摘要:

AbstractThe usefulness of computed tomography (CT) in guiding the management of 43 patients who had a complicated clinical course of acute pancreatitis was retrospectively studied. The CT scans were performed when patients had persistent fever, leucocytosis, hyperamylasaemia, palpable abdominal masses or when there was organ failure. The CT scans showed normal findings in six patients, features of pancreatic abscess in three patients, pseudocysts in three patients and inflammatory masses (a mixture of sterile inflammation and necrosis) in 31 patients. Patients with pancreatic abscesses underwent emergency laparotomy, drainage and debridement; patients with pseudocysts had delayed drainage unless complication occurred; patients with normal CT scan or findings of inflammatory masses were managed conservatively. For patients undergoing conservative management, repeated CT scanning and percutaneous aspiration of the inflammatory mass was performed when pancreatic sepsis was strongly suspected. By this approach, basing on careful clinical and CT scan surveillance, five patients with pancreatic sepsis (pancreatic abscess and localized abscess collection in pseudocyst) underwent emergency surgery and four survived, while 25 patients with inflammatory masses were successfully managed conservatively and some who may have been operated on clinical grounds were spared unnecessary early debridement surgery.

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01812.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractIn 18 patients with cancers of the gastrointestinal tract, lymphokine‐activated killer (LAK) cell activity was studied and compared with that of healthy subjects. After cultivation with 103iu/mL of recombinant interleukin‐2, the cytotoxicity of patients' lymphoid cells was increased from 13.6 ±6.8% to 76.2 ±19.5% against Daudi cells and from 12.8 ±8.1% to 76.2 ±19.5% against K‐562 cells.Based on these results, autologous LAK cells were given to patients. LAK cells injected into subdermal metastatic tumours demonstrated a significant inhibitory effect on tumour growth in comparison with that of control tumour nodules. Of four patients with metastatic tumours in the liver, to whom LAK cells were administered via the hepatic artery, tumour size was reduced by about 25% (minor response) in one patient, with a decrease of computerized tomography attenuation in the tumours occurring in the other three

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01813.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractIn order to test the hypothesis that increased basal vagal tone causes basal acid hypersecretion in duodenal ulcer (DU), the effect of sham feeding on gastric acid secretion was studied in 26 patients with DU and 20 healthy controls. Basal acid output (BAO), sham feeding‐stimulated acid output (SAO) and peak histamine‐stimulated acid output (PAO) were significantly higher in DU patients compared with healthy controls (P0.44), but only two of them did not show an increase over their basal rate of secretion in response to sham feeding. All other DU patients, including two with marked basal acid hypersecretion, and all healthy controls showed an appreciable increase in their acid secretion in response to sham feeding. In contrast to some earlier reports, these observations suggest that increased basal vagal tone might not be the cause of marked basal acid hypersecretion in all patients as it was present in only two of four such

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01814.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractIn rats with an interrupted enterohepatic circulation of bile acids, levels of serum taurine‐conjugated bile acids were increased significantly 3 h after intravenous administration of taurine. Similarly, serum taurine‐ or glycine‐conjugated ursodeoxycholic acid (UDCA) was increased significantly 2 h after UDCA administration. These findings suggested that the administered taurine or UDCA was taken up into hepatocytes and utilized to form conjugated bile acids, which were thereafter regurgitated into the systemic circulation from the liver. The proportion of regurgitated taurine‐conjugated bile acids relative to total serum bile acids measured by taurine loading (30%) almost coincided with that of regurgitated taurine‐ or glycine‐conjugated UDCA relative to total serum bile acids measured by UDCA loading (31.6%). Thus, the present study showed conclusively that at least 30% of serum bile acids are derived from newly conjugated bile acids that are regurgitated from the liver in rats with b

