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Biomedical subjects

C B Williams

Publications and source records attributed to C B Williams.

At least 145 records · Page 8Linked to original sources
PubMed1985

Histological diagnosis of chronic inflammatory bowel disease in childhood.

One hundred and four children were initially assessed by clinical, radiological, and endoscopic criteria as chronic inflammatory bowel disease. All were assessed independently using precise histological diagnostic criteria. Fifty eight patients were diagnosed as Crohn's disease, 25 as ulcerative colitis, 15 remained provisionally categorised as indeterminate colitis and six proved to be normal. Diagnostic granulomas were found in 36% of endoscopic biopsies from the 58 children with Crohn's disease. This appears to be an underestimate as only four of 14 children with granulomatous Crohn's disease operated on had granulomas on endoscopic biopsy. This study shows that there is a spectrum of histological appearances in endoscopic biopsies in chronic inflammatory bowel disease in childhood ranging from definite Crohn's disease to definite ulcerative colitis with indeterminate features in between. Accurate histological diagnosis of chronic inflammatory bowel disease is dependent upon either multiple endoscopic biopsies or assessment of a surgically resected specimen.

Adolescent↗
PubMed1985

Absent ileal uptake of IF-bound vitamin B12 in vivo in the Imerslund-Grasbeck syndrome (familial vitamin B12 malabsorption with proteinuria).

A Syrian family is described with three children who had inherited selective vitamin B12 malabsorption associated with proteinuria. (Imerslund-Grasbeck syndrome). Although inherited the defect was apparently not present at birth. A third child had less severe vitamin B12 malabsorption, was not vitamin B12 deficient and had no proteinuria. Studies on two of the affected children with subcellular fractionation of the uptake of radioactive vitamin B12 by ileal tissue in vivo indicate a defect in the ileal receptors for IF-bound vitamin B12. These findings are different from the single in vitro experiment on a patient with this condition that has been previously reported.

Adolescent↗
PubMed1985

The use of intravenous meptazinol for analgesia in colonoscopy.

A double blind study comparing intravenous pethidine and meptazinol has been performed to establish the efficacy and safety of meptazinol as an analgesic agent in colonoscopy. Twenty two patients received pethidine and 23 patients received meptazinol and no difference in analgesic effect or sedative effect could be demonstrated either by observer or patient assessment using a visual analogue scale. A group of 10 patients in the pethidine group and 9 in the meptazinol group had continuous recording of electrocardiogram, pulse rate and blood pressure throughout the procedure. Significant falls in both systolic and diastolic blood pressure were recorded in the pethidine group but not the meptazinol group. Benign cardiac arrhythmias were recorded in both groups before and after the administration of premedicant drug and 1 patient in each group had transient ST depression. Side effects were recorded with equal frequency in each group except for vomiting which occurred in 5 of 23 meptazinol patients but none of the pethidine patients. Meptazinol is an effective analgesic drug in colonoscopy which produces less cardiovascular depression than pethidine and thus may be useful in selected patients especially the elderly or those with known cardiovascular disease.

Azepines↗
PubMed1984

Carbon dioxide insufflation for more comfortable colonoscopy.

Forty patients examined with the use of carbon dioxide insufflation during fiberoptic colonoscopy showed no significant residual gas on plain radiographs taken 30 minutes after the procedure. By contrast, 19 of 20 patients examined with air insufflation showed excessive distension of large and/or small intestine. The rapid absorption of carbon dioxide may be a safety factor in a few patients and adds to the comfort of the procedure in many others by virtually eliminating overdistension afterwards. It also makes it technically possible to perform a barium enema immediately after colonoscopy.

Air↗
PubMed1984

Histopathology and prognosis of malignant colorectal polyps treated by endoscopic polypectomy.

