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Neoptolemos J, Stocken D, Dunn J, Buckels J, Deakin M, Sutton R, Imrie C, Kerr D, Büchler for the members of Espac M. Six of the Best, Upper GI 14. Br J Surg 2009. [DOI: 10.1046/j.1365-2168.89.s.1.14_2.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Leitch F, Dickson E, McBain A, Robertson S, O'Reilly D, Imrie C. C-reactive protein predicts mortality on admission to a surgical high-dependency unit. Crit Care 2007. [PMCID: PMC4095104 DOI: 10.1186/cc5210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Leitch F, Dickson E, McBain A, Robertson S, O'Reilly D, Imrie C. The calculated ion gap: a novel predictor of mortality in the critically ill surgical patient. Crit Care 2007. [PMCID: PMC4095504 DOI: 10.1186/cc5611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Leitch F, Dickson E, McBain A, Robertson S, O'Reilly D, Imrie C. Greater than the sum of its parts: C-reactive protein and the calculated ion gap together are superior in predicting mortality in critically ill surgical patients. Crit Care 2007. [PMCID: PMC4095103 DOI: 10.1186/cc5209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Affiliation(s)
- S S Harmeyer
- Veterinary Medicine Clinical Development, Pfizer Animal Health, Sandwich, Kent CT13 9NJ
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Affiliation(s)
- T.I.A. Gerber
- a Department of Chemistry , University of Port Elizabeth , 6000 Port Elizabeth, South Africa
| | - A. Abrahams
- a Department of Chemistry , University of Port Elizabeth , 6000 Port Elizabeth, South Africa
| | - C. Imrie
- a Department of Chemistry , University of Port Elizabeth , 6000 Port Elizabeth, South Africa
| | - P. Mayer
- b Department of Chemistry , Ludwig-Maximilians University , D-81377 München, Germany
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Imrie C. Introduction to Diagnostic Sonography. A. C. Fleischer and A. Everette James jun. 262 × 184 mm. Pp. 339 + xi. Illustrated. 1980. Chichester: Wiley. £15·85. Br J Surg 2005. [DOI: 10.1002/bjs.1800680333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Imrie C. Ultrasonically Guided Puncture Technique. H. H. Holm and J. Kvist Kristensen. 255 × 180 mm. Pp. 128. Illustrated. 1980. Copenhagen: Munksgaard. D. kr 150. Br J Surg 2005. [DOI: 10.1002/bjs.1800680427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Imrie C. The pancreas. W. M. Keynes and R. G. Keith. 220 × 140 mm. Pp. 371 + xii. Illustrated. 1981. London: Heinemann. £18·00. Br J Surg 2005. [DOI: 10.1002/bjs.1800690629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Imrie C. Pancreatic disease. Diagnosis and therapy. Edited by Thomas L. Dent, Frederic E. Eckhauser, Aaron I. Vinik and Jeremiah G. Turcotte. 232 × 155 mm. Pp. 553 + xvii. Illustrated. 1981. London: Academic. £39·00. Br J Surg 2005. [DOI: 10.1002/bjs.1800700532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Howes N, Lerch MM, Mössner J, Endres S, Deviere J, Verreman G, Lucidi V, Charnley R, Imrie C, Hall R, Olah A, Ihse I, Steenbergan W, O'Donnell M, Greenhalf W, Ellis I, Rutherford S, Mountford R, Whitcombe DC, Neoptolemos JP. High risk of surgical intervention in hereditary pancreatitis. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2001.01730-3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background
The aim of the study was to quantify the risk of surgical intervention in families with hereditary pancreatitis referred to the European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer (EUROPAC).
Methods
Recruitment to EUROPAC started in 1997; families were considered if two or more members had chronic pancreatitis of unknown aetiology. Families were tested for protease serine 1 (PRSS1) mutations using polymerase chain reaction restriction digestion, sequencing the PRSS1 gene-screened negative families. Clinical information about surgical intervention was obtained from family members and referring clinicians, and the cumulative incidence of surgical intervention in the N291 and R122H mutation groups was determined with the Kaplan–Meier method.
