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Biomedical subjects

C R Fleming

Publications and source records attributed to C R Fleming.

At least 37 records · Page 2Linked to original sources
PubMed1988

Zinc-induced copper deficiency.

Copper deficiency was found in an adult patient who had received excessive daily oral zinc for 10 mo. The deficiency was characterized by hypochromic-microcytic anemia, leukopenia, and neutropenia. Although initially thought to be caused by iron deficiency, the anemia did not respond to oral or intravenous iron. Cessation of zinc tablets and ingestion of an oral copper preparation daily for 2 mo failed to correct the anemia or leukopenia. It was not until shortly after intravenous administration of a cupric chloride solution during a 5-day period, at a total dose of 10 mg, that serum copper and ceruloplasmin levels increased and the anemia, leukopenia, and neutropenia resolved. These data suggest that the elimination of excess zinc is slow and that, until such elimination occurs, the intestinal absorption of copper is blocked.

Adult↗
PubMed1988

Surreptitious use of salicylates: a cause of chronic recurrent gastroduodenal ulcers.

We describe five patients who had chronic recurrent gastroduodenal ulcers and pain, intestinal obstruction, bleeding, or a combination of these symptoms. Four patients required surgical intervention because of a poor response to medical therapy. The ulcers recurred in all patients, despite evidence of achlorhydria in two of them. Although the patients denied the use of salicylates, all of them had therapeutic blood levels of salicylates. A salicylate level should be determined in patients with severe ulcer disease that is resistant to medical therapy or that is recurrent after appropriate surgical therapy when the presence of hypergastrinemia or hyperchlorhydria has been definitely excluded. A low serum level of uric acid can also be a clue to the abuse of salicylates.

Adult↗
PubMed1988

Controlled trial of bowel rest and nutritional support in the management of Crohn's disease.

To define the role of bowel rest as an independent variable from nutritional support a prospective, randomised controlled trial was undertaken in 51 patients with active Crohn's disease unresponsive to other medical management. Nutritional support for 21 days was randomised to total parenteral nutrition and nil by mouth (n = 17), defined formula diet administered through a nasogastric tube (n = 19), or partial parenteral nutrition and oral food (n = 15). Nutrient input in the first two groups provided 40 non-protein kcal/kg ideal body weight /d and 1g/ kg/d protein respectively, while the third group received 15 non-protein kcal/kg/d and 0.3 g/kg/d protein intravenously and ate unrestricted food. Clinical remissions occurred in 71% of patients on parenteral nutrition, in 58% on the defined formula diet and in 60% on partial parenteral nutrition; the probability for each group of being in remission at one year, after successful therapy was 42%, 55%, and 56% respectively. These differences were not significant. In patients with active Crohn's disease bowel rest was not a major factor in achieving a remission during nutritional support and did not influence outcome during one year's follow-up.

Adolescent↗
PubMed1987

Changes of plasma levels of apolipoproteins A-I, A-II, and B and their isoforms in patients with intestinal failure receiving long-term parenteral nutrition.

We have studied the plasma lipid and apolipoprotein profiles of 19 patients with intestinal failure who are receiving long-term total parenteral nutrition (TPN). These patients had significantly reduced levels of total and HDL cholesterol and normal levels of triglycerides. Radioimmunoassay determination of apolipoproteins showed a 30% and 50% reduction in apo A-I and A-II levels, respectively. Apolipoprotein B was normal in all but three patients. Isoelectric focusing showed two major isoforms of apo A-I in patients as compared with four isoforms observed in normal subjects and one major isoform of apo A-II compared with multiple isoforms. Recent epidemiologic studies indicate that an increased apo B:apo A-I ratio may be an important factor in atherogenesis. We suggest that patients with small-bowel syndrome who are currently on TPN may be at greater risk for atherosclerosis. Since TPN has restored a reasonably normal life expectancy for these patients, long-term follow-up will likely provide answers.

Adolescent↗
PubMed1987

Hair analysis in clinical and experimental medicine.

Each year approximately 9800 papers on trace elements are published. Of these, approximately 75 deal with trace elements and hair. Review articles appear annually. Some of these studies demonstrate that the mean concentration of an essential trace element is lower or that of a potentially toxic element is higher in the hair of a group of people afflicted with a specific disease. Associations between hair analyses and demographic variables have been found. Fewer studies have shown a correlation between essential elements in hair of animals and the same elements in organs. It is possible to measure trace elements in hair to satisfy the skeptical chemist. Although such measurement is a necessary prelude toward medical utility, it is not sufficient. Hair analysis seems potentially useful in experimental medicine but its use in clinical medicine for diagnosis, prognosis, and therapy will remain limited until validation by the standard methods of clinical investigation is achieved.

Animals↗
PubMed1986

Estimated versus measured basal energy requirements in patients with Crohn's disease.

