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Biomedical subjects

A Ferguson

Publications and source records attributed to A Ferguson.

At least 109 records · Page 6Linked to original sources
PubMed1994

Low bone mineral density in Crohn's disease, but not in ulcerative colitis, at diagnosis.

BACKGROUND/AIMS: The pathogenesis of low bone mineral density in patients with inflammatory bowel disease is unclear, and the relevance of secondary osteopenic influences is controversial. Our aim was to study bone mineral density in newly diagnosed patients. METHODS: Bone mineral density and biochemical parameters of bone metabolism were measured in 15 patients with Crohn's disease and 15 patients with ulcerative colitis, all of whom were newly diagnosed. Lumbar and forearm bone mineral densities were measured by dual energy x-ray absorptiometry, and Z scores were obtained by comparison with age- and sex-matched normal values. Twenty-three patients had repeat measurements 1 year later, and 20 had received systemic steroids. RESULTS: At diagnosis, the mean Z score for patients with Crohn's disease (spine, -1.06 +/- 0.86; forearm, -1.04 +/- 0.86) was significantly lower than that for patients with ulcerative colitis (spine, -0.03 +/- 1.16; forearm, 0.11 +/- 1.24). Inflammatory activity, disease localization, body mass index, smoking habits, sex, physical activity, or biochemical parameters did not account for this difference. Spine and forearm Z scores were significantly correlated. Mean Z scores after 1 year were not significantly different from initial Z scores. CONCLUSIONS: At diagnosis, low bone mineralization is a feature of Crohn's disease but not ulcerative colitis. Treatment with corticosteroids did not result in further bone loss in 1 year.

Adolescent↗
PubMed1994

Child accident prevention as a health promotion issue--how extensive is the problem and how far have A & E departments responded to the recommendations made?

Accidents to children are always a source of concern to any health care professional. Despite the wealth of evidence that suggests many of these accidents are preventable, the numbers of deaths and long-term disability have remained fairly constant. It would appear that only if all agencies and authorities who have a responsibility for the health and safety of children work closely together, to educate those caring for children, enforce legislation and pressure governments to improve the child's environment, will a dramatic reduction in accidents be achieved. Despite this, the Health of the Nation document looks solely towards an educational approach aimed at the general public with no apparent thought as to the effectiveness of this strategy.

Accident Prevention↗
PubMed1994

Dose-response studies of depletion and repopulation of rat intestinal mucosal mast cells after irradiation.

The effects of radiation on gut mucosal mast cells (MMC) and tissue eosinophils were examined. Groups of rat were given single doses of whole-body irradiation from 0.5 to 5 Gy. Serum rat mast cell protease II (RMCPII) concentration showed a significant dose-dependent fall after 1 Gy on day 3 and 1.5 Gy on day 7. MMC counts and tissue RMCPII values on day 7 decreased significantly by 70% after 1 Gy and were undetectable with larger doses. Rat with normal and expanded MMC populations were irradiated or given anaphylaxis. Serum RMCPII concentrations did not change after irradiation, but there was a 10-fold increase in RMCPII after anaphylaxis. Tissue eosinophils in jejunum were 50% of control at 7 days after 2 Gy, and this effect was progressively more marked with higher doses. Similar effects on MMC and eosinophils were demonstrated in ileum, ascending colon and rectum. After 4.5 Gy, repopulation of the gut with MMC did not occur until week 3-4 postirradiation and MMC counts were still 50% below those of controls at 5 weeks postirradiation. Counts of tissue eosinophils 5 weeks after 4.5 Gy irradiation had returned to control levels in jejunum but were still significantly depleted in colon. These experiments show that the high radiosensitivity of rat intestinal MMC is dose dependent, similar at four different levels in the gastrointestinal tract and does not lead to immediate release of granule protease; repopulation with MMC does not begin until at 3 weeks postirradiation.

Anaphylaxis↗
PubMed1994

Use of whole-gut lavage to measure intestinal immunity in healthy Sierra Leonean children.

