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Biomedical subjects

T L Fabry

Publications and source records attributed to T L Fabry.

14 recordsLinked to original sources
PubMed1993

A gastric acid secretion model.

A theory of gastric acid production and self-protection is formulated mathematically and examined for clinical and experimental correlations, implications, and predictions using analytic and numerical techniques. In our model, gastric acid secretion in the stomach, as represented by an archetypal gastron, consists of two chambers, circulatory and luminal, connected by two different regions of ion exchange. The capillary circulation of the gastric mucosa is arranged in arterial-venous arcades which pass from the gastric glands up to the surface epithelial lining of the lumen; therefore the upstream region of the capillary chamber communicates with oxyntic cells, while the downstream region communicates with epithelial cells. Both cell types abut the gastric lumen. Ion currents across the upstream region are calculated from a steady-state oxyntic cell model with active ion transport, while the downstream ion fluxes are (facilitated) diffusion driven or secondarily active. Water transport is considered iso-osmotic. The steady-state model is solved in closed form for low gastric lumen pH. A wide variety of previously performed static and dynamic experiments on ion and CO2 transport in the gastric lumen and gastric blood supply are for the first time correlated with each other for an (at least) semiquantitative test of current concepts of gastric acid secretion and for the purpose of model verification. Agreement with the data is reported with a few outstanding and instructive exceptions. Model predictions and implications are also discussed.

Animals↗
PubMed1992

Prediction of survival of patients with primary biliary cirrhosis. Examination of the Mayo Clinic model on a group of patients with known endpoint.

Increasing use of liver transplantation and new treatment regimens necessitate an accurate estimate of prognosis in primary biliary cirrhosis. To test the usefulness of the Mayo model for this purpose, the R value of the model was calculated for a group of 28 patients after each patient encounter and plotted against time. The data were best described by two linear regressions. For the period 10-2 years before death, the average increase in R value was 0.23 annually [R = 7.1-0.23 x time (in years)]. In the last 2 years of life, the average increase in R value was 1.4. This period could be fit by the expression R = 8.2-1.4 x time (in years). The increase in R value represents the natural progression of primary biliary cirrhosis and can be used for evaluating treatment of patients.

Forecasting↗
PubMed1990

Erythrocyte sedimentation as a measure of Crohn's disease activity: opposite trends in ileitis versus colitis.

To test our hypothesis that the erythrocytic sedimentation rate (ESR) correlates well with clinical activity in inflammatory disease of the colon, but not of the small bowel, we stratified 49 Crohn's disease patients according to their anatomic involvement and then measured the correlations between ESR and clinical activity within each of these anatomical subgroups. For 18 patients with Crohn's disease involving primarily the colon, there was a trend toward a direct correlation between clinical score and ESR (p = 0.15). In the 14 patients with Crohn's disease limited to the colon, this direct correlation was even more pronounced and statistically significant (p less than 0.02). By contrast, an opposite trend was observed for patients with small bowel disease. For the 26 patients with disease involving predominantly the small bowel, as well as for the 22 with disease limited to small bowel, there were statistically significant inverse correlations between clinical score and ESR (p less than 0.04). This difference between the directions of the correlations for Crohn's colitis versus ileitis was statistically significant (p less than 0.05). This study provides further evidence for the importance of analyzing putative indications of disease activity separately for each of the protean forms in which Crohn's disease occurs.

Blood Sedimentation↗
PubMed1989

A multicenter, randomized, double-blind trial of somatostatin in the management of acute hemorrhage from esophageal varices.

A prospective, randomized, placebo-controlled, double-blind, multicenter clinical trial of intravenous somatostatin (Stilamin; Serono Laboratories, Inc., Randolph, MA) was performed in 102 patients with actively bleeding esophageal varices from August, 1985, to November, 1986. Patients had major hemorrhage indicated by hematemesis or melena and evidence of significant blood loss. For entry, patients had to have endoscopic demonstration of active bleeding from esophageal varices or stigmata of recent hemorrhage and bright red blood in the gastric aspirate with no other source of bleeding found. Randomized patients received identical-appearing somatostatin or placebo for a 30-hr study period. Those given somatostatin received a 250-micrograms bolus and a 250-micrograms per hr infusion with repeat bolus and doubling of the infusion if the bleeding was not controlled. In retrospect, 18 patients could not be evaluated. Of the 84 evaluable patients, 48 received somatostatin and 36 placebo. They were comparable in age, gender, severity of liver disease and history of variceal bleeding. Transfusion requirements were similar in both groups. Bleeding stopped for 12 consecutive hr during 30 hr of the study period in 31 (65%) of the somatostatin group vs. 30 (83%) of the placebo group (p = 0.06). The median time to cessation of bleeding was 2 hr in the placebo group and 3 hr in the somatostatin group. Deaths following the study period were nine (25%) in the placebo group and 15 (31%) in the somatostatin group. Within the limitations of the present study, we conclude that somatostatin was ineffective in the management of active bleeding of esophageal varices.

Adult↗
PubMed1989

Mesenteric thrombosis following sclerotherapy during vasopressin infusion: mechanism and therapeutic implications.

