Biomedical subjects
Publications and source records attributed to B H Novis.
The effect of intravenous and intramuscular administration of diazepam on secretin- and cholecystokinin-stimulated pancreatic secretion was studied in man. Diazepam was not found to have a significant effect on mean volume out-put, bicarbonate and enzyme concentrations and colour index. It was acceptable as premedication for routine pancreatic function studies.
Urgent fibre-optic panendoscopy was performed in 400 patients within 24 hours of their admission to hospital for upper gastro-intestinal haemorrhage. The cause of bleeding was established by endoscopy in 87%. No cause was found in 10% and endoscopy failed in 3%. Twenty-five per cent of the patients had an additional lesion which was not the cause of bleeding. Complications owing to endoscopy occurred in 2% of the patients. Only 27% of the patients still had blood present in the stomach at the time of endoscopy. Chronic gastric ulcer was causative in 22%, and duodenal ulcer in 20% of the patients. Haemorrhagic gastritis accounted for 13%, Mallory-Weiss tear for 8%, acute ulceration for 5% and varices for 4% of the patients. Only 60% of the patients with dyspepsia were bleeding from peptic ulcers and only 64% of the patients bleeding from ulcers had a history of dyspepsia. Follow-up studies revealed that endoscopy, in experienced hands, is an accurate investigation which allows for an improved approach to management, and which probably also reduces the mortality rate.
The clinical and pathological features of 17 "Western" type primary abdominal lymphomas (WTL) are compared with 14 of "Mediterranean" type (MTL). The MTL involved only young adult Mulatto and African patients in whom malabsorption and abdominal pain were the major clinical features. The WTL also predominantly affected Mulatto patients but four cases occurred in Caucasians, and the mean age at presentation was two decades later. An obstructive presentation was the most common; only one patient in this group had evidence of malabsorption. The WTLs were located mainly in the distal small bowel and were nearly all of monomorphic lymphocytic or histiocytic type. The MTLs were sited mainly in the duodenum and jejunum and were of an unusual pleomorphic histologic type. A spectrum of cells from those resembling atypical lymphocytes to large histiocytic types were seen, some of the latter resembling Reed-Sternberg cells. The pattern of mesenteric node infiltration in the MTLs was also unusual in that preservation of the medullary sinuses was a common finding. A notable feature of the MTLs was the presence of a heavy infiltration of mature-looking plasma cells associated with a fairly severe villous atrophy in the lamina propria of the small bowel. In the WTLs the adjacent small bowel did not show this feature. In addition to the above cases three patients with a similar heavy plasma cell infiltrate and villous atrophy but without evidence of a lymphoma are described. These cases may represent examples of MTL in a pre-malignant phase. Also included in this study are three patients with alpha-chain disease (alpha-CD), all with a heavy plasma cell infiltration and villous atrophy of the lamina propria and a pleomorphic type lymphoma involving the mesenteric nodes in all, and the small bowel in two. The lymphomas in alpha-CD have been interpreted as immunoblastic sarcoma by Lukes and Collins. Both genetic and environmental factors may be operative in the MTLs including the cases of alpha-CD.
The value of emergency upper gastrointestinal fibre-endoscopy, followed where required by the use of a modified Sengstaken tube, was studied during 84 episodes of acute bleeding in 75 patients who had evidence of portal hypertension with varices. The portal hypertension was due to alcoholic cirrhosis in 80% and to cryptogenic cirrhosis in 9% of the patients. By definition, varices were present in all patients, but in only 66% of episodes were the varices the cause of the bleed. The correct diagnosis of the source of bleeding was made at endoscopy in 89%. A Boyce modification of the Sengstaken-Blakemore tube was passed in 73% of the episodes of variceal bleeding. It effectively stopped the bleeding primarily in 85% of patients but was successful as a final definitive measure only in 46%. Furthermore, only 40% of the patients in whom the tube was passed, survived. Mortality rate could be related to the severity of the bleed and to hepatocellular dysfunction. Survival increased from 23% in those patients with jaundice, ascites, and encephalopathy on admission to 92% in those without these manifestations. The in-hospital survival rate was 52% in patients bleeding from varices and 64% in those bleeding from other causes, with an overall survival rate of 56%, indicating the poor prognosis in cirrhotic patients with gastrointestinal bleeding, irrespective of the cause.
Gastroscopic and colonoscopic polypectomy by means of a diathermy snare has been carried out on 23 patients, without any significant morbidity. The techniques and potential complications are discussed, and it is concluded that endoscopic polypectomy is a safe and rapid procedure in experienced hands, if close attention is given to detail and if the necessary precautions are taken.
110 patients with proven chronic pancreatitis have been studied to assess the prevalence of the various Pi phenotypes of alpha1-antitrypsin in this disease compared with a control group of 116 blood-donors. The phenotype PiMZ (including Mweak) was significantly more prevalent and PiMM significantly less so in the patients with pancreatitis. It is possible that a heterozygous deficiency of this protease inhibitor renders the pancreas more vulnerable to aetiological agents (e.g., alcohol).
In the period 1970-1974, 45 patients with Crohn's disease were seen. The incidence of the disease seems to be increasing. Twenty-nine of the patients were White, and 16 Coloured. The disease involved the small bowel alone in 9 patients, the ileocaecal region in 17, the large bowel alone in 4 and both the small and the large bowel in 15. Alone or in combination, abdominal cramps and diarrhoea were the commonest modes of presentation. The type of therapy used is discussed. Only 10 patients in this study have not as yet required surgery. Salazopyrin, steroids, antibiotics and azathioprine have been used with varying success in the treatment of most of the patients. Crohn's disease has a high degree of morbidity, but a low mortality rate.
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Pancreatic volume, bicarbonate and enzyme secretion were studied after sequential and after simultaneous secretin and cholecystokinin (CCK) stimulation and the results compared. No statistical difference between sequential or simultaneous stimulation was noted. A comparison of secretin alone with simultaneous secretin plus cholecystokinin stimulation showed that the combination yielded a significantly higher trypsin concentration. Volume and bicarbonate were unchanged.
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One hundred and seventy-six students free of gastrointestinal disease were studied to establish normal acid secretion values for healthy male and female students by the augmented histamine test and to re-examine the relationship between gastric acid secretion and ABO blood groups, body weight, fat-free body mass, height, degree of ectomorphy and mesomorphy, the number of cigarettes smoked per day, and serum cholesterol. A prospective study was then carried out on gastric acid secretion and the subsequent development after 10 years of duodenal ulcers or dyspepsia.Young, healthy medical students have a fairly high mean basal and maximal acid output. There was very little difference in the mean acid outputs of the various ABO blood groups. A significant correlation was shown between acid output and body weight and fat-free body mass, but not with the other measurements of body build. Basal acid output was also related to the number of cigarettes smoked per day. Three students who subsequently developed duodenal ulcers all had a preexistent high level of acid secretion. The acid output was, however, similar in the groups who developed significant or minor dyspepsia or who remained asymptomatic.