Search PubMed⌕ Search

Biomedical subjects

D B Silk

Publications and source records attributed to D B Silk.

At least 37 records · Page 2Linked to original sources
PubMed1996

Interchange between collagenous and lymphocytic colitis in severe disease with autoimmune associations requiring colectomy: a case report.

BACKGROUND: Collagenous colitis and lymphocytic colitis present with a similar clinical picture. Whether these conditions are separate entities or whether they represent different pathological stages of the same condition is an unresolved issue. PATIENT: This is a case of collagenous colitis following a fulminant course in which a colectomy was necessary. In the operative specimen the thickened collagen plate, which had been present only two weeks preoperatively had been lost and the pathology was of a lymphocytic colitis. Six months postoperatively this patient developed a CREST syndrome and primary biliary cirrhosis. CONCLUSIONS: This case shows the lability of the collagen plate and the common ground between collagenous and lymphocytic colitis, and presents evidence that these two conditions are different manifestations of the same disease. It also describes for the first time an association between collagenous colitis and CREST syndrome and primary biliary cirrhosis.

Autoimmune Diseases↗
PubMed1996

How long does it take to operate? The implications for in patient malnutrition.

The development of in-patient malnutrition often begins long before hospital admission. The aim of this retrospective study was to assess the time period taken from when patients first present to their General Practitioners to surgery. Patients undergoing elective intraabdominal surgery over a 3 month period in a district general hospital were divided into two groups: One for those with underlying gastrointestinal malignancy requiring resection (n = 27), and the other in those with chronic biliary disease requiring laparoscopic cholecystectomy (n = 24). Patients with malignant disease presented to the GP at a mean of 3.0 months (SD 2.4) after symptom onset, and those with biliary disease at 3.5 months (SD 2.6). Those with malignancy were then referred and seen by the hospital within a mean of 2.8 weeks (SD 1.3), investigated in 3.3 weeks (SD 2.3) and operated on within 2.7 weeks (SD 1.2). The group with biliary disease were seen in hospital at 6.2 weeks (SD 1.9), investigated in 7.5 weeks (5.8) and operated on at 7.6 weeks (SD 2.1). Overall, the length of time it took from symptom onset to surgery in those with malignant disease was 26 weeks (SD 19), and in those with biliary disease 65 weeks (SD 35). This time period will inevitably lead many patients to become malnourished prior to admission, and this may have implications on the incidence of complications and length of in-patient stay.

Aged↗
PubMed1995

Artificial nutrition support in hospitals in the United Kingdom--1994: Third national survey.

OBJECTIVE: To determine how artificial nutrition support is used in hospitals in the United Kingdom and to determine whether there have been any alterations in practice when compared to similar studies in 1988 (1) and 1991 (2). DESIGN: A 94-question survey about artificial nutrition support (ANS) was sent to all district dietitians registered with the British Dietetic Association on 1 January 1994. Information was collected additionally from pharmacists, nutrition nurses and clinicians. RESULTS: 66.6% of questionnaires distributed were returned with analysable information. Of the respondents, 37.3% had access to nutrition support teams, compared with 27% in 1988. The documentation of usage of nutrition support was poor, only 33% of respondents being able to accurately quantify administration of enteral nutrition (EN), and 53% parenteral nutrition (PN). CONCLUSIONS: Despite increasing awareness about the role of artificial nutrition support, and the value of nutrition support teams there has only been a modest increase in the provision and monitoring of NSTs in the last 3 years. This has important implications when considering audit of such practices.

Journal Article↗
PubMed1995

Cholestatic jaundice induced by spontaneous disruption of an oestrogen implant.

OBJECTIVE: To describe the case of a women with cholestatic jaundice induced by the spontaneous fragmentation of an oestrogen implant. PATIENT: A 48-year-old woman, who presented with jaundice, pruritus and a flu-like illness 2 weeks after the insertion of a 100 mg oestradiol implant into her right buttock. INTERVENTIONS: At presentation the implant was removed and found to be fragmented. Investigations revealed an oestradiol level of 1548 pmol/l and an oestrogen-induced cholestatic jaundice. RESULTS: After removal of the implant and progesterone therapy, the patients symptoms resolved. CONCLUSION: This is the first reported case of cholestatic jaundice induced by a subcutaneous oestrogen implant.

Cholestasis↗
PubMed1994

Colonic secretory effect in response to enteral feeding in humans.

Diarrhoea complicating enteral feeding is a common clinical problem affecting up to 25% of patients. Its pathogenesis remains unknown. A new technique of human in vivo segmental colonic perfusion was used to investigate colonic water and electrolyte movement in response to enteral feeding. Four groups of studies were performed in which low and high load polymeric enteral diet infusions were undertaken, either intragastrically or intraduodenally (n = 6 each group). Net absorption of sodium, chloride, and water occurred during fasting throughout the colon in all groups. There was a significant net secretion of sodium, chloride, and water in the ascending colon during low load (sodium: -42 mmol/h; 95% confidence limits -52 to -19, Chloride: -18 mmol/h; -50 to +16, water: -174 ml/h; -348 to -30) and high load (sodium: -24 mmol/h; -60 to +8, chloride: -18 mmol/h; -31 to +16, water: -120 ml/h; -246 to +6) gastric feeding, and during high load duodenal feeding (sodium: -12 mmol/h; -22 to -6, chloride; -6 mmol/h; -16 to +3, water: -72 ml/h; -144 to -6). Net secretion persisted in the distal colon only during high load gastric feeding. In the other three groups there was a net absorption in the distal colon. This study identified a significant colonic secretory response to enteral feeding, which is related to the site and load of the diet infusion. This response may play an important part in the pathogenesis of enteral feeding related diarrhoea.