In view of the potential roles of intestinal immunodeficiency and hypersensitivity in the infection/diarrhea/malnutrition cycle, we need a safe and ethical method to study intestinal immunity of children in the developing world. Work in adults has shown that the fluid obtained by whole-gut lavage (WGLF), essentially a gut perfusate, can be used to assess intestinal immunity, inflammation, and gut losses of protein and blood. Gut lavage was successfully performed in 24 of 25 "normal" children aged 6-9 years, from Freetown, Sierra Leone, with parental informed consent. WGLF was treated with protease inhibitors, stored at -20 degrees C, and transferred to Edinburgh for laboratory studies. These showed that no child had occult blood loss but four had evidence of protein-losing enteropathy. Compared with values for Scottish adults, WGLF from the Sierra Leonean children had significantly higher concentrations of IgA and IgM and of IgA and IgM antibodies to dietary antigens and to Salmonella typhi lipopolysaccharide. In three children, very low levels of IgA and IgA antibody were present: Two of these were the only cases with detectable sIL2R in lavage fluid, indirect evidence of intestinal T cell activation; tumor necrosis factor was not detectable. Substantial information on childrens' intestinal immunity can be obtained by the method described.

Antibodies, Bacterial↗
PubMed1994

Evaluating the purpose and benefits of continuing education in nursing and the implications for the provision of continuing education for cancer nurses.

In the light of increasing emphasis upon mandatory continuing education in nursing, the need for cancer nurses to update and improve their knowledge and skills is heightened. The challenges lie in how to keep nurses up-to-date, broaden their outlook and ensure that patients benefit. In this paper the literature on the purpose and benefits of continuing education is reviewed, and the implications of the Post-Registration Education and Practice Project (PREPP) for cancer nurses are addressed. Arguments about a definition of 'continuing learning' rather than 'continuing education' are discussed, since outcomes vary depending upon the definition adopted. Inconsistencies between the benefits claimed and those measured are highlighted. Attention is drawn to the inconclusive nature of the studies that have measured impact; some of the problems encountered in the provision of adequate education and its accessibility to nurses; and the continuing discrepancy of perceived need between nurse and manager. Specific impact evaluation studies relating to continuing education in cancer nursing are reviewed. Recommendations for providing education with measurable outcomes are drawn from the literature, while a case is made for the alternative perspective of lifelong learning where outcomes are neither specific nor measurable. In conclusion, the questions of who should be responsible for education and the need for further development of impact evaluation tools are addressed.

Education, Nursing, Continuing↗
PubMed1994

Immunological functions of the gut in relation to nutritional state and mode of delivery of nutrients.

Gut immunology encompasses the need for local cellular immunity and prevention of systemic immune reactions to dietary antigens. The relation between these factors and nutritional state or the presence of luminal nutrients in the enterally fed and parenterally fed is poorly defined. Most studies suggest that acquisition of lymphoid characteristics is independent of luminal nutrition and its responsiveness is related more to bacterial challenge. Protein malnutrition may impair immune responsiveness by moderating the generalised inflammatory response, rather than through reduced T cell function and IgA synthesis. Predisposition to the development of gut hypersensitivity can be induced in animals by longterm feeding with elemental diets. The efficient absorption of these diets reduces the caecal microflora burden and together with changed gastric acid secretion and small bowel motility, may affect the composition of the gut flora. Changed luminal nutrition, enhanced tissue damage and inappropriately increased mucosal T cell function may thus be related. The clinical effectiveness, however, of elemental diets in treatment of unresponsive coeliac disease is reassuring. To investigate intestinal immunity in humans, an approach based on whole gut lavage has been developed. Data from this non-invasive human technique will prove to be a useful means of assessing the effects of nutritional rehabilitation on mucosal immunity.

Animals↗
PubMed1994

Intestinal antibody pattern of coeliac disease: association with gamma/delta T cell receptor expression by intraepithelial lymphocytes, and other indices of potential coeliac disease.