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01815.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractTo evaluate the effect of hepatitis B vaccine on the persistence of anti‐HBs and its efficacy in preventing hepatitis type B, anti‐HBs and anti‐HBc levels were studied over a period of 5.5 years.Plasma‐derived hepatitis B vaccine, containing 20 μg of HBsAg protein, was injected subcutaneously in 122 healthy medical staff members, followed by two identical injections 1 and 6 months later. Anti‐HBs and anti‐HBc levels were then measured by radio‐immunoassay. The anti‐HBs titres were expressed as the sample/negative (S/N) ratios, and an S/N ratio of more than 2.1 was considered positive.The mean (and s.d.) anti‐HBs titre peaked 7 months after the first vaccination with an S/N ratio of 153.6 ±149.8, after which it decreased with time. The mean anti‐HBs titre dropped to an S/N ratio of 8.0 ±5.1 5.5 years after the first vaccination. The percentage of vaccinees who were anti‐HBs positive also gradually decreased with time after a peak of 84.2% at 7 months following the first vaccination. The percentage of vaccinees who were anti‐HBs positive was 38.9% 5.5 years after the first vaccination. The anti‐HBc level was not positive in all subjects during the observation period.Five vaccinated volunteers who had developed anti‐HBs after the basic vaccination, but whose acquired antibody level became negative within 4.5 years following the first vaccination, were administered a booster dose of 20 μg of HBsAg 4.5 years after the first vaccination. Only one of these subjects did not respond to the booster vaccination. The peak anti‐HBs titre of this subject was very low following the initial vaccination.From these observations, it was concluded that, although the acquired antibody titres and percentage of vaccinees who were anti‐HBs positive decreased with time, the incidence of hepatitis B infection would be lower in vaccinees than that in other non‐vaccinated general medical staff members in Japan. This was probably due to the persistence of immunological memory in vaccinees who had r

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01816.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractThe postcholecystectomy patients who have a T‐tubein situoffer a convenient route through the T‐tube to perfuse solvents into the common bile duct (CBD) for dissolving any retained common duct stones. If successful, this approach is much simpler and cheaper than the usual therapeutic modality used for CBD stones, namely, endoscopic papillotomy. Thus a most potent cholesterol solvent, methylt‐butyl ether (MTBE) was perfused through the T‐tube into the CBD of five patients with retained common duct stones. The dose of the solvent varied, 1.5–5 mL 0.5–1 h, given 7–13 times amounting to a total of 20–66 mL. Instillation of MTBE in the T‐tube was alternated with aspiration of the bile through T‐tube. Only one patient showed complete disappearance of the bile duct stone following MTBE perfusion. Others did not show any appreciable response and had to be treated by endoscopic papillotomy (three patients) or mono‐octanoin perfusion (one patient). Side‐effects of MTBE perfusion included pain in the abdomen in all patients, somnolence and nausea/vertigo in two patients and the smell of ether on the breath in two patients. It is concluded that MTBE is not an effective agent for dissolution of retained CBD stones in pati

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01817.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractTwenty‐one patients with primary sclerosing cholangitis were seen during 1979–87. The mean age at onset of disease was 51.7 years (range: 13–78 years) with a male: female ratio of 2.5:1. Six (29%) were asymptomatic at the time of diagnosis. Eleven patients (52%) had ulcerative colitis. Cholangiography demonstrated abnormalities limited to the intrahepatic ducts in 10 cases, with both intrahepatic and extrahepatic involvement in 11. Histological features on liver biopsy included: portal tract inflammation and cholestasis in all; paucity of bile ducts in 56%; piecemeal necrosis in 19% and cirrhosis in 6%. Circulating autoantibodies and elevated serum immunoglobulins were found in half of the patients and HLA‐B8 was detected in 53%. A deficiency of circulating CD3 and CD8 cells was not found in the 12 patients tested. The mean follow‐up was 51 months (range: 3–180 months). Three patients died from non‐hepatic causes and another has received liver transplantation. A Kaplan‐Meier curve predicted 70% surviv

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01818.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractTo elucidate the effects of verapamil on splanchnic haemodynamics in rats with portal hypertension, verapamil was given at a low dose (0.2 mg/kg) and a high dose (2 mg/kg) to the rat model after portal vein ligation. Approximately 10% decrease in arterial pressure was caused by the low dose of verapamil, with significant decreases in cardiac output and portal venous inflow as well as reduced portal pressure; these were all indicative of a rise in portal vascular resistance. In contrast, the marked fall in both arterial pressure and cardiac output in the high dose, accompanied by a significant decrease in the portal pressure and the unchanged portal venous inflow, suggested a reduction in portal vascular resistance. This study shows that the acute effects of verapamil on portal hypertension may vary with the dosage used. These results also demonstrate that, since the therapeutic efficacy and safety of verapamil is only in a very limited range of dose, caution should be taken in its clinical use in the treatment of cirrhosis with portal hypertension.

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01819.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01820.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1990.tb01821.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY