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Biomedical subjects

J E Ray

Publications and source records attributed to J E Ray.

At least 37 records · Page 2Linked to original sources
PubMed1986

Drugs involved in self-poisoning: verification by toxicological analysis.

During a two-month prospective survey in a metropolitan teaching hospital's accident and emergency department, 239 consecutive drug-related attendances (excluding admissions to hospital that were primarily alcohol related) were identified. This represented 2.6% of total attendances. Of the 199 patients who presented to hospital with self-poisoning, a biological specimen was obtained from 158 (79%) for toxicological analysis, thus providing reliable data on the drugs that were involved in the overdoses. The most common drug groups that were identified were barbiturate (51% of cases) and benzodiazepine (49%) agents, alcohol with other drugs (44%), cannabinoids (32%) and opiate analgesic drugs (25%). Quinalbarbitone and amylobarbitone (Tuinal) and oxazepam were the most common "single" preparations. The use of cannabis and alcohol and the use of several drugs concurrently were more common than in previously reported surveys of self-poisoning. Discrepancies between the purported drug consumption and the toxicological results were frequent; complete agreement occurred in only 35% of the cases. The TOXI-LAB system was an adequate method for toxicological analysis. However, for epidemiological studies an additional back-up method is recommended to verify the presence of some drugs such as barbiturate and benzodiazepine agents.

Alcohol Drinking↗
PubMed1984

A potentially brighter prognosis for colon carcinoma in the third and fourth decades.

In contrast to earlier studies that suggested that colon carcinoma is unusually lethal in the young, 69 patients, ages 20 to 39 years, had a relatively good prognosis. Fifty-nine percent lived over 5 years after diagnosis, and 51% were cured. Furthermore, 67% were cured if they did not have distant spread of the carcinoma at the time of the initial operation. Neither age, sex, tumor size, location, mere presence of lymph node metastases, depth of tumor invasion, nor predisposing disease of the colon was a strong prognostic factor. Metastases to six or more lymph nodes and distant spread of the tumor at the time of initial surgery were ominous findings. Mucinous carcinoma was relatively frequent (28%) and was also an ominous feature (only 5 of 20 patients cured as opposed to 26 of 43 with classical adenocarcinoma).

Adenocarcinoma↗
PubMed1984

Cholelithiasis in ileostomy patients.

A retrospective study of 152 ileostomates with inflammatory bowel disease (IBD) revealed that 16 patients (10.5 per cent) had diagnoses of cholelithiasis before, at the time of, or after having ileostomies. Of the remaining patients, 69 were followed for possible cholelithiasis, most of those with sonographic examination. Sixteen of this latter group of patients (23.2 per cent) were found to have cholelithiasis, usually in an asymptomatic stage. Among women over 50 years old, seven of 11 (63.6 per cent) had gallstones. Due to this high prevalence of cholelithiasis, gallbladder imaging is recommended as a part of the preoperative workup and follow-up of ileostomates. Prophylactic cholecystectomy may be carefully considered in female patients with IBD at the time of proctocolectomy.

Adolescent↗
PubMed1984

Inflammatory bowel disease and cholelithiasis: the association in patients with an ileostomy.

Sixty-nine patients were evaluated prospectively by sonography and history to determine the presence of cholelithiasis. Sixteen patients (23%) had a positive diagnosis. A control group was also prospectively evaluated. We have determined that patients above age 50 with a permanent ileostomy are at statistically significant risk of having cholelithiasis, and their risk is greater than that of a control group matched for age and sex. Radiologists should recognize this association and carefully evaluate the gallbladder of any patient with a permanent ileostomy who has abdominal pain.

Cholelithiasis↗
PubMed1983

High-performance liquid chromatographic analysis of diflunisal in plasma and urine: application to pharmacokinetic studies in two normal volunteers.

A high-performance liquid chromatographic (HPLC) assay with fluorescence detection has been developed for the determination of diflunisal in plasma and urine. The plasma or urine, containing naproxen as the internal standard, was extracted with ether-hexane (1:1). The samples were analyzed on a microparticulate column, and the compounds were eluted using a mobile phase of 0.05 M phosphate buffer (pH 3) and methanol. Plasma samples were analyzed from two healthy male subjects who received a 250- and 750-mg oral dose of diflunisal 3 weeks apart. The data were analyzed according to a two-compartment open model. There was a disproportionate increase in the area under the plasma concentration-time curves (AUC 750 mg/AUC 250 mg was 3.84 for subject A and 4.22 for subject B) and a reduction in plasma clearance after the 750-mg dose of diflunisal. These data suggest that the kinetics of diflunisal may be dose dependent.

Chromatography, High Pressure Liquid↗
PubMed1982

Guidelines for use of the flexible fiberoptic sigmoidoscope in the management of the surgical patient.

