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Biomedical subjects

C R Fleming

Publications and source records attributed to C R Fleming.

At least 55 records · Page 3Linked to original sources
PubMed1982

Inhibition of postprandial pancreatic and biliary secretion by loperamide in patients with short bowel syndrome.

Patients with the short bowel syndrome are usually afflicted by chronic diarrhoea and treated with opiate drugs, yet little documentation of the effects of such drugs on digestive function is available. In the present study we found that acute oral administration of loperamide resulted in 50% inhibition of postprandial trypsin and bilirubin output in patients with short bowel syndrome. These changes are consistent with an opiate effect.

Adult↗
PubMed1982

Selenium deficiency and fatal cardiomyopathy in a patient on home parenteral nutrition.

An adult patient with chronic idiopathic intestinal pseudo-obstruction maintained on home parenteral nutrition for 6 consecutive years died from cardiomyopathy and ventricular fibrillation. Postmortem examination of the heart revealed widespread myocytolysis and replacement fibrosis similar to that seen in the selenium deficient cardiomyopathy in China (Keshan disease) and animal models. Selenium deficiency in this patient was documented with extremely low concentrations of selenium and decreased activity of the selenoprotein, glutathione peroxidase, in blood, heart, liver, and skeletal muscle. Reports of selenium deficient diets causing myocardial damage in humans and animals and the findings in our patient strongly suggest that his fatal cardiomyopathy was caused by selenium deficiency.

Adult↗
PubMed1982

Autoimmune associations in primary biliary cirrhosis.

The prevalence of autoimmune associations was determined in 113 patients with primary biliary cirrhosis who participated in a therapeutic trial of D-penicillamine. Eighty-four percent of the patients had at least one associated autoimmune disease and 41% had two or more such diseases in addition to primary biliary cirrhosis. Keratoconjunctivitis sicca, which was present in 66% of the patients, was the most commonly associated autoimmune disease. In most of the patients the autoimmune disease was recognized after the diagnosis of primary biliary cirrhosis had been made. The prevalence of autoantibodies in selected subgroups of patients ranged from 70% (rheumatoid factor) to 22% (anti-native DNA). Polyclonal elevation of serum immunoglobulins was a consistent finding, and frequently all three major isotypes were simultaneously increased. Only IgA elevations correlated with histologic progression of primary biliary cirrhosis. The prominent involvement of epithelial tissues in the autoimmune disease of primary biliary cirrhosis suggests that an autoimmune syndrome affecting the secretory immune system is associated with the pathogenesis of primary biliary cirrhosis and the coexisting autoimmune diseases.

Adult↗
PubMed1981

Zinc nutrition in Crohn's disease.

A prospective evaluation of zinc status was made in 63 randomly selected patients with Crohn's disease. In the patients, mean serum and 24-hr urinary zinc values--105 microgram/dl and 383 microgram/day, respectively--were not different from controls. However, 46% of these patients had less than normal serum zinc and 36% had low urinary zinc excretions. Simultaneous reductions in both serum and urinary zinc were detected in 19% of patients. A direct correlation (P = 0.01) was found between serum levels of zinc and the concentration of albumin, the major zinc-binding protein, in outpatients but not in hospitalized patients or patients with Crohn's disease as a whole. Intake of zinc was surprisingly good--a mean intake of 13.4 +/- 1.4 mg/day. A significant (P = 0.006) association was found between urinary zinc and the Crohn's disease activity index but not between serum zinc concentration and this index. No association was found between zinc measurements and the presence or absence of fistulas, use of prednisone or sulfasalazine (Azulfidine), large bowel resections, and length of small bowel resected.

Adult↗
PubMed1981

Lichen planus-like lesions caused by penicillamine in primary biliary cirrhosis.

Six patients with primary biliary cirrhosis experienced lichen planus-like lesions while taking penicillamine. Oral lesions developed in all patients, and the lichenoid lesions also appeared elsewhere in two patients. Lichen planus-like lesions developed from four to 16 months after penicillamine therapy had been started, and, in four cases, they resolved in one to three months after use of the drug was stopped. Two patients have continued using penicillamine despite adverse cutaneous and mucosal reactions and have continued to experience lichen planus-like lesions intermittently. Other cutaneous reactions associated with penicillamine are reviewed.

