Escherichia coli infection of an abdominal aortic aneurysm.
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Aneurysm, Infected↗
Biomedical subjects
A Allan
Publications and source records attributed to A Allan.
Mucosal enzyme activity for butyrate oxidation; no defect in patients with ulcerative colitis.
BACKGROUND: Butyrate is an important energy source for the colon and its metabolism has been reported to be defective in ulcerative colitis. One mechanism for defective butyrate metabolism in patients with ulcerative colitis could be an enzyme deficiency in the beta-oxidation pathway of butyrate. AIMS: This study was undertaken to measure the activity of each enzyme involved in the beta-oxidation pathway of butyrate in colonic epithelium. PATIENTS: Patients with ulcerative colitis (n = 33), Crohn's colitis (n = 10), and control subjects with colorectal cancer or diverticular disease (n = 73) were studied. METHODS: Analysis was carried out using fluorometric and spectrophotometric techniques on homogenised epithelial biopsy specimens. RESULTS: Significantly increased butyryl CoA dehydrogenase activity was found in mucosa from patients with ulcerative colitis (33.2 (28.3, 38.1) mumol/g wet weight/min:mean (95% CI)) compared with activity in mucosa from control patients (24.3 (20.9, 27.7) mumol/g wet weight/min:mean (95% CI)) p < 0.02. No significant increase in activity of the enzymes butyryl-CoA synthetase, crotonase or hydroxybutyryl-CoA dehydrogenase was found in patients with ulcerative colitis. In contrast the mucosal thiolase activity was significantly lower in those patients with quiescent colitis (3.21 (2.61, 3.81) mumol/g wet weight/min:mean (95% CI)) when compared with control mucosa (5.69 (5.09, 6.29) mumol/g wet weight/min:mean (95% CI)) p < 0.001. However, mucosal thiolase activity increases with the age of the donor patient and differences in the age range of the patient groups probably account for this finding. CONCLUSIONS: This study shows no substantial deficiency of enzyme activity in the beta-oxidation pathway of butyrate in the mucosa of patients with ulcerative colitis in histological remission.
Adolescent↗
Screening for colorectal cancer: a general-practice-based study.
BACKGROUND: A 2-year study was undertaken to determine the best way of setting up faecal occult blood screening for colorectal cancer in a single general practice in north Birmingham, a district with no pre-existing hospital-based screening programme for colorectal cancer. This programme was set up in close collaboration with the Departments of Surgery and Biochemistry at the local Good Hope Hospital Trust. This facilitated joint meetings between the staff of these hospital departments and the practice manager, who was responsible for organization of the study at the Hawthorns Surgery and also supervised the day-to-day running of the programme. Essentially, the study was organized and run by the practice manager and nurse. AIM: The study was undertaken to prepare the way for other general practices in north Birmingham to screen selected populations for colorectal cancer. METHOD: A Haemoccult test kit was posted to patients together with an explanatory letter. The design of the screening programme was similar to the design of the 'screened arm' of the Medical Research Council (MRC) colorectal screening trial in Nottingham. On completion of the programme, questionnaires were posted to 100 responders and 100 non-responders to assess the level of patient acceptability for the screening study. A total of 3509 patients (1599 men and 1910 women) were invited to take part in the screening. RESULTS: The response rate was 55.4%. Thirty-nine patients were referred from the screening study for further investigation. Colonoscopy identified nine adenomas in nine patients, and a further 12 patients were found to have colorectal carcinoma. CONCLUSIONS: The findings from the study suggest that this method could be used as a model for other general practices introducing colorectal screening using Haemoccult.
Aged↗
Local effects of colorectal cancer are well palliated by endoscopic laser therapy.
We review the results of treating the local effects of 26 cases of inoperable colorectal cancer with Nd:YAG laser. There were 16 men and 10 women of mean age 75, with 17 (65%) rectal, eight (31%) sigmoid and one (4%) ascending colon cancer. They presented with symptoms primarily of obstruction in 12 patients (46%), bleeding in 10 (39%) and diarrhoea in four (15%). Initial therapy to relieve symptoms required a mean of 1.5 (1-3) laser treatments over a mean of 1.5 (1-2) weeks. Twelve patients (46%) had total relief and 12 (46%) had partial relief. Sixteen patients received follow-up maintenance therapy, with laser treatments performed over a mean interval of 7.3 (1-20) weeks. One died at first follow-up treatment; all but two of the others were well maintained by laser treatment alone. Three patients (12%) suffered complications, with two deaths (8%), one due to cardiac failure and the other due to stercoral perforation of the colon. Four patients remained alive after a mean follow-up period of 51 (9-84) months. The mean survival of the others was 5 (0-23) months. Laser palliation for colorectal cancer is efficacious and relatively safe, allows improved quality of survival in 92% of patients after initial treatment, and, alone, can satisfactorily keep patients relatively free of local symptoms in 88% of patients surviving into the follow-up period.
