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Biomedical subjects

P E Isaacs

Publications and source records attributed to P E Isaacs.

At least 19 recordsLinked to original sources
PubMed1996

Malignant hepatic tumours associated with previous exposure to Thorotrast: four cases.

This report concerns four patients in a district general hospital who died from malignant liver tumours associated with Thorotrast (thorium dioxide) deposits in the liver. Three were known to have had diagnostic angiographic studies performed 36 to 43 years previously using Thorotrast as the contrast agent. In the fourth case no previous relevant information could be obtained. There were two men and one woman with hepatocellular carcinoma and one woman with cholangiocarcinoma. In one of the hepatoma cases there was associated hypercalcaemia of malignancy. Reported latency intervals suggest that cases of Thorotrast-related hepatic malignancy may present up to the second decade of the twenty-first century.

Aged↗
PubMed1995

Linear IgA dermatosis, coeliac disease, and extraintestinal B cell lymphoma.

Linear IgA dermatosis is a malignancy associated rare bullous disorder similar to dermatitis herpetiformis. Linear IgA dermatosis differs from dermatitis herpetiformis in that the IgA deposits in the epidermal basement membrane are linear rather than granular. A patient is presented with coeliac disease who presented with linear IgA dermatosis and anaemia caused by chronic low grade B cell lymphoma.

Aged↗
PubMed1993

Factor V inhibitor in thrombosis.

A 68-year-old previously well woman developed sudden onset of limb gangrene in association with liver dysfunction. An immediately acting inhibitor to factor V with some of the features of lupus anticoagulant was demonstrated. The patient required limb amputation within 2 weeks and activity of the anticoagulant seemed to be on the decline 6 months later.

Aged↗
PubMed1991

Upper gastrointestinal lesions in elderly patients presenting for endoscopy: relevance of NSAID usage.

The occurrence of upper gastrointestinal disease and the relevance of nonsteroidal antiinflammatory drug (NSAID) usage were documented in 511 consecutive patients (321 women, 190 men) over 70 yr old, referred for upper gastrointestinal endoscopy in a district general hospital. The findings were benign esophageal disease (43%), normal (15%), gastric ulcer (11.5%), and duodenal ulcer (11%). Gastric ulcers were more common in women taking NSAIDs (25%) than in NSAID abstainers (7%) p less than 0.001 and male NSAID users (8%) p less than 0.001. Esophagitis and esophageal stricture were not influenced by NSAID usage, but gastric erosions were more common (10% vs. 3%) p less than 0.01. Of 142 patients receiving NSAIDs, 41% presented with hemorrhage, compared with 20.5% of NSAID abstainers (p less than 0.001). Hemorrhage was as common in aspirin takers (15 of 33, 45%) as in standard-dose NANSAID takers (43 of 109, 39%), even though 86% were taking 300 mg of aspirin per day or less. In elderly patients, esophageal disease is common. NSAID use, even low-dose aspirin, is associated with an increased risk of hemorrhage. In females, NSAID usage is associated with gastric ulcer.

Aged↗
PubMed1990

Assessment of gastro-esophageal reflux disease: comparison of reflux scintigraphy with endoscopy biopsy and esophageal pH monitoring.

In a study designed to evaluate reflux scintigraphy in 79 patients with gastro-esophageal reflux disease, quantitated reflux scintigraphy was found to have predictive values of 73% in detecting reflux as judged by esophageal pH monitoring, of 63% in detecting esophagitis as judged by esophagoscopy and biopsy, and of 77% in detecting the presence of either esophagitis or reflux. However, its sensitivity was only 48, 58 and 42%, respectively. Gastro-esophageal reflux scanning has little value in the routine clinical diagnosis of mild to moderate gastroesophageal reflux disease, but none of the other tests (biopsy, endoscopic appearances of 24 hour esophageal pH monitoring) were sufficiently specific to be taken as a sole diagnostic criterion ("gold standard"). Investigation of gastro-esophageal reflux disease could probably best be limited to endoscopy (especially to detect ulceration or metaplasia and to exclude neoplasia) with 24 hour pH monitoring in addition for those patients with suspected reflux disease but negative endoscopy.

Adult↗
PubMed1989

Outbreak of botulism in north west England and Wales, June, 1989.

The clinical features of 27 patients identified in an outbreak of botulism in Lancashire, England, and North Wales are reviewed. All but 1 of the patients (age range 14 months to 74 years) were admitted to hospital: 12 were treated in intensive care units, and 8 received positive pressure ventilation. 1 patient died with an aspiration pneumonia. The clinical presentations contained several unusual features, with evidence of segmental demyelination in some patients and drowsiness, sore throats, and fever in others. The widely dispersed source of intoxication with patients presenting singly to several hospitals added to the difficulties of diagnosis. Successful clinical management depends on full and early recognition both of the dangers of impaired oropharyngeal function and of the rapid neurological changes in botulism.

Adolescent↗
PubMed1989

Unique appearance of the duodenal papilla in pancreatic cystadenocarcinoma.

Cystadenocarcinoma of the pancreas is uncommon, but should be positively identified and distinguished from other cystic lesions of the pancreas because of its good surgical prognosis in comparison with pancreatic adenocarcinoma. I report two cases of cystadenocarcinoma of the head of the pancreas, in which a previously undescribed abnormal appearance of the duodenal papilla was characteristic.

Adenocarcinoma, Mucinous↗
PubMed1988

Barrett's ulcer: response to standard dose ranitidine, high dose ranitidine, and omeprazole.

