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Biomedical subjects

A Millar

Publications and source records attributed to A Millar.

53 records · Page 3Linked to original sources
PubMed1993

Hepatitis C infection by polymerase chain reaction in alcoholics: false-positive ELISA results and the influence of infection on a clinical prognostic score.

Antibody to hepatitis C as measured by the ELISA method is common in alcoholics. The presence of antibody to C 100-3 has been associated with more advanced disease. However, few studies have investigated the clinical significance of hepatitis C infection as defined by the presence of circulating viral RNA in alcoholics. We have prospectively examined 48 consecutive alcoholic patients for the presence of antibody to hepatitis C by an ELISA for antibody to the C100-3 antigen and by the reverse transcriptase polymerase chain reaction (PCR) using nested primers for the 5' nontranslated region of the viral RNA. Patients with liver disease were scored for disease severity by the combined clinical and laboratory index (CCLI). Overall, 12 of 48 patients (25%) were ELISA positive and eight of 48 (16%) were PCR positive. Among the 34 patients with liver disease, 10 (29%) were ELISA positive and six (18%) were PCR positive. All PCR-positive patients were also ELISA positive. There was no significant difference in the disease severity score (CCLI) or the duration of clinical disease in PCR-positive versus PCR-negative patients with liver disease. However, PCR-positive patients were significantly younger (43 +/- 6 vs. 55 +/- 10 yr, p = 0.001), indicating an earlier onset of severe disease in PCR-positive patients. There were no false-negative ELISA tests in either those with or those without liver disease. Among the 34 patients with liver disease, four of 10 patients with positive antibody were negative by PCR. Neither individual immunoglobulin levels (IgG, IgM, IgA) nor total globulins were significantly different between the ELISA-positive/PCR-negative patients and ELISA-positive/PCR-positive patients. When the entire group of 34 patients with liver disease was considered, we could not detect a significant correlation between ELISA absorbance and total globulins, and only a weak correlation between absorbance and immunoglobulin G (p = 0.49). These data show that the majority of alcoholic patients with liver disease and positive antibody to hepatitis C also have demonstrable viremia by PCR, and may require further evaluation and treatment. Elevated immunoglobulins in these patients do not correlate strongly with ELISA absorbance for anti-HCV. The presence of clinically advanced disease at a significantly younger age in the PCR-positive group is consistent with the concept of synergy between active viral infection and alcohol abuse in the development of liver disease in alcoholic patients.

Alcoholism↗
PubMed1991

Brainstem vascular accidents and cranial arteritis.

Cranial Arteritis (Giant Cell Arteritis) is a clinical diagnosis supported by a raised erythrocyte sedimentation rate (ESR) and if required confirmed by a temporal artery biopsy. This case reports on an unusual presentation where a delay in the diagnosis resulted in visual impairment, illustrating the need for awareness of diagnosis in acute strokes in the elderly.

Aged↗
PubMed1991

Antibody to hepatitis C is common among patients with alcoholic liver disease with and without risk factors.

Thirty-seven patients with clinically suspected alcoholic liver disease were retrospectively studied for the prevalence of antibody to hepatitis C virus (HCV) by enzyme-linked immunosorbent assay (ELISA) and immunoblot assay. Twenty-four had biopsy-proven cirrhosis. Nineteen had identifiable risk factors for non-A, non-B viral hepatitis, and 18 did not. Five of 19 high-risk (26%) and 6 of 18 low-risk (33%) patients had positive antibody, compared with two of 179 healthy blood donors (p less than 0.01 for either group of alcoholics compared with blood donors). Nine of 11 ELISA-positive patients were also either positive or indeterminable by immunoblot testing. Histologic scores for parameters commonly associated with chronic viral hepatitis were numerically worse among anti-HCV-positive patients, but none reached statistical significance. Clinically, seven of 11 (64%) of anti-HCV-positive patients versus 14 of 26 (54%) anti-HCV-negative patients were Child's class C. Among the 21 Child's class C patients, seven (33%) were anti-HCV-positive versus four of 16 (25%) of Child's class A/B patients. A weak correlation between IgG and ELISA optical density was observed (r = 0.52). We conclude that antibody to hepatitis C by ELISA and immunoblot is common among alcoholics with liver disease even in the absence of known or suspected risk factors for viral hepatitis. Although hepatitis C-positive patients tended to have more severe histologic disease, neither histologic parameters nor clinical findings were adequate to predict antibody seropositivity.

Adult↗
PubMed1991

Highly selective vagotomy--a safe operation for duodenal ulcer. Immediate and long-term complications and sequelae in 500 patients.