Results
Forty-four families had the R122H mutation, 21 the N291 mutation, and 31 were negative for both. Some 14 (35 per cent) of 40 patients (median age 26·5 (95 per cent confidence interval (c.i.) 21·5–36·3) years) with the N291 mutation had an operative procedure for complications of pancreatitis, compared with 21 (25 per cent) of 83 patients (median age 24 (95 per cent c.i. 13·8–35·8) years) with the R122H variant. This resulted in a cumulative lifetime risk for surgical intervention of 0·6 (95 per cent c.i. 0·5–0·8) for the R122H mutation and 0·6 (0·5–0·8) for the N291 mutation (P = 0·11, log rank test).
Conclusion
Hereditary pancreatitis carries a significantly increased risk of surgical intervention in this cohort of patients, which equates to an estimated lifetime risk of around 60 per cent. The risk of surgery appears to be independent of PRSS1 mutation type.
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Affiliation(s)
| | - N Howes
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - M M Lerch
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - J Mössner
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - S Endres
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - J Deviere
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - G Verreman
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - V Lucidi
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - R Charnley
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - C Imrie
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - R Hall
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - A Olah
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - I Ihse
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - W Steenbergan
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - M O'Donnell
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - W Greenhalf
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - I Ellis
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - S Rutherford
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - R Mountford
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - D C Whitcombe
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
| | - J P Neoptolemos
- Department of Surgery, and Clinical and Molecular Genetics, Royal Liverpool University Hospital, Liverpool, UK
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12
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Imrie C. Nutritional management of acute pancreatitis: indications, timing and routes. Clin Nutr 2002. [DOI: 10.1016/s0261-5614(02)80030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Sharif F, McDermott M, Dillon M, Drumm B, Rowland M, Imrie C, Kelleher S, Harty S, Bourke B. Focally enhanced gastritis in children with Crohn's disease and ulcerative colitis. Am J Gastroenterol 2002; 97:1415-20. [PMID: 12094859 DOI: 10.1111/j.1572-0241.2002.05785.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Focally enhanced gastritis (FEG) has been suggested as a specific diagnostic marker for patients with Crohn's disease. However, the utility of FEG for distinguishing Crohn's disease from ulcerative colitis is uncertain in adults, and the occurrence of this lesion in children has not been defined. The aim of this study was to evaluate the occurrence of FEG and other gastric histological abnormalities in children with inflammatory bowel disease (IBD) and to examine the utility of FEG in discriminating between ulcerative colitis and Crohn's disease. METHODS This is a retrospective, case-controlled study of upper GI histopathological findings in children with IBD. Gastric histopathology was defined and graded according to the Updated Sydney System. RESULTS FEG was present in 28 of 43 (65.1%) children with Crohn's disease and five of 24 (20.8%) children with ulcerative colitis, compared to three of 132 (2.3%) children without IBD or one of 39 (2.6%) children with Helicobacter pylori infection. There were no differences between those with and without FEG with regard to upper GI symptoms or previous anti-inflammatory drug ingestion (5-aminosalicylic acid compounds or steroids). All patients with H. pylori infection had chronic antral gastritis, but only one child with H. pylori had FEG. In addition, mild to moderate chronic gastritis was present in 15 of 43 (34.9%) children with Crohn's disease and in 12 of 24 (50%) patients with ulcerative colitis. CONCLUSIONS The presence of FEG suggests underlying IBD. Although FEG is particularly common in children with Crohn's disease, it does not reliably differentiate between Crohn's disease and ulcerative colitis.
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Affiliation(s)
- F Sharif
- Children's Research Centre and Department of Pathology, Our Lady's Hospital for Sick Children, Dublin, Ireland
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14
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Imrie C, Modro TA, Rohwer ER, Wagener CCP. Photolysis of (arylmethyl)triphenylphosphonium salts. Substituent, counterion, and solvent effects on reaction products. J Org Chem 2002. [DOI: 10.1021/jo00073a023] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- J Toouli
- Flinders University, Adelaide, Australia.
