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Biomedical subjects

M E Denyer

Publications and source records attributed to M E Denyer.

16 recordsLinked to original sources
PubMed1990

Periampullary diverticula predispose to primary rather than secondary stones in the common bile duct.

Periampullary duodenal diverticula are known to be associated with an increased incidence of common bile duct stones. The nature of the association with gallstones remains uncertain. We have examined the incidence of periampullary diverticula and stones after cholecystectomy to determine whether the stones originate primarily in the common duct or migrate from the gallbladder under the influence of abnormal biliary motility. Six hundred and forty-one patients undergoing ERCP were studied. Ninety-five patients had diverticula (14.8%). Diverticula occurred more commonly in jaundiced patients, 47/95, (48.4%) than in patients with normal bilirubin 185/546 (33.8%) (p less than 0.01). Common duct stones were associated with the presence of a diverticulum in 41/95 patients (43%), compared with only 98/546 without a diverticulum (18%) (p less than 0.001). There was no difference in the incidence of common duct stones in association with a diverticulum between those who had had a cholecystectomy 20/41, and those with intact gallbladders, 21/54 (N.S.). Thus the absence of a gallbladder did not alter the high incidence of common duct stones. We conclude that the stones in the common duct are most likely to be primary stones which have formed as a result of periampullary dysfunction.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1990

Percutaneous-endoscopic placement of endoprostheses for relief of jaundice caused by inoperable bile duct strictures.

Fifty-three patients with biliary obstruction caused by unresectable malignancy were treated by attempted insertion of an endoprosthesis by the percutaneous-endoscopic route. This was successful in 50 patients. A single endoprosthesis was inserted in each case. Both right and left hepatic duct decompression were obtained in 31 patients, but only unilateral or segmental drainage was achieved in 19 patients. Procedure-related complications occurred in 18 (36%) patients, and 15 (30%) patients died within 30 days of the procedure. Satisfactory resolution of jaundice was obtained in 26 (84%) patients with bilateral decompression and in 12 (63%) of those with unilateral drainage. The 30-day mortality rate was 26% for patients with bilateral and 37% for those with unilateral drainage. The morbidity rate from cholangitis after endoprosthesis insertion was 10% after bilateral and 32% after unilateral drainage. None of these differences was statistically significant. Surviving patients with satisfactory bile drainage were relieved of symptoms such as pruritus. The combined percutaneous-endoscopic technique enables difficult biliary strictures to be intubated. Although bilateral duct drainage is preferable, the palliation is often worthwhile even when segmental ducts alone are drained.

Adenoma, Bile Duct↗
PubMed1989

Palliation of obstructive jaundice with a biliary endoprosthesis. Comparison of insertion by the percutaneous-transhepatic and the combined percutaneous-endoscopic routes.

Thirty-eight patients with obstructive jaundice due to inoperable malignancy were referred for insertion of an endoprosthesis. In 19 this was performed by the percutaneous-transhepatic route, and in 19 by a combined percutaneous-endoscopic approach. Satisfactory bile drainage was achieved in 15 patients after combined percutaneous-endoscopic insertion and in 11 after percutaneous-transhepatic prosthesis insertion. Cholangitis occurred after the combined approach in five patients and after percutaneous-transhepatic insertion in nine. None of these differences were significant. Thirty-day mortality rates and mean survival times were similar for each approach (26% and 10 weeks after combined insertion, 21% and 9 weeks after percutaneous-transhepatic). Prostheses inserted by the combined route were easily replaced when they occluded. This was not possible after percutaneous insertion. The combined percutaneous-endoscopic approach appeared to be better tolerated by the patients and is suggested as the method of choice in strictures which can not be intubated by the endoscopic route alone.

Adult↗
PubMed1989

Intestinal infarction caused by carcinoid associated elastic vascular sclerosis: early presentation of a small ileal carcinoid tumour.