The safety and efficacy of highly selective vagotomy were assessed in a prospective series of 500 patients who underwent the operation during a 15-year period. There was no peroperative or immediate postoperative mortality. None of the 22 late deaths was attributable to the operation. In six cases complications prolonged the hospital stay beyond 21 days, requiring a second laparotomy in four. The rate of ulcer recurrence was 18.5% by 15 years. Bloating was the commonest long-term complication (8.8%), but half of these patients regarded the operation as successful. Less common were dumping (5.4%), diarrhoea (3.8%) and gastric stasis (1.4%). Revisional surgery was performed on 37 patients--for recurrent ulcer in 28, for gastric stasis in seven and for perforation in two. Although almost 20% of the reviewed patients continue to require regular or frequent medication, the study shows that highly selective vagotomy can be therapeutically effective for duodenal ulcer, particularly in preventing haemorrhage and perforation in patients who have previously suffered these complications. Above all it is a safe operation with low long-term morbidity.

Adolescent↗
PubMed1990

Highly selective vagotomy 5-15 years on.

Highly selective vagotomy for duodenal ulcer was performed on 307 patients between 1973 and 1983 without operative mortality. Of these, 283 (92.2 per cent) were followed up prospectively for a minimum of 5 years. Recurrent ulcer was diagnosed in 49 (17.3 per cent). The recurrent ulcer rate increased from 13.2 per cent at 5 years to 19.4 per cent at 12 years. Age, length of history, previous haemorrhage or perforation and preoperative acid output were not associated with increased risk of recurrent ulceration. The risk in men and smokers was higher but not significantly so. The recurrence rate for individual surgeons varied from 5.3 to 25.6 per cent. Failure of healing with H2-receptor antagonists was not associated with a higher recurrent ulcer rate. Patients with a strong family history (more than one first degree relative affected) had a significantly higher recurrence rate (33.2 per cent at 10 years) than those without (13.5 per cent at 10 years). Of the 49 recurrent ulcer patients, 30 (61.2 per cent) required either an operation or regular H2-receptor antagonists. Of the 250 patients (81.4 per cent) available in 1988 for review of symptoms 5-15 years after operation, 5.4 per cent had dumping, 8.9 per cent epigastric pain, and 11.8 per cent heartburn every day or most days. H2-receptor antagonists were required by 10.7 per cent of patients on a frequent or regular basis. Of 239 patients who answered the question, 218 (91.2 per cent) felt that their symptoms had been cured or greatly improved and 203 (84.9) considered the operation a success. Despite the high recurrence rate, the operation was successful in controlling ulcer symptoms in around 90 per cent of patients and produced postvagotomy symptoms--none severe--in around 5 per cent of patients.

Adolescent↗
PubMed1990

Inflammatory response, neutrophil activation, and free radical production after acute myocardial infarction: effect of thrombolytic treatment.

Activated neutrophils releasing proteolytic enzymes and oxygen free radicals have been implicated in extending myocardial injury after myocardial infarction. Neutrophil elastase was used as a marker of neutrophil activation and the non-peroxide diene conjugate of linoleic acid was used as an indicator of free radical activity in 32 patients after acute myocardial infarction; 17 were treated by intravenous thrombolysis. Patients with acute myocardial infarction had higher plasma concentrations of neutrophil elastase and the non-peroxide diene conjugated isomer of linoleic acid than normal volunteers or patients with stable ischaemic heart disease. Patients treated by thrombolysis had an early peak of neutrophil elastase at eight hours while those who had not been treated by thrombolysis showed a later peak 40 hours after infarction. The plasma concentration of non-peroxide conjugated diene of linoleic acid was highest 16 hours after the infarction irrespective of treatment by thrombolysis. Quantitative imaging with single photon emission tomography showed decreased uptake of indium-111 labelled neutrophils in the infarcted myocardium (as judged from technetium-99m pyrophosphate) in those who had received thrombolysis, suggesting a decreased inflammatory response. The results indicate increased neutrophil activation and free radical production after myocardial infarction; they also suggest that thrombolysis does not amplify the inflammatory response and may indeed suppress it.

Adult↗
PubMed1990

Impact of H2-receptor antagonists on the outcome of treatment of perforated duodenal ulcer.

