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Biomedical subjects

M E Clouse

Publications and source records attributed to M E Clouse.

17 recordsLinked to original sources
PubMed1992

31P NMR assessment of orthotopic rat liver transplant viability. The effect of warm ischemia.

The relationship between NMR visible high energy phosphates and transplant outcome for the case of liver damage by warm ischemia was investigated. In vivo 31P nuclear magnetic resonance (NMR) spectroscopy of rat liver was performed before the induction of warm ischemia in the donor and 20 min after reestablishment of portal blood flow in the recipient. Pretransplant damage was varied by subjecting the livers to 0, 15, 30, or 60 min of warm ischemia prior to harvesting. In the controls (0 min warm ischemia), 4 of 4 rats survived transplantation (one week survival end-point) and the mean NTP recovery was 94 +/- 8%; 3 of 6 rats survived in the 15 min warm ischemia group. Mean NTP recovery was 77 +/- 20% in the 15 min survival subgroup and 32 +/- 20% in the nonsurvival subgroup. Of 6 rats, 1 survived in the 30 min group. NTP recovery was 44% for the 30 min survivor and 37 +/- 5% in the nonsurvival subgroup. Of 4 rats, 1 survived in the 60 min warm ischemia group. NTP recovery was 56% for the 60 min survivor and 28 +/- 7% in the nonsurvival subgroup. Overall, there was a significant difference between the mean NTP recovery of the survival and nonsurvival subgroups (78 +/- 21% versus 31 +/- 18%, P < 0.001). The dividing line between the survival and nonsurvival groups was approximately 50% NTP recovery. Of 9 rats with liver NTP recovery greater than 50%, 8 survived while 10 of 11 rats with less than 50% recovery died. NMR visible NTP recovery 20 min after the reestablishment of portal blood flow was a good indicator of transplant outcome in the case of rat liver damage by warm ischemia.

Animals↗
PubMed1979

Prolonged and continuous percutaneous intra-arterial hepatic infusion chemotherapy in advanced metastatic liver adenocarcinoma from colorectal primary.

Sixty patients with advanced metastatic adenocarcinoma of the liver from a colorectal primary were treated by prolonged and continuous intra-arterial hepatic arterial infusion chemotherapy over a period of time from December 1969 through July 1976. A 10-day course of 5-FU was administered in the hospital, and patients were discharged receiving 5-FUDR by continuous arterial infusion through a chronometric infusion pump. Objective responses of 100% were obtained in 15% of patients, 50% response in 39% of patients, and 25% response in 21% of patients. The median survival from onset of treatment was 8.5 months, 6.9 months, and 7 months, respectively, for 100%, 50%, and 25% responders versus 3.6 months for nonresponders. Survivals from onset of treatment were generally less in those with no disease-free interval. No relationship of response to sex and age was found. Patients previously treated with 5-FU intravenously responded to intra-arterial chemotherapy; 13% had a 100% response, and 54% had a 50% response. No relationship of drug dose to response was observed. Drug toxicity was frequently systemic and mild to moderate. Numerous complications occurred due to the catheter, complete or partial thrombosis occurring in 18.6% and 20.8%, respectively, and 30% of patients had displacement of the catheter. The role of partial arterial occlusion in terms of response and survival may be significant. Future studies should involve comparison of direct surgical placement versus percutaneous placement of catheters.

Adenocarcinoma↗
PubMed1978

Intraaterial hepatic infusion and intravenous adriamycin for treatment of hepatocellular carcinoma: a clinical and pharmacology report.

Four patients received intraarterial (ia) hepatic infusion and 10 received intravenous (iv) adriamycin for hepatocellular carcinoma. Four of each group are evaluable. The remaining 6 patients died within 14 days of intravenous therapy and are, therefore, considered nonevaluable. Patients received 2 to 9 courses of adriamycin every 3 weeks. One half of each group of evaluable patients had partial responses (pr). The group had pr for 22.5 weeks (range 8 to 37). The iv group had pr 27.2 weeks (range: 16 to 38.5). Mean survival was 21 weeks for nonresponders, and 43 weeks for responders. Intraarterial infusion did not protect patients from adriamycin toxicity. Cardiac and liver toxicity were not seen, but marrow and gastrointestinal toxicity developed at 1.2 X 10(-7)M adriamycin serum level. Adriamycin disappearance curves after ia and iv therapy were similar for similar bilirubin levels, and prolonged with hyperbilirubinemia. Ascites fluid did not accumulate detectable adriamycin. Pharmacokinetics are described in this report.

