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Biomedical subjects

A Ferguson

Publications and source records attributed to A Ferguson.

At least 73 records · Page 4Linked to original sources
PubMed1997

Circumventricular organs and fever.

We have examined the roles of three circumventricular organs, the area postrema, the subfornical organ, and the organum vasculosum of the lamina terminalis (OVLT), as possible access points for circulating pyrogens to cause fever. In conscious, unrestrained rats prepared with telemetry devices, intracerebroventricular cannulas, and intravenous catheters, body temperature was monitored after intravenously administered lipopolysaccharide and, on a different occasion, after intracerebroventricular prostaglandin E1. Lipopolysaccharide-induced fevers in sham control lesioned rats were indistinguishable from those observed in animals with lesions of the area postrema, the OVLT, or the tissue immediately adjacent to this structure (peri-OVLT). In contrast, rats with lesions of the subfornical organ displayed reduced fevers. In none of the groups of lesioned animals were prostaglandin E1 fevers reduced. Thus lesions did not interfere with central thermogenic pathways responsive to prostaglandin. Our results indicate that subfornical organ neurons respond to circulating pyrogens and through their efferent projections activate central pathways involved in fever.

Alprostadil↗
PubMed1996

Collaborating on the integration of cancer nursing services.

This article outlines the proposals contained in the Calman-Hine report (DoH 1995), and then presents the work of a nursing task group set up in response to its recommendations. The authors describe how different agencies collaborated in a network approach to improving the provision of cancer services.

Breast Neoplasms↗
PubMed1996

Transjugular intrahepatic portosystemic shunt as a treatment for protein-losing enteropathy caused by portal hypertension.

A case of a 41-year-old man with diarrhea, hypoalbuminemia, and cryptogenic cirrhosis with features of portal hypertension is described. Protein-losing enteropathy was confirmed by analysis of whole-gut lavage fluid, and intestinal inflammation and infection were excluded. Distal duodenal biopsy specimens showed evidence of edematous villi with prominent submucosal vascular and lymphatic vessels. A transjugular intrahepatic portosystemic stent-shunt was inserted, resulting in resolution of both his diarrhea and elevated whole gut lavage fluid protein concentrations. His symptoms recurred and then again improved after shunt thrombosis and parallel shunt placement, respectively. Histological improvement of the villous edema was also noted. This is the first recorded case of protein-losing enteropathy caused by portal hypertension confirmed by successful treatment with transjugular intrahepatic portosystemic stent-shunt.

Adult↗
PubMed1996

Effect of application of benzyl benzoate on house dust mite allergen levels.

BACKGROUND: Several acaricides have become available for reducing house dust mite allergen levels. OBJECTIVE: The purpose of this study was to assess whether the use of benzyl benzoate (Acarosan) provides additional benefit to the usual mite control measures including encasement of mattress and pillows with vinyl covers. METHODS: A randomized controlled trial was carried out in 26 homes (14 control versus 12 treatment) of asthmatic patients in two cities (Vancouver and Winnipeg). The control group had the usual house dust mite control measures including the use of vinyl covers for mattresses and pillows while the treatment group had application of benzyl benzoate to mattresses and carpets in the bedroom and the most commonly used room, in addition to the above control measures. Mite allergen levels were measured 3 months and immediately before, 1 week, and 1 and 3 months after the application of house dust mite control measures. Patients kept diary cards on asthma symptoms and peak expiratory flow rates morning and evening one month before and three months after the onset of mite allergen control measures. RESULTS: A reduction of mite allergen level was found in mattress samples in both groups, statistically significant at all times in the treatment group and at one and three months in the control group. Mite allergen levels on floor carpets also showed progressive reduction in both groups, but were significantly different in the treatment group (compared with controls) at 1 week, and were lower compared with baseline in the treatment group up to 3 months. No significant changes in asthma symptoms, peak expiratory flow rates, spirometric measurements, or bronchial hyperresponsiveness were observed among treatment or control group subjects. CONCLUSION: The addition of benzyl benzoate to conventional house dust mite control measures resulted in a significant reduction in floor carpet dust mite levels that persisted for 3 months. The results of this study should be confirmed in a larger and longer study.

