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Biomedical subjects

A E Read

Publications and source records attributed to A E Read.

At least 55 records · Page 3Linked to original sources

The digestive tract.

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Digestive System Diseases↗

Treatment of hepatic encephalopathy with metronidazole.

Neomycin, an antibiotic which is primarily active against the aerobic gut flora and hence reduces the endogenous production of ammonia, is a well-recognised form of treatment for acute or acute on chronic hepatic encephalopathy. This study suggests that metronidazole may be a useful alternative or even adjunctive treatment for such patients. Theoretical and practical justifications for the use of this drug are presented. The results of a week's prescription of each drug have been assessed by changes in clinical and biochemical criteria, including electroencephalograms and arterial ammonia sample. In the treatment of a series of 11 mildly or moderately, and seven severely affected, patients with histologically confirmed cirrhosis, metronidazole is shown to be as effective as neomycin.

Aged↗

Study of the carbohydrate content of mucus glycoproteins from normal and diseased colons.

1. Mucus samples obtained from colectomy colons from 10 patients with ulcerative colitis and four patients with Crohn's disease of the colon, together with samples from 10 normal postmortem colons, have been studied. 2. Two glycoprotein fractions were isolated from mucosal scrapings by gel-permeation chromatography. The high-molecular-weight fraction consisted largely of mucus glycoproteins and was further purified to the glycopolypeptides. The low-molecular-weight fraction contained a glycoprotein with a high mannose content. The carbohydrate content of both the mucus glycoprotein and glycopolypeptide fractions were significantly reduced in active colitis. 3. Oligosaccharides were prepared from the mucus glycoprotein material. In the normal material more than half the units contained eight or more monosaccharide residues, whereas in the disease material the bulk of the units were smaller than this.

Carbohydrates↗

Serum lysozyme activity in coeliac disease: a possible aid to athe diagnosis of malignant change.

Serum lysozyme activities were measured in 34 control subjects, 13 untreated adult coeliac patients, 21 adult coeliac patients on gluten-free diet, and eight coeliac patients with a histiocytic lymphoma. Serum lysozyme activities were raised in three untreated patients, three patients treated with a gluten-free diet, and in only two patients with coeliac disease and lymphoma. Serum lysozyme estimations cannot be recommended as an aid to the diagnosis of lymphoma in patients with coeliac disease.

Adult↗

Effect of coffee on human lower oesophageal function.

The effect of coffee on lower oesophageal sphincter pressure (LOSP) and intraoesophageal pH was assessed in 10 healthy volunteers, in the fasting state and after a standard Lundh test meal. LOSP was measured by the rapid pull-through technique. Coffee with or without milk has no significant effect on LOSP in the fasting subject. The Lundh meal alone (mean drop = 2.01 cm H2O), or when coffee with (mean drop = 1.80 cm H2O) or without milk (mean drop = 3.47 cm H2O) was taken after it, produced a significant drop in LOSP. Heartburn following coffee does not appear to be due to an effect of coffee on the lower oesophageal sphincter but is more likely due to the effect of a previous meal on sphincter pressure with associated acid reflux.

Adult↗

Clostridium difficile associated diarrhoea: a role in inflammatory bowel disease?

56 patients with diarrhoea were screened for the presence of Clostridium difficile toxin in their stool. The test was positive in 9: 5 had severe inflammatory bowel disease and were receiving systemic steroids; 2 were on steroids for other conditions; 1 had been on antibiotics; and in 1 there was no apparent predisposing factor. In each case clearance of the toxin was associated with clinical improvement. Evidently Cl. difficile toxin is not specific for antibiotic-associated diarrhoea, but is associated with diarrhoea of various aetiologies, often unrelated to antibiotic therapy. Cl. difficile may be an important factor in some exacerbations of inflammatory bowel disease.

Anti-Bacterial Agents↗

Gastric cancer detection in gastric ulcer disease.