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Neoptolemos JP, Stocken DD, Dunn JA, Almond J, Beger HG, Pederzoli P, Bassi C, Dervenis C, Fernandez-Cruz L, Lacaine F, Buckels J, Deakin M, Adab FA, Sutton R, Imrie C, Ihse I, Tihanyi T, Olah A, Pedrazzoli S, Spooner D, Kerr DJ, Friess H, Büchler MW. Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial. Ann Surg 2001; 234:758-68. [PMID: 11729382 PMCID: PMC1422135 DOI: 10.1097/00000658-200112000-00007] [Citation(s) in RCA: 448] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the influence of resection margins on survival for patients with resected pancreatic cancer treated within the context of the adjuvant European Study Group for Pancreatic Cancer-1 (ESPAC-1) study. SUMMARY BACKGROUND DATA Pancreatic cancer is associated with a poor long-term survival rate of only 10% to 15% after resection. Patients with positive microscopic resection margins (R1) have a worse survival, but it is not known how they fare in adjuvant studies. METHODS ESPAC-1, the largest randomized adjuvant study of resectable pancreatic cancer ever performed, set out to look at the roles of chemoradiation and chemotherapy. Randomization was stratified prospectively by resection margin status. RESULTS Of 541 patients with a median follow-up of 10 months, 101 (19%) had R1 resections. Resection margin status was confirmed as an influential prognostic factor, with a median survival of 10.9 months for R1 versus 16.9 months months for patients with R0 margins. Resection margin status remained an independent factor in a Cox proportional hazards model only in the absence of tumor grade and nodal status. There was a survival benefit for chemotherapy but not chemoradiation, irrespective of R0/R1 status. The median survival was 19.7 months with chemotherapy versus 14.0 months without. For patients with R0 margins, chemotherapy produced longer survival compared with to no chemotherapy. This difference was less apparent for the smaller subgroup of R1 patients, but there was no significant heterogeneity between the R0 and R1 groups. CONCLUSIONS Resection margin-positive pancreatic tumors represent a biologically more aggressive cancer; these patients benefit from resection and adjuvant chemotherapy but not chemoradiation. The magnitude of benefit for chemotherapy treatment is reduced for patients with R1 margins versus those with R0 margins. Patients with R1 tumors should be included in future trials of adjuvant treatments and randomization and analysis should be stratified by this significant prognostic factor.
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Affiliation(s)
- J P Neoptolemos
- Department of Surgery, Liverpool University, 5th Floor UCD Building, Daulby Street, Liverpool, L69 3GA, United Kingdom.
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Abstract
We determined the validity of the carbon 13-labeled urea breath test in young children. We found that although the 13C-labeled urea breath test had a specificity greater than 90%, borderline or false positive results occurred more frequently in children younger than 2 years compared with older children. False positive results may be caused by oral-urease-producing organisms because direct intragastric administration of 13C urea reduced the excess delta 13CO2. Care is urged in interpreting one positive 13C-labeled urea breath test in children younger than 2 years.
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Affiliation(s)
- C Imrie
- Department of Paediatrics, The Conway Institute of Molecular and Biomedical Research, University College, Dublin, Ireland
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19
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Abstract
We assessed the utility of expert oral examination as a part of the diagnostic evaluation of patients with suspected Crohn's disease. Of 45 patients with newly diagnosed CD, 25 had been examined by a dentist. Twelve (48%) of these had oral CD lesions. Mucosal tags constituted the most frequent form of oral lesion (8/12). Of 8 oral biopsy specimens, 6 (75%) contained non-caseating granulomas. Patients with oral CD had more oral symptoms, presented for diagnosis sooner, and were more likely to have other upper gastrointestinal inflammation than those without oral lesions. Oral manifestations of CD are common in children; therefore, expert oral examination may be useful during diagnostic evaluation of children with suspected inflammatory bowel disease.
