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Search Results: 1 - 10 of 139738 matches for " Andy K Burroughs "
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Neurogenic diabetes insipidus presenting in a patient with subacute liver failure: a case report
Manu Shankar Hari, Anthony K Parsons, Andy K Burroughs, Steve Shaw, James O'Beirne, Banwari Agarwal
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-232
Abstract: A 25-year-old man presented with subacute liver failure. While awaiting a liver transplant, the patient developed cerebral edema, which resulted in neurogenic diabetes insipidus secondary to cerebral edema. The patient died before the liver transplantation could be carried out.Neurogenic diabetes insipidus is well recognized in the neurosurgical population as a consequence of cerebral edema and increased intracranial pressure, both of which occur commonly in patients with subacute liver failure.Cerebral edema occurs in patients presenting with fulminant liver failure, resulting in increased intracranial pressure (ICP). The incidence and severity of cerebral edema increases as the onset of liver failure becomes rapid. It occurs in up to 80% of patients with acute and hyperacute fulminant liver failure but less frequently (20%) in those with subacute fulminant liver failure. There is a significant association between the presence of cerebral edema and the development of central diabetes insipidus in patients with traumatic brain injury [1] and in postoperative neurosurgical patients. We present a case of neurogenic diabetes insipidus that developed during the course of subacute fulminant liver failure.A 25-year-old Nigerian man was admitted to our hospital's intensive care unit (ICU), after emergency tracheal intubation and ventilation for worsening encephalopathy and a deteriorating Glasgow Coma Scale score. The working diagnosis was seronegative hepatitis leading to subacute fulminant liver failure and grade three hepatic encephalopathy.His admission to our hospital was preceded by an admission to a local hospital with a ten day history of painless jaundice and malaise, progressing to three days of nausea and vomiting. The patient had no history of encephalopathy or coagulopathy. Liver function tests on admission were abnormal (bilirubin, 381 μmol/L, alanine transferase [ALT], 684 U/L), but an ultrasound scan showed a normal liver. Autoimmune and viral screen result
Liver Diseases Specific to Pregnancy
E. Cholongitas,A. K Burroughs
Annals of Gastroenterology , 2009,
Abstract: During pregnancy, there are some changes in the liver that occur physiologically, such as alternations in blood flow and hepatic cholesterol synthesis and secretion. However, liver diseases specific to pregnancy can occur, and the differential diagnosis from diseases coincidental with pregnancy or pre-existing liver disease is mandatory for proper therapeutic algorithms. Hyperemesis gravidarum develops in 1- 20/1000 pregnancies. Intrahepatic cholestasis of pregnancy is the second most common cause of jaundice in pregnancy, mutations in the MDR3 biliary canalicular protein have been found, and ursodeoxycholic acid is considered the most effective therapeutic option. Acute fatty liver of pregnancy (AFLP) occurs in about 1 /14000 pregnancies and in some cases is associated with homozygous long-chain 3 hydroxyacyl coenzyme A dehydrogenase deficiency in the fetus with a heterozygote mother. AFLP has a wide range of severity and a large degree of overlap in clinical and laboratory findings with HELLP (haemolysis, hepatic enzyme elevation, and low platelets) syndrome and pre-eclampsia/eclampsia. The latter is the major cause of maternal death in developed countries associated with complications, such as hepatic rupture and early delivery is considered the key component for reducing mortality.
Close contact fluctuations: the seeding of signalling domains in the immunological synapse
Amit K Chattopadhyay,Nigel J Burroughs
Physics , 2006, DOI: 10.1209/0295-5075/77/48003
Abstract: We analyse the size and density of thermally induced regions of close contact in cell:cell contact interfaces within a harmonic potential approximation, estimating these regions to be below one-tenth of a micron across. Our calculations indicate that as the distance between the close contact threshold depth and the mean membrane-membrane separation increases, the density of close contact patches decreases exponentially while there is only a minimal variation in their mean size. The technique developed can be used to calculate the probability of first crossing in reflection symmetry violating systems.
