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Biomedical subjects

W D Clements

Publications and source records attributed to W D Clements.

31 records · Page 2Linked to original sources
PubMed1994

The role of mast cell activation in cholestatic pruritus.

Jaundiced patients experience intense pruritus, the pathophysiology of which is unclear. In this study, blood histamine concentrations, skin mast cell counts and intracellular histamine concentrations in peritoneal mast cells were examined in an experimental model of biliary obstruction. Three weeks after bile duct ligation (BDL), total blood histamine concentrations were significantly elevated compared with those from control animals (p < 0.0001). Skin mast cell counts were increased (p < 0.05) and peritoneal mast cell histamine content decreased (p < 0.05) in jaundiced animals. These results demonstrate that mast cells degranulate in biliary obstruction with consequent release of histamine into the systemic circulation. This may contribute to cholestatic pruritus. These data may have significant pharmacological implications in patients with obstructive jaundice.

Animals↗
PubMed1993

Effects of extrahepatic obstructive jaundice on Kupffer cell clearance capacity.

Systemic endotoxemia consistently occurs in jaundiced patients undergoing surgery. Kupffer cell dysfunction is implicated in the development of endotoxemia and its postoperative complications. A novel in situ single-pass hepatic perfusion technique using a fluorescein isothiocyanate-labeled latex probe was developed for measuring Kupffer cell clearance capacity and was applied in an animal model of biliary obstruction. Control rats and rats jaundiced for 1, 2, 3, and 4 weeks' duration were studied. Kupffer cell clearance capacity, plasma bilirubin, endotoxin, and anticore glycolipid concentrations were measured. Maximal hyperbilirubinemia preceded reduced Kupffer cell clearance capacity. Rats jaundiced for greater than 2 weeks had a significantly decreased Kupffer cell clearance capacity but significantly higher endotoxin and anticore glycolipid concentrations. Anticore glycolipid concentrations correlated strongly with systemic endotoxemia and both were inversely correlated with duration of jaundice. Impairment of Kupffer cell clearance capacity may contribute to endotoxemia associated with cholestasis.

Animals↗
PubMed1993

Biliary drainage in obstructive jaundice: experimental and clinical aspects.

Jaundiced patients undergoing invasive diagnostic and therapeutic procedures are at increased risk of complications and death. Despite the large number of clinical and experimental investigations carried out to identify relevant risk factors, no single parameter has been found to be consistently useful in predicting morbidity or mortality. Biliary decompression was initially employed by surgeons and subsequently by interventional radiologists. More recently, endoscopic retrograde cholangiopancreatography has provided an alternative route for decompression of the biliary tree and preliminary data using this method are encouraging. Although there are enthusiastic proponents of various therapeutic techniques, controlled trials have not been convincing in highlighting the benefits of biliary drainage or in determining the best approach. This article reviews the literature pertaining to this complex surgical problem; an attempt has been made to balance the advantages and disadvantages of biliary decompression as palliation and/or preliminary treatment for extrahepatic biliary obstruction.

Animals↗
PubMed1993

GRAP repair: single-stage reconstruction of hypospadias as an out-patient procedure.

A novel repair of the distal urethra with glanular and preputial reconstruction is described for distal penile hypospadias; 52 consecutive patients underwent this procedure without catheter splintage or urinary diversion. All voided without problems on the day of operation; 44 (85%) were treated as day cases, while the remaining 8 boys stayed in hospital for at least 1 night post-operatively for reasons not associated with the operation. Follow-up was complete and ranged from 15 to 30 months (mean 18). There was no evidence of meatal stenosis, phimosis or urethral stricture; 26 boys (50%) had associated chordee pre-operatively which was incompletely corrected in 2 (8%). These have a minor degree of chordee of glans on penile shaft and neither has required further treatment. Four boys (8%) developed partial wound breakdown which necessitated reconstruction in 2 and both of these have now been treated successfully. Functional and cosmetic results are excellent.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Unusual extraskeletal myxoid chondrosarcoma.

We describe an unusual soft tissue tumor occurring within the rectus femoris muscle of a 64-year-old woman. The site, size, macroscopic, and histological appearances were all consistent with an extraskeletal myxoid chondrosarcoma. However, the present case differs significantly from previous reports of this uncommon tumor in that electron microscopy did not show any evidence of chondroblastic differentiation. Furthermore, the cells failed to stain for vimentin while labeling intensely for neuron-specific enolase, contained large numbers of cytolysosomes having a multivesicular appearance, and focally produced an external lamina. Based on the typical histological appearances we conclude that this is an unusual variant of extraskeletal myxoid chondrosarcoma in which there is evidence of nerve sheath differentiation.

Chondrosarcoma↗
PubMedDate not supplied

A rare late complication of breast cancer treatment.

In 1948 Stewart and Treeves recognised and described six cases of lymphangiosarcoma arising in the oedematous upper limb of patients who had previously undergone radical mastectomy and radiotherapy for breast carcinoma. The incidence of lymphangiosarcoma in such patients is 0.45% and is uniformly aggressive and fatal, with a 5-year survival of less than 5% regardless of the treatment modality. We present a case report to increase the clinical awareness of this rare and fatal iatrogenic complication occurring subsequent to breast cancer treatment, and speculate on ways of improving survival.

Aged↗
PubMedDate not supplied

Heparin induced thrombocytopenia causing life-threatening postoperative haemorrhage.

Heparin is ubiquitously employed in surgery in the prevention and treatment of thromboembolic disorders. A small but significant number of patients receiving heparin develop thrombocytopenia and are at risk of both serious thromboembolic disease and haemorrhage. A case is reported where a young woman developed life-threatening postoperative haemorrhage associated with heparin induced thrombocytopenia (HIT).

Acute Disease↗