Adolescent↗
PubMed1978

Dearterialization of the liver for metastatic cancer. Clinical, angiographic and pathologic observations.

Five cases of dearterialization of the liver for metastatic cancer are presented. Subjective and objective improvement was accomplished in three patients. Pre- and postoperative arteriography demonstrates the extent of devascularization and the routes of reestablished collateral. Microscopic studies demonstrated effects on tumor and on hepatic parenchyma and biochemical data indicate the extent and duration of hepatic dysfunction.

Aged↗
PubMed1977

Problems in the diagnosis of pancreatic carcinoma by endoscopic retrograde cholangiopancreatography.

Diagnostic problems occurred in five out of 55 patients undergoing endoscopic retrograde cholangiopancreatography who subsequently proved to have carcinoma of the pancreas. In one patient the pancreatic duct was normal, two had non-specific ductal abnormalities, one had pancreas divisum, and one had ductal ectasia. Two patients with non-specific changes on retrograde pancreatography had evidence of tumor on their retrograde cholangiogram. Two patients had ductal obstruction simulating pancreatic cancer, in one due to compression by the thoracic spine, in the other by inflammatory changes.

Aged↗
PubMed1977

Percutaneous fine needle aspiration biopsy of pancreatic carcinoma.

Carcinoma of the pancreas was diagnosed in 13 patients by percutaneous fine needle aspiration. The tumor was localized by angiography in eight, ultrasound in five, and endoscopic retrograde pancreatography in three patients. In four patients aspiration was performed using two of the three localizing techniques. Cytological diagnosis of carcinoma of the pancreas can be made accurately by percutaneous fine needle aspiration of the tumor and operative intervention avoided in those patients who do not require operative bypass procedures. Percutaneous fine needle aspiration can be used with equal facility with arteriography, ultrasound, or endoscopic retrograde pancreatography. There have not been complications due to fine needle biopsy, and one can expect a 77-86% positive diagnostic yield.

Angiography↗
PubMed1977

Problems in the diagnosis of adrenal tumors.

The angiographic findings of cortical nodular hyperplasia, adenolipoma, and intracaval extension of recurrent pheochromocytoma were correlated with the pathological findings. Adenolipoma was angiographically similar to other adrenal neoplasms, adding difficulties to its differential diagnosis. Two cases of cortical nodular hyperplasia showed possibly pathognomonic patterns of discrete vascular cortical accumulations of contrast media which represent capillary malformations within the hyperplastic nodules. Intracaval extension of recurrent pheochromocytoma was found to be similar to other tumors which invade veins.

Adrenal Cortex↗
PubMed1977

Complications of lymphangiography in patients of advanced age.

The case records of 81 patients over the age of 60 were reviewed with respect to complications following lymphangiography. Adverse prognostic factors and complications were studied. Of the 81 patients, 48 were 60-69 years old and 33 were 70 or older; 19 patients had mild risk factors and 16 had severe risk factors. There were only six complications secondary to lymphangiography--two moderate and four mild. No severe complications were noted. This study suggests that age in itself is not a contraindication to lymphangiography.

Aged↗
PubMed1977

Subselective angiography in localizing insulinomas of the pancreas.

Preoperative angiography was performed on 10 patients who had insulin-producing islet cell adenomas. Eight of the 10 islet cell tumors were localized. Seven of the eight adenomas were demonstrated only on subselective injections into the small intrapancreatic arteries, and one was demonstrated by a selective injection into a large artery. Failure to localize two islet cell adenomas was probably caused by the inability to subselect the small intrapancreatic arteries supplying the tumor. One tumor was seen only with subtraction techniques, which were used in all cases. Localization was not related to vascularity, size of tumor, or location within the pancreas. Vasoconstrictive pharmacoangiography was not helpful; magnification was helpful but not essential. The most important factor in localizing islet cell tumors is demonstrating the complete pancreatic blood supply with subselective injections into the small intrapancreatic arteries supplying the tumor (inferior and superior pancreaticoduodenal and dorsal arteries).

