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Biomedical subjects

A Ferguson

Publications and source records attributed to A Ferguson.

At least 91 records · Page 5Linked to original sources
PubMed1995

Gut inflammation in children with cystic fibrosis on high-dose enzyme supplements.

We used a whole-gut perfusion technique to study subclinical gut inflammation in children with cystic fibrosis (18 elective tests, three lavages to treat distal intestinal obstruction syndrome); and in 12 control children with constipation or pre-colonoscopy. We assayed for haemoglobin, IgG, albumin, alpha-1-antitrypsin, granulocyte elastase, interleukin-1 beta (IL-1 beta) and IL-8 concentrations in whole-gut lavage fluid. Results for two children with distal intestinal obstruction syndrome, the only children in the series taking Nutrizym 22, were strikingly abnormal. This new test has revealed subclinical gut mucosal inflammation in a minority of CF children, for which distal intestinal obstruction syndrome, Nutrizym 22 treatment, or both, may be risk factors.

Adolescent↗
PubMed1995

Electronic quality of life questionnaires: a comparison of pen-based electronic questionnaires with conventional paper in a gastrointestinal study.

The use of pen-based electronic questionnaires and conventional paper questionnaires was compared in a randomized crossover study. Forty-six patients, aged 17-81 years, suffering from gastro-intestinal disorders, initially filled in a paper quality of life questionnaire for familiarization purposes, then on two subsequent visits completed electronic and paper questionnaires in randomized order. At the last visit they completed a preference survey. The results showed a high degree of acceptability of the electronic questionnaire, with 57% of patient preferring electronic and 13% preferring paper, while the remaining 30% expressed no preference. Neither age, gender nor familiarity with technology showed any marked association with patients' preferences. All patients found both paper and electronic questionnaires easy to use. Data were more complete on the electronic questionnaire (100%) than on the paper (99.1%). Data handling procedures were greatly simplified. These results show that major benefits in completeness of data, speed of data flow, and data handling workload can be obtained from the use of pen-based electronic questionnaires.

Adolescent↗
PubMed1995

Coeliac disease research and clinical practice: maintaining momentum into the twenty-first century.

Recent research shows that each word in the definition of coeliac disease, permanent gluten sensitive enteropathy, must now be reviewed, revised or reinterpreted. Permanent--but there are now well-documented cases of acquired disease, and perhaps also partial recovery of gut gluten tolerance. Enteropathy--gluten sensitivity is expressed in a spectrum, with a mild form seen as normal architecture with high count of intraepithelial lymphocytes. Gluten--the provoking agent--Investigators are intensively working to identify the precise toxic sequence, and to establish how this will link in with new genetic information. Mechanism of sensitivity? or hypersensitivity?--Critical to this is new knowledge on the modulation and regulation of immunity to intestinal antigens, including gliadin. A hypothesis is presented, as to the pathogenesis of gluten-sensitive enteropathy, which combines concepts of oral tolerance and of the regulation of expression of delayed type hypersensitivity reactions in the gut mucosa.

Celiac Disease↗
PubMed1995

Successful Helicobacter pylori eradication incorporating a one-week antibiotic regimen.

BACKGROUND: The optimum regimen for the eradication of Helicobacter pylori remains unclear. The aim of this study was to determine the efficacy and tolerability of omeprazole 40 mg daily given for 2 weeks, plus amoxycillin 500 mg t.d.s. and metronidazole 400 mg t.d.s. given for the first 7 days, in the treatment of H. pylori associated peptic ulcer disease. RESULTS: One hundred and thirty-two consecutive patients with peptic ulcer disease were entered into the study (89 male, 41 female; median age 47 years; inter-quartile range: 36-58 years). H. pylori was eradicated successfully in 109 of 130 patients (intention-to-treat: 83%; 95% confidence limits: 76-89%); per protocol: 85% (95% CI: 78-91%)). Ninety per cent of patients completed the full course of therapy. Only four patients (3%) stopped treatment as a result of side effects although these occurred in 41% of patients. One patient developed pseudomembranous colitis requiring hospital admission. CONCLUSION: Omeprazole combined with one week of treatment of amoxycillin and metronidazole is an effective and well tolerated Helicobacter eradication regimen. Occasional severe side effects remain a risk, even when the duration of antibiotic exposure is reduced.

Adult↗
PubMed1995

House dust mite allergen levels in two cities in Canada: effects of season, humidity, city and home characteristics.

