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Biomedical subjects

W S Hendry

Publications and source records attributed to W S Hendry.

15 recordsLinked to original sources

Epidemiology and outcome of acute pancreatitis.

Acute pancreatitis in North-East Scotland from January 1983 to December 1985 was examined. The criteria for diagnosis were a serum amylase greater than 1000 units/l with a consistent clinical presentation, or acute pancreatitis confirmed at laparotomy or post mortem. All serum amylase assays were performed in one regional laboratory. The commonly used diagnostic coding search for pancreatitis yielded only half the cases found. We identified 378 episodes of acute pancreatitis (196 males and 182 females). The mean annual incidence for first attacks of acute pancreatitis was 242 per million of the population. The commonest aetiology was biliary tract disease (30 per cent of males and 53 per cent of females). Alcohol related pancreatitis occurred in 26.5 per cent of males but only 3 per cent of females. Complications included 26 pseudocysts, 11 pancreatic abscesses, 9 patients with respiratory failure, 11 patients with renal failure and 6 patients with disseminated intravascular coagulation.

Acute Disease↗

Post operative stimulation of cell mediated immunity.

The consequences of altered immuno-competence resulting from anaesthesia and surgery are potentially hazardous to the patient with malignant disease. Malnutrition also produces reduction in cell mediated immunity, a condition which is commonly incurred in patients with neoplastic disorders. Numerous agents have been claimed to stimulate the immune responses but few have proved to be of practical value. This paper reports the use variously of protease inhibitors, using Aprotinin, and post operative nutritional therapy, following major surgical resection for carcinoma - specifically as regards their influence on parameters believed to relate to cell mediated immunity. No clinical, metabolic or immunologic benefit was identified from either method of post operative stimulation of cell mediated immunity, although this study did confirm post operative depression of these parameters. The significance of these changes is unclear but there is no evidence to support an immunological mechanism for either of these approaches being of benefit in clinical practice.

Adult↗

Intra-operative colonic irrigation in the management of left-sided large bowel emergencies.

In a consecutive series of 93 patients who required emergency surgery for distal colonic lesions, 61 had primary bowel resection with immediate anastomosis after intra-operative antegrade colonic irrigation. The operative mortality was 8 per cent, anastomotic leakage rate 7 per cent and superficial wound infection occurred in 3 per cent of patients. The mean hospital stay was 13 days. Of the remaining 32 patients, 3 did not have a resection and 29 had a primary resection and end colostomy without anastomosis: bowel continuity was later restored in 17 of 28 survivors (61 per cent) but 11 (39 per cent) were left with a permanent colostomy. The hospital mortality in this group was 6 per cent, superficial wound infection rate 14 per cent and the mean hospital stay 26 days. The results of this study suggest that intra-operative colonic irrigation is an effective method enabling the surgeon to perform a primary anastomosis with reasonable safety after emergency resection of selected distal colonic lesions.

Adolescent↗

Ultrasonic detection of occult testicular neoplasms in patients with gynaecomastia.

Gynaecomastia occurs in up to 10% of patients with malignant testicular tumours. In most cases a testicular mass will be easily palpable but occasionally these tumours are occult. Ultrasound has been shown to be of value in the detection of occult neoplasms in patients presenting with nodal disease. Two patients with gynaecomastia and palpably normal testes are presented in whom testicular tumour was diagnosed by ultrasonic examination of the scrotum.

Adult↗

Transfer of specific unresponsiveness to organ allografts by thymocytes. Specific unresponsiveness by thymocyte transfer.

Prolonged survival of vascularized organ allografts has been produced in unmodified inbred rats by transfer of thymocytes from enhanced, engrafted, syngeneic animals. For these thymocytes to increase significantly the survival of test allografts they must be harvested 6-9 d after transplantation. Thymectomy of the enhanced, engrafted animals during the same critical period causes acute rejection of othewise long surviving grafts. For optimal effect, the enhanced thymocyte donor must be actively and passively immunized and receive a cardiac allograft. The necessity for erythrocytes in the initial active immunization regimen is noted. Additionally, the antigenic specificity of the suppressor effect has been established with two histoincompatible donor rat strains. Cellular and humoral host responses mounted by test graft recipients after thymocyte transfer from enhanced, engrafted donors are different from those mounted either by unmodifed animals acutely rejecting their grafts or by enhanced rats bearing well-functioning grafts. Numbers of T lymphocytes are reduced in the grafted hearts and in the spleens of test graft recipients, a finding paralleled by the complete absence of specific direct lymphocyte-mediated cytotoxicity. In contrast, cytotoxic antibody production, although delayed, is increased in magnitude, peaking around the time of graft rejection. These studies provide evidence that different biological manipulations can modify separate pathways in the complex cellular and humoral responses towards organ allografts. They demonstrate that cellular immunity is critically involved in immunological enhancement of vascularized organ allografts, a phenomenon hitherto considered primarily humoral. It seems clear that cells with suppressor activity are present within the thymus during the early phases of immunological enhancement.

Animals↗

Immune responses to organ allografts. II. Decreased B cell responses to cardiac allografts in rats pretreated with enhancing, suppressor cell, or T lymphocyte depletion protocols.

Primarily vascularized LBN cardiac allografts transplanted to LEW rats are rejected 6 to 8 days after transplantation. Immunoperoxidase stains for cells producing immunoglobulin (Ig) demonstrate a proliferation of Ig-containing immunoblasts in the splenic red pulp (RP) and peripheral periarterial sheath (PAS) within 2 days after transplantation. These immunoblasts differentiate into plasma cells that triple the RP volume by the time of rejection. By 14 days, the plasma cells are replaced by mitotically active large and small lymphocytes with no demonstrable cytoplasmic Ig. Splenic Ig production is followed by a venous vasculitis in the graft and by the appearance of circulating cytotoxic antibodies 5 days after grafting. Three biological methods of prolonging cardiac graft survival were found to derange this sequence of immunological reactions at different stages. Enhancement by antigen and antibody pretreatment of the recipient elicited a premature production of Ig that subsided and was not reinitiated by cardiac transplantation. Transfer of suppression with thymocytes from enhanced cardiac recipients temporarily inhibited differentiation of splenic B cells into immunoblasts and plasma cells. T cell depletion by thymectomy, irradiation, and bone marrow reconstitution also decreased the plasma cell response, possibly by removing helper cells required to switch IgM production to IgG. These studies reemphasize the importance of Ig production in the complex interaction of immune reactions leading to acute rejection of organ transplants.

Animals↗