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Biomedical subjects

J L Cameron

Publications and source records attributed to J L Cameron.

At least 271 records · Page 15Linked to original sources
PubMed1983

The Budd-Chiari syndrome. Treatment by mesenteric-systemic venous shunts.

Twelve patients with the Budd-Chiari syndrome have been managed surgically. Ten of the patients were female, two were male, with a mean age of 40 years. Three of the patients had polycythemia vera, two had pre-existing cirrhosis, one had ingested estrogens, one had an occult tumor, and in four there were no associated factors. Ten patients presented with ascites and two with bleeding esophageal varices. The diagnosis was confirmed in all 12 patients by liver biopsy and hepatic vein catheterization. Inferior vena cavography revealed the abdominal vena cava to be thrombosed in six patients. The superior mesenteric vein was used to decompress the congested liver in all 12 patients. In five patients, a mesocaval shunt (MCS) was performed and in seven patients, a mesoatrial shunt (MAS) was carried out. There were four hospital deaths (two MCS, two MAS). One late death (MAS) occurred from liver failure following shunt thrombosis. Two additional patients (one MCS, one MAS) re-developed ascites immediately following surgery and angiography revealed a thrombosed shunt. Ascites has been controlled with a LeVeen shunt in these two patients, but liver biopsies showed progression to cirrhosis. The remaining five patients (three MAS, two MCS) did well, and angiography revealed patent shunts. Two of these patients, however, re-developed ascites at 4 and 10 months following MAS and required a second MAS. Follow-up ranges from 6 to 68 months. In three of the patients (two MCS, one MAS) with patent shunts, liver biopsy shows a remarkable return toward normal liver architecture and histology.

Adolescent↗
PubMed1983

CT evaluation of therapeutic embolization of hepatic hemangiomas.

Computed tomography (CT) was used to monitor the response to therapeutic embolization in two cases of giant cavernous hemangiomas of the liver. Base-line tumor volume and rat of enhancement were calculated. Therapeutic embolization with a detachable balloon or Ivalon microsphere plus a detachable balloon was then performed. CT was repeated to evaluate both change in tumor volume and in rate of enhancement ("fill-in") of the lesion. It was possible to document the response to embolization by changes in the size and the degree of enhancement of the lesions. Thus, CT can be used to document the success or failure of embolization of hepatic hemangiomas.

Adult↗
PubMed1983

Crohn's disease and ulcerative colitis in the same patient.

A well documented case of a patient with both Crohn's disease and ulcerative colitis is presented. A 29 year old woman underwent resection of her terminal ileum and ascending colon for typical Crohn's disease with ileocolitis. Eleven years later, an ileoproctocolectomy was performed for typical ulcerative colitis involving the left colon. The resection specimen also showed evidence of colonic Crohn's disease near the anastomotic site. This unusual case shows that Crohn's disease and ulcerative colitis can occur in the same patient. The rarity of such cases supports the concept that Crohn's disease and ulcerative colitis are separate entities, rather than different manifestations of the same disease process.

Adult↗
PubMed1983

Consequences of preoperative cholangitis and its treatment on the outcome of operation for choledocholithiasis.

During a 30-month period 73 patients underwent operation for choledocholithiasis. Thirty-three of these patients (45%) had cholangitis preoperatively. When compared to patients with common duct stones who had no preoperative cholangitis, patients with cholangitis were older (P less than 0.001), more likely to present with jaundice (P less than 0.01) and leukocytosis (P less than 0.01), and more likely to have retained or primary common duct stones (P less than 0.01). Cholangitis patients were also more likely to have bactibilia (P less than 0.025), and anaerobes were isolated from the bile of 27% of these patients (P less than 0.01). Twenty-nine of 33 cholangitis patients (88%) received a minimum of 4 days of broad-spectrum antibiotics including an aminoglycoside prior to operation (P less than 0.01). Despite these clear differences, patients with preoperative cholangitis were not more likely to develop infective sequelae or biliary complications. However, cholangitis patients were much more likely (P less than 0.001) to develop an increase in serum creatinine (33% versus 3%) which, in turn, contributed to a longer (P less than 0.01) postoperative hospitalization. Since therapy with aminoglycosides may have contributed to postoperative morbidity and prolonged hospital stay, aminoglycosides should be reserved only for patients with the most severe cholangitis and should be used with great caution.

Adolescent↗
PubMed1983

Aspiration pneumonia: treatment with pulmonary vasodilators.