The histopathological features and results of treatment of malignant polyps removed by endoscopic polypectomy from 60 patients are presented. The patients were followed for a minimum of five years. Forty six patients were treated by polypectomy alone as local excision was judged complete and the invasive carcinoma was well or moderately well differentiated. Thirty seven of these patients are alive and well after five years and the remaining nine have died of other causes up to four years later: there was no evidence of recurrence in any of these cases. Fourteen patients underwent a subsequent major surgical resection and residual tumour was found at the site of polypectomy in two cases but regional lymph nodes were not involved. Only one patient from this group with a high grade tumour developed metastases although the operative specimen was free of tumour. Malignant polyps can be successfully treated by polypectomy alone provided both the laboratory techniques of examination and the histopathological criteria are strictly applied.

Adenoma↗
PubMed1984

An unusual cause of variceal haemorrhage in an elderly patient.

An elderly patient with nodular regenerative hyperplasia of the liver and hypothyroidism who presented with life-threatening bleeding from oesophageal varices is discussed. Progress has been uneventful following a semi-emergency portocaval shunt 5 years ago with no evidence of hepatic encephalopathy. This is presumably a tribute to the relatively well-preserved hepatic function in this condition.

Aged↗
PubMed1984

A new therapeutic approach in fibrinolytic therapy: intracoronary streptokinase.

Although it is certain that thrombolytic therapy is effective in achieving reperfusion in an acutely thrombosed coronary artery, the ability of such restoration of flow to preserve myocardial function must be demonstrated. It must also be determined if the gains in contractile function are of sufficient magnitude to reduce morbidity and deaths after infarction. The patient population that can potentially benefit from this procedure is largely unknown. However, it is certain that the institution of thrombolytic therapy must begin in the early hours of acute infarction. The vast majority of patients with MI are cared for in hospitals that do not perform cardiac catheterizations. Thus the question of efficacy of intravenous fibrinolytic therapy is very important. Randomized clinical trials are already in progress and answers to important questions are forthcoming.

Coronary Angiography↗
PubMed1983

Cancer surveillance in ulcerative colitis. Experience over 15 years.

In the years 1966-80, 303 patients with radiologically extensive ulcerative colitis were followed up regularly, both by clinical assessment and by mucosal biopsies, to detect dysplastic (precancerous) change. Moderate or severe dysplasia (but no carcinoma) was found in the specimen in 8 patients treated surgically. Despite regular surveillance, carcinoma developed in 13 of the 186 patients with a history of disease for ten years or more. Of the total sixteen carcinomas in these 13 patients, eleven were Dukes stage A, three stage B, one stage C, and one was inoperable. There has been 1 death from carcinoma in this series over the fifteen year observation period. The method of follow-up has probably prevented the development of carcinoma in 8 patients and permitted diagnosis of carcinoma at a stage when cure is likely in 11. The incidence of moderate or severe dysplasia and carcinoma in these patients with mild or symptomless extensive colitis shows that either proctocolectomy or careful follow-up should be advised once the duration of symptoms reaches ten years.

Adult↗
PubMed1983

Multiple endoscopic polypectomies for schistosomal polyposis of the colon.

Endoscopic polypectomy alone dramatically reduced bowel frequency and colonic blood-loss in seven patients who had multiple schistosomal polyps which had persisted despite previous medical treatment. The disappearance of hypoproteinaemic leg oedema in five patients was associated with a corresponding rise in serum albumin. Up to 100 polypectomies could be performed during a single endoscopic examination. Multiple endoscopic polypectomy quickly improved the well-being of debilitated patients with schistosomal polyposis.

Adult↗
PubMed1983

Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies.

The diagnostic and therapeutic benefits of colonoscopy are well known but most large-scale surveys, especially those involving multiple centres, may underestimate the range and incidence of complications. The detailed records of 5000 colonoscopies in a specialist unit have been analysed and conclusions drawn which may help to make the procedure safer. The incidence of haemorrhage was 1% and bowel perforation 0.1%. All the major haemorrhages occurred during polypectomies over 2 cm in size. Secondary haemorrhage was an unpredictable occurrence, one to 14 days later. Three deaths followed colonoscopy: one cardiorespiratory death was related to oversedation; a second was due to mismanaged ischaemic colitis developing two days after traumatic instrumentation, and the third was due to peritonitis. Minor complications included thrombophlebitis, abdominal distension, and vasovagal episodes. Because of experience during the first half of the series and also due to improvements in instrumentation, the complication rate of the later part of the series was halved. Recommendations include the avoidance of oversedation, review of previous barium enema films so as to be aware of large polyps which are more likely to bleed, and the recognition of situations where perforation or septicaemia is likely to occur.

