Unilateral hyperhidrosis associated with underlying intrathoracic neoplasia.
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Aged↗
Biomedical subjects
C O Record
Publications and source records attributed to C O Record.
Plasmapheresis in acute liver failure.
A series of 9 patients with acute hepatic failure and Grade IV hepatic coma received daily plasmapheresis until they recovered or death ensued. Of the nine, seven (77%) showed an improvement in coma grade and five (55%) survived to leave hospital. Plasmapheresis significantly decreased serum bilirubin, aspartate aminotransferase and plasma ammonia concentrations. Survival following plasmapheresis appeared substantially better than in a non randomized group of similar patients not plasmapheresed. The simplicity of the procedure, biochemical improvements observed and apparent efficacy, suggest that further evaluation of the technique as a means of providing temporary hepatic support is indicated.
Hepatic Encephalopathy↗
Effect of isosorbide dinitrate, verapamil, and labetalol on portal pressure in cirrhosis.
The effects on portal pressure of the vasodilatory drugs isosorbide dinitrate and verapamil and of an alpha and beta blocking agent, labetalol, were assessed in 21 patients with cirrhosis and portal hypertension. The wedged hepatic venous pressure gradient (wedged minus free hepatic venous pressures) was used as an index of portal pressure and was not significantly changed by treatment with labetalol (n = 5) but was significantly decreased by verapamil (n = 6; p less than 0.05) and isosorbide dinitrate (n = 10; p less than 0.01). Long term administration of isosorbide dinitrate also had a significant effect (p less than 0.01).
Humans↗
Demonstration of pancreatic parenchyma by digital subtraction techniques during endoscopic retrograde cholangiopancreatography.
This paper reports the feasibility of using digital subtraction angiography techniques during endoscopic retrograde cholangiopancreatography to obtain greater detail of pancreatic structure. The pancreatic duct was filled in 23 of 27 cases attempted and in 17 cases parenchymal detail was obtained. Filling defects due to neoplasm were clearly defined and the changes of chronic pancreatitis visualised. The technique seems valuable for small lesions but may carry a higher risk of producing pancreatitis.
Acute Disease↗
Captopril in the hepatorenal syndrome.
Five patients with hepatorenal syndrome were treated with the orally active angiotensin-converting enzyme inhibitor captopril (25 or 50 mg 6 hourly) for up to 48 hours. Only one patient showed a significant increase in urinary sodium concentration (from less than 10 to 70 mmol/liter), but without associated diuresis; renal function continued to deteriorate in all patients with persistent oliguria and rising serum creatinine. The outcome was uniformly fatal. These results suggest that in the hepatorenal syndrome, captopril in standard dosage is without benefit, and provide further evidence that the changes in the renin-angiotensin system are probably secondary to reduced renal perfusion from some other cause.
Adult↗
Acute gluten challenge in treated adult coeliac disease: a morphometric and enzymatic study.
Using a Quinton hydraulic biopsy tube, jejunal biopsies were obtained from 10 patients with adult coeliac disease in remission and four healthy volunteers before and after administration of gluten fraction III into the proximal duodenum. The biopsies taken at hourly intervals for four hours, were analysed for changes in brush border enzymes, light microscopic appearances, and villous and crypt population counts. The results indicate that mucosal damage occurs within three to four hours of gluten administration with significant falls in brush border enzyme concentrations and villous population counts. The absence of any change in control biopsies indicates that gluten sensitivity is specific to the mucosa of patients with coeliac disease, the timing of the changes being consistent with a type III immune response or direct toxicity. Some recovery of the brush border enzymes but not the villous population was evident 24 hours after gluten administration while the crypt population showed evidence of a compensatory hyperplastic reaction.
Adult↗
The flexible sigmoidoscope.
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Colonic Neoplasms↗
Effect of intraluminal hydrocortisone on solute and water absorption in the human jejunum.
To compare the effects of intravenous and intraluminal hydrocortisone on jejunal transport, the proximal jejunum was perfused with glucose (28 mmol/l) in saline in two groups of normal subjects. In the first group of seven subjects, compared with the control period results there were no changes in sodium, water and glucose absorption during the intravenous administration of hydrocortisone. In contrast, intraluminal hydrocortisone (100 mg/l) increased sodium, water and glucose absorption by 169%, 223% and 81% respectively (P less than 0.001 in each case) above the control values, when peripheral plasma cortisol levels were similar to those achieved with intravenous hydrocortisone. In the second group of three subjects, intraluminal hydrocortisone (10 mg/l and 30 mg/l), followed by an intravenous infusion of hydrocortisone, had no effects on sodium, water and glucose absorption. In a third group of six normal subjects perfused with fructose (28 mmol/l) in saline and bicarbonate (28 mmol/l) in saline intraluminal hydrocortisone (100 mg/l) had no effect on solute and water absorption. These results suggest that intraluminal hydrocortisone stimulates glucose-coupled sodium transport by exerting a topical effect on the apical membrane of the jejunal mucosa.