Between January 1984 and December 1986, 116 patients were found to have columnar-lined esophagus (Barrett's esophagus) during upper gastrointestinal endoscopy. Twenty-eight patients (16 men and 12 women) were found to have peptic ulcer of the esophagus (Barrett's ulcer). In 17 (60%), standard measures and ranitidine 300 mg daily resulted in healing. Two men with resistant ulcers were treated by surgical repair of their hiatus hernia. Nine (six men, three women) in whom healing failed to occur on this regimen after 3-15 months were treated with high dose ranitidine (300 mg bd). In five, healing was complete after 8 wk and one more healed after an additional 4 wk. The three patients with unhealed ulcers after high dose ranitidine received omeprazole 40 mg in the morning. In two of these, ulcers healed after 4 wk; in the third, one of two ulcers persisted after 8 wk, although the remaining ulcer was smaller and more superficial. Pain relief was good, but minor reflux symptoms persisted in both treatment groups. On completion of the study, patients received 300 mg ranitidine at night. Powerful acid-reducing regimens may be required to heal a proportion of Barrett's ulcers.

Barrett Esophagus↗
PubMed1987

Comparison of effects of ingested medium- and long-chain triglyceride on gallbladder volume and release of cholecystokinin and other gut peptides.

In a double-blind, crossover study of the effect of ingested medium-chain triglyceride (MCT) and long-chain triglyceride (LCT) in six normal subjects, the gallbladder did not contract after ingestion of MCT but instead had significantly increased in volume at 2 hr after the meal. Plasma cholecystokinin (CCK) increased after the MCT meal, but gastrin, motilin, pancreatic polypeptide (PP), and GIP were unaffected. The long-chain triglyceride meal evoked a brisk and sustained gallbladder contraction, higher levels of CCK, and a significant increase in plasma PP and GIP levels.

Adult↗
PubMed1987

Mefenamic acid enteropathy.

The clinical, radiological, and histological features of two patients with severe intestinal damage induced by mefenamic acid and mimicking coeliac disease are described. Symptoms rapidly reverted on withdrawal of the drug, and in one case, did not relapse during treatment with other non-steroidal anti-inflammatory drugs.

Aged↗
PubMed1986

Human gastrointestinal absorption of acyclovir from tablet duodenal infusion and sipped solution.

On two occasions at least 1 week apart, nine healthy male volunteers were administered in random order either 2 X 200 mg (1.8 mmol) acyclovir tablets or 400 mg of acyclovir in 500 ml of 5% dextrose solution which was infused at constant rate into the duodenum over 4 h. Six of the subjects subsequently sipped the same solution at the rate of 10.4 ml in each 5 min period for 4 h. Blood and urine were sampled over 24 h for each mode of administration. Acyclovir was assayed by radioimmunoassay. Mean areas under the plasma concentration-time curves (AUCs) +/- s.d. for tablet (T), intraduodenal infusion (I) and sipping (S) were, respectively: T = 14.7 +/- 5.1; I = 24.6 +/- 5.1; S = 28.4 +/- 9.5 (n = 6) mumol l-1 h. AUCs for I and S were significantly greater than that for T (2P less than 0.05). Mean apparent maximum plasma concentrations (Cmax) +/- s.d. were T = 3.8 +/- 1.5; I = 4.8 +/- 0.9; S = 5.1 +/- 1.5 mumol l-1. This trend to higher values for I and S was not significant. Mean apparent plasma disappearance half-lives (t1/2) +/- s.d. were respectively T = 2.3 +/- 0.4; I = 2.7 +/- 0.5; S = 3.0 +/- 0.2 h, I being significantly greater than T (2P less than 0.05), as was S greater than T (2P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Acyclovir↗
PubMed1986

Fasting and postprandial ileal function in adapted ileostomates and normal subjects.

The output of 11 established ileostomies was compared with ileal flow measured by intestinal perfusion in five normal volunteers when fasting and during the ileal passage of test meals containing different proportions of medium chain triglyceride and long chain triglyceride. Oroileal transit of the meal was the same in the two groups, but ileostomy output was less than ileal flow of normal persons both fasting (16.3 +/- 10.9 vs 62.4 +/- 24.7 ml/h, p less than 0.001) and after the long chain triglyceride rich meal (35.4 27.0 vs 96.1 +/- 20.2 ml/h, p less than 0.001). After ingestion of the medium chain triglyceride rich meal, ideal flow failed to increase in normal subjects but in ileostomates the changes in flow after medium chain triglyceride and long chain triglyceride rich meals were not significantly different. The fasting ileostomy effluent composition differed from that of normal fasting ileal content in having a higher concentration of potassium (8.0 +/- 2.9 vs 4.7 +/- 0.6 mmol/1, p less than 0.04) and a higher osmolality (353 +/- 63 vs 287 +/- 5 mosm/kg, p less than 0.05). Sodium concentration tended to be lower in ileostomy effluent, but in contrast to previous reports, ileostomy effluent was of consistently alkaline pH (7.2 +/- 0.3). These concentrations were not significantly altered by either type of meal. The long chain triglyceride rich meal increased the ileal flow of bile acids in both normal subjects and ileostomates, whereas the medium chain triglyceride rich meal increased bile acid flow in ileostomates but not in normal subjects, possibly reflecting a different amount of the bile acids in the ileum of the ileostomate. In the adapted ileostomate, the low volume and high potassium concentration of fasting effluent suggest that sodium and water absorption are continuously stimulated by chronic salt depletion.

Adaptation, Physiological↗