Adenoma↗
PubMed1977

Complications of long term transbrachial hepatic arterial infusion chemotherapy.

A total of 127 transbrachial hepatic artery catheters were placed in 75 patients for prolonged infusion of chemotherapeutic agents for primary and secondary tumors of the liver. Hepatic or celiac artery catheterization was possible in 97.4% of patients. The most frequent major complication was partial or complete arterial thrombosis (30 patients). bleeding at the arteriotomy site and pseudoaneurysm also occurred. Minor complications included displacement of catheter from the hepatic artery in 46, cracks or leaks in the catheter at the arteriotomy site in 21, and clotted catheter in 10 instances. Infection occurred in four patients and loss of radial pulse in seven. In view of a significant increase in survival, the complications did not contraindicate long term intraarterial infusion of chemotherapeutic agents. The no. 5 French blue thin wall 1.24-1.70 mm tubing proved to be easiest to use and least prone to complications. Proper management of these patients by a team approach (nurse, oncologist, and radiologist) helps to minimize the frequency and severity of complications.

Adolescent↗
PubMed1976

Ectopic pelvic spleen.

We are reporting the first, to our knowledge, ectopic pelvic spleen demonstrated preoperatively by means of a liver-spleen scan and a selective splenic arteriogram. Symptoms, consisting of crampy pain in the lower part of the abdomen exacerbated by standing or stooping, were relieved by splenectomy in this 19-year-old woman. Splenopexy, which has been advocated in the past, has no place in the management of this rare and interesting congenital variant. Laxity or failure of development of the phrenicosplenic and gastrosplenic ligaments is thought to account for the splenic descensus.

Abdomen↗
PubMed1975

Congenital renal arteriovenous malformation: angiography in its diagnosis.

Two patients with renal arteriovenous malformations are presented along with the distinct changes shown by urography, arteriography, and pharmacoangiography. The relevant roentgen signs in such patients include multiple small cobblestone-like identations caused by well-formed vascular channels projecting into the collecting structures, no angiographic or urographic evidence of a mass displacing the intrarenal vessels or collecting structures, normal sized arteries and veins leading to and from the malformation, and a decrease in size of the malformation after intra-arterial infusion of epinephrine. These patients may have flank pain or hematuria later in life or may remain asymptomatic. A complete urographic and angiographic examination will help to determine the appropriate therapy. Corrective surgery is usually reserved for symptomatic patients and, when indicated, require only surgical ligation of the vessels feeding and draining the malformation.

Adult↗
PubMed1975

Renal angiomyolipoma in adult-type polycystic disease.

Two adults with renal angiomyolipomas and polycystic disease are presented with emphasis on the angiographic manifestations of the coexisting lesions. One patient had multiple episodes of gross hematuria and a perinephric abscess which resulted in bilateral nephrectomies; the second presented with hypertension and underwent unilateral nephrectomy to treat a hypervascular tumor. The clinical and radiographic diagnoses of the combined lesions are discussed and suggestions for management offered.

Adult↗
PubMed1975

Angiography vs. pancreatography in diagnosis of carcinoma of the pancreas.

Relative efficacy of angiography and pancreatography in the diagnosis of pancreatic carcinoma was assessed in 13 patients. Pancreatography provided a correct preoperative diagnosis in 10 patients. In 3 patients the duct could not be cannulated. Twelve patients underwent angiography and a correct diagnosis was made in 10. Preoperative diagnosis was not made by either technique in 1 patient. Pancreatography did not detect carcinoma of the pancreas at an earlier stage than did angiography. These procedures should be considered complementary to each other. Angiography defines the size, extension and resectability of the tumor. Pancreatography outlines the internal architecture of the gland and duct system.

Aged↗