Adult↗
Incidence and origin of Clostridium difficile in neonates.
The stools of 65 of 92 (71%) infants in a special care nursery yielded Clostridium difficile on culture. Ninety percent of stools collected after 6 to 35 days in the unit were positive, and 36% of these also contained toxin. When tested in vitro, 94% of the isolates produced toxin. Of 110 swabs collected from the environment of the unit, 9% were positive for C. difficile, but the stools of 12 nurses working on the unit were negative. Thirty-five vaginal swabs collected from mothers just before delivery were negative for C. difficile on culture, but 16 of their infants had C. difficile in their stools. It was concluded that there is a high carriage rate in the stools of neonates of C. difficile acquired progressively during the course of their stay in the special care unit. Infection is mainly from environmental sources rather than maternal transmission.
Bacterial Proteins↗
Blood and brain concentrations of mercaptans in hepatic and methanethiol induced coma.
It has been suggested that mercaptans are important factors in the pathogenesis of hepatic encephalopathy. Using a gas liquid chromatographic technique which uses propanethiol as internal standard and a sulphur specific detector, blood methanethiol concentration was found to be significantly risen in encephalopathic patients with liver disease (13.2 +/- 1.0 nmol/ml; n = 47) compared with control subjects (5.7 +/- 0.3, n = 29; p less than 0.05) and non-encephalopathic patients with liver disease (7.7 +/- 1.1, n = 35; p less than 0.05) but ethanethiol and dimethylsulphide concentrations were similar in the three groups. Blood methanethiol, however, was not clearly related to coma grade, similar values being found in deeply comatosed patients to those showing only mild cerebral dysfunction. When rats were injected with 40-120 mumol methanethiol a range of responses was obtained which varied between normal consciousness and coma. The minimum blood concentration of methanethiol associated with coma (200 nmol/ml) was at least 10-fold greater than in patients with hepatic encephalopathy but brain concentrations were similar in comatose rats and those which remained awake. Blood methanethiol concentrations were similar in control and germ free rats and did not rise in cirrhotics or controls after ingestion of 2 g methionine. It is concluded that while methanethiol may accumulate in hepatic coma, it is unlikely to be of major pathogenetic importance. Endogenous mercaptans are unlikely to originate from bacterial metabolism in the gut.
Ammonia↗
Clostridium difficile isolation in neonates in a special care unit. Lack of correlation with necrotizing enterocolitis.
The stools of 78% of 45 infants in a Special Care Baby Unit yielded Clostridium difficile on culture, and in 67% of these it was possible to detect C. difficile toxin by means of a tissue culture technique. The stools of six of the seven infants with necrotizing enterocolitis were positive for C. difficile, but neither of the two most severely affected contained C. difficile toxin. The incidence of C. difficile isolation was similar in infants treated by exchange transfusion, those treated with antibiotics, those of low birth weight, and those with respiratory distress. The serum of only 2 of 28 infants and 1 of 20 mothers contained a neutralizing factor to C. difficile toxin. The present study does not support a role for C. difficile in neonatal disorders and in particular necrotizing enterocolitis. The reason for the apparent tolerance of the neonatal bowel to C. difficile toxin remains to be explained.
Antitoxins↗
Constrictive pericarditis and intestinal haemorrhage due to Whipple's disease.
Two months after a pericardectomy for constrictive pericarditis a 37-year-old man presented with diarrhoea, abdominal pain and weight loss. During the course of investigation he developed brisk rectal bleeding and emergency angiography revealed a bleeding site related to an area of abnormal vasculature in the caecum. At laparotomy, the small bowel was found to be inflamed and the mesenteric lymph nodes enlarged. The overall histological appearances, confirmed later on endoscopic duodenal biopsies, were those of Whipple's disease. His symptoms resolved promptly after starting tetracycline therapy. The clinical features of Whipple's disease are protean and often bizarre. We report here a case where the diagnosis was made after the onset of profuse rectal bleeding.
Adult↗
Controlled trial of terlipressin ('Glypressin') versus vasopressin in the early treatment of oesophageal varices.
