Biomedical subjects

M S Cappell

Publications and source records attributed to M S Cappell.

108 records · Page 6Linked to original sources

PubMed1989

Treatment with ciprofloxacin of Aeromonas hydrophila associated colitis in a male with antibodies to the human immunodeficiency virus.

A 36-year-old white male intravenous drug abuser and homosexual, with antibodies in the serum to the human immunodeficiency virus and a history of ulcerative colitis, had bloody diarrhea and spiking fevers that did not respond to treatment for 1 month with total parenteral nutrition, orally administered sulfasalazine, and 5-amino-salicylic acid enema. Aeromonas hydrophila was isolated from bacterial culture of a biopsy specimen obtained by sigmoidoscopy. The symptoms resolved after a 2 week course of treatment with orally administered ciprofloxacin. Although ciprofloxacin has been reported to be effective against Aeromonas hydrophila in vitro, this is the first report of successful treatment of Aeromonas-associated colitis with ciprofloxacin.

Adult↗

PubMed1989

Esophageal perforation at a Barrett's ulcer.

An alcoholic man with known reflux esophagitis and Barrett's esophagus developed fever, epigastric pain, subcutaneous crepitus, and leukocytosis from an esophageal perforation at a Barrett's ulcer. Possible risk factors for perforation in this patient included alcoholism, severe gastroesophageal reflux, corticosteroid therapy, noncompliance with antacid and H2 blocker therapy, and the presence of acid-secreting parietal cells in the Barrett's epithelium. Five cases of this complication have previously been reported in a review of the literature, which included 536 cases of Barrett's esophagus or esophageal perforation. This entity may present with a clinical triad of a patient (a) in acute distress with fever and epigastric or noncardiac chest pain and without signs of peritonitis, (b) with symptoms of or known gastroesophageal reflux, and (c) with chest examination revealing subcutaneous crepitus, or chest roentgenogram revealing subcutaneous emphysema, pneumomediastinum, or hydropneumothorax.

Adult↗

PubMed1989

Rapid development of pancreatitis following reuse of 6-mercaptopurine.

A patient with Crohn's disease developed acute pancreatitis 4 h after retaking one 50 mg dose of orally administered 6-mercaptopurine (6-MP). All seven previously reported patients who were rechallenged with 50 mg or more of 6-MP developed pancreatitis within 48 h. These findings suggest that 6-MP can produce pancreatitis due to an idiosyncratic immune-mediated response. Patients with this complication should not reuse 6-MP.

Adult↗

PubMed1989

Profound spatial clustering of simultaneous peptic ulcers.

In an endoscopic study of 90 consecutive patients with more than one peptic ulcer, the ulcers in an individual were profoundly spatially clustered. Clustering of ulcer locations was shown using a non-parametric test of clustering (Kruskal-Wallis statistic with 89 degrees of freedom = 151.31, probability of observing this extreme statistic with no clustering less than 0.0005) and a parametric test of clustering (F test statistic with 89 and 124 degrees of freedom = 5.41, probability of observing this extreme statistic with no clustering less than 0.0005). Patients having their largest ulcer in any given region had a much greater likelihood than other patients of having other ulcers in that same site. For example, the 26 patients with their largest ulcer in the proximal duodenal bulb had 20 of 33, or 61% (9) (standard error), of their other ulcers in the proximal duodenal bulb. In contrast, the 18 patients with their largest ulcer in the proximal stomach had four of 23, or 17% (8), of their other ulcers in the proximal duodenal bulb. Of the 59 patients who had two simultaneous ulcers, 28 patients had adjacent ulcers (distance between ulcers less than 4% of the distance from the gastric cardia to the apex of the duodenal bulb). These findings suggest that local factors may be important in the pathogenesis of simultaneous peptic ulcers, including infection caused by Campylobacter pylori or other microorganisms, ischaemia and mucosal barrier disruption.

Cluster Analysis↗

PubMed1989

Terminal ileitis associated with cytomegalovirus and the acquired immune deficiency syndrome.

A 41-yr-old homosexual male had cytomegalovirus infection localized to the terminal ileum as his initial and sole evident opportunistic infection due to the acquired immune deficiency syndrome. The symptoms, signs, roentgenographic findings, and appearance at surgery were suggestive of Crohn's disease. The pathogen was identified only by microscopic examination of bowel resected during a second laparotomy. The terminal ileum had profound mucosal ulceration and transmural fibrosis without granulomas. This novel report suggests that cytomegalovirus infection should be carefully searched for in immunocompromised patients presenting with clinical features suggesting Crohn's disease.

Acquired Immunodeficiency Syndrome↗

PubMed1988

Colonic adenocarcinoma associated with the acquired immune deficiency syndrome.