Experimental aspiration pneumonia induced in the isolated perfused ventilated canine pulmonary lobe by the intrabronchial instillation of hydrochloric acid is characterized by pulmonary edema, intrapulmonary shunting, and loss of lung compliance. In addition, pulmonary artery pressure increases. In an attempt to modify the injury response, we restricted the increase in pulmonary artery pressure in the isolated lobe model by administering vasodilator drugs. In control lobes perfused for 4 hours there was minimal weight gain (14 gm), pulmonary artery pressure remained stable (13 mm Hg), and intrapulmonary shunting did not occur. Following intrabronchial instillation of 0.2 ml of 0.1N HCl/gm of lobe weight, lobe weight tripled (183 gm), pulmonary artery pressure (20 mm Hg) was significantly increased, and significant intrapulmonary shunting (32%) developed. When sodium nitroprusside (2 micrograms/min/kg of dog body weight) was infused into the pulmonary artery 3 minutes after HCl instillation, the pulmonary artery pressure was significantly reduced (13 mm Hg) compared to that in untreated acid lobes. This was accompanied by a significant reduction in mean weight gain (100 gm) and intrapulmonary shunting (15%) compared to untreated acid lobes. Similarly, when isoproterenol (0.04 micrograms/min/kg dog body weight) was infused into the pulmonary artery following acid instillation, the pulmonary artery pressure (12.5 mm Hg) was significantly reduced compared to that in untreated acid lobes. This was also accompanied by a significant reduction in weight gain (60 gm) and intrapulmonary shunting (6%) compared to untreated acid lobes. These data demonstrate that the increase in pulmonary artery pressure following acid injury can be lowered pharmacologically and that a significant decrease in injury response follows. This suggests that the magnitude of the injury response is in part a function of pulmonary artery pressure.

Animals↗
PubMed1983

Sclerosing cholangitis: biliary reconstruction with Silastic transhepatic stents.

Because of multiple areas of stricturing and small fibrotic ducts, sclerosing cholangitis has generally not been amenable to direct reconstructive procedures. In reviewing the cholangiograms of 29 patients with sclerosing cholangitis, it became apparent that despite diffuse disease, the hepatic duct bifurcation was often (22 patients) the most severely narrowed area. Because of this finding it was decided to manage patients who have sclerosing cholangitis, persistent jaundice, and hepatic duct bifurcation narrowing with a direct surgical approach. In 11 patients the extrahepatic biliary tree including the bifurcation was resected and the right and left hepatic ducts were dilated. Bilateral 6 mm silicone rubber (Silastic) transhepatic biliary stents were inserted and bilateral hepaticojejunostomy was performed. Eight patients were men, three were women, and the mean age was 41.9 years. At the time of surgery the mean serum bilirubin concentration was 15.3 mg/dl (range 1 to 50 mg/dl). The disease had been present clinically for a mean duration of 3.6 years. There was one hospital death. Nine of the ten remaining patients have responded with a decrease in serum bilirubin concentration to a mean of 2.9 mg/dl. These nine patients have returned to normal activity. The tenth patient has done poorly and awaits liver transplantation. Follow-up ranges from 4 to 36 months (mean 18 months). The stents have been left in position permanently.

Adult↗
PubMed1982

Biliary bacteria: significance and alterations after antibiotic therapy.

Patients undergoing urgent and complex biliary operations were studied to determine (1) whether bactibilia is associated with postoperative complications amd (2) whether antibiotic therapy influences biliary bacteriology. Aerobic and anaerobic cultures were performed on hepatic bile obtained at surgery in 134 patients. Cultures were repeated four to seven days postoperatively in 111 patients who had indwelling biliary tubes. Positive operative bile cultures were associated with an increased incidence of wound infection and postoperative renal dysfunction. Postoperative bile cultures showed a significant increase in the number of patients having bactibilia, and a significant alteration in the types of organisms isolated. Anaerobes were cultured from 15% of operative and 23% of postoperative cultures. Antibiotic therapy did not sterilize bile, but merely altered biliary bacteriology. Furthermore, prolonged aminoglycoside therapy was associated with a high incidence of renal dysfunction, especially in elderly patients.

Adolescent↗
PubMed1982

Current role of intravenous cholangiography.

One hundred consecutive intravenous cholangiograms were reviewed. In terms of bile duct and gallbladder visualization, 20 were of excellent quality, 40 were of adequate quality, and 40 were of poor quality or did not visualize. In retrospect, 12 of the studies were originally misinterpreted. Among the 29 patients who were eventually proven to have biliary tract disease, intravenous cholangiography was helpful in making the diagnosis in only 17 (59 percent). In 20 patients the study was performed to establish or rule out a diagnosis of acute cholecystitis; the test was helpful in only 9 (45 percent). It is concluded that intravenous cholangiography frequently results in marginal visualization that is subject to interpretive error. With the current variety of available tests that are able to visualize the biliary tree with a high degree of resolution, intravenous cholangiography has become a diagnostic anachronism.

Adult↗
PubMed1982

Surgical management of ileosigmoid fistulas in Crohn's disease.