Aged↗
Rhesus sensitisation.
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Drug Administration Schedule↗
Types and causes of miscarriage.
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Abortion, Spontaneous↗
Law and psychology: a historical perspective (1).
In this first of a series of three articles, the relationship between law and psychology is discussed from a historical perspective. The article is divided into four sections: First, the early developments are described. Secondly, the use of medical knowledge and experts in Roman law is discussed. Thirdly, attention is devoted to the legal status of the mentally ill during the Middle Ages and how the thirteenth century appears to have been a turning-point in this regard. Lastly, important medicolegal developments during the Renaissance and the replacement of the belief in witchcraft by a more scientific approach are described.
Europe↗
Expert evidence: the emergence of psychiatry and psychology (2).
In this second of a series of three articles, attention is devoted to the developing role of psychiatrists and psychologists as expert witnesses. As far as psychiatry is concerned, the first recorded use of psychiatric evidence in an English court dates back to the first half of the eighteenth century, but it was not until the nineteenth century that psychiatry was recognized as a field that could contribute significantly to the law. Developments in South Africa regarding forensic psychiatry followed a similar pattern. As for psychology, immediately after its emergence as an autonomous science late in the nineteenth century, it interacted with law. Developments from the stormy early years to the present in the United Kingdom are discussed.
Expert Testimony↗
Law and psychology in South Africa: development and recommendations (3).
In this last article in a series, the historical development and present status of forensic psychology in South Africa are discussed. First, a critical comparison is made between the legal status of forensic psychologists and that of psychiatrists, and reasons for the present situation are given. Secondly, the reasons why psychologists may soon be expected to play a more important role in the forensic field, are discussed. Lastly, prerequisites for the development of forensic psychology in South Africa are listed: the need for a sound theoretical and clinical knowledge of the chosen field or fields of psychology, knowledge of the relevant legal principles in the specific legal field, the promotion of research and the address of ethical aspects of forensic psychology.
Forecasting↗
An old head on new shoulders.
A modified stapling technique for anterior resection is described. A pursestring suture is placed in the proximal colon after resection of the specimen; the head of a stapling gun is detached from the stapler and inserted into the proximal bowel and the pursestring suture is tied. A pursestring suture is placed in the rectal stump. A stapling device head from a previous case is autoclaved and then fitted to the stapling device to allow safe insertion per anum: this head is discarded as soon as the distal pursestring is tied. The anastomosis is then completed in the usual way. This technique has been used successfully in twenty-one cases with minimal morbidity and no mortality.
Anastomosis, Surgical↗
Mucosal glucosamine synthetase activity in inflammatory bowel disease.
Abnormalities in colonic glycoprotein synthesis have been implicated in the pathogenesis of ulcerative colitis and Crohn's disease. Glucosamine synthetase is the rate-limiting step in the biosynthesis of gastrointestinal glycoprotein and has been measured in control subjects (N = 23) and patients with ulcerative colitis (N = 26) or Crohn's disease of the colon (N = 20) classified according to the macroscopic status of the rectum. Glucosamine synthetase activity was relatively constant around the normal colon but lower levels were found in the terminal ileum. In ulcerative colitis, glucosamine synthetase activity was similar to controls (24.0 +/- 1.9) mmol/g wet (wt/hr) irrespective of disease activity (quiescent: N = 13, = 27.3 +/- 1.9; active N = 16, = 26.2 +/- 2.3). Rectal glucosamine synthetase activity was normal in the presence of active Crohn's proctocolitis (29.4 +/- 3.1) but raised in patients with Crohn's colitis and rectal sparing (37.2 +/- 4.9 P < 0.02). Glucosamine synthetase activity was strongly influence by the degree of epithelial preservation.
