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Biomedical subjects

A S Mee

Publications and source records attributed to A S Mee.

At least 19 recordsLinked to original sources
PubMed1990

Mucin depletion in inflammatory bowel disease.

The mucin and gland content of 26 rectal biopsy specimens--five normal specimens, 10 from patients with ulcerative colitis, and 11 from patients with Crohn's disease--were measured using a Quantimet image analyser. There was significantly less mucin in the groups with ulcerative colitis compared with either those with Crohn's disease or the normal controls. The difference in the gland content between the groups with ulcerative colitis and Crohn's disease and between the group with Crohn's disease and the normal controls did not reach significance. The results suggest that it is worth while assessing the mucin content of rectal biopsy specimens from patients with inflammatory bowel disease. In routine practice this assessment can be made by eye using a suitably stained section.

Colitis, Ulcerative↗
PubMed1987

Favourable response to conservative surgery for extra-pancreatic gastrinoma with lymph node metastases.

Five patients with the Zollinger-Ellison syndrome who had extra-pancreatic (duodenal or paraduodenal) gastrinoma with lymph node metastases responded favourably to simple excision or mere shelling out of macroscopic tumour. Acid studies, serum gastrin and the secretin test became normal in all cases in the immediate postoperative period and remained so in three of the five patients when tested at 57, 33 and 8 months. The tests became abnormal in two patients when tested 8 and 53 months after surgery, but both patients are currently well-controlled on ranitidine 150 mg b.d. 22 and 65 months respectively after surgery. These results suggest that in patients with extra-pancreatic gastrinoma who have lymph node metastases simple excision of all macroscopic tumours may offer the prospect of long-term control. The place of total gastrectomy in such patients is questioned.

Adolescent↗
PubMed1985

Small bowel biopsy for malabsorption: comparison of the diagnostic adequacy of endoscopic forceps and capsule biopsy specimens.

Biopsy specimens of the small bowel were obtained from 40 patients suspected of having malabsorption. Four different techniques were used at a single session--namely, endoscopic biopsy of the descending duodenum using paediatric and standard size forceps and suction capsule biopsy of the descending duodenum and the proximal jejunum. Specimens were compared for size, adequacy, and ability to confirm or exclude mucosal abnormality. Fourteen patients had villous atrophy. In all patients four biopsy specimens were obtained with paediatric endoscopic forceps and four with standard endoscopic forceps. No capsule biopsy specimen was retrieved from the duodenum in three patients and from the jejunum in five patients. Specimens were considered to be adequate in 36 patients when paediatric forceps were used, in 39 when standard forceps were used, in 28 on duodenal capsule biopsy, and in 32 on jejunal capsule biopsy. This study indicates that the most reliable method for diagnosing or excluding villous atrophy is endoscopic forceps biopsy of the descending duodenum, provided that at least four specimens are obtained with standard size forceps.

Adult↗
PubMed1985

Vitamin A therapy in patients with Crohn's disease.

Vitamin A therapy has been claimed in isolated reports to be of benefit to patients with Crohn's disease. To investigate this further, 86 patients were entered into a long-term double-blind study of vitamin A, 50,000 U twice daily, as compared with placebo. After a mean of 14.1 mo of treatment there was no significant difference between the groups as measured by a variety of activity indices (including the National Cooperative Crohn's Disease Activity Index), the number of acute attacks, and the surgical rate. No toxic effects of vitamin A were observed during the study. In this study vitamin A has not been shown to be of benefit to patients with Crohn's disease who are in remission.

Adolescent↗
PubMed1985

Comparison of the oral (PABA) pancreatic function test, the secretin-pancreozymin test and endoscopic retrograde pancreatography in chronic alcohol induced pancreatitis.