In a randomised controlled trial the effect of intermittent bolus injection of triglycyl lysine vasopressin (terlipressin 'Glypressin') (2 mg that 6-hourly), an analogue of vasopressin, was compared with that of a constant peripheral intravenous infusion of vasopressin (0.4 units/Min) in the initial management of bleeding oesophageal varices in nineteen patients. Failure of vasopressin therapy was defined as continued bleeding of sufficient severity to necessitate the passage of a Sengstaken tube. Bleeding was controlled in 70% of patients treated with glypressin but in only 9% of patients given vasopressin. The glypressin group required significantly less blood after randomisation than the vasopressin group. Because of its efficacy, lack of side-effects, and ease of administration, glypressin appears to be valuable in the management of bleeding varices.
Adult↗
Paracetamol-induced acute renal failure in the absence of fulminant liver damage.
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Acetaminophen↗
Inter-relationships between the absorptions of hydrocortisone, sodium, water and actively transported organic solutes in the human jejunum.
The effect of intraluminal hydrocortisone (100 mg/l) on sodium and water transport in the small intestine was investigated by jejunal perfusion (flow rate 15 ml/min) of healthy subjects with normal saline and saline containing 56 mmol/l galactose or alanine. Minimal absorption of sodium and water occurred with normal saline and did not change significantly in the presence of hydrocortisone. Galactose and alanine enhanced sodium and water absorption and further significant increases occurred in the presence of hydrocortisone. Glucocorticoid induced increases in absorption were detected within 20-30 min, while plasma cortisol concentrations were in the normal range. 43% of the perfused dose of hydrocortisone was absorbed with normal saline (p less than 0.01). There was a significant positive correlation (p less than 0.0025) between hydrocortisone and water absorption. Thus, in the presence of actively absorbed organic solutes, hydrocortisone rapidly increased sodium absorption and the concurrent increase in water absorption appears to have facilitated passive absorption of hydrocortisone.
Adult↗
Propranolol absorption in untreated coeliac disease.
1. To compare the bioavailability and the elimination of propranolol in seven untreated coeliac patients and six normal subjects, plasma concentrations were measured after oral and intravenous propranolol. The bioavailability and clearance of propranolol were similar in both groups. 2. With the use of a perfusion technique, propranolol absorption in the proximal jejunum was found to be decreased by 71% in five untreated coeliac patients, compared with the absorption in four normal subjects. 3. There results indicate that propranolol absorption is decreased in the proximal jejunum in untreated coeliac disease but overall absorption in the small bowel is not impaired.
Absorption↗
The use of ranitidine in the management of duodenal ulcer: controlled and open comparison with cimetidine in 59 patients.
Forty patients with duodenal ulcer were randomly allocated either ranitidine 150 mg twice daily or cimetidine 1 g daily on a single blind basis for 4 weeks initially, with an additional month of treatment if endoscopy showed incomplete healing. The endoscopist was unaware of the patients' treatment. After 8 weeks treatment, the healing rate was 85% for ranitidine and 95% for cimetidine; the difference was not statistically significant. An additional 19 patients who did not fulfill the trial criteria, 11 of whom had not responded to cimetidine, were openly treated with ranitidine 150 mg twice daily. In 16 of the patients, the ulcer had healed at 8 weeks (84%), but in one patient, the ulcer perforated after 6 weeks of therapy. Thus, although overall healing rates with ranitidine and cimetidine are similar, ranitidine may be useful in patients where cimetidine has proved ineffective.
Adolescent↗
Flexible sigmoidoscopy in outpatients with suspected colonic disease.
One hundred and fifteen patients attending a gastroenterology clinic were investigated by flexible sigmoidoscopy as outpatients. There were asked to fast before the examination and give a high-volume enema and sedated before the examination. A standard long colonoscope was used rather than the 60-cm sigmoidoscope, which limits the distance that can be examined and forces the operator to work very close to the patient. Preparation was considered good in 95 patients and 49 were examined as far as the hepatic flexure or beyond. Sixty-one patients were found to have lesions of the colon, 25 of them ulcerative colitis, 16 a poly, and nine carcinoma. Despite the fact that these patients were selected (some of them had already had ulcerative colitis diagnosed), flexible sigmoidoscopy proved to be a valuable initial outpatient investigation. The proximal colon was well visualised in 46 patients and a subsequent barium enema was considered unnecessary. There were no complications and the procedure seemed to be well tolerated.
Ambulatory Care↗