We describe a patient with extensive ischaemic necrosis of the ileum as a result of elastic vascular sclerosis (EVS). A 2 cm carcinoid tumour was located nearby with microscopic evidence of spread to regional lymph nodes. Severe intestinal ischaemia caused by carcinoid associated EVS may be the presenting feature of small carcinoid tumours resulting in their early diagnosis.

Aged↗
PubMed1989

Late results of endoscopic sphincterotomy for bile duct stones in elderly patients with gall bladders in situ.

Endoscopic sphincterotomy was undertaken in 186 patients with common bile duct stones and an intact gall bladder who were considered unfit for surgery. One hundred and seventy one patients had jaundice of whom 18 also had clinical cholangitis. The mean age of treated patients was 79.7 years (range 27-92) and only 13 were aged less than 60. Sphincterotomy was successful in 185 (99%) and complete clearance achieved in 172 (92.5%). Early complications occurred in nine patients (4.8%) of whom three died (1.6%). The patients have been followed on average for 32 months (range six to 72 months). Eighteen patients have subsequently required cholecystectomy (9.6%), with six major complications, but no deaths. There have been 27 natural deaths and 156 patients remain alive and symptom free. Endoscopic treatment alone is safe and effective in the majority of frail and elderly patients and can reduce the need for surgery in this high risk group.

Aged↗
PubMed1988

Cytosolic retinoic acid binding protein in the human pancreas.

Cytosolic retinoic acid receptor in carcinoma, chronic pancreatitis, and normal pancreatic tissue were examined using sucrose density gradient centrifugation, isoelectric focussing on agarose gel and saturation analysis. Thirteen patients were studied. Cytosolic retinoic acid binding protein (cRABP) was detected in all the samples with chronic pancreatitis and pancreatic carcinoma, but not in the normal tissue. Using sucrose gradient centrifugation, the highest concentrations of cRABP were found in pancreatic carcinoma tissues, ranging from 5.5-23.9 pmol/mg protein. These concentrations were markedly different than in chronic pancreatitis tissue (0.7-2.7 pmol/mg protein). Saturation analysis of cRABP showed a mean dissociation constant of 21.5 nM and maximum binding sites of 5.2 pmol/mg protein. Cytosolic retinoic acid binding protein was separated at an isoelectric point of 4.5 on agarose gel. The presence of cRABP suggest that retinoic acid may have a role to play in the function of the pancreas.

Adult↗
PubMed1987

Composition of pure pancreatic juice in normal human subjects and in pancreatic disease.

Pure pancreatic juice (PPJ) was collected at endoscopic retrograde cholangio-pancreatography from patients with or without pancreatic disease. Two-dimensional polyacrylamide gel electrophoresis of PPJ proteins demonstrated a wide heterogeneity of proteins, differing in molecular weight and isoelectric points. There was one major difference in the protein patterns between normals and those with chronic pancreatitis. A glycoprotein has been identified and shown to be present in 28/30 patients without pancreatic disease, but absent in 11 or greatly reduced in 8 of 19 patients with mild pancreatitis and absent in all 13 patients with moderate or marked pancreatitis and both patients with pancreatic carcinoma.

Adolescent↗
PubMed1984

Structure and function in noncalcific pancreatitis.

A group of 47 carefully assessed patients with noncalcific pancreatitis was studied with ERCP and the secretin pancreozymin pancreatic function test (PFT). A simple scoring system was constructed for each of the PFT indices to create a PFT score for each patient and four grades of ERCP abnormality were documented, from minimal to gross. A simple pancreatic pain score was constructed to allow for the inclusion of patients with classical pancreatic pain in the absence of acute attacks associated with an elevated serum amylase. In general there was a correlation between the degree of structural change and functional impairment, with patients with the worst pancreatic function having the grossest ERCP changes. ERCP was abnormal in 45 of the 47 patients (96%) and the PFT in 34 of the 47 (72%). However, there were some marked discrepancies between the two methods, in particular two patients with normal function in the presence of gross structural changes. ERCP proved to be the more sensitive diagnostic technique than the PFT in this group of patients.