Colitis, Ulcerative↗
Faecal diversion for Crohn's colitis: a model to study the role of the faecal stream in the inflammatory process.
The high incidence of clinical remission after faecal diversion for Crohn's colitis suggests the faecal stream may play a part in the inflammatory mechanism. The effect of faecal diversion (n = 22) and restoration of intestinal continuity (n = 10) was assessed in patients with Crohn's colitis and compared with controls. Faecal diversion produced significant improvement in the disease activity index mean (SEM) (before 176 (9); after 114 (9), p < 0.01) and serum albumin concentrations (before 33 (3.0); after 38 (3.0), p < 0.05) in all patients with Crohn's colitis. The crypt cell production rate (CCPR) was maintained after faecal diversion for Crohn's colitis but fell in the control group (before = 3.6 (0.8)), at two (1.4 (0.4), p < 0.02), and six weeks (1.6 (0.4), p < 0.05). Mucosal glucosamine synthetase activity, reflecting glycoprotein synthesis, was significantly lower in patients with Crohn's colitis (analysis of variance p < 0.05) after diversion but was maintained in the control group. Restoration of intestinal continuity failed to produce reciprocal changes. The sustained cellular proliferation and fall in glycoprotein synthesis in Crohn's colitis after faecal diversion may represent the end of an exaggerated protective response and regenerative hyperplasia after exclusion of the faecal stream. This study suggests the faecal stream may participate in the inflammatory process in Crohn's colitis. The underlying mechanism is unknown.
C-Reactive Protein↗
Vaginal bleeding in early pregnancy.
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Abortion, Spontaneous↗
The use of Foley balloon catheters in cardiac surgery.
Situations may arise during elective and emergency surgery when vascular control is required but conventional vascular clamps cannot be used. We have found the Foley catheter useful for the control of inadvertent perforation of the heart especially in "redo" operations. We describe the use of the Foley catheter for the control of the difficult aorta and illustrate its potential versatility in a variety of uncommon situations. As Foley catheters are present in every operating theatre we hope that our experience will be of benefit to other surgeons who encounter similar problems.
Adult↗
The influence of ileal pouch-anal anastomosis for ulcerative colitis on ileal glycoprotein synthesis.
Restorative proctocolectomy and ileal pouch-anal anastomosis are frequently associated with the onset of low-grade inflammation, colonic metaplasia, and pouchitis. The influence of intestinal adaptation and inflammatory activity on ileal glycoprotein synthesis (GS) has been assessed. Ileal GS activity in controls (n = 13, 28.9 +/- 3.6) was similar to that of patients with ulcerative colitis (n = 18, 26.4 +/- 3.6) irrespective of the presence of backwash ileitis (n = 6, 22.0 +/- 4.0). Ileoanal pouch construction was not associated with a significant change in ileal GS activity regardless of the presence of low-grade inflammation (n = 19, 25.9 +/- 2.2), frank pouchitis (n = 5, 24.4 +/- 4.6), or transformation to a colonic type of mucosa (n = 6, 25.4 +/- 5.2). The transformation of ileal mucosa from an absorptive to a storage function is associated with characteristic morphologic and inflammatory changes but does not produce a protective response mediated by increased GS.
Adaptation, Physiological↗
Sternal wound infections and internal mammary artery grafts.
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Humans↗
Risk stratification for open heart surgery.
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Cardiac Surgical Procedures↗
Link protein shows species variation in its susceptibility to proteolysis.
Human cartilage link protein exists as three native components, while equine, bovine, and porcine cartilage link protein exist as two and Swarm rat chondrosarcoma link protein exists as only one component. These nonhuman link protein components represent intact protein structures, and there is little evidence for proteolytically modified forms in nonhuman tissues. In human cartilage, the proteolytic production of modified link proteins increases with age, whereas high amounts of such products were not seen in the nonhuman tissues. However, the small amounts of link protein fragments that were observed in the nonhuman cartilages were of a similar size to their human counterparts. On digestion of human proteoglycan aggregate with stromelysin, rapid modification of the link protein components occurred, whereas the aggregates from nonhuman cartilages showed incomplete cleavage of their link protein components. The relative resistance of nonhuman link protein to stromelysin may in part be due to a unique amino acid substitution present near the enzymic cleave site.
Amino Acid Sequence↗