Combined use of water immersion and frusemide in treatment of resistant ascites in liver cirrhosis.
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Biomedical subjects
Publications and source records attributed to A E Read.
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A transcutaneous Doppler ultrasound technique was used to investigate superior mesenteric artery blood velocity waveforms in normal subjects. The shape of the waveforms was quantified by means of the pulsatility index (PI). The mean value +/- standard error of the mean of the PI measured in 82 normal subjects in the resting and fasting state was 3.57 +/- 0.11. There was no difference in the PI between sexes nor correlation between the PI and age. Following the ingestion of a meal in a group of 15 subjects the PI decreased by 46% (p less than 0.001). A significant fall persisted over the next two hours.
The extent of biliary excretion of paracetamol and its principal metabolites was studied in 10 healthy adults. Duodenal intubation was performed approximately 12 h after an oral dose of 1 g paracetamol. Duodenal fluid was aspirated following intravenous cholecystokinin, and urine was collected for 12 h after dosing. The mean concentration of the cysteine and glucuronide conjugates in the bile was 253.7 +/- 39.0 micrograms ml-1 (s.e. mean) and 69.3 +/- 15.3 micrograms ml-1, respectively. The mean recoveries of the cysteine and glucuronide conjugates in the bile were 6.0 +/- 1.5 mg and 1.2 +/- 0.41 mg, respectively. The bile is an important route of elimination for the cysteine conjugate and accounts for 19.4 +/- 4.4% of the total excretion of the metabolite. The fate of the biliary excreted conjugates is not known, and needs further investigation.
A duplex scanner which consists of a real time two dimensional scanner and a pulsed Doppler flowmeter was used to measure superior mesenteric blood flow in 70 healthy subjects. By processing the Doppler shift signals, the instantaneous average Doppler shift frequency and then the instantaneous average velocity of the flow rate were calculated. Both diameter of the vessel and angle between vessel and beam were measured from real time imaging. The mean (+/- standard error of the mean) of the superior mesenteric blood flow was 517 +/- 19 ml/min. There was neither significant difference in flow between sexes, nor correlation between flow and age (r = 0.042). The mean of coefficients of variability were 6.8% over the short term, and 8.2% in long term studies.
Four patients with renal transplants developed hepatic veno-occlusive disease after immunosuppressive therapy with azathioprine. Severe progressive portal hypertension developed in all patients, with the clinical presentation varying from a mild viral-like syndrome to rapidly fulminant liver failure and death. The disease was associated with cytomegalovirus infection but not with the dose of azathioprine, the type or duration of transplant, or the type of underlying kidney disease. In view of the high mortality rate associated with veno-occlusive disease (a combined 55% in our four patients and in five reported in the literature) and wide spectrum of clinical presentation in patients with renal transplants, a high index of suspicion is required and aggressive intervention indicated.
A transcutaneous Doppler ultrasound method was used to measure the superior mesenteric artery blood flow in nine healthy volunteers in the fasting state and serially for 1 h after the ingestion of 400 ml of an isotonic glucose solution. These measurements were repeated on a second occasion following the ingestion of 400 ml of an isotonic lactulose solution. Superior mesenteric artery blood flow increased by 53 per cent (p less than 0.05) 5 min after the end of ingestion of the glucose solution. The increase persisted at 10 min and declined to 47 per cent at 15 min and to 23 per cent at 30 min. No significant change in blood flow was found following the ingestion of the lactulose solution. Significant differences between the two responses were found at 5, 10 and 15 min (p less than 0.05). The increase in blood flow after a glucose solution and not after lactulose suggests therefore that the process of absorption is an important factor governing postprandial superior mesenteric artery blood flow.