The homes of 120 patients with asthma, 57 in Vancouver and 63 in Winnipeg, were studied. The characteristics of the homes were assessed by a questionnaire. Dust samples were collected and the indoor relative humidity was measured four times during the year covering all four seasons in both cities. Mite allergen levels were determined using monoclonal antibodies against Der p I and Der f I by the ELISA method. The mean levels of both mite allergens in mattress and floor samples in the homes in Vancouver and in Winnipeg were relatively low for all seasons. Mite allergen levels were found to be associated with city, season and individual home differences. They were significantly higher in Vancouver than in Winnipeg. Der p I and Der f I in mattress samples in both cities and Der f I in floor samples in Vancouver, varied by season. The indoor relative humidity level in the homes in Vancouver were also significantly higher than those in Winnipeg. There was, however, no significant association between the levels of indoor relative humidity and the levels of mite allergens after adjusting for variations in city, season and individual home. Although individual home differences were highly associated with mite allergen levels, only a few home characteristics were found to be related to mite allergen levels such as the type and the age of the home, the type of heating, the use of feather pillows and the number of occupants in the homes. Whether low levels of mite allergens are partially responsible for the relatively low prevalence of childhood asthma in Canada remains to be investigated.

Allergens↗
PubMed1995

Technical report: results of immunological tests on faecal extracts are likely to be extremely misleading.

Clinical investigation of gut immunity is difficult because of the need to study intestinal tissues or secretions directly. Others have reported that immunoglobulins, antibodies and cytokines can be detected in saline extracts of faeces. We have assessed the validity of this approach by measuring immunoglobulins, albumin, alpha 1-antitrypsin and isotype-specific antibodies in matched samples of faeces and whole gut lavage fluid. Results were compared as estimated output per day, and by using haemoglobin as a common reference substance. Samples were obtained from 10 patients with active inflammatory bowel disease and 10 with other benign GI diseases. For immunoglobulins, albumin and antibodies, the amount detected in faeces varied from < 0.01% to 35.5% (based on estimated daily output) and < 0.01% to 18.5% (based on haemoglobin) of the amount known to be produced in the gut from results of assays on whole gut lavage fluid (WGLF); there were significantly higher rates of recovery in faecal specimens from patients with active gut inflammation than from other patients. Detection rates and titres of specific antibody in faeces were even lower than those for immunoreactive IgA. These data indicate that immunological tests on saline extracts of faeces do not represent the true status of the gut humoral immune system, and such studies should be strongly discouraged.

Adult↗
PubMed1995

Mite and cat allergen levels in homes and severity of asthma.

The relationships between mite and cat allergen levels in the home, skin test reactivity, and severity of asthma were explored in 120 asthmatic subjects, 57 in Vancouver and 63 in Winnipeg. Patients in the two cities were similar in age, gender distribution, and severity of asthma. Skin tests were performed using 13 common allergens, including D. pteronyssinus, D. farinae, and cat dander, as well as control subjects. Patients recorded their asthma symptoms, medication requirement, and twice daily peak expiratory flow rate for 1 yr. Dust samples were collected every 3 mo during each season of 1992 through 1993 in both cities. Mite and cat allergen levels were determined with an ELISA using monoclonal antibodies against Der p I, Der f I, and Fel d I. There was no relationship between skin test reactivity and levels of mite and cat allergens. In children with positive skin tests to either mite allergen, total mite (sum of Der p I and Der f I) allergen level was positively related to the mean daily symptom score and negatively related to the daily mean PEF (% of predicted). There was no such relationship among adult asthmatic patients with positive skin tests to either mite allergen. No relationship was found between cat allergen level and the severity of asthma.

Adult↗
PubMed1995

Major cat allergen (Fel d I) levels in the homes of patients with asthma and their relationship to sensitization to cat dander.

BACKGROUND: Exposure and sensitization to the major cat allergen, Felis domesticus allergen I (Fel d I), significant causes of allergic respiratory disease. Many patients who are allergic to cats, however, do not own a cat and there is not an obvious source of allergen in their home environment. OBJECTIVE: We investigated the levels of Fel d I in dust from homes of 120 subjects with asthma in two climatologically diverse Canadian cities (Vancouver and Winnipeg). Fel d I levels were related to exposure to cats as well as to skin reactivity to cat dander. METHODS: Dust samples from bedroom floors and mattresses were collected in four different seasons and Fel d I content was determined by 2-site monoclonal antibody based-ELISA. RESULTS: Although only 18 patients (15%) were cat owners, detectable levels of Fel d I were found on at least one occasion in all homes. The geometric mean concentration of Fel d I on floors was 1.15 micrograms/g of dust (range 0.07 to 26.3 micrograms/g) and on mattresses 0.89 micrograms/g (range 0.01 to 17.4 micrograms/g). Seasonal variation of Fel d I levels was only observed in Winnipeg, where Fel d I concentrations were highest in the winter and spring compared with either summer (P < .05) or autumn (P < .005). The highest Fel d I levels were found in homes with a cat (P < .05), however, rather high levels were also found in homes of patients who did not have a cat but visited others with cats. Cat dander was the most frequent sensitizer (60%) in these patients but no correlation was found between the size of the wheal induced by cat dander extract and Fel d I levels in dust samples. CONCLUSION: Cat allergen was universally found in homes of asthmatic patients and this may explain the high frequency of cat sensitization among patients with asthma in these two cities. A seasonal variation in cat allergen was observed in Winnipeg with no variation in Vancouver.

Adolescent↗
PubMed1995

Mechanisms in adverse reactions to food. The gastrointestinal tract.

