John H. Gilliam

Primary Hepatocellular Carcinoma After Chronic Non-A, Non-B Post-Transfusion Hepatitis

Excerpt Epidemiologic evidence of an association between hepatitis B virus and hepatocellular carcinoma is strong, but evidence of a similar association between non-A, non-B hepatitis virus infecti...

Dormia basket entanglement with a T tube: management with interventional radiologic techniques

the sigmoid to be pneumatically distended and to occupy the left lower quadrant. Adjacent viscera are displaced, and the wall of the colon abuts the peritoneum. In such a situation, endoscopic sigmoidopexy becomes feasible. Our patient was subjected to full bowel preparation before the endoscopic sigmoidopexy. This allowed a colonoscopic view of the colon to rule out concomitant pathologic conditions.

The liver in rheumatic diseases

HE HEPATIC manifestations of the rheumatic diseases are not well described. The frequency, significance, and the specific hepatic pathology varies with each rheumatic illness. Abnormalities of liver tests in this setting may lead to diagnostic confusion and the need for extensive evaluation. Additionally, many of the drugs used in the treatment of these diseases are hepatotoxic. The aim of this contribution is to review the current published data regarding liver involvement in the rheumatic diseases and discuss the hepatic complications of medications commonly prescribed. RHEUMATOID ARTHRITIS Hepatic involvement in adult rheumatoid arthritis (RA) is incompletely described. Early observations included the apparent improvement in joint disease with the onset of jaundice. Still,’ in 1897, noted “catarrhal jaundice to be followed by distinct improvement of the joint symptoms” and Hench,’ in 1940, noted remission in articular symptoms when patients with “chronic infectious arthritis” became jaundiced. Because of these observations, attempts were made to induce jaundice in patients with RA. Oral ingestion of ox and human bile, and intravenous administration of liver extracts and jaundice blood were ineffective.3 Temporary improvement in joint symptoms occurred in 25 of 32 patients who were inoculated with serum from patients with hepatitis and became jaundiced.4 The joint improvement was transient and the mechanism for the improvement was not determined. Biochemical evidence of hepatic involvement in RA has been described in several studies. Elevation in serum transaminases (SGOT, SGPT) have not been noted but serum alkaline phosphatase elevation has been found in 25%50% of patients with RA.‘16 This elevation in serum alkaline phosphatase is hepatic in origin since simultaneous elevations in five prime nucleotidase and gamma glutamyl transpeptidase have been noted.’ Serum alkaline phosphatase elevation correlates with disease activity and decreases with improvement in the arthritis.’

Weight Loss Induced by Gastric Implant in Rats Effects of Capsaicin Sensory Denervation

To study the efficacy and mechanism of action of the intragastric bubble, 1- to 5-ml silicone bubbles were surgically implanted into the stomachs of 10- to 12-week-old female rats. To test the hypothesis that the satiety effects of the implant are mediated by visceral sensory nerves, a subgroup was treated as neonates with the sensory neurotoxin capsaicin, 50 mg/kg subcutaneously. In control animals, the implants caused a transient decrease in body weight, compared to sham-implanted animals, most evident at three days and abolished by 18 days after operation. In contrast, capsaicin-treated animals did not lose weight in response to gastric implantation. Substance P was decreased in the vagus nerves of capsaicin-treated animals, confirming sensory denervation. At autopsy, all gastric implanted rats had enlarged stomachs. We conclude that intact sensory innervation is essential for weight loss in response to the gastric bubble.

A blinded, stratified, randomized clinical trial comparing magnetic resonance cholangiopancreatography (MRCP) to endoscopic ultrasound (EUS) for the evaluation of common bile duct stones (CBDS)

Purpose: MRCP and EUS have emerged as non-invasive / minimally-invasive tests with good accuracy in detecting CBDS. Our aim was to prospectively compare the diagnostic accuracy of EUS to MRCP in patients with suspected CBDS based on clinical criteria.

Prevalence of upper gastrointestinal disease in relation to age: Radiologic and clinical implications

Reports of 1126 endoscopies were reviewed to determine the age-related prevalence of upper gastrointestinal (UGI) diseases as a guide to radiologists performing UGI examinations. Results indicate that (1) there were positive findings in 78% of all endoscopic examinations, and thus most symptomatic patients can be expected to have at least one UGI abnormality; (2) many patients with UGI symptoms have two or more reportable disease processes; (3) the prevalence of serious or lifethreatening disease, such as cancer or large ulcers, rises steadily with age; and (4) after age 60, approximately 60% of symptomatic patients have a serious UGI disease. Based on these findings, radiologists should not hesitate to make the diagnosis of multiple abnormalities and should expect to diagnose at least one abnormality in most symptomatic patients having an UGI study. Also, because of the high prevalence of serious lesions in the elderly, endoscopy should be considered for the initial examination of an elderly patient if poor physical status would render the radiologic examination difficult or unreliable.

Percutaneous dislodgement of an impacted cystic duct stone

An obstructing cystic duct stone was dislodged with an angiographic catheter and guidewire via a percutaneous cholecystostomy tract in a mildly sedated patient. After brief stenting of the cystic duct, the patient remained asymptomatic with internal bile drainage. When endoscopic negotiation of the cystic duct is difficult, an impacted cystic duct stone can sometimes be dislodged with standard angiographic techniques.