Colonic adenocarcinoma developed in an intravenous drug abuser with the acquired immune deficiency syndrome (AIDS) that was diagnosed by the presence of antibodies to the human immunodeficiency virus (HIV), generalized lymphadenopathy, and biopsy proven esophageal candidiasis. The colon cancer presented atypically at a young age with no known risk factors and with a bulky primary tumor and a local fistula. AIDS and AIDS risk factors have been associated with Kaposi's sarcoma, lymphomas, and anal and oropharyngeal carcinoma. This report suggests a possible association between colonic adenocarcinoma and AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1988

Stationary and non-stationary occurrences of miniature end plate potentials are well described as stationary and non-stationary Poisson processes in the mollusc Navanax inermis.

Protractor muscles in the gastropod mollusc Navanax inermis exhibit typical spontaneous miniature end plate potentials with mean amplitude 1.71 +/- 1.19 (standard deviation) mV. The evoked end plate potential is quantized, with a quantum equal to the miniature end plate potential amplitude. When their rate is stationary, occurrence of miniature end plate potentials is a random, Poisson process. When non-stationary, spontaneous miniature end plate potential occurrence is a non-stationary Poisson process, a Poisson process with the mean frequency changing with time. This extends the random Poisson model for miniature end plate potentials to the frequently observed non-stationary occurrence. Reported deviations from a Poisson process can sometimes be accounted for by the non-stationary Poisson process and more complex models, such as clustered release, are not always needed.

Action Potentials↗

PubMed1988

Gastrointestinal histoplasmosis.

Three cases are reported of gastrointestinal histoplasmosis in patients who came from the Caribbean or South America and had lymphoma, acquired immunodeficiency syndrome, and prior local radiation therapy. The patients had small-bowel obstruction with ileal involvement, mucosal erythema, and friability on colonoscopy with colonic involvement and an exophytic rectal mass with rectal involvement. Review of the 77 reported cases of gastrointestinal histoplasmosis shows that this is a clinical subset of disseminated histoplasmosis. With gastrointestinal involvement, pulmonary symptoms are uncommon and gastrointestinal symptoms predominate. Fever is less common than in other forms of dissemination. The most common lesions are a mass or ulcers, which often mimic inflammatory bowel disease or carcinoma. Terminal ileal involvement predominates in one third. The complement fixation test was positive in about three quarters of cases tested, but the skin test is not diagnostically useful. In one quarter of patients there is other evidence of immunosuppression. In the immunosuppressed, gastrointestinal histoplasmosis must be considered, even in a patient from a nonendemic area, who presents with lesions appearing like carcinoma or inflammatory bowel disease. When feasible, endoscopic examination and biopsy with stains and culture for histoplasmosis is recommended for diagnosis. Medical management is recommended, with surgery reserved for acute emergencies or when mandatory for diagnosis.

Adult↗

PubMed1988

Neoplasia in chronic erosive (varioliform) gastritis.

Chronic erosive gastritis is a gastric mucosal lesion characterized by multiple, small, sessile elevations with central erosions. Symptoms typically resemble those in peptic ulcer disease. The elevations may persist and appear as sessile polyps after the erosions heal and symptoms resolve with therapy. Adenomatous transformation is reported in a patient with chronic erosive gastritis who had serial gastroscopies. This report suggests a possible association between chronic erosive gastritis and gastric neoplasia.

Aged↗

PubMed1988

Esophageal bleeding after percutaneous endoscopic gastrostomy.

Two patients bled significantly following percutaneous endoscopic gastrostomy. Panendoscopy in both patients after feeding tube insertion demonstrated lower esophageal mucosal erosions that were not seen on panendoscopy performed just before feeding tube insertion. In one patient, the feeding tube was pulled into place using a string. In the other, the feeding tube was inserted over a guide wire. Traumatic passage of the string, guide wire, or feeding tube crossbar through the esophagus could possibly produce these erosions. This novel cause should be considered in evaluating bleeding after percutaneous endoscopic gastrostomy.

Aged↗

PubMed1988

Indomethacin-associated cholestasis.

A patient with no prior history of liver disease developed mild cholestasis, with a moderate elevation of the serum alkaline phosphatase level, several days after instituting indomethacin therapy. The cholestasis resolved soon after the medication was discontinued. An extensive workup, including liver biopsy, revealed no alternative cause. Despite extensive use, indomethacin therapy has been associated with hepatic injury in only nine previously reported cases, as near as we can tell.

Cholestasis↗

PubMed1988

Obstructive jaundice from benign, nonparasitic hepatic cysts: identification of risk factors and percutaneous aspiration for diagnosis and treatment.

Obstructive jaundice due to benign, nonparasitic hepatic cysts is rare, with only 11 previously reported cases. We report a case in which relief of jaundice was obtained by percutaneous cyst aspiration. For the elderly, infirm, or high-risk patient, percutaneous aspiration is recommended to relieve obstructive jaundice. Immense size and porta hepatis proximity are major risk factors for developing jaundice from simple hepatic cysts. Abdominal pain of recent onset and rising alkaline phosphatase are warning signs that this complication is developing. In these situations, treatment prior to developing jaundice is recommended.

