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Biomedical subjects

R Lendrum

Publications and source records attributed to R Lendrum.

At least 19 recordsLinked to original sources
PubMed1994

Expression of glutathione S-transferases in normal and malignant pancreas: an immunohistochemical study.

The glutathione S-transferases (GSTs) are a family of detoxification and metabolising enzymes, which have been linked with the susceptibility of tissues to environmental carcinogens and resistance of tumours to chemotherapy. Environmental carcinogens have been implicated in the pathogenesis of pancreatic carcinoma, which is also a tumour characterised by marked chemotherapeutic drug resistance. In this study 26 pancreatic adenocarcinoma and 12 normal pancreatic samples were examined immunohistochemically for expression of pi (acidic), alpha (basic), and mu (neutral) GST. Fourteen (54%) of the tumours expressed pi GST alone, two (8%) expressed both pi and alpha GST, and two (8%) showed immunoreactivity with alpha GST alone. In the normal pancreas the intralobular ducts and centroacinar cells expressed pi GST alone whereas the large ducts expressed both pi and alpha GST. The acinar cells showed immunoreactivity only with anti-alpha GST. Mu GST was not expressed by normal or malignant pancreas. Expression of pi GST by pancreatic carcinoma may be a marker of the malignant phenotype and be induced during neoplastic transformation. Alternatively it could possibly reflect cell of origin, suggesting that the tumour arises from the centroacinar cells or intralobular ducts, or both rather than the large ducts.

Adenocarcinoma↗
PubMed1992

Treatment of common bile duct stones using mono-octanoin.

A retrospective analysis of 48 patients undergoing mono-octanoin infusion via nasobiliary catheter following failure of endoscopic extraction of common bile duct stones is reported. Among 35 patients who received a complete course of treatment, nine (26 per cent) had duct clearance by the completion of the infusion and a further eight on subsequent endoscopic retrograde cholangiopancreatography (ERCP) (total 49 per cent). Two patients had a successful stone extraction after enlargement of the sphincterotomy (total non-surgical clearance rate 54 per cent). None of five patients with stones greater than 2 cm in diameter had stone clearance at the completion of the infusion and only one at subsequent ERCP. Among 13 patients receiving an incomplete course of treatment seven had clear ducts on repeat ERCP (54 per cent). Mono-octanoin infusion via a nasobiliary catheter is of limited value in the management of this difficult group of patients, although it may be successful in some.

Aged↗
PubMed1992

Role of endoscopic retrograde cholangiopancreatography in the investigation of pain after cholecystectomy.

Patients who continue to have or who develop abdominal pain after apparently successful cholecystectomy pose diagnostic difficulties. This study reports 384 such patients, investigated by endoscopic retrograde cholangiopancreatography (ERCP). There were 146 patients with abdominal pain alone with no previous history of common bile duct (CBD) exploration, of whom only 17 (11.6 per cent) had CBD stones on ERCP. Bile duct calculi were present in 76 of 140 patients (54.3 per cent) with abnormal biochemical findings (raised alkaline phosphatase and/or amylase level) and in 34 of 57 (60 per cent) with an abnormality detected on ultrasonography or intravenous cholangiography. A combination of biochemical and radiological abnormalities was present in 37 patients and was associated with CBD stones in 28 (76 per cent). Patients who had undergone CBD exploration represented a special group, of whom the majority (75 per cent) had common duct stones at ERCP even in the absence of biochemical and radiological abnormalities. ERCP is a useful investigation in patients with persistent postcholecystectomy symptoms. Other features in addition to pain or a history of CBD exploration may be relevant to the decision to perform ERCP in the investigation of these patients.

Abdominal Pain↗
PubMed1992

Oesophageal candidiasis after omeprazole therapy.

Oesophageal candidiasis was diagnosed incidentally at endoscopy in two patients receiving omeprazole therapy. There were no other predisposing factors for the development of candidiasis. The infection was resolved rapidly by anti-candidal therapy and by stopping omeprazole. These findings suggest that gastric acid secretion and physiological reflux of acid into the oesophagus may play a protective role in preventing candida infection.

Aged↗
PubMed1988

Hepatic epithelioid haemangioendothelioma: difficult name, difficult diagnosis?

Two patients with epithelioid haemangioendotheliomata of the liver are described. Both presented with abdominal pain and malaise, with hepatomegaly and a variable degree of hepatocellular dysfunction. Diagnosis was delayed in both cases, each patient undergoing a protracted series of investigations including repeated liver biopsies. The major obstacles to early diagnosis were a lack of clinical awareness of the condition and difficulties in interpretation of the liver histology: the widespread sclerosis in the tumour tissue is easily mistaken for a post-necrotic or cirrhotic process. The key to the diagnosis is the demonstration of cells containing Factor-VIII-related antigen confirming the endothelial origin of the tumour. One patient died within three months of presentation and the other after 18 months. The tumour may, therefore, be more aggressive than earlier reports seem to suggest. It seems likely that the tumour is being under-diagnosed and although no specific therapy has been shown to be of value, a greater awareness of the condition, resulting in a more prompt diagnosis, should save patients from undergoing unnecessary investigation.

Female↗
PubMed1987

A randomised, prospective study comparing two contrast media in ERCP.

