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Biomedical subjects

W P Dyck

Publications and source records attributed to W P Dyck.

At least 19 recordsLinked to original sources
PubMed1994

Massive bleeding from a Zenker's diverticulum: case report and review of the literature.

Zenker's diverticulum is an unusual site of origin for clinically significant upper gastrointestinal hemorrhage. Only three such cases have been previously documented. We report a case of massive upper gastrointestinal bleeding from a Zenker's diverticulum seen as hemoptysis and associated with chronic ingestion of one aspirin tablet every other day. Because of the propensity for ingested tablets to lodge in the diverticulum, caution is urged when prescribing ulcerogenic agents in pill form to a patient with a known Zenker's diverticulum.

Aged↗
PubMed1994

The accuracy of technetium-99m-labeled red cell scintigraphy in localizing gastrointestinal bleeding.

OBJECTIVE: To evaluate the success of technetium-99m-labeled red blood cell scintigraphy in localizing the site of gastrointestinal bleeding, and to identify the clinical and technical factors that contribute to scan accuracy. METHODS: A retrospective review was conducted of all patients who underwent a tagged red blood cell scan for the evaluation of gastrointestinal bleeding at our institution from 1981 to 1991. RESULTS: Of a total of 153 patients, 90 (59%) had positive scans, whereas, in 63 (41%), they were negative. Of the 90 patients who had positive scans, it was possible to assess scan accuracy in 44 who had corrective surgery or an additional diagnostic procedure which definitively localized the site of bleeding. Of those 44 patients, the correct bleeding site was identified by red blood cell scanning in 33 patients (75%) overall and in all six patients with a left colon bleeding site. In this group of 44 patients, 22 scans were positive within 2 h, and of these the scan was accurate in localizing the bleeding site in 19 of 22 (86%). When the three subjects with upper gastrointestinal bleeding were excluded, the scan was positive in 100% of the remaining 19 patients. CONCLUSION: The technetium-labeled red blood cell scan is a reliable tool for the assessment of unexplained lower gastrointestinal bleeding when the scan is positive within the first 2 h, and an upper gastrointestinal source has already been excluded.

Aged↗
PubMed1992

CT-guided needle biopsy of the pancreas: a retrospective analysis of diagnostic accuracy.

The purpose of this study was to evaluate the accuracy of percutaneous needle biopsy of the pancreas and to compare its sensitivity with that of simple computerized tomographic (CT) prediction of malignancy. The records of 41 patients who underwent CT-guided percutaneous needle biopsies of the pancreas during a 4-yr period were reviewed retrospectively. Pre-biopsy CT scans were evaluated independently by two experienced radiologists in a blinded fashion. Needle biopsy yielded a correct diagnosis of cancer (sensitivity) in only 45% of patients ultimately found to have a malignancy, whereas the radiologic interpretation alone correctly predicted cancer in 76% of such patients. The negative predictive value of needle biopsy was no better (43%) than the radiologist's CT interpretation alone. Our findings confirm previous observations that percutaneous needle biopsy is an insensitive method of diagnosing pancreatic cancer. In our experience, needle biopsy proved less accurate than expert radiologic interpretation of CT scans alone.

Adenocarcinoma↗
PubMed1987

Treatment of duodenal ulceration in the United States.

Nizatidine, a new H2-receptor antagonist for the treatment of duodenal ulcer disease, was compared with placebo in a dose-response, double-blind, parallel, multicenter clinical trial. Patients were randomly allocated to receive either nizatidine (25 mg b.i.d., 150 mg b.i.d., or 300 mg at bedtime) or placebo. At the end of 4 weeks, patients whose ulcer had not healed were randomly reallocated to receive either the nizatidine 150 mg b.i.d. dosage regime or placebo for an additional 4 weeks. Nizatidine doses of 300 mg at bedtime and 150 mg b.i.d. demonstrated similar healing frequencies. Both of these doses were statistically significantly superior in ulcer healing to the nizatidine 25 mg b.i.d. dose and to placebo at the end of 4 weeks. Patients randomly reallocated to receive nizatidine had significantly greater healing rates than patients randomly reallocated to receive placebo. In summary, nizatidine given as a single evening dose of 300 mg or as 150 mg b.i.d. proved to be equally safe and effective in the healing of active duodenal ulcers.