The oral (PABA) pancreatic function test (PFT), the secretin-pancreozymin test and endoscopic retrograde pancreatography (ERCP) have been carried out in 32 patients with suspected chronic alcohol induced pancreatitis (CAIP) in order to evaluate which, if any, test was most likely to confirm the provisional diagnosis. Thirty one patients had changes of minimal (n = 6) moderate (n = 7) or advanced (n = 18) chronic pancreatitis on pancreatography, whilst one patient had a pancreas divisum. Eight hour urinary PABA excretion was significantly reduced in patients with moderate and advanced structural changes (p less than 0.001) and correlated significantly with all parameters of the PFT, although eight patients with an abnormal pancreatogram and pancreatic function test had a normal PABA value. The PFT was abnormal in 23 patients, but normal in five patients with an abnormal pancreatogram and low PABA value. Most patients with minimal change pancreatitis had a normal PABA test and PFT. We conclude that pancreatography appears to be the most sensitive method for detecting chronic pancreatic damage and for confirming a clinical diagnosis of chronic alcohol induced pancreatitis. Both the PFT and PABA test are useful confirmatory tests and whilst the PFT is slightly more sensitive for assessing pancreatic exocrine function, the PABA test is well tolerated and simple to perform. It may therefore be the complementary investigation of choice for this group of patients.

4-Aminobenzoic Acid↗
PubMed1985

Plasma cell infiltration of the small bowel: lack of evidence for a non-secretory form of alpha-heavy chain disease.

Eight patients with diffuse plasma cell infiltration of the small bowel who had the clinical features of immunoproliferative small intestinal disease (IPSID), but whose serum was negative for free alpha-heavy chains, were investigated for evidence of a non-secretory form of alpha-chain disease (alpha-CD). Molecular sieving and immunoblotting of serum, immunoperoxidase staining of biopsy specimens, and in vitro protein synthesis studies utilising an immunoprecipitation technique and polyacrylamide gel electrophoresis, failed to detect any new cases of alpha-CD. Four of the eight cases were found to have diffuse intestinal lymphoma. The remaining four patients, who were unsuccessfully investigated for evidence of a significant abnormality in cellular immunity, have not developed detectable alpha-CD protein or lymphoma over a mean of 143 months. Despite continuing exposure to possible environmental stimuli, it is concluded that not all cases of IPSID elaborate detectable alpha-CD protein or evolve to lymphoma.

Adolescent↗
PubMed1985

Campylobacter colitis: differentiation from acute inflammatory bowel disease.

We describe 10 patients with campylobacter colitis who gave a characteristic history of an acute diarrhoeal illness, rectal bleeding and colicky abdominal pain. For the majority of patients the clinical and sigmoidoscopic features differentiated campylobacter colitis from acute inflammatory bowel disease. Where doubt remained, evidence of a specific antibody response to campylobacter enabled a presumptive clinical diagnosis to be confirmed.

Adult↗
PubMed1984

Long survival in a patient with alpha-chain disease.

A patient with evidence at presentation of alpha-heavy chain disease and an immunoblastic lymphoma is presented, who had remained in clinical, histologic, and immunologic remission for more than 12 years following initial radiotherapy and corticosteroids. The suggested management of this condition and its prognosis is discussed.

Adolescent↗
PubMed1984

Conservative surgery in the Zollinger-Ellison syndrome.

Laparotomy failed to show an obvious primary lesion in two patients with the Zollinger-Ellison syndrome (ZES), one of whom had metastatic gastrinoma in a solitary lymph node which was removed. Both patients underwent a truncal vagotomy and pyloroplasty. Postoperative acid studies have shown a marked and sustained diminution in acid hypersecretion which was particularly striking in the patient with a solitary metastatic lymph node. The patient without a detectable lesion is now well-controlled on half the dose of cimetidine required pre-operatively and the other no longer requires therapy. We believe that patients in whom pre-operative investigations have shown no evidence of extensive metastases should undergo laparotomy in the hope of finding a solitary primary or isolated metastatic lesions unassociated with an obvious primary in the pancreas. Available evidence suggests that simple removal of such lesions offers the patient an excellent chance of long-term remission. However, if no such lesion is discovered, vagotomy may be the logical procedure to assist in the subsequent pharmacological control of the acid hypersecretory state.