A randomised, prospective, stratified, double blind study comparing two contrast media in endoscopic retrograde cholangio-pancreatography (ERCP) was undertaken. Forty-six patients received Meglumine/Sodium Ioxaglate (Hexabrix 320) and forty-eight received Meglumine/Sodium Diatrizoate (Urografin 310). The two groups were evenly matched for age, sex and diagnosis. Radiographs were examined independently by two radiologists. There were no differences in radiograph quality with either type of contrast medium. More patients developed pancreatitis following Urografin, suggesting that Hexabrix is a safer contrast medium for ERCP.

Adult↗
PubMed1987

Disseminated intravascular coagulation, antiphospholipid antibodies, and ischaemic necrosis of extremities.

A middle aged woman presented with acute, severe, intravascular coagulation leading to ischaemic necrosis of the extremities. Pulmonary involvement required artificial ventilation, and there was evidence of hepatic, pancreatic, and renal damage, which resolved without complication. These events may have been triggered by the ingestion of compound diuretic tablets. The finding of the 'lupus anticoagulant' and anticardiolipin antibodies, together with high titre antinuclear factor in the serum, and antibodies to extractable nuclear antigen (RNP), and a past history of spontaneous abortion, suggest that this was a dramatic manifestation of an immune connective tissue disorder.

Antibodies↗
PubMed1984

Gallstones presenting as mental and physical debility in the elderly.

Within 1 year six elderly patients (aged 80-89 years) were admitted because of non-specific deterioration in mental or physical well-being. In no instance was hepatobiliary disease suspected at the time of hospital admission. One patient presented with intermittent confusion only. The other five were referred with "falls" or having "gone off legs", with malaise, confusion, or incontinence. All had raised alkaline phosphatase levels of 159-1230 IU/l, which led to investigation of the biliary tree. At endoscopic retrograde cholangiopancreatography all were shown to have biliary disease (three common duct stones, one gallbladder calculus, one an abscess, and one a widely dilated common bileduct ). With appropriate treatment (endoscopic sphincterotomy for two, surgery for two, and antibiotics alone for two), all showed a gratifying return of mobility and mental function. Biliary disease is a treatable cause of chronic ill health in the elderly and should be excluded, even in the absence of "classical" symptoms, when there is abnormal liver function.

Aged↗
PubMed1983

Autoantibodies to gut hormone secreting cells as markers of peptide deficiency.

Autoantibodies reacting with endocrine cells in the gastrointestinal mucosa were found by indirect immunofluorescence in 22 out of 268 sera (8.2%) obtained from patients with coeliac disease, Crohn's disease, ulcerative colitis, irritable bowel syndrome, and from subjects without bowel disease. A double immunofluorescence technique showed that the autoantibodies reacted with cells secreting gastric inhibitory polypeptide (glucose dependent insulinotropic polypeptide, GIP), secretin, somatostatin or enteroglucagon. Most sera contained antibodies against more than one cell type. Neither the presence of a particular antibody nor the pattern of antibody combinations appeared to be specific for any diagnostic category. The mean plasma GIP concentrations, however, both fasting and two hours after a test meal, were significantly lower in subjects with GIP cell autoantibodies. Thus gut hormone cell autoantibodies may be markers of impaired hormone secretion.

Adolescent↗
PubMed1980

What is involved in endoscopic sphincterotomy for gallstones?

This study reports our first year's experience of endoscopic sphincterotomy for common bile duct stones. Forty patients were considered for the procedure and it was attempted in 37. An effective endoscopic sphincterotomy was eventually achieved in 32 (86 cases per cent), 7 after a "pre-cut". Twenty-three patients passed stones spontaneously (72 per cent), 6 could not be reassessed and 3 still had stones present (9 per cent). Bed occupancy was 9.5 +/- 5.9 days. Complications occurred in 30 per cent, the most common being pancreatitis in 6 cases with 1 death. It is concluded that endoscopic sphincterotomy offers a valuable alternative to surgery in the management of common bile duct stones.

Adult↗
PubMed1977

Aetiology of juvenile-onset diabetes. A prospective study.

110 people in whom insulin-dependent diabetes developed when they were less than 30 years old were studied as soon as possible after diagnosis. There was evidence for clustering of cases with BW15-positive phenotypes during the winter peak (1976) but not during the autumn peak (1975). Subjects who were BW15-positive, and in particular those who were both B8 and BW15-positive, had higher neutralising antibody titres to Coxsackle virus types B1-B4 58% of cases had islet-cell antibodies (I.C.A.), but the presence of I.C.A. was not correlated with HLA phenotypes or viral antibody titres. In 41 subjects (37%), who gave a definite history of antecedent illness, evidence indicated that this was a precipitating infection and not the initiating event producing islet-cell damage. Nearly half the subjects had had diabetic symptoms for more than 4 weeks before diagnosis.

Adolescent↗
PubMed1976

Islet-cell antibodies in diabetes mellitus.

Islet-cell antibodies (I.C.A.) were found in 38% (319/829) of insulin-dependent diabetic patients, in 5% (6/112) of insulin-independent diabetics, and in 1.7% (3/177) of non-diabetic subjects. In the insulin-dependent group I.C.A. were found in 85% of patients immediately after the onset of symptoms and they became less common as the duration of disease increased I.C.A. were equally common in both sexes and the decline in their prevalence was independent of age. The antibodies were directed against cytoplasmic components of islet cells but not against insulin itself. The appearance of I.C.A. probably follows cell damage occurring before the onset of symptoms. By contrast, thyroid and gastric autoantibodies were more common in older patients and females. There was no correlation between the presence of these antibodies and I.C.A. in patients with either diabetes of recent onset or longstanding disease.

Adolescent↗