Patients with coeliac disease have IgM antibodies and IgA anti-gliadin antibody in gut secretions, and also high counts of intraepithelial lymphocytes (IEL) that express the gamma/delta T cell receptor. These features of intestinal immunity may be markers of latent coeliac disease. Their occurrence was examined in 77 patients referred for jejunal biopsy, in whom biopsy histology was normal, to establish the extent to which these, and other candidate markers (high total IEL count, serum IgA anti-gliadin antibody (AGA), and increased permeability) coexist in the same patient. Twelve patients had high serum anti-gliadin antibody titres and nine increased permeability. The gamma/delta IEL count was high (> 5.5 per mm villus epithelium) in nine patients, the intestinal antibody pattern was positive in 21, and the total IEL count was high (> 40 per 100 enterocytes) in 13. Overall, 31 patients had positive indices, but in 19 only a single test was abnormal. High gamma/delta IEL counts were found in six of 21 intestinal antibody positive patients, but in only two of 56 who were intestinal antibody negative (p < 0.001); there were no other significant associations. Clinical tests of gluten sensitivity will be required to establish the prevalence of latent gluten sensitive enteropathy in the 40% of patients referred for jejunal biopsy in whom one or more of the immunological indices of potential coeliac disease is present.

Adolescent↗
PubMed1994

Morbidity of juvenile onset inflammatory bowel disease: effects on education and employment in early adult life.

Seventy young adults (50 with Crohn's disease (CD) and 20 with ulcerative colitis (UC) (from a geographically derived cohort of patients with juvenile onset inflammatory bowel disease were interviewed and examined at a mean of 14 (range 5.2-29.5) years after diagnosis. Details of education and employment were collected as part of a structured clinical interview. Although 57% had had periods of absence from school of two months or more, their school examination pass rates were similar to those of the healthy population. The achievements of CD patients were consistently better than those of the UC group. In 15 patients, relapses of inflammatory bowel disease had adversely affected examination performance or prevented them from sitting school examinations. Extra tuition in hospital had been provided for only four patients, and three others had had privately arranged tuition at home. Fifty per cent proceeded to full time higher education. At the time of review, seven patients were full time students, one was a university research fellow, 47 were in full time and three in part time employment, one was self employed, four were housewives, and only six were involuntarily unemployed. All four unemployed CD patients attributed this to inflammatory bowel disease, but other factors were relevant in the unemployed UC patients. Few had direct evidence of rejection by employers on health grounds, though some did not declare their illness to prospective employers.

Adult↗
PubMed1994

Analysis of disease distribution, activity and complications in the patient with inflammatory bowel disease.

Management strategies in Crohn's disease and ulcerative colitis should be based on up-to-date information on disease distribution, extent, activity and complications. A system of structured analysis is suggested, with separate consideration of destructive ulceration, inflammatory activity and other factors. Direct investigation of gut immunity by using whole gut lavage fluid (WGLF) is a valuable new technique of clinical investigation in IBD and related disorders. Recent studies have shown that the concentrations of plasma-derived proteins in WGLF provide objective measures of disease activity; and that this activity is a separate phenomenon from destructive ulceration and fibrosis. Neutrophils in the lumen can be in- investigated by cytology, or by assay of neutrophil elastase in WGLF. Cytokines and other immuno-regulatory mediators can also be detected. These new techniques can provide a description of intestinal immunity and inflammation, based on a non-invasive test of 2-4 h duration. Work in progress shows that patients who respond clinically to elemental diet treatment have unusually high concentrations of soluble IL2 receptor in WGLF; cytokine profiles may facilitate the selection of patients suitable for other new treatment modalities.

Child↗
PubMed1993

The oral motor development of low-birth-weight infants who underwent orotracheal intubation during the neonatal period.

OBJECTIVE: To investigate the potential development of oral motor problems following prolonged orotracheal intubation in low-birth-weight infants. DESIGN: Prospective observational. SETTING: Tertiary-care hospital. PATIENTS: Fifty-one low-birth-weight infants and 10 full-term infants divided into three groups--group 1 with 15 low-birth-weight infants (< or = 1250 g) who had been intubated for more than 1 week; group 2 with 36 low-birth-weight infants who had been intubated for 1 week or less; and group 3 with 10 full-term control infants. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Oral motor assessments of nutritive sucking were compared at corrected ages of term and 3 months. The results showed that low-birth-weight infants with prolonged intubation had significantly poorer sucking abilities at both term and 3 months. The number of days of oxygen use and the postnatal age (weeks) at which nipple feeding was begun were the most powerful predictors of sucking ability at term (P < .001), whereas the number of days of orotracheal intubation and gestational age at birth were the most powerful predictors of sucking ability at 3 months (P < .001).