Transcutaneous Doppler ultrasound was used to measure resting and postprandial blood flow in the superior mesenteric artery (SMABF) in nine patients with dumping syndrome and in ten normal volunteers of matching age and sex. All nine patients experienced signs and symptoms of dumping during the investigation, but none of the controls did so. At rest, SMABF in the dumping patients (567 +/- 47 ml/min) (mean +/- s.e.m.) did not significantly differ from that of the normal volunteers (493 +/- 72 ml/min). Five minutes from the end of a balanced liquid meal, flow had approximately doubled in each group (1232 +/- 140 and 941 +/- 128 ml/min). Compared with controls, increased SMABF was observed in patients with dumping syndrome at 10 min (76 per cent), 15 min (66 per cent), 30 min (55 per cent) and 45 min (42 per cent) (P = 0.05-0.01). Splanchnic pooling and abnormal redistribution of blood probably contribute to the pathogenesis of the early dumping syndrome.
Transcutaneous Doppler ultrasound was used to measure coeliac axis blood flow in 42 normal subjects in the fasting state and in 10 subjects following a liquid meal. A Duplex scanner was used and coeliac axis blood flow was estimated by calculating the instantaneous average velocity of blood flow over the cardiac cycle. Both the diameter of the vessel and the angle between the vessel and the beam were measured from real time imaging. The mean (+/- s.e.m.) of coeliac axis blood flow was 703 +/- 24 ml/min. There was no difference in the results between the sexes nor any correlation between flow and age. The mean coefficient of variability was 7.8 per cent in a 1 day test and 9.2 per cent in a 2 day test. Coeliac axis blood flow increased by 38 per cent immediately after the end of ingestion of the meal and declined to 29 per cent 5 min and 24 per cent 10 min later.
The role of goblet cells in the adaptive response of the intestine to jejunoileal bypass was studied in rats submitted to an 85% end-to-side jejunoileal bypass or sham bypass. At 36 weeks the length and wet weight of the duodenum and large bowel was 13-48% greater in animals with jejunoileal bypass. Measurements of villous height and crypt depth confirmed mucosal hyperplasia in the residual functioning small bowel and the distal colon. Histochemical studies in both groups of rats showed an overall predominance of sulphomucins throughout the intestinal tract, but jejunoileal bypass caused a disproportionate increase in the number of sialomucin containing goblet cells in functioning segments of small bowel and distal colon. An abundance of sialomucin cells at the site of anastomosis after jejunoileal bypass may have been a protective response to local mechanical trauma. Goblet cell hyperplasia is a feature of compensatory growth of the intestinal tract after surgical shortening. The changes in colonic mucin seen after jejunoileal bypass resemble those observed in ulcerative colitis and mucosal dysplasia.
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To determine the relative frequency of different diseases and of functional gastrointestinal disorders among patients referred by general practitioners to a gastroenterology clinic, 2000 patients referred over a five-year period were studied. 980 had organic diseases, of which peptic ulcer, oesophagitis, and inflammatory bowel disease accounted for about half. 888 patients had functional disorders of the gastrointestinal tract, without any disease. Among these, various syndromes could be distinguished; abdominal pain with altered bowel habit (irritable bowel syndrome, spastic colon type) accounted for about half of these patients. More attention could profitably be directed towards understanding these common functional syndromes so that they can be more readily diagnosed and better managed.
Lactoferrin is present in pancreatic juice, and greatly increased concentrations are found in the pancreatic juice of patients with chronic pancreatitis. It is not known whether these high levels of lactoferrin represent a genetically determined defect predisposing to the later development of chronic pancreatitis or are simply a consequence of the disease. In view of the morphological and functional similarities between the pancreatic and parotid glands, we have measured the immunoreactive lactoferrin concentration in pure parotid saliva of 30 patients with chronic calcific pancreatitis, 26 controls, 5 patients with proven pancreatic cancer, 2 patients with Sjögren's disease and 2 patients with chronic recurrent parotitis. No difference in the lactoferrin concentration was detected between control subjects and patients with chronic pancreatitis or pancreatic cancer. Raised levels were found in the 4 patients with parotid gland disease. These findings suggest that increased lactoferrin secretion is confined to the exocrine pancreas in patients with chronic pancreatitis and is thus probably a phenomenon secondary to the disease.
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