscopy, biopsy, cytology and retrograde cholangiopancreatography. Of 16 patients with apparently localised disease at laparotomy, nine had pancreatoduodenectomy (Whipple's operation), three had local resection and four had biliary bypass. Six of nine patients treated by pancreatoduodenectomy are surviving for periods ranging from one to ten years, mean four years, whereas the four patients treated by biliary bypass survived for 0 to 18 months. Tumour recurred in the region of the papilla in two of three patients treated by local resection. Carcinoma of the papilla of Vater is usually localised at the time of diagnosis and prolonged survival can be achieved by pancreatoduodenectomy.

Adenocarcinoma↗
PubMed1982

Correlation between pancreatic polypeptide response to secretin and ERCP findings in chronic pancreatitis.

Previous studies have shown an impaired pancreatic polypeptide response to secretin in most patients with advanced chronic pancreatitis, but the sensitivity of the investigation in milder degrees of chronic pancreatitis remains unclear. In the present study the pancreatic polypeptide response to secretin was evaluated in 32 patients categorised as having advanced, moderate, or minimal chronic pancreatitis on the basis of the degree of abnormality of the retrograde pancreatogram. The pancreatic polypeptide response was abnormal (peak:basal pancreatic polypeptide ratio less than 5) in 17 of 19 patients (90%) with advanced or moderate chronic pancreatitis, but was normal in patients with minimal disease. The simple and non-invasive nature of this test makes it an attractive investigation for evaluation of the severity of pancreatic damage.

Adult↗
PubMed1982

Granulomatous hepatitis and cholangitis associated with giardiasis.

Biopsy of the liver revealed granulomas in portal tracts and cholangitis in a woman with chronic diarrhea, weight loss, fever, hypoalbuminemia, and anemia attributed to giardiasis. Eradication of Giardia resulted in rapid improvement of symptoms and resolution of histologic changes on a second biopsy of the liver after 3 mo. The patient had serum immunoglobulin levels that were either normal (IgG, IgM) or elevated (IgA), detectable levels in serum of anti-Giardia antibody, and an HLA phenotype (B12, B27) known to be associated with prolonged giardiasis.

Antibodies↗