Adult↗
PubMed1996

Mucosal immunology: from bench to the bedside and beyond.

This paper, written by the President of the Society for Mucosal Immunology, marks the 9th International Congress of Mucosal Immunology, in Sydney: Mucosal Solutions. Current molecular, cellular and animal work in mucosal immunity has great potential when applied to issues of human and animal health. However, practical and technical problems in the transfer of theoretical concepts into clinically based research must not be underestimated. Ideally, studies in disease need to be designed and run jointly by clinicians and scientists, as illustrated by examples drawn from Crohn's disease. Ethical aspects of research in mucosal physiology and disease are challenging, but not insurmountable.

Crohn Disease↗
PubMed1996

Strengths and limitations of the Crohn's disease activity index, revealed by an objective gut lavage test of gastrointestinal protein loss.

BACKGROUND: Several factors contribute to overall illness in patients with inflammatory bowel disease. The Crohn's disease activity index (CDAI), correlates closely with symptoms and is widely used to assess efficacy in clinical trials; previous work indicated that a gut lavage test for protein-losing enteropathy (PLE) may measure the same symptomatic, acute inflammatory component of overall inflammatory bowel disease illness. METHODS: Results of the protein-losing enteropathy test have been compared with the CDAI in 42 routinely presenting inflammatory bowel disease patients, and in 26 patients with ileostomies, eight children and five psychologically disturbed individuals with inflammatory bowel disease. RESULTS: For general adult patients with Crohn's disease or ulcerative colitis, concentrations of proteins in gut lavage fluid, particularly IgG, correlated well with CDAI. However, high CDAIs (> 150) were obtained in patients with fibrous small bowel strictures, in psychologically disturbed patients and also in five of seven patients in whom a provisional diagnosis of inflammatory bowel disease was subsequently shown to be wrong. In all these cases, normal values in the protein-losing enteropathy test reinforced the clinical judgement of a low probability of acute inflammatory activity of the inflammatory bowel disease. In the children, results of the protein-losing enteropathy test were positive in all cases; this was consistent with the clinical diagnosis, but CDAI values ranged from -66 to 275. In ileostomy patients, concentrations of IgG in gut lavage fluid discriminated well between groups judged, globally, to have either acute inflammatory activity or inactive disease, but there was no significant association with CDAI. CONCLUSIONS: These data confirm that, in most inflammatory bowel disease patients, the CDAI measures a true biological phenomenon which also causes gastrointestinal protein loss. However there are a number of situations where the CDAI in inappropriate or unreliable; for these, tests based on whole gut lavage, including the protein-losing enteropathy test, offer an alternative method to measure the efficacy of pharmacological and other anti-inflammatory therapies.

Adolescent↗
PubMed1996

Ability and dependency in adolescents with severe learning disabilities.

In order to investigate the abilities and care needs of adolescents with severe learning disability, the authors conducted structured interviews with parents/carers of 42 males and 29 females aged 11 to 25 years and attending a school or adult training centres in Salford, Manchester. 56 per cent of the subjects could talk in sentences and 82 per cent could walk. The ability to walk and talk well was associated with better social behaviour. Mean onset of shaving and of menarche was earlier in subjects with than without Down syndrome. Five of the females and two of the males had been abused sexually, 24 per cent of the males and 59 per cent of the females were thought by their parents to have received sex education.

Activities of Daily Living↗
PubMed1996

Coeliac disease and malignancies.