Increased energy expenditure associated with active inflammation has been thought to be one cause of weight loss in patients with Crohn's disease. Our aim was to test this hypothesis by determining if resting energy expenditure (REE) measured by indirect calorimetry was greater than the predicted energy expenditure (PEE) calculated from the Harris-Benedict formula (variables--sex, age, height, and weight) in each patient. Fifty-four patients with radiographic evidence of Crohn's disease were studied. There was a highly significant relationship (p less than 0.001) between REE and PEE, which can be expressed as follows: REE = 39.40 + 0.99 (PEE). The mean REE was 1427 +/- 228 kcal/day, whereas the mean PEE was 1404 +/- 197 kcal/day. Patients with the lowest weights when expressed as percentages of ideal body weights had the greatest resting energy expenditure per kilogram of body weight (r = -0.73, p less than 0.001). The mean REE per kilogram per day was 25 +/- 4 kcal, and only 4 of 54 patients (7%) had REE greater than or equal to 30 kcal/kg X day. Thus, REE measured by indirect calorimetry in Crohn's disease patients was not significantly higher than PEE that can be estimated from the Harris-Benedict equation. These findings show that most Crohn's disease patients without fever or sepsis do not have increased REE.

Adult↗
PubMed1986

Plasma carnitine levels in patients receiving home parenteral nutrition.

Patients on long-term home parenteral nutrition (HPN) are known to frequently develop hepatic steatosis or steatohepatitis. The etiology of this steatosis or steatohepatitis is unknown, but carnitine deficiency has been one of the postulated mechanisms. The importance of L-carnitine in hepatic fatty acid oxidation and the steatosis observed in primary and acquired carnitine deficiencies prompted us to determine plasma carnitine levels in 37 patients receiving long-term HPN. Thirteen patients (35%) had low total and free plasma carnitine levels. Fifteen of the 37 HPN patients were matched for age and sex with 15 patients with Crohn's disease who did not require HPN. Mean total and free plasma carnitine values were significantly lower (p less than 0.001) in these 15 HPN patients (32.2 +/- 11.9 and 28.4 +/- 10.8) when compared to Crohn's patients not requiring HPN (49.1 +/- 10.9 and 46.4 +/- 11.5). Associations were not detected between plasma carnitine and clinical or biochemical parameters that might have explained the low values.

Adolescent↗
PubMed1985

Trial of penicillamine in advanced primary biliary cirrhosis.

A total of 227 patients with histologically advanced primary biliary cirrhosis entered a double-blind, randomized, controlled trial to determine whether penicillamine (1 g per day) was therapeutically effective; 111 patients received the drug, and 116 received placebo. The two groups were highly comparable at entry with regard to clinical, biochemical, and histologic features. Penicillamine therapy did not result in an overall improvement in survival as compared with placebo. Clinical symptoms and serial hepatic laboratory values reflected the progressive nature of the disease and were similar in both groups. There were no substantial differences between treatment groups in the morphologic features of sequential biopsy specimens. The development of major side effects led to permanent discontinuation of penicillamine in 22 per cent of the patients taking the drug. We conclude that penicillamine is not useful for patients with histologically advanced primary biliary cirrhosis. The trial is being continued in patients with early histologic disease whose better prognosis necessitates longer follow-up.

Clinical Trials as Topic↗
PubMed1985

Preoperative nutritional status and other factors that influence surgical outcome in patients with Crohn's disease.

Among 124 patients who underwent an elective surgical procedure for Crohn's disease during 1 year at our institution, 16(13%) had postoperative complications, including one death. The risk of developing postoperative complications was inversely related to the concentrations of serum albumin and total iron-binding capacity. The complication rate was 29% among patients with low (less than 3.1 g/dl) serum albumin levels but only 6% among patients with normal albumin levels. Patients were also more likely to experience postoperative complications if they had previously undergone an operation for Crohn's disease, received sulfasalazine, or required an ileostomy. No correlations were noted between postoperative complications and preoperative weight loss or preponderance of Crohn's disease of the colon. The median duration of postoperative hospitalization was 24.5 days for the 16 patients with complications in comparison with only 10 days for patients without complications.

Adolescent↗
PubMed1984

Antemortem diagnosis and short-term survival of a patient with Wilson's disease presenting as fulminant hepatic failure.

When Wilson's disease presents as fulminant hepatic failure, it may be extremely difficult to differentiate from other causes of hepatic insufficiency. A recently described diagnostic biochemical profile (elevated serum and urine copper levels, mild transaminase elevation, very high bilirubin levels, and low hemoglobin with intravascular hemolysis) was employed to diagnose this form of Wilson's disease prior to death in a young woman without Kayer-Fleischer rings and with a normal serum ceruloplasmin level. Since hepatic transplantation now offers a possible cure for this previously uniformly fatal form of Wilson's disease, it should be considered the treatment of choice for this disease entity. Combined with the availability of hepatic transplantation, this patient's temporary improvement and unusually long survival of four months further emphasizes the importance of this diagnostic profile in recognizing Wilson's disease quickly and accurately when it presents as fulminant hepatic failure.