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Affiliation(s)
- S Pittock
- Children's Research Centre, Our Lady's Hospital for Sick Children, and Department of Pediatrics, The Conway Institute for Biomolecular and Biomedical Science, University College Dublin, Ireland
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Abstract
Helicobacter pylori infection is associated with chronic gastritis and peptic ulcer disease. Furthermore, the World Health Organization has classified this organism as a carcinogen for gastric cancer. H pylori infection is mainly acquired in childhood. Children with H pylori infection are asymptomatic except for a very small number that develop peptic ulcer disease. However, if H pylori gastritis is associated with gastric cancer, do pediatricians need to screen children for this infection and treat those who are infected? In an attempt to determine the significance of the association between H pylori and gastric cancer, we have reviewed all of the English language literature on this topic. H pylori infection seems to be associated with an increased risk of developing gastric cancer. However, only a small number of infected individuals (~1%) will develop gastric cancer. Furthermore, there are potential cofactors other than H pylori that could be equally important. The effect of the eradication of H pylori alone on the development of gastric cancer is unknown. Based on our knowledge to date, we suggest that it is not indicated to treat all children with H pylori infection because of the risk of developing gastric cancer or to institute a screening and treatment program.
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Affiliation(s)
- C Imrie
- Department of Paediatrics, University College Dublin and The Children's Research Centre, Our Lady's Hospital for Sick Children, Dublin, Ireland
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Howes N, Greenhalf W, Rutherford S, O'Donnell M, Mountford R, Ellis I, Whitcomb D, Imrie C, Drumm B, Neoptolemos JP. A new polymorphism for the RI22H mutation in hereditary pancreatitis. Gut 2001; 48:247-50. [PMID: 11156648 PMCID: PMC1728213 DOI: 10.1136/gut.48.2.247] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS Hereditary pancreatitis (HP) is a rare form of recurrent acute and chronic pancreatitis. Mutations in the cationic trypsinogen (protease serine 1, PRSS1) gene have been identified as causing HP. The R122H (previously known as R117H) mutation is the commonest and can be detected by a single and rapid polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP) based technique using the AflIII enzyme. This test however may give a false negative result in the presence of a neutral polymorphism within the enzyme recognition site. The frequency of this event was examined by sequencing studies in patients with HP and in healthy controls. METHODS Of 60 families identified by the UK and Ireland consortium of EUROPAC (European Registry for Hereditary Pancreatitis and Familial Pancreatic Cancer), 51 were screened for R122H, N29I, and A16V mutations using standard techniques, and by sequencing of all five exons of cationic trypsinogen. RESULTS Twelve families had the N29I mutation, one family had A16V and, on standard testing, 15 families had the R122H mutation. An additional family with the R122H mutation was found on direct sequencing. The false negative result was due to a neutral polymorphism C-->T at the third base of the codon, not affecting the amino acid coded for, destroying the AflIII restriction site. This polymorphism was not observed in 50 DNA specimens (100 chromosomes) from controls nor from 50 individuals from PRSS1 mutation negative HP families. A novel mutation specific PCR was developed to avoid this pitfall. CONCLUSIONS One of the 16 families with HP and an R122H mutation contained a polymorphism affecting the AflIII restriction site. Adoption of an alternative R122H assay is important for genetic studies in individuals with apparent HP.
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Affiliation(s)
- N Howes
- Department of Surgery, University of Liverpool, 5th Floor UCD Building, Daulby Street, Liverpool L69 3GA, UK
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Abstract
Hereditary pancreatitis is a genetically transmitted condition usually presenting in childhood or adolescence. The natural history of the condition is that recurrent episodes of pancreatitis may be followed by the development of pancreatic exocrine and endocrine failure. Treatment options are limited, usually consisting of surgical drainage procedures whose efficacy is uncertain and whose effect on disease progression is unknown. We report a child with hereditary pancreatitis treated by means of a pancreatic duct stent placed via endoscopic retrograde cholangiopanctreatography resulting in long-term control of symptoms and speculate that earlier intervention may alter the disease course.