When compared with the general population, patients with coeliac disease (CD) have an increased risk of developing enteropathy-associated T-cell lymphoma (EATCL), esophageal and pharyngeal squamous carcinomas and small intestinal adenocarcinomas. The prevalence of histologically confirmed CD in Edinburgh and the Lothians in 1979 was 61 per 100,000. The National Health Service Central Records of all 653 subjects registered at that time have been flagged, allowing us to analyse mortality in CD. At a mean of 13.5 years, mortality overall was 1.9-fold that of the general population (115 deaths observed. 61.8 expected; p < 0.0001). For both sexes the early mortality was much greater than expected, but the excess steadily diminished with time from diagnosis. Much of the increased mortality from malignant disease was accounted for by deaths from lymphoproliferative disease and esophageal cancer. Interim re-analysis after a further 9 years shows that the pattern of later deaths is consistent with these trends. Clinical and pathological features of lymphomas in CD are described. In serum samples of 41 patients with normal villus architecture while taking a normal diet, but with minor pathological and/or immunological abnormalities, i.e. potential CD, IgA antiendomysium antibodies were positive in 7 with dermatitis herpetiformis but in only 3 others.

Cause of Death↗
PubMed1996

Use of whole gut perfusion to investigate gastrointestinal blood loss in patients with iron deficiency anaemia.

Iron deficiency anaemia may be due to occult bleeding into the gut. However, although clinical investigations may show a high frequency of gastrointestinal tract disease in these patients, the cause-effect relationship between the lesions detected and anaemia remain uncertain. This study aimed to establish whether lesions detected by endoscopy or imaging of the gastrointestinal tract in patients with unexplained iron deficiency anaemia are bleeding continuously. Routine clinical tests were performed in 42 patients with unexplained iron deficiency anaemia referred to this unit. Whole gut lavage and assay of haemoglobin in the gut perfusate were also performed. The main outcome measures were clinical diagnoses (by imaging and endoscopy of the upper gastrointestinal tract and colon); the concentration of haemoglobin in whole gut lavage fluid; and the calculated gastrointestinal blood loss per day. There were 73 clinical, dietary, or iatrogenic factors of possible aetiological importance in the 42 patients--poor diet (10), gross gastrointestinal abnormality (34 in 28 patients), malabsorption (14), coagulation problems (6), and NSAID use (9). The gut lavage test showed, however, that at the time the test was performed, only eight patients were losing more than 2 ml blood daily into the gut, including all four with colonic cancer, one with diffuse gastric vascular ectasia, and one with severe ulcerative oesophagitis. It is concluded that occult gastrointestinal bleeding sufficient to cause anaemia was evident in only 19% of 42 patients. There was a high frequency of other potential causes of iron deficiency in the remainder, suggesting that most of the gastrointestinal diseases and lesions detected in them were probably coincidental. Factors other than blood loss should be considered and treated in patients referred for anaemia assessment.

Adult↗
PubMed1996

Changes in peak flow, symptom score, and the use of medications during acute exacerbations of asthma.

Changes in symptom score and peak expiratory flow (PEF) and the use of medications during the first acute exacerbation of asthma were studied in 41 patients and matched controls who took part in a panel study. An acute exacerbation was defined as the presence of at least one of the following: any unscheduled physician visit, visit to an emergency room, or hospitalization for treatment of asthma; a decrease in PEF by 30% from the patient's best reading; an increase in asthma symptoms during the day and night for over 48 h and not responding to usual medications; and the commencement or doubling of the dose of oral or inhaled steroids for any of the foregoing reasons. Data from -9 to -7 d before the onset of an acute exacerbation were taken as the baseline data, with which the values of the subsequent 14 d were compared. Significant increases in symptoms occurred before a significant reduction in PEF. None of the patients had a decrease of more than 30% in PEF before the onset of symptoms. Daily variation in PEF was not significantly increased from the baseline. Our results suggest that PEF monitoring is not as sensitive as a symptom diary for revealing acute exacerbations of asthma, and that a 30% decrease in PEF is too stringent a criterion for defining an acute exacerbation.

Acute Disease↗
PubMed1996

Investigation of neutrophils in the gut lumen by assay of granulocyte elastase in whole-gut lavage fluid.