Apgar Score↗
PubMed1993

Gut lavage fluid protein concentrations: objective measures of disease activity in inflammatory bowel disease.

BACKGROUND: Fluid obtained by whole gut lavage normally contains traces of immunoglobulin (Ig) G, albumin, and alpha-1-antitrypsin; higher concentrations have been found in patients with inflammatory bowel disease (IBD). METHODS: In a prospective study, 53 lavages were performed in 45 IBD patients (27 Crohn's disease, 18 ulcerative colitis), in whom disease activity was simultaneously assessed by Crohn's Disease Activity Index or Powell Tuck index. Concentration of IgG in lavage fluid was measured by enzyme-linked immunosorbent assay, and of albumin and alpha-1-antitrypsin by immunoturbidimetry. RESULTS: For IgG, concentrations in lavage fluid correlated closely with activity indices: in Crohn's disease, r = 0.723 (P < 0.0001), in ulcerative colitis, r = 0.714 (P < 0.0001). Results for albumin and alpha-1-antitrypsin concentrations were similar to those for IgG, but they were less sensitive in detecting active disease. However, this method cannot be used as a diagnostic test for IBD; normal results were obtained for IgG in 6 (all inactive) of 42 lavages in patients who had unequivocal radiological or endoscopic abnormalities. CONCLUSIONS: Assay of protein concentrations in gut lavage fluid is a simple, objective means of grading disease activity in patients with IBD; its potential uses are likely to be in the evaluation of complex cases and in clinical trials.

Adult↗
PubMed1993

Intestinal antibody pattern of celiac disease: occurrence in patients with normal jejunal biopsy histology.

BACKGROUND: Patients with celiac disease have immunoglobulin (Ig) M antibodies and IgA antigliadin antibody in gut secretions; this pattern of intestinal immunity may be a marker of latent celiac disease. Its frequency in patients referred for jejunal biopsy has been examined. METHODS: Serum IgG and IgA antigliadin antibody, jejunal fluid IgA and IgM antibodies to gliadin, ovalbumin and beta lactoglobulin, and jejunal fluid IgA and IgM concentrations were measured by enzyme-linked immunosorbent assay. RESULTS: Seventeen of 19 celiac patients on normal diet and 16 of 23 on gluten-free diet had the celiaclike antibody pattern, as did 41 of 217 other patients. Jejunal biopsy histology had been classified as normal in 38 of these, with minor abnormalities in 3; however, intraepithelial lymphocyte (IEL) counts were high in 13 cases. Trial of a gluten-free diet produced clinical improvement in 6 of 7 antibody-positive patients. After extra dietary gluten, one developed subtotal villous atrophy. CONCLUSIONS: The celiaclike intestinal antibody pattern and a high IEL count may be markers of latent gluten-sensitive enteropathy; some of these patients are clinically gluten sensitive in the absence of enteropathy.

Adolescent↗
PubMed1993

Evaluation of canine small intestinal permeability using the lactulose/rhamnose urinary excretion test.

The use of the lactulose and rhamnose urinary excretion test was evaluated in dogs with gastrointestinal disease. Lactulose and rhamnose urinary excretion was measured in three groups of dogs: clinically healthy dogs and dogs with gastrointestinal disease with and without coexistent panhypoproteinaemia. A significant increase in both the percentage of lactulose:percentage of rhamnose urinary excretion ratio and the percentage of lactulose excretion was demonstrated in dogs with hypoproteinaemia when compared to the other two groups. The results suggest that the lactulose/rhamnose urinary excretion test may prove a useful adjunct to currently available tests for assessing small intestinal function, but lacks sensitivity in detecting small intestinal mucosal damage in the absence of villus atrophy.

Animals↗