Adult↗
PubMed1983

Evaluation of an extended pancreatic function test in normal subjects and in patients with chronic pancreatitis.

Exocrine pancreatic response was evaluated in patients with varying degrees of pancreatic damage and in control subjects by means of an extended pancreatic function test (PFT). A second injection of secretin and pancreozymin was given after completion of the standard test. The discriminatory value of the standard PFT with regard to bicarbonate and enzyme output was not enhanced by a second bolus dose of hormones. It is concluded that the secretory potential of damaged pancreatic exocrine tissue cannot be exhausted by prolonged stimulation employing repeat bolus stimulation.

Adult↗
PubMed1983

Comparative study of pancreatic polypeptide (PP) secretion, endocrine and exocrine function, and structural damage in chronic alcohol induced pancreatitis (CAIP).

The serum pancreatic polypeptide response to intravenous Boots secretin (1.5 U/kg), glucose tolerance, and insulin responses have been studied in 25 patients with chronic alcohol induced pancreatitis of varying severity, and these results compared with a secretin-pancreozymin test, and the structural damage noted on pancreatography. For the pancreatic polypeptide response 16 healthy subjects acted as controls. There was a marked reduction in pancreatic polypeptide response in patients with advanced structural changes of chronic alcohol induced pancreatitis compared with patients with minimal/moderate changes (p less than 0.01) and with healthy controls (p less than 0.05) although there was no difference between the latter two groups. Similarly, while the ratio of peak to mean basal pancreatic polypeptide concentration was also significantly reduced in patients with advanced changes compared with healthy controls (p less than 0.05) there was a marked degree of overlap in patients with lesser degrees of structural damage and control subjects. For all patients with chronic alcohol induced pancreatitis, however, there was a significant correlation between the pancreatic polypeptide response and each parameter of the standard secretin-pancreozymin test and with glucose tolerance and the integrated insulin response. We conclude therefore that while the secretin stimulated pancreatic polypeptide response correlates significantly with accepted tests of pancreatic structure and function, there is a significant degree of overlap in the response obtained in patients who have minimal/moderate damage and healthy controls making the test insufficiently sensitive for routine diagnostic use.

Adult↗
PubMed1983

Changing concepts in the presentation, diagnosis and management of the Zollinger-Ellison syndrome.

Nine patients with the Zollinger-Ellison syndrome seen at a single referral centre between 1976 and 1981 are presented to highlight changes in the recognition, diagnosis and management of the condition. Less well recognized manifestations such as diarrhoea and features of the multiple endocrine neoplasia (MEN) type I syndrome are described, and the simplification of the pre-operative diagnosis by the use of both the serum gastrin estimation and the secretin provocation test considered. The problem of tumour localization is discussed with special reference to the newer techniques such as ultrasound, endoscopic retrograde cholangiopancreatography (ERCP) and CAT scanning, and the value of arteriography confirmed. The striking advances in management during the past few years are stressed with special reference to the role of the H2-receptor blocking drugs. Despite their profound inhibitory effect on both acid secretion and symptoms, all patients with the exception of those with proven metastases or the MEN type I syndrome underwent laparotomy to exclude a resectable lesion. If no resectable lesion was found truncal vagotomy was performed to facilitate acid secretory control post-operatively and H2-receptor blocking drugs continued in a dose necessary to maintain basal acid secretion under 5 mmol/hr.

Adolescent↗
PubMed1983

Immunoproliferative small-intestinal disease: follow-up of an alpha-chain negative, lymphoma-free group.

Six patients had the clinical and pathological features of immunoproliferative small-intestinal disease (IPSID). All were female with malabsorption or growth retardation in whom testing for alpha-heavy chains was repeatedly negative. They were followed for a mean of 7.5 years, during which time no significant alteration in the jejunal biopsy appearances of five patients has occurred, none have developed lymphomas.

Adolescent↗