Adolescent↗
PubMed1979

Prospective study of ultrasonography in chronic pancreatic disease.

Grey-scale ultrasonography was used in 212 unselected patients in whom the presence or absence of pancreatic disease was subsequently confirmed by other means. Ultrasonographic criteria were established in the first 92 patients and by reference to previous experience. The remaining 120 patients were studied prospectively. The accuracy and clinical impact of the ultrasonographic diagnosis were judged alongside a standard clinical assessment. Clinical diagnoses were tentative and inaccurate. Ultrasound failed in three cases; otherwise it detected all the 33 patients with chronic pancreatic disease and correctly distinguished cancer from chronic pancreatitis. The ultrasonographic diagnosis of a normal pancreas was always correct, but four false-positive diagnoses were made in patients subsequently judged to have no pancreatic disease. Ultrasonography gave more accurate or more confident and accurate information than the clinical assessment in 57 of the 98 patients studied as problems in diagnosis. With this degree of accuracy ultrasonography should be the first imaging investigation in patients suspected of suffering from pancreatic disease. In our gastrointestinal unit the combination of grey-scale ultrasonography with techniques designed to outline the duct systems (such as endoscopic pancreatography) provides precise diagnosis and documentation of pancreatic disease.

Chronic Disease↗
PubMed1979

Pure pancreatic juice studies in normal subjects and patients with chronic pancreatitis.

Pure pancreatic juice was obtained from within the pancreatic duct in 54 patients after endoscopic cannulation of the papilla of Vater. In all 20 normal subjects there was a brisk response to intravenous injections of GIH secretin in small dosage (1 and 4 CU). Peak bicarbonate concentrations occurred after a 4 CU stimulus, whereas volumes, and bicarbonate and protein outputs were greatest after 70 CU. Total protein and amylase concentrations were highest in the first specimens collected from each patient, and fell rapidly after stimulation. Plateau levels for all indices were achieved 10-20 minutes after starting infusions of secretin and pancreozymin. When normal patients and those with chronic pancreatitis were compared, there was considerable overlap in all indices (volume, bicarbonate and total protein concentrations) after bolus injections of secretin. Most patients with chronic pancreatitis achieved a peak bicarbonate concentration in excess of 100 mmol/l. The median concentrations were not significantly different from normal after any dose of secretin when pooled 10 minute samples were analysed. However there were significant differences in peak bicarbonate concentrations (after 1 and 4 CU, but not after 70 CU), when one minute samples were compared. There were also statistically significant differences in the median 10 minute responses for volume after 1 and 70 CU, for bicarbonate output after 1, 4, and 70 CU, and for protein output after 70 CU. The results of juice studies in patients believed to have early chronic pancreatitis did not differ significantly from those in normal subjects or those with chronic pancreatitis. Endoscopic duct cannulation cannot guarantee complete recovery of pancreatic secretions, and measurements of volume and output may be inaccurate. When standard biochemical indices are used, the diagnostic role of pure juice studies is limited; further research may reveal more specific disease markers.

Bicarbonates↗
PubMed1978

Comparative clinical impact of endoscopic pancreatography, grey-scale ultrasonography, and computed tomography (EMI scanning) in pancreatic disease: preliminary report.

Grey-scale ultrasound scanning (US), computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) were performed in a series of 50 patients with known or suspected pancreatic disease. The impact of the individual tests were assessed in the relevant clinical context. With a maximum of 100, the overall clinical impact score of ERCP (75) exceeded that of CT(63) and US (36). In patients with obscure pain, and in those with relapsing pancreatitis, a combination of US and ERCP provides good clinical guidance. Computed tomography scanning can currently be reserved for documentation of patients with a major mass lesion. None of the techniques can detect early pancreatic cancer, except of the papilla of Vater, where ERCP is diagnostic. Recommendations for future diagnostic strategies may alter as grey-scale ultrasonography and computed tomography develop, and, in any case, depend on many factors including local expertise, availability, and cost.

Adolescent↗