Adult↗
PubMed1985

Healing of benign gastric ulcer: comparison of cimetidine and placebo in the United States.

Recently the Food and Drug Administration approved cimetidine for the treatment of benign gastric ulcer. Approval was based in part on the results of our large multicenter trial involving 172 patients with benign gastric ulcer between 0.5 and 2.5 cm in diameter: 87 were randomly assigned to receive cimetidine (300 mg four times daily) and 85 to receive placebo. Cimetidine treatment resulted in significantly more rapid healing than placebo; after 2 and 6 weeks of therapy, 10.0% and 44.8% of patients receiving placebo were healed, as compared to 22.6% and 65.1% receiving cimetidine. The results of our study were compared with the time-response curve previously published (0, 4, and 8 weeks of therapy). The combined data yielded linear healing rates for the first 8 weeks of therapy (r greater than 0.99 for both cimetidine and placebo). These studies can be used to define expectations for healing of benign gastric ulcer, and we recommend follow-up intervals of 8 and, if unhealed, 16 weeks.

Adult↗
PubMed1979

Rod-shaped organism in the liver of a patient with Whipple's disease.

Histological review of a liver biopsy from a patient with known Whipple's disease revealed a prominence of Kupffer cells containing PAS-positive granules. Electron microscopy revealed rod-shaped organisms in the Kupffer cells but the presence of these structures were not associated with overt liver injury. This is thought to be the first reported demonstration of these bacillary bodies in this location.

Bacteria↗
PubMed1979

Erythromycin ethylsuccinate-induced cholestasis.

A 52-year-old Caucasian female developed abdominal pain, fever, and jaundice after erythromycin ethylsuccinate administration. Similar symptoms followed the administration of the same drug 5 mo earlier. It is believed that this is the first published case of erythromycin ethylsuccinate-induced cholestasis.

Cholestasis↗
PubMed1978

Cimetidine and placebo in the treatment of benign gastric ulcer: a multicenter double blind study.

A randomized, prospective, multicenter trial of the effects of cimetidine on benign gastric ulcer was conducted in 60 outpatients. Endoscopic assessment was used as the criterion for healing. Although none of the differences was statistically significant, mean healing rates were higher and mean decreases in ulcer size were greater with cimetidine than they were with placebo. Twenty-four per cent of the ulcers healed completely in 2 weeks when cimetidine was administered, compared with a placebo healing rate of 14 percent. At 6 weeks in the incidence of healing increased to 60 percent in the cimetidine group and 41 percent in the placebo group. The mean percentage of decrease in ulcer size was greater at both 2 and 6 weeks in the cimetidine group than it was in the placebo group. In both, the cimetidine and placebo groups, relatively liberal intake of a potent antacids in treatment of gastric ulcers has not been defined definitively. Thus, a possible beneficial effect of cimetidine may have been obscured. For more clear discimination between the effects of cimetidine and placebo in healing of gastric ulcer, studies utilizing either no antacid or antacids of low neutralizing capacity will be needed.

Antacids↗
PubMed1977

Alcohol and the upper gastrointestinal tract and pancreas.

Alcohol relaxes the lower esophageal sphincter, stimulates acid secretion, and reduces the gastric mucosal barrier to hydrogen ion back-diffusion. These actions may result in esophagitis, acute gastritis, and ulcer formation. Although excessive alcohol consumption commonly produces acute and chronic pancreatitis, and pathogenesis is unclear.

Alcoholism↗
PubMed1976

Myxedema ascites.

A 74-year-old man presented with mental obtundation and massive ascites without evidence of significant impairment of liver function. Thyroid function studies suggested hypothyroidism. Aspirated ascitic fluid had the characteristics of an exudate. Thyroid replacement therapy resulted in rapid clinical improvement with resolution of the ascites. Prompt recognition of myxedema ascites may prevent the inappropriate use of diuretic agents, therapeutic paracentesis, and sometimes unnecessary laparotomy.

Aged↗
PubMed1976

Intrahepatic cholestasis after griseofulvin administration.

The occurrence of cholestatic jaundice in a patient receiving griseofulvin is described. The clinical manifestations, laboratory features, and pathological lesion of drug-induced hepatotoxicity are discussed. Complete recovery followed the discontinuation of drug administration. The potential hepatotoxicity of griseofulvin and the importance of close monitoring of liver function studies in patients receiving this drug are emphasized.

Biopsy, Needle↗