Adult↗

PubMed1987

HTLV-I-associated lymphoma involving the entire alimentary tract and presenting with an acquired immune deficiency.

A patient with HTLV-I-associated adult T cell lymphoma presented like a patient with the acquired immune deficiency syndrome (AIDS) with peripheral lymphadenopathy, profuse diarrhea, weight loss, night sweats, and multiple opportunistic infections. Infections included cytomegalovirus, Pneumocystis, Histoplasma, Strongyloides, Giardia, and Staphylococcus aureus. Histoplasma has not previously been associated with this lymphoma. The lymphoma involved the entire alimentary tract from pharynx to rectum, which has not previously been reported for adult T cell lymphoma, and is rare for any lymphoma, with only one case reported in this century. Despite extensive gastrointestinal involvement, steatorrhea was not present, perhaps due to preservation of normal intestinal villous architecture.

Acquired Immunodeficiency Syndrome↗

PubMed1987

Characterization of the syndrome of small and large intestinal variceal bleeding.

Massive bleeding from jejunal varices in a young alcoholic with cirrhosis and portal hypertension ceased following a portocaval shunt. Although rare, bleeding from small or large bowel varices has a high mortality. In 62 cases, small or large bowel varices are almost always associated with a predisposing condition including previous abdominal surgery and portal hypertension from cirrhosis or other causes. Hematochezia without hematemesis and nonbleeding esophageal varices generally occur. Angiography is the best diagnostic test.

Adult↗

PubMed1987

Gallstone ileus.

Explore the source record for details and available documents.

Cholelithiasis↗

PubMed1987

Pharyngeal movements during feeding sequences of Navanax inermis (Gastropoda: Opisthobranchia) in successive stages of dissection.

Feeding in Navanax inermis Cooper was filmed and analysed after various dissections. In preparations with a cut through the body wall exposing the pharynx and buccal ganglia, completely normal feeding was observed. In addition to seven motor acts previously described in intact animals, an eighth act, peristalsis, was observed. In preparations with the pharynx excised from the animal but attached to the buccal ganglia, four motor acts were observed: flaring, expansion, contraction and peristalsis. In addition to increasing information about the nature of feeding movements in Navanax, these data indicate that preparations suitable for neurophysiological studies are capable of producing a variety of feeding acts.

Animals↗

PubMed1986

Cessation of recurrent bleeding from gastrointestinal angiodysplasias after aortic valve replacement.

Recurrent bleeding from gastrointestinal angiodysplasias associated with aortic stenosis ceased after aortic valve replacement in two patients. In one patient numerous gastrointestinal angiodysplasias disappeared, as shown by endoscopy, after aortic valve replacement. Valve replacement may be adequate treatment for gastrointestinal bleeding from angiodysplasia associated with aortic stenosis. Elective surgery for angiodysplasias should be postponed until after a trial period to ascertain whether bleeding stops after valve replacement.

Aged↗

PubMedDate not supplied

Gastrointestinal endoscopy in high-risk patients.

In America more than 100,000 high-risk patients/year have conditions normally evaluated by gastrointestinal endoscopy. This review analyzes the safety and efficacy of gastrointestinal endoscopy in high-risk patients. Endoscopy during pregnancy raises the unique issue of fetal safety. The safety of esophagogastroduodenoscopy (EGD) during pregnancy has been examined in a case-controlled study of 83 patients, a mailed survey of 73 patients, and case reports. The safety of sigmoidoscopy during pregnancy has been examined in a case-controlled study of 45 patients, a mailed survey of 26 patients, and case reports. These studies suggest that EGD and sigmoidoscopy are not contraindicated during pregnancy. For example, EGD should be performed for significant upper gastrointestinal bleeding. The safety of colonoscopy during pregnancy is inadequately analyzed. In a study of 34 EGDs performed within 3 weeks of myocardial infarction, no endoscopic complications occurred in 26 clinically stable patients with uncomplicated myocardial infarction. However, 3 major endoscopic complications occurred in 8 clinically unstable patients. In a study of 9 sigmoidoscopies within 3 weeks of myocardial infarction, no sigmoidoscopic complications occurred in 7 clinically stable patients. Several studies have shown that EGD, sigmoidoscopy, or colonoscopy is safe in patients with advanced HIV infection. AIDS patients should generally be endoscoped with the same aggressiveness as other patients. However, endoscopy may be unwise in any terminal patient. No complication occurred in 60 patients undergoing EGD within 3 weeks of esophageal, gastric, or duodenal surgery. One minor complication occurred in 36 patients undergoing sigmoidoscopy within 3 weeks of colonic surgery. These results suggest that EGD or sigmoidoscopy is not contraindicated within 3 weeks of gastrointestinal surgery. No complications occurred in 53 chronic obstructive pulmonary disease patients undergoing EGD. EGD appears to be safe in chronic obstructive pulmonary disease patients without severe hypoxemia or acute bronchospasm. Emergency EGD can be performed in patients with severe hypoxemia after endotracheal intubation.

Contraindications↗