Seventeen patients with ileosigmoid fistula complicating Crohn's disease are reported on. Eighty-two percent of the fistulas were diagnosed radiologically. Thirteen of the patients (76 percent) were treated by resection of the diseased ileum and cecum with primary anastomosis, division of the fistula, and simple closure of the colon. There were no anastomotic leaks, and long-term follow-up demonstrated excellent results. Segmental sigmoid resection in addition to resection of the diseased ileum and cecum should only be performed when there is radiologic or histologic evidence of Crohn's disease of the colon. Proximal diversion is generally not required, and most procedures can be performed in one stage.

Adolescent↗
PubMed1982

Experimental gallstone pancreatitis. Pathogenesis and response to different treatment modalities.

Partial pancreatic duct obstruction due to gallstone migration has been suggested as an important step in the pathogenesis of gallstone, pancreatitis. Since gallstone migration often follows a meal, pancreatic secretory stimulation is also present. Utilizing the isolated perfused canine pancreas, an experimental model of gallstone pancreatitis was developed by partial obstruction of the main pancreatic duct and secretin stimulation (POSS). In control glands (n=6) perfused for a four-hour period, gross appearance remained normal, weight gain (8 g) was minimal, and mean amylase (875 Caraway units/dl) remained within normal limits. POSS glands (n=9) became markedly edematous during the perfusion period, with significant weight gain (47 g) and hyperamylasemia (7200 Caraway units/dl). Steroid-treated (n=6) and Trasylol-treated (n=6) POSS glands became edematous, and mean weight gain and hyperamylasemia were similar to those seen in untreated POSS glands. Glucagon-treated POSS glands (n=6) became edematous, but mean weight gain (24 g) was significantly decreased compared with that of untreated POSS glands. Mean amylase elevation was unchanged (8536 Caraway units/dl). POSS glands treated with albumin (n=6) remained normal in gross appearance, mean weight gain (12 g) was minimal and mean amylase (3120 Caraway units/dl) was significantly decreased compared to that of untreated POSS glands. The failure of Trasylol to ameliorate the injury response and the effectiveness of albumin were interpreted as evidence against enzyme extravasation and for capillary injury as the initial step in the pathogenesis of gallstone pancreatitis.

Albumins↗
PubMed1982

Proximal bile duct tumors: surgical management with silastic transhepatic biliary stents.

Over a nine-year period, 27 patients with proximal biliary tumors were operated upon. In ten of the 27 patients (37%) tumor resection including the hepatic bifurcation was possible, and bilateral hepaticojejunostomies were performed using silastic transhepatic biliary stents. In the remaining 17 patients the tumor was partially resected, dilated, or bypassed, and reconstruction to a Roux-en-Y-jejunal loop was carried out using silastic transhepatic biliary stents. Hospital mortality for those patients undergoing resection was zero, and for the entire group 4% (1/27). The mean bilirubin on admission was 13.2 mg/dl and after discharge fell to a mean of 1.5 mg/dl. Mean survival for the entire group is 18 months with 11 patients still alive. Mean survival for the first nine patients undergoing resection is 21 months with seven patients still alive (one for over 5 years). The 15 patients dying following discharge survived for a mean of 14 months.

Adult↗
PubMed1982

In vitro effects of ethanol on primate luteal membranes: exposure of additional gonadotropin receptor sites.

The presence of 0.8-8.0% (vol/vol) ethanol increased the specific binding of [125I]human luteinizing hormone (hLH) to membrane particulate fractions prepared from the rhesus monkey corpus luteum in a dose-dependent manner. Ethanol increased the number of available gonadotropin binding sites without altering their affinity for LH. These results suggest that (1) there are additional gonadotropin receptors in the macaque corpus luteum which are not detected by conventional in vitro techniques, and (2) ethanol exposes receptors previously unavailable for hormone interaction.

Animals↗
PubMed1982

Percutaneous biliary drainage in the management of biliary sepsis.

Percutaneous biliary drainage was performed in 18 patients with biliary sepsis due to acute obstructive cholangitis and postoperative complications. Internal drainage could be established in 78% of patients, and 22% were managed on external drainage. Nine patients were managed on long-term internal drainage, six underwent uneventful surgery after successful percutaneous decompression, and three died as a result of septic shock. Percutaneous biliary drainage procedures can be lifesaving in biliary sepsis. Once infection and the hyperbilirubinemia are controlled, rational therapy plans can be formulated on the basis of the anatomy and natural history of the underlying disease.

Aged↗
PubMed1982

A clinical trial of cimetidine in acute pancreatitis.

A prospective randomized clinical trial was carried out to evaluate the efficacy of cimetidine in the treatment of acute pancreatitis. One hundred and sixteen patients with a clinical diagnosis of acute pancreatitis and an elevated serum amylase level were included in the study. All patients were treated with fluids, given intravenously, analgesia and nasogastric tube suction, if required. In addition, on a random basis, 52 received cimetidine given intravenously and 64 did not. There were no significant differences in the clinical courses of the two groups.

Acute Disease↗