One hundred and eighty-five patients were perforated duodenal ulcer were treated at one hospital over the 21-year period which straddled the introduction of H2-receptor antagonists. Of these 107 had simple closure, 58 simple closure with immediate H2-receptor antagonists and 20 immediate definitive surgery. The overall operative mortality rate was 5.4%. The rate of subsequent definitive surgery declined significantly in the years after the introduction of H2-receptor antagonists. Only a minority of those who came to subsequent definitive surgery had done so within the first year, the percentage rising from 16% at 1 year to 43.7% at 10 years. Of the patients treated by simple closure alone, 44.3% had subsequent definitive surgery compared with 24.1% having H2-receptor antagonists in addition, but this difference was not statistically significant using life table analysis. Review of the 104 patients available in 1989 showed no significant differences in symptoms between the treatment groups. The only preoperative predictor of subsequent definitive operation was non-steroidal anti-inflammatory drug consumption which showed a negative correlation. A 3-month history of dyspepsia before perforation did not predict the need for subsequent surgery. The symptomatic results in a different group of patients who had undergone highly selective vagotomy subsequent to a previous perforation were no different from patients treated by simple closure alone or with immediate prescription of H2-receptor antagonists. Bloating, however, was significantly more common after highly selective vagotomy. We believe that perforated duodenal ulcer should be treated by simple closure.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1988

Imipenem-cilastatin in the treatment of respiratory infections in patients with chronic airways obstruction.

Chest infections with organisms resistant to conventional antibiotics are common in patients with chronic lung disease. We have studied the use of imipenem in 40 (28 M 12 F) patients admitted for treatment of chest infections. Patients were treated with imipenem 0.5 g four times daily by intravenous infusion for 6.3 +/- 1.6 (S.D.) days. Forty-six respiratory pathogens were cultured from 36 patients including 18 Haemophilus influenzae, 6 H. parainfluenzae, 6 Streptococcus pneumoniae, 8 Pseudomonas aeruginosa, and 6 Branhamella catarrhalis. Forty-three of the 46 isolates were sensitive to imipenem, 28 to ampicillin, 33 to tetracycline and 35 to cotrimoxazole. Thirty-eight of the 40 patients improved clinically, and 34 of the 36 patients with positive sputum culture had no pathogens in their sputum after treatment. Twenty patients developed minor phlebitis at the infusion site but there were few other side effects. Imipenem may prove useful in the treatment of chest infections, particularly when the organism is resistant to conventional antibiotics.

Adult↗
PubMed1988

Altered lung vascular permeability during intermittent haemodialysis.

Hypoxia is known to develop during intermittent haemodialysis. To investigate if increased pulmonary capillary permeability to protein contributes to this phenomenon, a dual-isotope technique using Indium-labelled transferrin and Technetium-labelled red blood cells was used. Lung vascular permeability was measured in eight patients with dialysis-dependent chronic renal failure immediately before and during intermittent haemodialysis with cuprophane membranes. As a group there was a significant increase in lung vascular permeability during the early stages of haemodialysis, compared to predialysis values (P less than 0.05) and this increase occurred during the period when the patients were leucopenic and maximally hypoxic. During the haemodialysis period, but not the predialysis period, the permeability index was also significantly increased compared to a group of eight controls (P less than 0.05). These results suggest that increased vascular permeability may contribute to dialysis-induced hypoxia and that this may relate to neutrophil activation within the pulmonary vascular bed.

Adolescent↗
PubMed1988

Time course of the effects of epoprostenol on effective pulmonary blood flow in normal volunteers.

1. Epoprostenol (prostacyclin) has been widely used as a vasodilator, but its effects on cardiac output are controversial and the time course of its effects little studied. 2. We report its cardiovascular effects in doses of 5 and 10 ng kg-1 min-1 in six healthy volunteers. 3. Each of the two doses caused a mean 20% rise in effective pulmonary blood flow and a 15% rise in heart rate. These effects appeared to reach a maximum within 10 min of starting or increasing the rate of infusion, with no evidence of a rebound effect. 4. When the dose was reduced, heart rate and effective pulmonary blood flow appeared to reach a new steady state within 5 min of reducing or stopping the infusion. Only minor side-effects were encountered, and they were rapidly reversed on stopping the drug. 5. These results should be applied to the therapeutic use of epoprostenol as a vasodilator, particularly when titrating the optimum dose for a given individual.

Adult↗
PubMed1982

Alternative medicine: cost and subjective benefit in rheumatoid arthritis.

Seventy-eight patients with seropositive rheumatoid arthritis were asked about money spent in an attempt to help their arthritis. This included expenditure on alternative medicine, aids for the home, and conventional medicine. Most money was spent on, and most benefit was derived from, aids for the home. Sixty per cent of the patients had tried alternative medicine, but expenditure on this was relatively low and only a small proportion found it helpful.

Arthritis, Rheumatoid↗