Treatment of acute variceal bleeding
C.K. Triantos,A.K. Burroughs
Annals of Gastroenterology , 2009,
Abstract: Acute variceal bleeding is a life-threatening complication in patients with portal hypertension. Although overall survival may be improving, mortality is still closely related to failure to control hemorrhage or early re-bleeding. Factors that influence this failure include severity of liver disease and active bleeding during endoscopy. In addition increased portal pressure has been proposed as a prognostic factor of early re-bleeding. There is also a strong association between variceal hemorrhage and bacterial infection. Recent meta-analyses confirmed that antibiotic prophylaxis significantly increases the short-term survival rate. Effective resuscitation,protection of the airway, particularly with severe bleeding and disturbed conscious level, especially during endoscopy are initial priorities. The following treatment strategies have been compared: a)Vasoactive drugs (±tamponade) vs Vasoactive drugs (±tamponade)+ sclerotherapy, b)vasoactive drugs vs sclerotherapy, c)vasoactive drugs+ endoscopy vs endoscopy, d)sclerotherapy vs ligation and e)Recombinant factor VII +endoscopy vs placebo+endoscopy. According to Baveno IV Consensus endoscopic treatments are best used in association with pharmacological therapy, which preferably should be started before endoscopy. Lastly in order to identify the group with poor outcome, new diagnostic/treatment algorithms are needed using known predictive factors. In this group more effective vasoactive regimens, early TIPS, and the use of self-expanding covered oesophageal stent could be considered.
Trends in the Management of Hepatitis B Virus Infection after Liver Transplantation
G.V. Papatheodoridis, V. Sevastianos, A.K. Burroughs
Annals of Gastroenterology , 2007,
Abstract: SUMMARY Post-transplant hepatitis B virus (HBV) recurrence occurs in the majority of patients transplanted for HBV liver disease, if left untreated. Post-transplant prophylaxis with hepatitis B immune globulin (HBIG) has significantly reduced HBV recurrence rates, but it is rather ineffective in patients with chronic liver disease and pre-transplant detectable serum HBV-DNA by hybridization assays. Moreover, long-term HBIG administration increases the cost of post-transplant medical therapy and may be associated with emergence of escape HBV mutants. Lamivudine is the first antiviral agent to be widely used in the management of HBV transplant patients. Pre-transplant lamivudine therapy lowers HBV viremia, decreasing the risk of post-transplant HBV recurrence, but to try and minimize virologic breakthroughs due to resistant HBV strains, it should be started within the prior to 6 months the anticipated timing of transplantation, which is often difficult in practice. Prophylactic post-transplant lamivudine monotherapy is associated with progressively increasing HBV recurrence rates, but combined therapy with lamivudine and HBIG at relatively low dosage is currently the most effective approach in this setting, even in HBV-DNA positive patients, who also receive lamivudine in the pre-transplant period. The most frequent therapy for post-transplant HBV recurrence is lami- vudine, but the increasing resistance rates represent a challenging problem. Adefovir dipivoxil is currently the most promising agent amongst those tried for lamivudine resistant HBV strains. All these advances in anti-HBV therapy have made HBV liver disease an indication for liver transplantation, irrespective of viral replication status, a complete turn around from 10 years ago. Key words: hepatitis B virus, liver transplantation, hepatitis B immune globulin, nucleoside analogues, lamivudine, adefovir, entecavir, viral resistance, YMDD mutants
Haemofiltration and Noradrenaline Corrects life-Threatening Cardiovascular Instability Following Delayed Anaphylactic Reaction to Patent Blue Dye in Sentinel Node Biopsy for Breast Cancer  [PDF]
Peter K. Donnelly, Louise Robinson, Matt Halkes, Andy Goodman
Journal of Cancer Therapy (JCT) , 2014, DOI: 10.4236/jct.2014.512111
Abstract: The aim of this case report is to present a novel approach to the management of very severe anaphylactic reaction to Patent Blue Dye used in Sentinel Node Biopsy for breast cancer treatment. The severity and duration of cardiovascular effects has not been described previously in this setting. Comprehensive ICU support including heamofiltration resulted in the patients’ complete recovery and successful long-term well-being despite a change to our routine cancer care plan.
How Reliance on Nuclear Weapons Erodes and Distorts International Law and Global Order
John Burroughs
Cadmus , 2012,
Abstract: Deployment of nuclear forces as an international security mechanism for prevention of major war is far removed from the world envisaged by the United Nations Charter in which threat or use of force is the exception, not the rule. Reliance on nuclear weapons has also distorted the development of major instruments of international humanitarian law and international criminal law, the 1977 Protocol I to the Geneva Conventions and the 1998 Rome Statute of the International Criminal Court. Awareness is deepening of the inherent incompatibility of reliance on nuclear weapons with an ever more entrenched normative framework stressing states’ responsibilities to protect their populations against atrocities and to comply with international humanitarian law and the Rome Statute. International humanitarian law is a solid foundation for the emerging norm of non-use of nuclear weapons and for building a legal framework of a nuclear-weapons-free world that is universal in its approach.
Rheumatoid Arthritis and Primary Biliary Cirrhosis: Cause, Consequence, or Coincidence?