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Affiliation(s)
- D Vaughan
- Department of Paediatrics, University College Dublin, Children's Research Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
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23
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Abstract
It is now recognised that Helicobacter pylori, like most enteric infections, is mainly acquired in childhood. Adults rarely become infected, with seroconversion rates varying between 0.33and 0.5% per person year. The age at which children are most likely to become infected is still unclear, but findings in a number of cross-sectional studies suggest that infection is acquired before the age of five. The prevalence of infection is highest in children in the developing world where up to 75% of children may be infected by the age of 10. In the developed world the prevalence of infection is noticeably increased among socially deprived children. The diagnosis of H pylori infection in childhood is most often made at endoscopy, for which there are many indications. Symptoms such as abdominal pain, vomiting, and haematemesis may be associated with duodenal ulcer and H pylori infection. However, in the case of children undergoing endoscopy for assessment of oesophagitis, failure to thrive, coeliac disease, Crohn's disease, or portal hypertension, the finding of H pylori infection is likely to be incidental. How should we manage these children with a diagnosis of H pylori infection? Currently, there are no consensus guidelines for the management of H pylori infected children. In 1994 the National Institutes of Health consensus statement recommended that adults with gastric or duodenal ulcer disease, who are infected with H pylori, should receive antimicrobial treatment. The European Maastricht Consensus Report suggested broader indications for treatment of infected adults. It states that treatment is advisable for all H pylori infected dyspeptic patients diagnosed non-invasively under 45 years of age at a primary care level. Patients older than 45 years with dyspeptic symptoms should be treated for H pylori infection but only after endoscopy to rule out any other underlying pathology. The European guidelines also recommend treatment for infected patients with mucosa associated lymphoid tissue lymphoma and patients who are found to have intestinal metaplasia and gastric atrophy.
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Affiliation(s)
- M Rowland
- Department of Paediatrics, University College Dublin, Children's Research Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin 12, Ireland
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Lerch MM, Ellis I, Whitcomb DC, Keim V, Simon P, Howes N, Rutherford S, Domschke W, Imrie C, Neoptolemos JP. Maternal inheritance pattern of hereditary pancreatitis in patients with pancreatic carcinoma. J Natl Cancer Inst 1999; 91:723-4. [PMID: 10218513 DOI: 10.1093/jnci/91.8.723] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
BACKGROUND Duodenal ulcer disease is strongly associated with Helicobacter pylori infection of the gastric mucosa. Eradication of H pylori from the gastric mucosa in adults is associated with long term healing of ulcers. AIMS To follow a cohort of children with duodenal ulcer disease for a minimum of two years after the eradication of H pylori. PATIENTS AND METHODS Over a three year period, all children diagnosed with duodenal ulcer disease had their symptoms documented and their H pylori status evaluated. The histories of these children were carefully screened to determine previous symptoms and to document previous treatment regimens. RESULTS Sixteen children were diagnosed with ulcers and 15 were available for treatment and long term follow up. The median age at which symptoms first occurred was 10.5 years (range, 6-14) and the median duration of symptoms was 24 months (range, 2-60). Ten of the children had been treated with H2 receptor antagonists for a median of 3.5 months (range, 1-60). Duodenal ulcers healed in all children after eradication of H pylori and all children have remained asymptomatic for a median of 37 months (range, 26-62). No child has required subsequent admission to hospital. CONCLUSION Eradication of H pylori is very effective in the long term healing of duodenal ulcer disease. H pylori eradication should be the standard treatment for all infected children who present with duodenal ulcer disease.