Clinical Trials as Topic↗
PubMed1980

Catheter-related complications in patients receiving home parenteral nutrition.

Twenty-seven patients (22 adults, five adolescents, and one child) were treated with home parenteral nutrition (HPN) for 662 patient-months. A Broviac Silastic right atrial catheter which is tunnelled subcutaneously down the anterior chest wall served as a venous access. Thirty-four catheters were used in 27 patients, and the mean catheter life spans to date for adults and adolescents have been 21 and 14 months, respectively. There were no deaths attributable to the catheters. Infections and damaged external catheter segments were clustered in adult patients, whereas serious mechanical problems occurred in adolescents. Five of 27 patients (19%) experienced septicemia and one patient had two episodes. These six episodes (five of Staphylococcus aureus, one of Candida parapsilosis) in 662 patient-months represented only one case of sepsis every 9.1 patient-years on HPN. The external segments of 12 catheters were damaged and all were repaired in the outpatient setting. Eight of nine major mechanical problems occurred in five adolescents and one child; the most serious being four intravascular displacements, one extravascular displacement with mediastinitis, and a fractured catheter with a retained intravascular catheter segment. Although the HPN catheter is associated with definite risks, there has been a very acceptable incidence of complications resulting in a high benefit-to-risk ratio for HPN.

Adolescent↗
PubMed1980

Organization and operation of a home parenteral nutrition program with emphasis on the pharmacist's role.

A home parenteral nutrition program was organized at Mayo Clinic-Rochester Methodist Hospital in 1975. To date, 26 patients with chronic malnutrition usually due to either severe short bowel syndrome or extensive Crohn's disease have been trained in home parenteral nutrition for a total treatment period of 430 patient-months. Home parenteral nutrition is an attractive alternative for these patients in that it dramatically improves nutrition, promotes rehabilitation at home, and probably decreases long-term expenses. The numerous medical, psychosocial, and financial problems confronting patients on home parenteral nutrition are managed through a multispecialty team consisting of physicians, pharmacists, nurse, social worker, dietitian, physiatrist, psychiatrist, and business manager. The pharmacist is the person with whom the patient has the most contact during a 2-week training period. In addition to patient education, the pharmacist coordinates the transition to home care, offers in-service education on home parenteral nutrition to nurses and house officers, tests and evaluates the equipment, coauthors a training manual, and edits a quarterly newsletter to patients who are on home parenteral nutrition.

Crohn Disease↗
PubMed1979

Liver function values in adults receiving total parenteral nutrition.

A retrospective review was made of results of conventional liver function tests in adult patients who received fat-free total parenteral nutrition (TPN) for two weeks or longer and who did not have other obvious causes for liver function abnormalities. A "meaningful" increase (greater than or equal 50% increase above baseline pre-TPN value) in SGOT levels was noted in 68% of patients, in alkaline phosphatase levels in 54%, and in serum bilirubin levels in 21% of patients. The median peak values for SGOT, alkaline phosphatase, and bilirubin were 3-, 1.9-, and 0.25-fold above the upper limit of normal, respectively. The median time interval of peak increase for each of the three tests was between 9 and 12 days after TPN was started. Liver biopsy specimens from four patients, taken when liver function values were abnormal, showed pronounced steatosis in three patients and mild periportal cholestasis in the fourth patient. The cause(s) of the elevated liver values is unknown, but possibilities include cellular damage, such as steatosis, and an "overshoot" of enzymes when starved patients are refed.

Adult↗
PubMed1979

Takayasu's arteritis in Crohn's disease.

This report describes a patient with coexistent Crohn's colitis and Takayasu's arteritis involving the thoracic aorta, superior mesenteric artery, and left hepatic artery. Unlike most previously reported cases of this association, characteristic histopathology is demonstrated. This case is also unusual in that the Takayasu's arteritis presented as aneurysmal disease instead of occlusive disease. We believe that Takayasu's arteritis may represent another of the many extra-intestinal manifestations of inflammatory bowel disease.

