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Biomedical subjects

N Raby

Publications and source records attributed to N Raby.

At least 37 records · Page 2Linked to original sources
PubMed1991

Pharmacokinetics and toxicity of intraarterial adriamycin for hepatocellular carcinoma: effect of coadministration of lipiodol.

To determine the effect of coadministration of lipiodol on the pharmacokinetics and systemic toxicity of intraarterial Adriamycin in patients with hepatocellular carcinoma, nine patients were studied in detail. Each received two courses of a bolus injection of Adriamycin (60 mg/m2), in one of which the Adriamycin was mixed with 10 ml of lipiodol. Analysis of the paired data, and additional 'non-paired' data from a further seven patients, showed that there was no significant difference in the area under the concentration-time curve for Adriamycin or adriamycinol or, in the case of Adriamycin, the terminal half-life. Likewise the fall in haemoglobin concentration, white cell count and platelet count following treatment, and the degree of nausea and vomiting were not significantly different. Comparison with a series of 12 patients receiving intravenous Adriamycin, in the same dose schedule, revealed no difference in terms of pharmacokinetic parameters or toxicity with intraarterial administration of Adriamycin, with or without lipiodol.

Adult↗
PubMed1991

Stenoses of vascular anastomoses after hepatic transplantation: treatment with balloon angioplasty.

Vascular complications after liver transplantation include occlusion or stenosis at the sites of anastomosis in the hepatic artery, portal vein, and vena cava. From our experience with more than 600 liver transplants, vascular stenoses have been identified in 10 patients and treated by balloon angioplasty in nine. Three patients with hepatic artery stenosis and deteriorating graft function were treated by balloon angioplasty with a coaxial technique. A specially designed catheter facilitated a successful femoral artery approach. Portal vein stenoses in three patients resulted in portal hypertension. These were treated by balloon dilatation via transhepatic catheterization of the portal vein. Stenoses of the suprahepatic caval anastomosis were dilated in three patients with severe lower limb edema. Technical success was achieved in all three cases of hepatic artery stenosis with improvement in graft function. Recurrent stenoses in two patients were successfully treated with repeated dilatations. Portal hypertension resolved in two of three patients after portal venoplasty. Dilatation of a caval stenosis resulted in the resolution of leg edema in all three cases. Repeated dilatation was required in one case. No reduction in the portal venous pressure gradient occurred after venoplasty in one case, and an ultimately fatal caval thrombosis developed in one patient with caval stenosis before venoplasty could be performed. Our experience suggests that balloon angioplasty of arterial and venous stenoses complicating hepatic transplantation carries little risk and is a useful procedure for the treatment of these problems.

Adult↗
PubMed1991

[Lysine and collagen].

The amount of lysine in collagen is only 3 or 4% of total aminoacids, but it has an important function in the constitution of the cross-links between the molecules to built the fibrils and the fibers of collagen. For this function, some lysine molecules must be hydroxylated and other oxidized to aldehyde compounds. Some deficits in these metabolic pathways are responsible for heritable diseases of the connectivite tissue as types IV and IX of the Ehlers-Danlos syndrome, lathyrism, the Menkes kinky hair syndrome, Cutis-Laxa or the type II of osteogenesis imperfecta. The contribution to fibrosis is also discussed.

Collagen↗
PubMed1990

Intraarterial adriamycin and lipiodol for inoperable hepatocellular carcinoma: a comparison with intravenous adriamycin.

The technique of 'targeting' cytotoxic drugs by mixing them with the contrast medium lipiodol is now widely used in Japan and the Far East where it has been reported to enhance response rates in patients with hepatocellular carcinoma. In the present study 19 patients with this tumour were treated with intra-(hepatic) arterial adriamycin (60 mg/m2), at least one course of which was combined with lipiodol (10-20 ml). Two patients (11%) had a remission as indicated by a significant fall in serum alphafetoprotein and there was a reduction of tumour size in one of these. The median survival period was 3 months (range 1-18) with the two responding patients surviving 8 and 12 months. This response rate was no better than the figure of 14% seen in 31 consecutive patients treated with intravenous adriamycin at the same dose, and the survival curves of the two groups of patients were not significantly different. Lipiodol in combination with adriamycin is not superior to intravenous adriamycin administered alone.

Adult↗
PubMed1990

Aortic dissection presenting as acute leg ischaemia.

Lower limb ischaemia as the only or main clinical manifestation of aortic dissection is a rare event. Two cases are presented where this occurred resulting in attempted embolectomy before the correct diagnosis was made. The diagnosis should be considered when embolectomy fails to retrieve thrombus and when angiography demonstrates spiral lucencies within the lumen of large vessels or non-filling of major vascular branches. The value of pre-operative angiography is emphasized.

Aged↗
PubMed1990

Nocardia infection in patients with liver transplants or chronic liver disease: radiologic findings.