Adult↗
PubMed1984

Pulmonary infiltrates and eosinophilia associated with sulfasalazine.

Asymptomatic pulmonary infiltrates and eosinophilia developed in a patient with chronic ulcerative colitis 1 month after therapy with sulfasalazine had been instituted. The abnormalities resolved completely after use of the drug was discontinued. The sulfapyridine component of the sulfasalazine was the likely causative agent because 41 years earlier, the patient had experienced fever, myalgias, and eosinophilia after taking a sulfonamide. Ten previous cases of sulfasalazine pulmonary toxicity, including one fatality, have been reported.

Aged↗
PubMed1983

Intestinal pseudo-obstruction as the presenting manifestation of small-cell carcinoma of the lung. A paraneoplastic neuropathy of the gastrointestinal tract.

A 58-year-old woman who had presented with intestinal pseudo-obstruction died 9 months later from rapidly progressive neurologic symptoms and autonomic insufficiency. Her gastric emptying had been markedly delayed and transit of markers had been slowed throughout the small bowel. A 5-hour manometric recording of the antrum and duodenum had shown absence of the normal interdigestive motor complex, which was replaced by irregular contractile activity of reduced amplitude. A small-cell carcinoma of the lung was found at autopsy. Pathologic study of the gut showed widespread degeneration of the myenteric plexus, which was infiltrated by plasma cells and lymphocytes and contained significantly reduced numbers of neurons. The extra-intestinal nervous system had neuronal loss and lymphocytic infiltrates in dorsal root ganglia. Thus, a gastrointestinal neuropathy causing intestinal pseudo-obstruction may be the presenting manifestation of a paraneoplastic syndrome associated with small-cell carcinoma.

Autonomic Nervous System Diseases↗
PubMed1983

Percutaneous endoscopic gastrostomy. Simplified access for enteral nutrition.

The recently described technique of endoscopic placement of a permanent feeding gastrostomy is reviewed with several modifications. Our experience in 23 adults has led us to conclude that this nonsurgical technique is the procedure of choice in achieving long-term enteral nutrition in patients who have an intact, nonobstructed gut and in whom the stomach can be directly apposed to the anterior abdominal wall.

Adolescent↗
PubMed1983

Diagnosis of Wilson's disease presenting as fulminant hepatic failure.

The clinical course, results of standard laboratory tests, parameters of copper metabolism, and hepatic morphology in 9 cases (3 of our own and 6 from the literature) of Wilson's disease presenting as fulminant hepatic failure were compared with the findings in 5 cases of idiopathic fulminant hepatic failure. Patients with Wilson's disease were usually younger, and 7 of the 9 patients had Kayser-Fleischer rings. Patients with idiopathic fulminant hepatic failure had elevated 24-h urinary copper, decreased ceruloplasmin, and low or normal serum copper. Fulminant hepatic failure with Wilson's disease differed from idiopathic fulminant hepatic failure by the following biochemical findings: (a) higher copper levels in serum, urine and liver; (b) less pronounced elevations of transaminase levels; (c) higher concentrations of total bilirubin; and (d) lower hemoglobin values. Serum copper was the most useful biochemical test in diagnosing Wilson's disease before death. At autopsy, only hepatic copper concentrations clearly separated the two groups. Serial serum copper levels (antemortem) and quantitative analysis of hepatic copper (after recovery or postmortem) in patients with fulminant hepatic failure should help to exclude Wilson's disease.

Adolescent↗
PubMed1983

Abnormalities in gastrointestinal motor activity in patients with short bowels: effect of a synthetic opiate.

We have investigated the fasting and postprandial patterns of gastrointestinal pressure activity in a group of patients with extensive (greater than 100 cm) resections of the distal small bowel. Each short bowel patient was studied on 2 consecutive days with random single blind administration of either loperamide (6 mg at 5 h and at 30 min before the meal) or placebo, and 20 healthy controls were studied on single days (13 basal fasting, 7 placebo). During fasting, the duration of the interdigestive motor complex was significantly shorter in patients with short bowel syndrome (71.1 +/- 15.6 min vs. 109 +/- 7.8 min for controls, p less than 0.03); hence, the frequency of complexes was increased. The duration of phase 2 was strikingly shorter in patients (18.7 +/- 7.0 min vs. 52.9 +/- 8.5 min for controls, p less than 0.03). Gastric emptying and postprandial motor activity were identical in patients and controls. During fasting, loperamide prolonged phase 3 (7.6 +/- 2.2 min vs. 4.3 +/- 1.1 min for placebo, p less than 0.03). Postprandially, loperamide shortened the time from meal ingestion to the first phase 3 by 50% (p less than 0.003), and increased motility index and frequency of contraction in the gut (p less than 0.01). Thus, gut motor activity in the short bowel syndrome is characterized by more frequent interdigestive motor complexes, marked reduction in phase 2 activity, and a normal feeding pattern. Loperamide therapy increases feeding activity while at the same time shortening its duration.

Adult↗