Daniel S. Smyk,Dimitrios P. Bogdanos,Maria G. Mytilinaiou,Andrew K. Burroughs,Eirini I. Rigopoulou
Arthritis , 2012, DOI: 10.1155/2012/391567
Abstract: Primary biliary cirrhosis (PBC) is a progressive cholestatic liver disease characterized serologically by cholestasis and the presence of high-titre antimitochondrial antibodies and histologically by chronic nonsuppurative cholangitis and granulomata. PBC patients often have concomitant autoimmune diseases, including arthropathies. This raises the question as to whether there are shared features in the pathogenesis of those diseases with the pathogenesis of PBC. Epidemiological and large case studies have indicated that although the incidence of rheumatoid arthritis (RA) is not significantly raised in PBC patients, there appears to be a higher rate of RA in PBC patients and their relatives. Genetic studies have demonstrated that several genes implicated in PBC have also been implicated in RA. Epigenetic studies provided a wealth of data regarding RA, but the findings on epigenetic changes in PBC are very limited. As well, certain infectious agents identified in the pathogenesis of PBC may also play a role in the pathogenesis of RA. These data suggest that although RA is not significantly present in PBC, some individuals with certain genetic traits and environmental exposures may develop both conditions. This concept may also apply to other concomitant diseases found in PBC patients.
Surveillance and diagnosis of hepatocellular carcinoma in patients with cirrhosis
Lorenzo Andreana, Graziella Isgrò, Maria Pleguezuelo, Giacomo Germani, Andrew K Burroughs
World Journal of Hepatology , 2009,
Abstract: Early identification of hepatocellular carcinoma (HCC) is more frequent because of surveillance programs for HCC worldwide. The optimal strategy of surveillance in cirrhosis is a current topical issue. In terms of diagnosis, recent advances in non-invasive imaging technology, including various techniques of harmonic ultrasound, new ultrasound contrast agents, multi-slice helical computed tomography and rapid high quality magnetic resonance, have all improved the accuracy of diagnosis. Consequently the role of liver biopsy in diagnosis of HCC has declined. The imaging diagnosis relies on the hallmark of arterial hypervascularity with portal venous washout. However, with recent advances in genomics and proteomics a great number of potential serum and tissue markers have been identified and are being developed as new candidate markers for both diagnosis and prognosis of hepatocellular carcinoma, and may increase the need for liver biopsy.
Rheumatoid Arthritis and Primary Biliary Cirrhosis: Cause, Consequence, or Coincidence?
Daniel S. Smyk,Dimitrios P. Bogdanos,Maria G. Mytilinaiou,Andrew K. Burroughs,Eirini I. Rigopoulou
Arthritis , 2012, DOI: 10.1155/2012/391567
Abstract: Primary biliary cirrhosis (PBC) is a progressive cholestatic liver disease characterized serologically by cholestasis and the presence of high-titre antimitochondrial antibodies and histologically by chronic nonsuppurative cholangitis and granulomata. PBC patients often have concomitant autoimmune diseases, including arthropathies. This raises the question as to whether there are shared features in the pathogenesis of those diseases with the pathogenesis of PBC. Epidemiological and large case studies have indicated that although the incidence of rheumatoid arthritis (RA) is not significantly raised in PBC patients, there appears to be a higher rate of RA in PBC patients and their relatives. Genetic studies have demonstrated that several genes implicated in PBC have also been implicated in RA. Epigenetic studies provided a wealth of data regarding RA, but the findings on epigenetic changes in PBC are very limited. As well, certain infectious agents identified in the pathogenesis of PBC may also play a role in the pathogenesis of RA. These data suggest that although RA is not significantly present in PBC, some individuals with certain genetic traits and environmental exposures may develop both conditions. This concept may also apply to other concomitant diseases found in PBC patients. 1. Introduction Primary biliary cirrhosis (PBC) is a chronic cholestatic, autoimmune liver disease characterised by progressive inflammatory destruction of the intrahepatic bile ducts, with fibrosis leading to cirrhosis [1–5] and liver failure [6, 7]. The disease most commonly affects middle-aged females [8–10]. PBC is often found to affect more than one member of the same family, and it appears that first degree relatives (FDRs) of PBC patients have and increased risk of developing the disease [1–5]. There is a consensus that the incidence and prevalence of PBC is increasing [11–15]. This may be due to a true increase in the disease or due to the awareness for the disease amongst clinicians and the meticulous diagnostic assessment, such as disease-specific autoantibody testing. PBC is characterised by several disease-specific autoantibody profiles [16], which are a key component of the diagnostic workup. Included in the autoantibody profiles are antimitochondrial antibodies (AMA) [17, 18] and/or disease-specific antinuclear antibody (ANA) [19, 20]. AMA positivity appears to be indicative of future PBC development [21]. Autoimmune rheumatic diseases such as Sj?gren’s syndrome and systemic sclerosis, as well as other extra-hepatic autoimmune manifestations such as autoimmune
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