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Biomedical subjects

A E Read

Publications and source records attributed to A E Read.

At least 91 records · Page 5Linked to original sources
PubMed1976

131I Rose Bengal scanning and clearance ratios in the investigation of jaundiced patients.

It may be difficult to distinguish between obstructive and non-obstructive jaundice despite the use of clinical, biochemical and radiographic tests. Endoscopic cannulation tests promise to be the most accurate means of separating the two groups, but they are not yet widely available, and are not entirely safe. In contrast, the 131I-Rose Bengal test is simple, safe and comparatively widely available. Its accuracy in 70 jaundiced patients is reviewed to determine whether it still has a place in the investigation of jaundiced patients. Blood clearance traces, intestinal radioactivity traces and serial abdominal scans were done during a period of 3 h. The blood clearance ratios were not helpful discriminators, and the most helpful information was the timing of intestinal radioactivity. Its rapid appearance excluded mechanical obstruction. A delay of up to 3 h in its appearance was characteristic of cholestasis. A delay of more than 3 h was found in all cases of mechanical obstruction, but also in ten cases of severe cholestasis which could not be distinguished from those with mechanical obstruction. A follow-up examination within another ten days was of diagnostic value in two of these cases and the overall accuracy of the test was 86%. The potential value of prolonging the test to 24 h is discussed. It is concluded that the 131I-Rose Bengal test is a helpful diagnostic discriminator in the great majority of patients with jaundice. It is offered as a screening procedure for specialised techniques.

Biliary Tract Diseases↗
PubMed1976

A study of factors influencing drug disposition in chronic liver disease, using the model drug (+)-propranolol.

The pharmacokinetics, following i.v. administration of (+)-propranolol (40 mg) have been compared to in vitro measurement of protein binding and biochemical parameters of liver function in six normal subjects and twenty patients with stable chronic liver disease. The clearance of (+)-propranolol decreased with evidence of increasing severity of impairment of liver function correlating significantly with a fall in serum albumin, a rise in bilirubin and a prolongation in prothrombin index. The clearance of (+)-propranolol correlated with and was numerically similar to the clearance of indocyanine green in normal subjects and also in patients with chronic liver disease. Protein binding was decreased in chronic liver disease, but this change was not related to changes in plasma proteins. In normal subjects and patients without ascites the volume of distribution increased with decreases in protein binding. Ascites was associated with a further increase in the volume of distribution. The considerable variation in half-life largely depends on changes in liver blood flow, the degree of protein binding and the plasma protein pool size.

Adult↗
PubMed1976

Intravenous administration of diazepam in patients with chronic liver disease.

The EEG response and drug kinetics after intravenous infusion of diazepam at 1-0 mg/min until nystagmus, dysarthria, and moderate sedation developed, has been investigated in five normal subjects and 17 patients with chronic liver disease. Diazepam induced adequate premedication with a similar clinical response in all subjects with no adverse reactions. Maximal response was during or within five minutes of infusion. The dose of diazepam required in liver chronic disease was 17-9 +/- 1-4 mg (M +/- SEM) compared with 27 +/- 5-4 mg in controls (p less than 0-01). Dose correlated significantly with serum albumin (p less than 0-05). Baseline mean dominant frequency (MDF) and slow wave index (SWI) significantly correlated with albumin (p less than 0-01). After diazepam, the MDF decreased and SWI increased. The change was greatest at the time of maximal clinical response. It was greater in liverdisease and was greatest in patients with previous hepaticencephalopathy. In spite of reduced dose requirements in liver disease, there was no significant difference in plasma concentration at the end of drug infusion...

Chronic Disease↗
PubMed1976

Positive skin reactions to gluten in coeliac disease.

Following intradermal challenge with a peptic-tryptic digest of gluten, visible Arthus-type skin reactions were observed in 33 per cent of a group of 55 adults with coeliac disease. Of the 23 with untreated disease positive skin reactions occurred in 52 per cent. There was an invariable association between serum gluten antibodies and the presence of a skin reaction to gluten, indicating that gluten antibody combination with gluten in the skin provides the basis of the skin response. Since no false positive reactions were found in 52 normal controls, skin testing with gluten may provide a useful adjunct to the diagnosis and management of coeliac disease, especially in the outpatient department.

Adult↗
PubMed1975

Detection of continuing gluten ingestion in treated coeliac patients.

To assess the incidence and effects of continuing gluten ingestion in coeliac disease 51 adult coeliac patients were studied after four to 132 (mean 63) months on a prescribed gluten-free diet. Each patient completed a prospective dietary questionnaire, underwent a repeat jejunal biopsy, and gave serum for gluten antibody estimation. Altogether 65% of patients were still ingesting gluten, often inadvertently. Direct questioning on dietary habits had failed to uncover most of this consumption. The gluten antibody test proved a useful screening test for detecting continuing gluten ingestion and patients with both persistent subtotal villous atrophy and gluten antibodies were almost certain to be taking large amounts ( more than 2 g/day). The presence of persistent partial villous atrophy was found, however, to be an unreliable guide to gluten intake.

