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Biomedical subjects

R Vender

Publications and source records attributed to R Vender.

8 recordsLinked to original sources
PubMed1998

Extremely high levels of alkaline phosphatase in hospitalized patients.

We determined the diseases associated with extremely high levels of alkaline phosphatase in hospitalized patients. Computerized laboratory records of the Hospital of Saint Raphael identified all inpatients who had elevations of alkaline phosphatase above 1,000 U/l from April 1994 to September 1995. Thirty-seven inpatients with alkaline phosphatase levels above 1,000 U/l were identified. Six had bone involvement from malignancy or Paget's disease and were eliminated from further analysis, and 31 patients were included in the study. Levels of alkaline phosphatase ranged from 1,014 to 3,360 U/l. Ten patients had sepsis as the cause of the elevated alkaline phosphatase. These included gram-negative organisms, gram-positive organisms, and two patients with fungal sepsis. Seven of 10 patients with sepsis had an extremely high alkaline phosphatase level and a normal bilirubin, 3 of 10 patients with sepsis also had acquired immunodeficiency syndrome (AIDS). Eight patients had biliary obstruction, 7 with malignant obstruction and 1 with a common bile duct stone. Nine patients had AIDS. The cause of the elevated alkaline phosphatase in these included three with sepsis, three with mycobacterium avium intracellulare (MAI) infection, two with cytomegalovirus infection, and one with Dilantin toxicity. Three patients had diffuse liver metastases. Finally, four patients had benign intrahepatic disease, including one patient with liver hemangiomas, one patient with sarcoid hepatitis, one patient with lead toxicity, and one patient with drug-induced cholestasis. Extremely high elevations of alkaline phosphatase are most frequently seen in patients with sepsis, malignant obstruction, and AIDS. Patients with sepsis can have an extremely high alkaline phosphatase level and a normal bilirubin. A variety of other causes were also noted.

Adult↗
PubMed1997

Clinical utility of endoscopic retrograde cholangiopancreatography.

BACKGROUND: ERCP is a frequently performed procedure, but its necessity for diagnosis and ability to change management plans are unclear in many cases. METHODS: We prospectively evaluated diagnosis, certainty of diagnosis, and management recommendations, both before and after ERCP, as well as therapeutic maneuvers performed during ERCP, in unselected patients undergoing this procedure. RESULTS: ERCP procedures (1341) were studied at a university hospital, an ERCP referral center, and two community hospitals. Among patients undergoing first-time ERCP, the preceding clinical diagnosis was correct for 64% of those predicted to have bile duct stones, 86% to 89% of those given other biliary diagnoses, and 88% predicted to be normal. In 35% of cases, diagnostic confidence improved substantially after ERCP. Endoscopic therapy was successfully completed in 51%. After ERCP, plans for other invasive procedures changed in 82%: percutaneous biliary studies and open surgical procedures were recommended less often and laparoscopic cholecystectomy more often. Endoscopic therapy and overall clinical utility were most common in patients with cholangitis, jaundice, or bile leaks. CONCLUSIONS: ERCP is particularly helpful for diagnosis of bile duct stones but is less likely to change other diagnoses. The endoscopic therapy commonly carried out during ERCP often changes the treatment plan, leading to fewer surgical and percutaneous interventions in general, but more laparoscopic cholecystectomies.

Bile Duct Diseases↗
PubMed1994

Cholestatic jaundice due to ackee fruit poisoning.

A 27-yr-old Jamaican male presented with a 2-month history of jaundice, pruritus, intermittent diarrhea, and right upper quadrant abdominal pain. Over the next month, his abdominal pain and diarrhea improved, but his jaundice and pruritus worsened. He was afebrile and profoundly jaundice, with a benign abdominal examination. Medical workup included a normal abdominal ultrasound, iron studies, ceruloplasm, and serum electrophoresis. Negative viral (Epstein-Barr virus, cytomegalovirus, mononucleosis, hepatitis A, B, C) studies, ANA, AMA, ASMA, RPR were noted. He denied any alcohol, drug, or toxin exposure. Liver tests revealed total bilirubin of 25.6 mg/dl, direct bilirubin of 13.9 mg/dl, alkaline phosphatase 278 IU/L, AST 45 IU/L, and ALT 71 IU/L. Liver biopsy demonstrated centrilobular zonal necrosis and cholestasis most consistent with a toxic reaction. The patient was again interviewed regarding potential toxins, and he admitted to the ingestion of ackee fruit, a native Jamaican fruit that is illegal in the United States. Shortly after he had ceased intake of the fruit, his symptoms resolved and his liver function tests returned to normal. We present a case of chronic ackee fruit ingestion that led to cholestatic jaundice, vomiting, and abdominal pain.

Abdominal Pain↗
PubMed1991

Fecal carriage of Streptococcus bovis and colorectal adenomas.

An association between fecal carriage of Streptococcus bovis and colorectal carcinoma has been reported. A relationship between S. bovis and colorectal adenomas has also been suggested. In the present study, the relationship between S. bovis and adenomas was investigated. Two of 18 current adenoma patients (11%) were found to have S. bovis in their stool compared with 12 of 84 controls (14%). Six of 38 patients who had ever had a diagnosis of adenoma (16%) had S. bovis compared with 8 of 64 controls (13%). These results rule out a strong association between fecal carriage of S. bovis and adenomas; however, because of the relatively small sample size, a weak to moderate association cannot be excluded.

Adenoma↗
PubMed1987

Tetracycline-induced pancreatitis.

A 21-year-old man developed acute pancreatitis on two separate occasions after a short-term course (less than 10 days) of tetracycline in the presence of normal liver and renal function. Although tetracycline is frequently listed as a cause of pancreatitis, this is only the second documented case of tetracycline-induced pancreatitis in an otherwise healthy person. We review the pertinent literature.

Acute Disease↗