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Biomedical subjects

P Hillenbrand

Publications and source records attributed to P Hillenbrand.

17 recordsLinked to original sources
PubMed1994

Prevention of rebleeding from oesophageal varices: two-year follow up of a prospective controlled trial of propranolol in addition to sclerotherapy.

A prospective randomised trial comparing propranolol and sclerotherapy to sclerotherapy alone was conducted over a 2-year follow up in a district hospital setting of unselected patients. Rebleeding and survival were analysed. Thirty-nine patients were randomised to propranolol plus sclerotherapy and 34 to sclerotherapy alone. The two groups were clinically comparable. There was no significant difference in the cumulative percent of patients free of rebleeding; 54% of the sclerotherapy group rebled compared to 52% of the group treated with propranolol plus sclerotherapy (Hazard ratio 1.09 (0.54-2.22) and p = 0.81, NS). Two-year actuarial survival was also not significantly different, with 77% of the propanolol plus sclerotherapy group surviving, compared to 74% of sclerotherapy alone (Hazard ratio 1.08 (0.35-2.22) and p = 0.79, NS). The mean time to eradication of varices was not significantly different between the two groups (propranolol plus sclerotherapy 222 days, sclerotherapy alone 243 days), nor did the rate of variceal recurrence differ (72.7 vs 72 days). This study did not show long-term improvement in rebleeding or survival using propranolol in addition to a regular sclerotherapy programme.

Adolescent↗
PubMed1989

[Introduction of an aspiration-irrigation-reflow system with a special handle for extracapsular cataract operation].

A new irrigation/aspiration system consisting of an electromechanical switch and a special handle is described. The switch mechanisms acts on a tube system connected to the handle, enabling the anterior chamber to be refilled immediately via the aspiration opening, so that collapse is impossible. A further advantage is that fluid exchange is minimized, because aspiration only occurs when the pedal switch is operated. When the pedal is released the fluid is spontaneously flushed back via the aspiration opening. This results in a significant reduction in capsular and iris complications. Thanks to the special handle the fluid flushed back is practically free of lens particles.

Cataract Extraction↗
PubMed1986

Crohn's disease involving the penis.

Perianal complications of Crohn's disease occur in 25-70% of patients but perineal and genital lesions are rare. Treatment is controversial and there is a risk of recurrent or persistent disease. We report two cases of Crohn's disease involving the penis, one with multiple scrotal urinary fistulae, partial destruction of the proximal urethra, and ulceration of the penile shaft; the other with metastatic cutaneous ulceration of the penile shaft. The second case is particularly unusual in that the patient presented at the VD clinic as a case of syphilis.

Adolescent↗
PubMed1986

A randomized controlled trial of variceal compression as an adjunct to endoscopic variceal sclerosis.

Endoscopic variceal sclerosis is effective at eradicating oesophageal varices and prolonging survival, but early rebleeding before varices have been obliterated remains a problem. A randomized controlled trial was therefore conducted to determine whether more rapid variceal obliteration and hence a lower morbidity and mortality in the first month could be achieved by compressing the varices after the first injection of sclerosant. Forty patients bleeding from previously untreated varices were studied. There was no demonstrable benefit from post-sclerosis variceal compression in terms of early death from rebleeding (compression, 3 of 19; no compression, 3 of 21 in the first month), total number of patients rebleeding (compression, 5 of 19; no compression, 6 of 21 in the first month), or speed of variceal obliteration (percentage of variceal columns obliterated at 1 month: compression, 13%; no compression, 26%). This study shows that post-sclerosis variceal compression by means of the Williams overtube and Sengstaken tamponade does not improve the efficacy of endoscopic variceal sclerosis.

Clinical Trials as Topic↗
PubMed1974

Significance of intravascular coagulation and fibrinolysis in acute hepatic failure.

Twenty-two patients with acute hepatic failure were studied to determine the incidence and magnitude of intravascular coagulation and fibrinolysis and their relation to the severity of bleeding and prognosis. The mean platelet count, Thrombotest, plasminogen activator, and plasminogen were reduced; the reduction in fibrinogen was not statistically significant. Fibrin/fibrinogen degradation products were only moderately increased. Hepatic fibrin deposition was not extensive, being present in 11 of 22 hepatic sections, more in areas of confluent necrosis than in the sinusoids. The combination of increased fibrin/fibrinogen degradation products with decreased plasminogen activator, plasminogen, and thrombocytopenia is consistent with a diagnosis of intravascular coagulation and secondary local fibrinolysis. However, neither of these processes was severe. Severity of bleeding was related only to plasminogen levels and prognosis only to Thrombotest levels. There was no relation between hepatic histological and haematological findings. Heparin therapy is not indicated in the routine management of acute hepatic failure, as intravascular coagulation is not severe and heparin may itself cause massive bleeding.

Acute Disease↗
PubMed1973

Fibrinolysis in cholestatic jaundice.

The fibrinolytic system was studied in primary biliary cirrhosis (16 patients) and large bile duct obstruction (10 patients, nine of whom had carcinoma). Plasma fibrinolysis (plasminogen activator activity) was decreased and fibrinogen increased in both groups of patients, particularly in those with large duct obstruction. These changes were related to the degree of cholestasis. Plasminogen activator activity was inversely related to serum triglyceride levels in patients with primary biliary cirrhosis. Urokinase inhibitors were decreased in both groups and antiplasmins increased in patients with large duct obstruction; fibrin/fibrinogen degradation products were normal in primary biliary cirrhosis and moderately increased in large duct obstruction. None of these fibrinolytic indices was related to the degree of cholestasis. Fibrinolytic activity and fibrinogen returned almost to normal levels after palliative surgery in the three patients with large duct obstruction who were studied. The decreased plasma fibrinolysis and increased fibrinogen may be due to altered lipid metabolism in cholestatic jaundice. In patients undergoing surgery for large duct obstruction there may be an increased risk of thrombosis.

Adult↗
PubMed1972

Plasminogen activator in bile during extracorporeal perfusion of pig liver.

Plasminogen activator activity was studied in bile and perfusate during extracorporeal pig liver perfusion. Plasminogen activator activity in bile was up to 58 times greater than in perfusate. A high level of plasminogen activator activity in bile was also found after the addition of urokinase to the perfusate. These results suggest that bile is the main route of active excretion of plasminogen activator and urokinase from the liver in experimental liver perfusion.

Animals↗
PubMed1971

Use of metolazone in the treatment of ascites due to liver disease.

In 8 out of 20 patients with chronic liver disease ascites was controlled with metolazone, 10 required additional amiloride or spironolactone to achieve control, and 2 were resistant to all diuretic therapy. An initial dose of 5 mg daily is suggested, though much higher doses may be required ultimately. When metolazone is used alone the high incidence of hypokalaemia (80%), hypochloraemia (35%), and encephalopathy (35%) compared with the results of other series is a major disadvantage and indicates that this drug should be used with caution in patients with liver disease. Hypokalaemia can usually be prevented by the simultaneous administration of amiloride or spironolactone. The low incidence of azotaemia (5%) suggests that this diuretic may be useful if renal function is particularly impaired.

Adult↗