In a series of 602 consecutive sclerotherapies, two cirrhotic patients who had received successful sclerotherapy for control of variceal bleeding while on vasopressin infusions developed mesenteric thrombosis. We found no other cases (in our institution or in literature review) where sclerotherapy or vasopressin infusion alone precipitated mesenteric thrombosis. During vasopressin infusion, there is portal stasis and an increased caudad flow of sclerosant. We suggest that mesenteric thrombosis is a consequence of the combination of these two effects. Direct injection of gastric varices is difficult because of increased postsclerotherapy bleeding, but sclerosis of esophageal varices often leads to their obliteration by the caudad flow of sclerosant. We propose, therefore, that vasopressin infusion during esophageal sclerotherapy may be beneficial in the obliteration of gastric varices. We conclude that (a) in patients without gastric varices, vasopressin infusion increases the incidence of mesenteric thrombosis, and (b) vasopressin infusion during sclerotherapy may enhance the sclerosis of gastric varices.

Adult↗
PubMed1987

Mechanism of erythrocyte aggregation and sedimentation.

Unstirred suspensions of erythrocytes form stable spherical aggregates of uniform size. The radius of the spheres depends upon the suspending medium and the hematocrit. Erythrocyte suspensions will undergo sedimentation only after these aggregates are formed. Aggregation is a two-step process: first, erythrocytes associate in long chains (rouleau formation). Next, these chains form spheres of uniform size. The requirements for this well-defined process are an electrolyte and a neutral or negatively charged macromolecule in the solution and a metabolically active red cell. If these conditions are not met, red cells either will not aggregate at all or will form amorphous aggregates. Rouleau formation and sedimentation are inhibited by 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid, an inhibitor of anion transport, but not by ouabain, a cation transport inhibitor. The kinetics of erythrocyte sedimentation reflects the aforementioned mechanism: no sedimentation occurs during rouleau formation. Once the spheres of uniform size are formed, they will settle according to the Einstein-Stokes equation. In this model, parameters of sedimentation kinetics are the delay before sedimentation starts, the rate of sedimentation in the steady state, and the radius of the sedimenting aggregate. The radius can be calculated from the rate of fall of the aggregates and agrees well with the microscopically observed radius. It is inversely proportional to the hematocrit, which explains the elevated sedimentation rates in anemia.

4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid↗
PubMed1983

Pseudodiverticula secondary to injection sclerotherapy.

The spectrum of complications encountered after injection sclerotherapy span esophageal, extraesophageal, and systemic sequelae of the sclerosing process. We report a case of pseudodiverticula secondary to sclerotherapy, a hitherto unreported complication of this modality.

Adult↗
PubMed1982

Gastric polyps.

We suggest an approach to patients with gastric polyps, based on a study of 73 patients seen at this institution over a 5-year period. There were 40 cases of adenomatous and 20 cases of hamartomatous polyps. Differentiation between these two groups of polyps was not possible on the basis of clinical presentation, laboratory data, radiological, or endoscopic appearance. Differentiation was possible only on histologic examination of a totally resected specimen. In this series, only the adenomatous polyps were associated with gastric cancers in five patients. Since the malignancy either preceded or followed the recognition of adenomatous polyps, it is important to establish an early definite histological diagnosis. Patients with known adenomatous polyps should be followed closely for the development of gastric carcinoma, even after the polyps have been removed.

Adenoma↗
PubMed1980

Acute myelogenous leukemia in patients with ulcerative colitis.

Of approximately 400 patients with ulcerative colitis admitted to the Mount Sinai Hospital in New York City during 1970-1978, five developed acute myelogenous leukemia in the course of their illness. This association may be more than fortuitous.

Adolescent↗
PubMed1979

The photochemical action spectrum of the microsomal ethanol oxidizing system.

The inhibition of the microsomal ethanol oxidizing system (MEOS) by carbon monoxide (CO) can be reversed by illumination with lights of differing wavelengths. The authors determined the efficiency of this reversal as a function of the illuminating light. Maximum efficiency was obtained in the wavelength band around 440-450 nm, which is near the absorption of the reduced cytochrome-P-450-carbon monoxide complex. When the experiment was repeated with microsomes prepared from ethanol-fed rats, the wavelength for maximum efficiency shifted towards higher values.

Animals↗
PubMedDate not supplied

The technique of abdominal pressure in total colonoscopy.

Total colonoscopy can be difficult. It is recognized that abdominal pressure can be helpful in the performance of colonoscopy by externally splinting the endoscope to prevent loop formation. Properly applied abdominal pressure can limit patient discomfort and shorten examination time. Various techniques for abdominal pressure were studied in 201 consecutive patients who had total colonoscopy to the cecum. Abdominal pressure or change of body position was used 619 times in 165 patients (82%), with an average of 3.75 pressure applications per colonoscopy, most lasting less than 30 sec. Pressure was most commonly used when the endoscope tip was at the splenic flexure. Non-specific pressure to a region of the abdomen where looping developed, endoscopically observed specific pressure near the tip, and position change were used in a stepwise manner. Non-specific pressure was more successful in the left (78%) than in the right (47%) colon (p less than 0.0005). As intubation progressed left to right, specific pressure became more useful. When abdominal pressure was not useful, a change in patient position from left lateral to supine was successful in advancing the endoscope tip in 68% of patients.

Abdomen↗