Application of strict diagnostic criteria to celiac disease has led to the realization that there is a wide clinical spectrum within this disease. Normally there are immune reactions to dietary proteins, particularly secretory antibodies of IgA class, low titers of serum antibody and specific down-regulation of IgE and T cell reactivity (oral tolerance). From time to time, abnormal immunity to foods, either as inappropriately high titers of antibodies or qualitatively altered responses, produce disease. Lactase deficiency, with dose-related lactose and milk-intolerance, occurs in 50-90% of most populations. White, western Europeans are the exception.

Food Hypersensitivity↗
PubMed1995

Investigation of neutrophil migration into the gut by cytology of whole gut lavage fluid.

OBJECTIVE: Radiolabelling studies have shown that neutrophils migrate into the gut lumen in inflammatory intestinal diseases. We aimed to establish whether whole gut lavage fluid can be used to investigate intestinal neutrophilia. DESIGN: A prospective single centre study comparing inflammatory bowel disease patients, patients with other gastrointestinal diseases and normal controls. METHODS: Gut lavage with a polyethylene glycol-based solution was performed in 56 patients (29 with inflammatory bowel disease). Gut lavage fluid samples were collected when the rectal effluent was clear. Cells were then separated by density gradient centrifugation, counted, and cytospin preparations examined. RESULTS: High cell counts (> 3.7 x 10(5)/ml), predominantly neutrophils, were present in 12 out of 29 inflammatory bowel disease patients and in two out of 27 others. High cell counts and luminal neutrophilia characterized active ulcerative colitis and active colonic Crohn's disease, but not active small bowel Crohn's disease, or inactive disease. CONCLUSION: Whole gut lavage fluid samples can be used to investigate luminal inflammatory cells. We observed previously unrecognized differences between small bowel and colonic Crohn's disease using this method. The mechanisms of neutrophil migration into the gut lumen may differ with disease distribution.

Cell Count↗
PubMed1994

Juvenile onset inflammatory bowel disease: height and body mass index in adult life.

OBJECTIVE: To establish the frequency of permanent growth failure in juvenile onset inflammatory bowel disease. DESIGN: Measurement of height and weight in a geographically based cohort at a mean of 14 (range 5.2-29.5) years after diagnosis. Comparison with data from surveys of British adults in 1980 and 1987. SETTING: NHS hospitals throughout Scotland. SUBJECTS: 105 Children admitted to hospital during 1968-83 who fulfilled diagnostic criteria for Crohn's disease or ulcerative colitis and lived in specified regions. 87 were aged over 18 and living in Britain at follow up. MAIN OUTCOME MEASURES: Height, weight, body mass index, and sexual maturity. RESULTS: All patients were sexually mature. 67 of the 70 patients examined were of normal height, and three women with Crohn's disease were abnormally short. Weight and body mass index were normal in all patients with ulcerative colitis. Patients with Crohn's disease had significantly lower weight than those with ulcerative colitis (men 66.8 (9.5) kg v 78.4 (13.8) kg, P = 0.04; women 51.5 (8.2) kg v 63.0 (12.1) kg, P < 0.02) irrespective of disease activity. Body mass index was also significantly lower than the normal distribution (P < 0.01). Growth retardation was not mentioned as a problem for any of the 17 patients interviewed only by telephone. CONCLUSIONS: Despite growth retardation in the teenage years most young people with inflammatory bowel disease will eventually achieve normal height. Reasons for lower weight in patients with Crohn's disease remain to be established.

Adult↗
PubMed1994

Pathogenesis of acute radiation injury to the rectum. A prospective study in patients.

In a prospective investigation of the clinical and pathological effects of pelvic radiotherapy on the rectum, nine patients (age range 58-77 years) had symptoms assessed weekly during radical treatment for bladder and prostatic tumours, and at 2, 4 and 12 weeks after treatment. Stool frequency increased in all patients from a mean of 1.7 per day before treatment to 5.0 per day at 4 weeks (P < 0.05). Seven patients developed liquid stools during treatment; 6 had pain on defaecation, 8 had urgency of defaecation, all experienced tenesmus and 3 had episodes of faecal incontinence. One patient had symptoms of such severity that treatment was interrupted. Virtually all symptoms had resolved by 12 weeks after treatment. Sigmoidoscopy with biopsy of anterior and posterior rectal walls was performed before treatment began, at 2 weeks and 4 weeks during treatment, and 4 and 12 weeks after treatment. All patients during treatment had evidence of acute inflammatory damage with hyperaemic, oedematous mucosa and failure of healing of biopsy sites. Histological examination of the rectal biopsies revealed the well described characteristic mucosal changes with crypt cell damage, inflammatory cell infiltrate and loss of crypts. In 2 of 7 cases studied, pathology was still abnormal at 3 months. Radiation injury to bowel is an underemphasised cause of morbidity and further prospective studies are required to determine methods of reducing normal tissue damage and ameliorating symptoms.

Aged↗