The radiologic findings in eight patients with nocardiosis were reviewed. Infection followed liver transplantation in six cases and was associated with chronic liver disease in two. Abnormalities of the chest radiograph predominated and included pleural effusions (n = 6), consolidation (n = 5), cavitating lesions (n = 1), and intrapulmonary nodules (n = 3), but there were no diagnostic features. The diagnosis was made on the basis of bronchial washings (n = 3), skin aspiration (n = 3), pleural fluid (n = 1), and aspiration biopsy of a pulmonary nodule (n = 1). Computed tomography (CT) was helpful in evaluating chest disease in three cases and allowed guided biopsy to obtain material for a definitive diagnosis. In three patients skin lesions in disseminated disease were associated with cerebral lesions seen at CT. A definitive tissue diagnosis is especially important in patients who have received transplants because of malignancy, since the radiologic manifestations of this unusual infection may mimic metastatic recurrence. Conventional radiography and CT are nonspecific but will enable determination of disease extent and selection of the most suitable site for tissue sampling, which is required to confirm the diagnosis.

Adult↗
PubMed1989

Lipiodol enhanced CT scanning in assessment of hepatocellular carcinoma.

We studied 20 patients with computed tomography (CT) following the intra-arterial injection of Lipiodol. Comparison with conventional CT, angiography and plain abdominal radiographs revealed additional satellite tumours in four patients. Technical difficulties occurred in selective hepatic arterial catheterisation and in satisfactory delivery of Lipiodol to all segments of the liver in a third of our patients. Plain abdominal radiographs following Lipiodol injection are inadequate in our experience in assessing tumour mass and distribution; we failed to demonstrate retention of Lipiodol by tumour tissue for longer than a few weeks in any case. The pattern of Lipiodol uptake within the tumour is not related to histology but to the vascular supply and size of the tumour. Our findings do not accord with the Japanese experience and this small study suggests that Lipiodol enhanced CT should be reserved for patients with small tumours in non-cirrhotic livers who are being considered for resection of their tumour. Such patients are likely to be encountered rarely in UK practice.

Adult↗
PubMed1989

Budd-Chiari syndrome: shunt selection and post-operative assessment.

Radiological investigation of patients with the Budd-Chiari syndrome is helpful in making the diagnosis and to determine the most suitable method of surgical decompression of the portal venous system where this is indicated. The radiological findings in four patients with Budd-Chiari syndrome who were treated by meso-atrial shunt operations are described. The key pre-operative investigation is inferior vena cavography with pressure measurements. Postoperatively shunt patency is most reliably assessed by dynamic CT scanning. Doppler ultrasound studies may detect flow within the shunt but patency may be inferred by observing reversal of blood flow within the portal vein.

Adolescent↗
PubMed1989

The value of routine radiology in young psychiatric patients.

The current policy of obtaining routine skull and chest X-rays on all psychiatric admissions to military hospitals has been examined by scrutiny of the radiology reports on all such admissions during one calendar year. No clinically unexpected finding was demonstrated in any of the 352 patients so examined. Routine radiological investigation of these patients may safely be abandoned.

Adult↗
PubMed1988

The role of ultrasound scanning in management after liver transplantation.

A total of 368 ultrasound scans in 72 patients following liver transplantation have been reviewed. Thirty-seven intra-abdominal fluid collections were identified. Twenty-four resolved spontaneously and 13 required aspiration under ultrasound control. Dilated bile ducts were seen in 22 patients, 11 of whom required further intervention. The main indications for intervention post-transplantation were increasing or late onset (after 3 months) duct dilatation. Recurrent or persistent fluid collections particularly in the right subhepatic space also indicate further investigation. Twelve ultrasound-guided liver biopsies were performed to detect rejection or tumour recurrence. Eight cases of portal vein anastomotic narrowing and three abnormalities of the inferior vena cava were also detected.

Adolescent↗
PubMed1988

Assessment of portal vein patency: comparison of arterial portography and ultrasound scanning.

The accuracy of ultrasound assessment of portal vein patency has been defined by comparing it with the results of arterial portography in 115 cases. The accuracy of arterial portography was confirmed in 21 cases where orthotopic liver transplantation was performed and used as a 'bench-mark' against which to assess the ultrasound findings. Ultrasound correctly assessed portal vein patency in 87.5% of patients. It was more accurate in assessing patency (90%) than occlusion (68%). Ultrasound correctly assessed portal vein patency in 90% of cases of cirrhosis and hepatic malignancy. Difficulties occurred in children with biliary atresia particularly following the Kasai operation (37.5% accuracy). In the absence of previous surgery to the portal vein or biliary system, ultrasound is comparable to arterial portography and can be used as the sole means of assessment.

Adolescent↗
PubMed1988

Radiological awareness of current recommendations on prophylaxis of infective endocarditis.

In 1982 the British Society for Antimicrobial Chemotherapy produced a report recommending that all patients with a prosthetic heart valve should receive prophylactic antibiotics prior to any procedure likely to cause a transient bacteraemia. This includes barium enema and genitourinary tract instrumentation. A postal survey of 38 radiology departments has shown that there is very poor awareness of this report and of its implications for radiology departments and suggestions are made as to how this may be improved.

Awareness↗
PubMed1988

Duplex Doppler ultrasound in the diagnosis of cavernous transformation of the portal vein.

Duplex Doppler ultrasound scans were performed in 10 patients with proven cavernous transformation of the portal vein. All cases exhibited absence of the normal portal vein lumen with replacement by numerous tortuous vessels. Doppler studies revealed a characteristic "flat" waveform with a reduction in the time averaged velocity to less than 8 cm/s which is well below the normal range. The combination of real-time and Doppler ultrasound enabled an accurate diagnosis to be made in all cases.

Adolescent↗