BACKGROUND: Intestinal neutrophils can be studied by radiolabelling techniques and by cytology of whole-gut lavage fluid. Our aim was to evaluate the use of a biochemical test for the presence of these cells in whole-gut lavage fluid. METHOD: Whole-gut lavage was performed by having the patients drink a polyethylene-glycol-electrolyte solution; the clear fluid passed per rectum after complete bowel cleansing had been collected. In 203 patients granulocyte elastase was assayed in sonicated unfiltered lavage fluid, using the specific enzyme substrate L-pyroglutamyl-I-prolyl-L-valine-p-nitroanilide. Free granulocyte elastase was also assayed in filtered (that is, cell-free) lavage fluid in 39 of the 43 patients in whom the enzyme was present in unfiltered fluid. In 47 of the patients, cells were also separated by density gradient centrifugation, and counted. RESULTS: Granulocyte elastase concentration correlated significantly with cell count (r = 0.80, p < 0.001). Granulocyte elastase concentration was high (> 100 nkat/l) in fluid from 25 of 68 inflammatory bowel disease patients and 6 of 135 others with radiation colitis, diverticulitis, pericolic abscess, and use of non-steroidal anti-inflammatory drugs. In patients with detectable total granulocyte elastase, cell-free granulocyte elastase was present in 11 of 29 with inflammatory bowel disease and 1 of 10 others. CONCLUSION: Whole-gut lavage fluid samples can readily be used to investigate luminal inflammatory cells.

Centrifugation, Density Gradient↗
PubMed1996

Direct assessment of gastrointestinal inflammation and mucosal immunity in children with cystic fibrosis.

Fibrosing colonopathy is a recently described complication of cystic fibrosis, of unknown aetiology but possibly related to treatment with high-dose pancreatic enzyme supplements. We have used a whole gut perfusion technique to study subclinical gut inflammation in cystic fibrosis patients; concentrations of haemoglobin, IgG, albumin, alpha-1-antitrypsin, granulocyte elastase, IL1 beta, and IL8 were measured in whole gut lavage fluid: 23 tests were performed in 17 children with cystic fibrosis (20 elective tests, three lavages to treat distal intestinal obstruction syndrome (DIOS)). None has had fibrosing or haemorrhagic colitis. There were 12 tests in control children with constipation or precolonoscopy. Moderately abnormal results were obtained for many of the parameters studied, in specimens from all the cystic fibrosis children; however there were no significant differences between tests on high-dose and low-dose enzyme supplements of the same brand in the five children who had duplicate tests performed electively. The lavage fluid specimens from two cystic fibrosis children were strikingly abnormal in all tests apart from haemoglobin and alpha-1-antitrypsin. These were two of the three children with DIOS, and were also the only cases in the series taking Nutrizym 22. These data suggest that the majority of cystic fibrosis children, including those on high-dose enzyme supplements, do not have clinically significant colitis, but that there is subclinical mucosal inflammation in a minority (two of 17 in this series), for which DIOS and/or Nutrizym 22 treatment may be risk factors. Alternatively, inflammation and dysmotility in the proximal colon may be directly produced by a drug or other agent, producing a clinical syndrome indistinguishable from DIOS. Tests for indices of inflammation in gut lavage fluid offer a new approach to the detection and measurement of iatrogenic intestinal and colonic injury.

Adolescent↗
PubMed1996

Gastric tonometry: evaluating tissue oxygenation.

Critically ill patients require vigilant monitoring of tissue oxygenation, particularly oxygenation of the gut mucosa, because of the mucosa's fragile blood supply. With the advent of gastric tonometry, splanchnic tissue oxygenation can be measured in a minimally invasive and cost-effective manner. Requiring only a gastric tonometer (approximately $70) and facilities to measure arterial blood gases, this method allows early detection of covert compensated shock by determining pHi. Thus, early intervention and correction of deficits in tissue oxygenation are possible and may improve patients' outcome.

Bias↗