Based on data from many clinical studies and programs, guidelines are presented for application of the flexible fiberoptic sigmoidoscope in the management of the surgical patient. The flexible fiberoptic sigmoidoscope has proved to be an instrument of extraordinary capability in detecting colorectal neoplasms with yields being two or three times greater than those of the rigid sigmoidoscope in the symptom-resolution, polyp and cancer surveillance patient categories. In addition, the practical advantages of the narrow diameter, flexibility, and length of the fiberoptic sigmoidoscope are readily appreciated when the surgeon finds that he can satisfactorily examine patients with rectal or sigmoid strictures, marked angulations, or contracted lumens in whom a rigid scope would be unsuitable. Data from the authors' comparative study of more than 3000 patients have permitted the development of not only guidelines for the application of the flexible fiberoptic sigmoidoscope but an appreciation of the modified role of the rigid sigmoidoscope and the proper relationship between the flexible fiberoptic sigmoidoscope and the flexible fiberoptic colonoscope. A most important consideration is based on data regarding the site distribution of 400 benign premalignant neoplasms detected in the comparative study. The even distribution of these lesions throughout the terminal 50 cm of colorectum underscores the need to examine as much of the colorectum as possible.

Colonic Diseases↗
PubMed1980

Colonic manifestations of collagen vascular diseases.

Upper gastrointestinal manifestations of collagen vascular diseases have been well described. Recently our attention has been focused on the colonic complications: fibrosis and stricture resulting in obstruction, severe obstipation and recurrent fecal impactions secondary to pseudo-obstruction, progressive colonic dilatation resulting in gangrene of the colon, and sigmoid volvulus and diverticulitis in the presence of both wide- and narrow-mouth pseudodiverticula. Patients with these colonic manifestations of collagen vascular disease are disabled, if not severely ill. Recognition of the problem enables the surgeon to plan definitive surgical intervention ranging from segmental resection to total colectomy and ileoproctostomy to restore satisfactory large bowel function.

Adult↗
PubMed1980

Comparison of transient ischemic colitis with that requiring surgical treatment.

The records of 27 patients with colonic ischemia were reviewed. Twelve patients had typical reversible or transient ischemic colitis. Thirteen patients had an ischemic stricture or gangrene of the colon that required operation. Two of the patients have asymptomatic strictures of the splenic flexure and are under observation. The sigmoid colon in our series of patients was the most frequent area of symptomatic stricture formation. Any patient with ischemic colitis, especially that involving the sigmoid colon, should be observed closely for the development of a stricture. Surgical intervention is indicated only after colonoscopy and careful evaluation of symptoms and risk factors.

Adult↗
PubMed1979

Sigmoidoscopic examinations with rigid and flexible fiberoptic sigmoidoscopes in the surgeon's office: a comparative prospective study of effectiveness in 1,012 cases.

The results obtained from 1,012 examinations in an on-going, cooperative study indicate that the overall yield provided by use of the flexible fiberoptic sigmoidoscope is 3.2 times greater than that of examinations with the rigid sigmoidoscope. More than twice (2.4 times) the number of polyps and more than three times the number of cancers were detected with the flexible fiberoptic sigmoidoscope. Experienced endoscopists can perform an examination with the flexible fiberoptic sigmoidoscope expeditiously in the office with minimal patient preparation, a high level of patient and physician acceptance, and relative safety when the usual mandatory colonoscopic precautions and guidelines are obeyed. The extraordinary advantages demonstrated by this study warrant wide clinical application of the flexible fiberoptic sigmoidoscope. We strongly recommend provision be made for appropriate training of physicians in the use of the instrument.

Colon, Sigmoid↗
PubMed1979

Vascular ectasias of the colon.

Vascular ectasias are an acquired type of arteriovenous malformation distinct from neoplastic and congenital lesions. They can be the source of occult, recurrent or massive colonic bleeding usually in elderly patients but, occasionally, in younger adults. The vascular lesions are usually small but can be quite diffuse. The majority occurs in the right colon, but in our group of patients, a substantial number occurred distal to the hepatic flexure. The diagnosis can be made preoperatively, with colonoscopy but, more consistently, with arteriography. Therefore, arteriography should be performed in any patient with bleeding of the colon before surgical intervention. We recommend resection of the involved segment of the intestine as the treatment of choice.

Angiography↗
PubMed1978

Repair of rectal prolapse: experience with the Ripstein sling.

Forty-eight patients with rectal prolapse were seen at Ochsner Clinic from 1955 to 1977. The charts of these patients were reviewed to assess the results of treatment and to evaluate a suggested association between rectal prolapse and solitary rectal ulcer syndrome. Since 1970 the Ripstein sling procedure has been used exclusively to treat those patients with rectal prolapse who are able to undergo a transabdominal procedure. We compared the results of this procedure with the ones formerly used: perineal (Altemeer), sigmoidectomy, and Thiersch procedures. Although the earlier operations for rectal prolapse were associated with either a high recurrence or a high complication rate, the Ripstein has both a low recurrence and a low morbidity rate: two patients had recurrence and two had the sling applied too tightly. The Ripstein procedure was shown to be an effective, safe procedure for repair of rectal prolapse, and the result was considered satisfactory by 20 of the 21 patients questioned. Regarding the association of rectal ulcer and rectal prolapse, we found that, although the symptoms of the solitary rectal ulcer syndrome and rectal prolapse are similar, they appear to represent a different response to the same stimulus, and the syndrome is relatively unabated by repair.

Adolescent↗