A retrospective study has been performed of all cases of gastric ulcer diagnosed or investigated within the Endoscopy Unit of the Department of Medicine, Bristol, over a three year period (1974-76). The average length of follow-up was two years. Two hundred and sixty five cases of gastric ulcer were studied of which 37 proved to be malignant (14%). Presenting complaints of anorexia, weight loss, nausea and/or vomiting, and multiple (greater than 3) symptoms, were commoner in the malignant ulcer group. Ulcer site and the presence of coexisting duodenal ulceration were largely unhelpful in deciding the status of an ulcer. Malignant ulcers tended to be large (greater than 1 cm diameter). Radiology was highly unreliable in distinguishing benign from malignant ulcers. Visual inspection at endoscopy was more reliable, but associated with a tendency to over-diagnose malignancy. False positive biopsies were uncommon (two cases). Three cases of clinically unsuspected superficial gastric carcinoma were revealed. Repeated endoscopy and biopsy of all gastric ulcers until they are completely healed is advised.

Adult↗

Pyoderma gangrenosum and ulcerative colitis.

The relationship of pyoderma gangrenosum and ulcerative colitis remains uncertain. We investigating 14 patients with pyoderma gangrenosum by colonoscopy with multiple biopsies. Six patients had ulcerative colitis and all of these had disease affecting the whole colon. There were no correlations between exacerbations of the colitis and the onset or course of pyoderma gangrenosum. The remaining eight patients with pyoderma gangrenosum had no other disease and they were found to be significantly older than those patients with coexisting colitis (P less than 0.002).

Adult↗

Trypsin and lactoferrin levels in pure pancreatic juice in patients with pancreatic disease.

Levels of immunoreactive trypsin were measured in pure pancreatic juice obtained endoscopically from 44 patients with suspected pancreatic disease. Patients with pancreatic cancer all had low trypsin concentrations (median 3.6 micrograms/ml, range 0.6--12.0), but those with chronic pancreatitis had very variable levels (median 14.2 micrograms/ml, range 3.2--76.8), showing a considerable overlap with patients without pancreatic disease (median 37.1 micrograms/ml, range 10.4--66.0). When levels of lactoferrin in pancreatic juice were measured, all patients with chronic pancreatitis were found to have much higher levels (all greater than 900 ng/ml) than control subjects or patients with pancreatic cancer (all less than 400 ng/ml). The combined measurement of trypsin and lactoferrin in pure pancreatic juice appeared to be more promising than any other currently available test for the separation of patients with pancreatic cancer from those with chronic pancreatitis.

Chronic Disease↗

Antipyrine clearance per unit volume liver: an assessment of hepatic function in chronic liver disease.

Liver size has been estimated clinically and by a non-invasive ultrasound technique in 16 normal subjects, 16 patients with cirrhosis, 10 patients with chronic biliary obstruction, and three patients with primary hepatoma. Antipyrine disposition was also measured in each subject. Hepatomegaly was not clinically detectable until there was approximately a 20% increase in liver size. Additional increases in size correlated significantly with clinical estimates of hepatomegaly. Antipyrine clearance had a three-fold range in normal subjects. Its mean value was significantly reduced in each subgroup of patients with liver disease. However, 48% of patients with liver disease had values within the normal range. In normal subjects there was a significant correlation between antipyrine clearance and liver volume. Thus, intersubject variation in clearance normalised for liver volume was less than clearance alone. Antipyrine clearance normalised for liver volume in patients with liver disease was significantly lower than in normal subjects and there was no overlap with normal subjects. In conclusion, assessment of drug metabolising efficiency per unit volume of liver increased the discrimination in differentiating subjects with normal from abnormal livers.

Aged↗

Argon laser photocoagulation in the dog stomach.

Laser photocoagulation is one of a number of methods currently under investigation for the endoscopic treatment of gastrointestinal haemorrhage. The Argon ion and Neodymium Yttrium Aluminium Garnet (Nd YAG) lasers are theoretically suitable as the beam from each may be transmitted via a flexible fibre. Argon laser photocoagulation has been shown to be effective and we have elucidated which factors determine its safety and efficacy. Studies on normal canine gastric mucosa showed that the depth of tissue damage depended chiefly on the total incident laser energy on any one spot, and that below 50 J the risk of perforation was extremely low. The energy density was much less important. The haemostatic effect depended more on the laser power. In artificial bleeding gastric ulcers in heparinised dogs the most effective level was 7--9 W, at which 22 out of 23 ulcers (96%) stopped bleeding completely, compared with one out of 12 controls. Photocoagulation was achieved in these cases with energies well within the safe limits. The procedure was effective endoscopically, and these results justify early clinical studies in man.

Absorption↗