Adult↗
PubMed1982

A method for isolation and culture of lymphocytes from endoscopic biopsies.

Human small and large intestinal lamina propria lymphocytes have been successfully prepared from endoscopic biopsies by a combined enzymatic and mechanical method which gives higher yields of viable mucosal lymphocytes than previously reported, despite the small size of the biopsy samples. Viability of the cells was demonstrated by dye exclusion and they could be satisfactorily maintained in short-term culture. Phytohaemagglutinin-P (PHA-P) transformation characteristics of intestinal lymphoid cells and those of peripheral blood were studied in 20 patients with Crohn's disease and 10 control subjects. Peripheral blood lymphocytes were separated according to this technique, no decrease in viability being observed when compared to a standard Ficoll-Hypaque gradient technique. Endoscopically abnormal (EA) and endoscopically normal (EN) Crohn's tissue showed significantly different responses to PHA-P (P less than 0.001), EA tissue lymphocytes giving lower blastogenic responses.

Adolescent↗
PubMed1982

Colonoscopic diagnosis of minimal change colitis in patients with a normal sigmoidoscopy and normal air-contrast barium enema.

8 patients with normal sigmoidoscopic appearances and normal results by high-quality air contrast barium enema had substantial or total colitis diagnosed for the first time at colonoscopy performed within a month of the radiological examination. Colitis was confirmed in all 8 patients by histological examination of biopsy specimens. Barium enema radiographs were independently reviewed by three experienced observers who also reviewed other normal and abnormal radiographs. One observer regarded all 8 sets of radiographs from the patients with colitis as being of normal appearance, and 4 patients were reported as having normal radiographs by all three observers. All 7 of the rectal biopsy specimens taken showed histological features of inflammatory bowel disease. This emphasises the importance of performing a rectal biopsy in patients with gastrointestinal symptoms of unknown cause.

Adult↗
PubMed1982

Chronic inflammatory bowel disease in childhood.

The diagnosis of Crohn's disease in childhood has been facilitated by the use of fibreoptic endoscopy with biopsies, complemented by double-contrast radiology. Clinical suspicion leads initially to several relevant blood tests. These are followed by endoscopy and multiple colonic biopsies or barium follow-through studies depending on whether large-bowel or small-bowel disease is suspected. The present approach to diagnosis is based on corroborative investigative techniques-endoscopy, radiology, and histology, The availability of paediatric colonoscopes of small diameter should make it possible for paediatricians to perform limited examinations, but when more extensive endoscopy is indicated the child should be referred to special centres.

Child↗
PubMed1982

Neoplasia and ureterosigmoidostomy: a colonoscopy survey.

Patients who have undergone implantation of ureters into the sigmoid colon (ureterosigmoidostomy) are known to be at high risk of developing cancer of the colon many years later. The operation is often performed in infancy for congenital abnormalities of the bladder, thus creating a long term surveillance problem. Six of 34 patients (17.6 per cent) who had undergone ureterosigmoidostomy were found at a screening fibresigmoidoscopy to have adenomas of the left colon or severe dysplasia of the stoma, a mean interval of 22 years after their urinary diversion. Four other patients had previously had a sigmoid adenoma or cancer; thus, 29 per cent overall had developed colonic neoplasms, almost all closely related to their stomas. Another patient who, by error, was excluded from the surveillance, died of metastatic cancer of the sigmoid colon within the study period. Regular surveillance by fibresigmoidoscopy of patients who have had urinary diversion affords the opportunity to detect and remove potentially malignant sigmoid lesions. In addition to its clinical importance, it allows a closer study of this unique model of colon carcinogenesis.

Adenoma↗