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Affiliation(s)
- N Goggin
- Department of Paediatrics, University College Dublin, Ireland
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McKay C, Baxter J, Imrie C. A randomized, controlled trial of octreotide in the management of patients with acute pancreatitis. Int J Pancreatol 1997; 21:13-9. [PMID: 9127169 DOI: 10.1007/bf02785915] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONCLUSION In this study, octreotide was not found to be of benefit in the treatment of acute pancreatitis. BACKGROUND Somatostatin and its long-acting analog octreotide have both been proposed for the treatment of patients with acute pancreatitis, but neither agent has been adequately assessed in patients with severe attacks. METHODS Fifty-eight patients with moderate or severe acute pancreatitis who were admitted to hospitals within the west of Scotland over an 18-mo period were randomized to receive octreotide, 40 micrograms/h, by continuous i.v. infusion for 5 d, or placebo in addition to standard supportive therapy. RESULTS There was no significant difference in the incidence of complications (54% octreotide group and 40% placebo group) or mortality (octreotide group 18%; placebo group 20%).
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Affiliation(s)
- C McKay
- Department of Surgery, Glasgow Royal Infirmary, UK
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28
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Abstract
The peritoneal exudate formed during experimental pancreatitis is toxic when administered intraperitoneally or intravenously to other animals. Overwhelming of the peritoneal antiprotease defences by proteolytic enzymes released from the pancreas may be a key factor responsible for this toxicity and is examined in the current study. Human pancreatitis exudates possessed tryptic amidase activity indicating trypsinogen activation. The trypsin inhibitory capacities of exudates were reduced indicating a degree of consumption of the peritoneal antiproteases. Of 21 exudates examined, three showed marked reduction of their trypsin inhibitory capacity indicating almost complete consumption of their antiproteases. All three patients were shocked at the time of sampling, two dying of fulminant pancreatitis within 24 h. Overwhelming of the peritoneal antiproteases was not confirmed, but may occur in a few instances where proteolytic enzyme release or zymogen activation continues. Intraperitoneal administration of exogenous antiproteases prolongs survival in rats with pancreatitis and has been suggested as a therapy in man. The current data suggests that few patients are likely to benefit from such an approach.
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Affiliation(s)
- C Wilson
- Department of Surgery, Royal Infirmary, Glasgow, UK
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Pipeleers-Marichal M, Somers G, Willems G, Foulis A, Imrie C, Bishop AE, Polak JM, Häcki WH, Stamm B, Heitz PU. Gastrinomas in the duodenums of patients with multiple endocrine neoplasia type 1 and the Zollinger-Ellison syndrome. N Engl J Med 1990; 322:723-7. [PMID: 1968616 DOI: 10.1056/nejm199003153221103] [Citation(s) in RCA: 297] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In patients with multiple endocrine neoplasia type 1 (MEN-1), gastrinomas are common and thought to occur predominantly in the pancreas. We describe eight patients with MEN-1 and hypergastrinemia (seven with the Zollinger-Ellison syndrome) in whom we searched for neuroendocrine tumors in the pancreas and duodenum. Tumors were found in the proximal duodenum in all eight patients: solitary tumors (diameter, 6 to 20 mm) in three patients and multiple microtumors (diameter, 2 to 6 mm) in the other five. Paraduodenal lymph-node metastases were detected in four patients. Immunocytochemical analysis revealed the presence of gastrin in all the duodenal tumors and in their lymph-node metastases. In contrast, no immunoreactivity for gastrin was present in the endocrine tumors found in the seven pancreatic specimens available for study, except for one tumor with scattered gastrin-positive cells. In four of the six patients whose duodenal gastrinomas were removed, serum gastrin levels returned to normal; in the other two patients gastrin concentrations decreased toward normal. We conclude that in patients with MEN-1 and the Zollinger-Ellison syndrome, gastrinomas occur in the duodenum, but the tumors may be so small that they escape detection.
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Adami JG, Bowman FB, Adams F, Fleming AG, Farquharson CD, Imrie C, Janes RM. Combined Inquiry into the Presence of Diphtheria and Diphtheroid Bacilli in Open Wounds. Can Med Assoc J 1918; 8:769-785. [PMID: 20311157 PMCID: PMC1585224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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