Adolescent↗
PubMed1979

Systemic mastocytosis with review of gastrointestinal manifestations.

A 63-year-old man presented with fever, splenomegaly, steatorrhea, diarrhea, and weight loss. A tissue diagnosis of systemic mastocytosis was made. This case is unusual in that diarrhea and steatorrhea were present in the absence of skin lesions and because fever was a prominent symptom. Thus, systemic mastocytosis should be included in the differential diagnosis of intestinal malabsorption even when the skin shows no abnormalities. The gastrointestinal manifestations of systemic mastocytosis are reviewed.

Body Weight↗
PubMed1979

Transmural eosinophilic gastroenteritis with ascites.

An atopic patient with recurrent abdominal pain, diarrhea, and ascites was shown to have eosinophilic gastroenteritis. Transmural involvement was inferred from the findings of dense eosinophilic infiltrates in the jejunal mucosa and eosinophilia in the ascitic fluid. An impressive response to steroid treatment occurred. The reported cases of eosinophilic gastroenteritis with ascites are reviewed.

Adult↗
PubMed1978

Asymptomatic primary biliary cirrhosis. Presentation, histology, and results with D-penicillamine.

Of 103 patients with the syndrome of primary biliary cirrhosis (chronic, nonsuppurative destructive cholangitis) who entered a double-blind, randomized, controlled treatment trial with either D-penicillamine or placebo, 21 (20%) were asymptomatic with respect to their liver disease. Study of these 21 patients revealed that (1) 43% of patients with asymptomatic primary biliary cirrhosis had advanced histologic lesions (fibrosis or cirrhosis); (2) asymptomatic patients with advanced histologic lesions likely have had their disease for 10 years or more; (3) stage of primary biliary cirrhosis may remain unchanged for years; and (4) most asymptomatic patients receiving D-penicillamine, when compared with patients given placebo, had improved liver function tests at 1-year follow-up. However, the incidence of major toxicity with D-penicillamine for primary biliary cirrhosis in a maintenance dose of 1 g approximates 20%. Furthermore, one of our patients who was asymptomatic but who had advanced histologic changes died recently from D-penicillamine-associated bone marrow suppression. It remains to be determined whether the benefit-to-risk ratio of D-penicillamine in primary biliary cirrhosis justifies its use.

Adult↗
PubMed1978

Roentgenographic simulation of colonic cancer by benign masses in Crohn's colitis.

Crohn's colitis has recently been shown to predispose the patient to cancer of the colon. Unfortunately, many of the manifestations of colonic malignancy, such as polypoid intraluminal masses and strictures, can be simulated roentgenographically by Crohn's colitis. We present five patients in whom this diagnostic difficulty arose. As established by total or subtotal colectomy, none proved to have malignancy; instead, pronounced transmural inflammation and, in two cases, multiple large pseudopolyps were found to account for the roentgenographically indeterminate lesions. These findings exemplify the difficulty in roentgenographic diagnosis of colonic mass lesions in patients with Chrohn's colitis.

Adult↗
PubMed1977

Pigmented corneal rings in non-Wilsonian liver disease.

Kayser-Fleischer rings are pigmented corneal rings at the limbus of the cornea in Descemet's membrane that have been deemed pathognomonic of Wilson's disease. However, we have observed four exceptions in patients with non-Wilsonian liver disease. Three patients had primary biliary cirrhosis and one patient had chronic aggressive hepatitis with cirrhosis. Pigmented corneal rings were seen only by slit-lamp examination. Hepatic, serum, and urinary copper and serum ceruloplasmin levels were significantly elevated in the patients with primary biliary cirrhosis. Radiocopper (64Cu or 67Cu) studies in patients with primary biliary cirrhosis showed plasma disappearance curves which allowed a clear distinction from Wilson's disease in that all three patients with primary biliary cirrhosis showed a secondary rise in radiocopper that presumably represented copper incorporation into ceruloplasmin. In one patient, in whom 64Cu in ceruloplasmin was studied specifically, incorporation was found to be normal.

Ceruloplasmin↗