Biomedical subjects
Publications and source records attributed to A N Smith.
A study comparing the effects of bran and ispaghula in constipated elderly patients is described. Ispaghula and bran increased the wet and dry stool weight. There were no serious side-effects and no change in colonic pressures. The use of these bulking agents is shown to be better than the traditional use of laxatives in the elderly.
The content of the rabbit colon has been examined and found to contain the secondary bile acid deoxycholate. Infusions of sodium deoxycholate stimulated colonic motor activity, but the infusion of the primary bile acid sodium glycocholate did not have this effect. Infusions of control amounts of distilled deionized water and isotonic saline were not followed by a significant change in motor activity. Histological damage was caused by 15 mmol.l-1 solutions but was not severe till above 24 mmol.l-1. The possibility that mucosal damage produced motor activity was discounted by the fact that this damage was also present in rabbits treated by sodium glycocholate with no observed motor response. It is postulated that the secondary bile acid, sodium deoxycholate, could have a role in the production of colonic motor activity in the rabbit.
Daily faecal calcium and magnesium outputs were inversely related to food-stimulated colonic intraluminal pressure in diverticular disease subjects. There was no relationship to sodium potassium and bile acid concentrations, nor to intestinal transit.
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A simulated retrospective exercise in the diagnosis and management of 53 readmissions to a gastrointestinal unit was undertaken by two consultants. Diagnosis of the illness at readmission was made on evidence sought from a referee, who also supplied, on request, items of relevant evidence from the past medical record. Patient management was agreed from these sources. For each item of evidence the evidential weight, the irrecoverability, and the expected benefit accruing to the patient of its availability was calculated. It was concluded that the evidence worth recording in the event of subsequent hospital admission could be largely specified for each diagnosis and each operation. It would be brief and could be numerically coded.
Weight, height, and head circumference measurements of 4,167 Spanish-surnamed school-aged children were compared with similar data from 2,322 non-Spanish surnamed children who resided in the same Denver, Colorado neighborhoods. These data were also compared with data from six other studies. Both male and female Spanish-surnamed children were found to weigh less, be shorter, and have smaller head circumferences than non-Spanish-surnamed children living in the same Denver neighborhoods. The sizes of the children in these two populations residing in lower and lower-middle class neighborhoods were closer to each other than to the sizes of children from middle and upper-middle socioeconomic classes as measured in previous studies or to the sizes of children in the recently published cross-sectional National Center for Health Statistics study. Such comparisons suggest that growth retardation is more a reflection of socioeconomic factors than of ethnic-genetic factors.
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Diverticular disease is thought to be associated with prolonged intestinal transit-time, a reduced stool weight, and increased intracolonic pressure. Sixty patients with diverticular disease did not regularly show these features. Variation in colonic function was considerable in these patients and was similar to that in the general population from which the patients were recruited. Constipation may be a complication of diverticular disease and not necessarily part of its aetiology.
Bran, ispaghula (Fybogel), and lactulose were given to three groups of patients with diverticular disease for four weeks. Faecal weights, bile acids, fat and electrolytes, transit time, and colonic motility were estimated before and after treatment. Stool weight increased, notably with Fybogel. Cereal bran had the greatest effect on the transit time, reducing it significantly. There were no changes in faecal bile acids, fat or electrolytes. Coarse bran reduced colonic motility and the number of high pressure waves after food; Fybogel increased the basal pressure and was without effect on the food-stimulated pressures; whereas lactulose influenced neither. All agents paradoxically equally alleviated symptoms.
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Colonic intraluminal pressure and intestinal transit were examined in diverticular disease, idiopathic constipation, and the irritable colon syndrome. Small bowel transit was normal. Total gastrointestinal transit was prolonged. Colonic transit showed an equal delay in all segments, expedited by bran. In constipation, transit was the more prolonged, but in the irritable colon syndrome, pressure was more affected. Diverticular disease patients showed features resembling each of these two groups. Pressure and transit showed an inverse relationship maintained after bran.
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Sterculia with and without a smooth-muscle relaxant (alverine citrate) had similar beneficial effects on constipation and reduced the transit times in diverticular disease. Intracolonic pressure, however, varied with the preparation used. Though both preparations relieved the symptoms of diverticular disease, the one containing alverine citrate was more effective. Part of the mode of action of bran may be to relax the smooth muscle of the gut, since its actions were more comparable to those of sterculia plus alverine citrate than to those of sterculia alone.