Adolescent↗
PubMed1975

Polyposis in ulcerative colitis.

One hundred and fifty cases of ulcerative colitis were assessed by total colonoscopy with multiple biopsies. Inflammatory polyposis was found in 25 (17%) cases and six of these had a large (greater than 1-5 cm) solitary polyp which radiologically resembled carcinoma in four cases. Adenomatous polyps were discovered in four cases. Three carcinomas were found at endoscopy, of which two were entirely unsuspected. In all cases endoscopic polypectomy or surgical intervention was performed to establish the exact histological diagnosis.

Colectomy↗
PubMed1975

Antibodies to double-stranded (native) DNA in active chronic hepatitis.

Sera from 36 patients with active chronic hepatitis were studied for the presence of antibodies to double-stranded (native) DNA. These antibodies are a specific antinuclear antibody previously shown to have a high degree of specificity for systemic lupus erythematosus. Fifteen of the 36 patients (42%) were found to have levels of antibody usually only reported in systemic lupus erythematosus and higher than those seen in a control population. Anti-DNA antibodies were not found in a group of 22 patients with other forms of liver disease.

Antibodies, Antinuclear↗
PubMed1975

The immune response of phiX 174 in man. III. Evidence for an association between hyposplenism and immunodeficiency in patients with coeliac disease.

The ability of patients with coeliac disease to produce primary and secondary antibody in response to a new antigen has been tested. Eight patients with coeliac disease were injected intravenously with the coliphage phiX 174. Antibody levels were measured throughout the primary response. On day 28 a second injection was given and the secondary response was also studied in detail. The production of antibody in the primary response is lower than in a group of normal subjects. The secondary response is severely reduced and the difference between the coeliac group and controls is highly significant. The secondary response in the coeliac patients contains a much higher proportion of IgM antibody than normal. These abnormalities correlate approximately with clinical status and with hyposplenism. It is concluded that in patients with coeliac disease the ability to produce antibody is impaired, with a defect in switching from IgM to IgG antibody.

Adult↗
PubMed1974

Medium chain triglycerides and hepatic encephalopathy.

The oral administration of short (C(6)) and medium (C(8) and (C(10)) chain triglycerides produced no clinical or electroencephalographic changes in patients with cirrhosis of the liver. Arterial ammonia levels were also monitored in these patients and showed no significant change after medium chain triglycerides. It was concluded that medium chain triglycerides, known to be of potential value in the treatment of malabsorption in patients with cirrhosis, are not clinically contraindicated, even in patients with evidence of hepatic encephalopathy.

Ammonia↗
PubMed1974

Evaluation of colloidal bismuth (De-Nol) in the treatment of duodenal ulcer employing endoscopic selection and follow up.

A double-blind, placebo-controlled trial of colloidal bismuth (De-Nol) was performed on 20 patients with active duodenal ulceration employing endoscopic selection and follow up after a treatment period of 28 days. By these means it was shown that healing of ulcers was significant in those patients treated with the active compound. In addition a greater number (9/10) of patients treated with colloidal bismuth showed symptomatic improvement than those receiving placebo (6/10) but this difference did not reach statistical significance. The results of endoscopic and symptomatic assessment of the patients receiving colloidal bismuth were in complete agreement although there was a poor correlation between these results in those receiving the placebo. This supports the results from a previous study that endoscopic assessment of duodenal ulcer healing provides a more objective assessment than do clinical methods.

Acid-Base Equilibrium↗
PubMed1974

Radioimmunoassay of cholecystokinin-pancreozymin.

A sensitive and specific radioimmunoassay for cholecystokinin-pancreozymin (CCK-PZ) has been developed, using rabbit antisera to crude porcine hormone. Highly purified porcine CCK-PZ, labelled with (131)I, and repurified by column chromatography on Sephadex G15, was used as tracer. Separation of free from antibody-bound labelled CCK-PZ was carried out using charcoal, ion-exchange resin, or a double antibody procedure. Non-specific interference with the assay system by serum factors was abolished (as judged by in-vitro and in-vivo recovery studies) by boiling and diluting the serum samples before assay. Ninety-nine per cent pure porcine CCK-PZ (standard), commercial CCK-PZ preparations, caerulein, the C-terminal 8- and 12-amino acid fragments of the CCK-PZ molecule, and endogenous human CCK-PZ all cross reacted in the assay system and showed parallel inhibition curves. No significant cross reaction was found with gastrin, secretin, glucagon, or insulin. The sensitivity of the assay is approximately 5 pg per ml of test solution, which proved adequate for measuring physiological levels of CCK-PZ in peripheral blood in man.The mean immunoreactive CCK-PZ concentration in 50 fasting normal subjects was 60.4 pg per ml. The distribution of individual values was skewed, however, so that the median was much lower (30 pg per ml). Older subjects had higher fasting levels of CCK-PZ than were found in young adults.

Adult↗