Adult↗
PubMed1994

Palliation of malignant dysphagia by ethanol induced tumour necrosis.

Thirty two patients (74 (43-93) years; median, (range)) with dysphagia because of inoperable, unresectable or recurrent oesophagogastric carcinoma were treated by ethanol induced tumour necrosis (ETN). Endoscopic injection of absolute alcohol was performed using a variceal injector needle, with 0.5-1 ml aliquots injected retrogradely from distal to proximal tumour margin. Dilatation to 12 mm was used only if the endoscope would not traverse the stricture. In patients with total occlusion, injection into the proximal tumour was followed by a repeat endoscopy 3-7 days later. Dysphagia was graded from 0 = no dysphagia to 4 = total dysphagia. The significance of changes in the dysphagia grade after ETN were assessed using the Wilcoxon rank sum test. Results (median (range)) were as follows: stricture length = 5.0 cm (1-15). Dysphagia grade before treatment was 3 (2-4) improving after first treatment to 1 (0-3), p < 0.003. Best dysphagia grade achieved was 1 (0-3) and interval between treatments was 28.5 days (4-170). The volume of ethanol injected = 10 ml (1.5-29) and survival after first treatment was 93 days (6-660). The number of treatment sessions required to achieve best grade = 1 (1-3). There were no treatment complications. ETN significantly improves dysphagia. Results of palliation are similar to those of laser therapy, but can be achieved quickly and safely on a day case basis in most patients and at a small proportion of the cost.

Adult↗
PubMed1993

Reversal by short-chain fatty acids of colonic fluid secretion induced by enteral feeding.

Diarrhoea complicates enteral feeding in up to 25% of patients. In-vivo perfusion studies in healthy subjects have shown secretion of salt and water in the ascending colon in response to enteral feeding. This study investigated the effect of short-chain fatty acids (SCFA) on this secretory response. Six healthy volunteers underwent segmental in-vivo colonic perfusion. First, baseline fasting colonic water and electrolyte movement was established, then a standard polymeric enteral diet was infused into the stomach while the colon was perfused with either a control electrolyte solution or a test solution containing SCFA. The electrolyte concentrations and osmolality of the two perfusates were identical. In the fasting state water was absorbed throughout the colon. During the control infusion there was significant (p < 0.05) secretion of water in the ascending colon (median rate 1.0 mL per min [95% CI 2.8 mL per min secretion to 0.8 mL per min absorption]). During the SCFA infusion the secretion was significantly reversed (p < 0.05) and there was net absorption (1.6 [0.8-3.7] mL per min). In the distal colon water absorption was significantly greater during the control infusion than during fasting (3.7 [2.5-4.6] vs 1.3 [0.3-2.2] mL per min); during the test infusion this absorption persisted (2.8 [1.3-3.6] mL per min). Movement of sodium, chloride, and potassium ions was similar to that of water in all stages of the study. Bicarbonate movement did not significantly change at any stage. Infusion of SCFA directly into the caecum reverses the fluid secretion seen in the ascending colon during enteral feeding. This finding could have implications for the management of diarrhoea related to enteral feeding.

Adult↗
PubMed1993

The effect of a fibre free and fibre supplemented polymeric enteral diet on normal human bowel function.

Although the effects of dietary fibre in a normal diet on intestinal function are well known, the effects of supplementing enteral diet with fibre on intestinal function are not so clear. The aims of the present study were two fold: firstly to compare intestinal function during ingestion of a self selected diet and fibre free polymeric enteral diet and secondly to investigate the effect of adding the fibre source, soy polysaccharide to the same polymeric diet, on bowel function. Six healthy subjects were randomly assigned to 3 treatment periods (7 days) of a self selected diet (SSD), 2 l polymeric enteral diet (ED), or 2 l of the same polymeric enteral diet supplemented with 20 g/l of soy polysaccharide fibre (SPED). Parameters measured were bowel frequency/day, mean daily wet stool weights and whole gut transit time. Highest stool wet weights (g/24 h +/- SEM) were obtained from subjects consuming a SSD (180.3 +/- 30.6). This was significantly higher (p < 0.02) than those consuming an ED (81.9 +/- 14.5) but not a SPED (123 +/- 22.3). Whole gut transit (h +/- SEM) on a SSD (47 +/- 5.9) was significantly (p < 0.05) quicker than on an ED (73 +/- 4.9), but not significantly different from those ingesting a SPED (54 +/- 5.5). Bowel frequency/day (+/- SEM) in subjects consuming a SPED (1.0 +/- 0.1) was significantly (p < 0.02) higher than in subjects ingesting an ED (0.8 +/- 0.1) but was not significantly different when compared to a SSD (1.0 +/- 0.2). We conclude that ingestion of an ED results in significantly longer whole gut transit time, significantly decreased daily stool wet weights and decreased bowel frequency when compared to a SSD. The ingestion of 30 g of soy polysaccharide in a polymeric enteral diet not only tends to normalise whole gut transit time and daily stool wet weights, but also significantly increases bowel frequency when compared with values seen during the consumption of a fibre free polymeric enteral diet.

Journal Article↗
PubMed1993

Initial response and subsequent course of Crohn's disease treated with elemental diet or prednisolone.

Elemental diet is as effective as corticosteroids in the treatment of previously untreated Crohn's disease. It is unclear whether a poor nutritional state is a prerequisite for efficacy of elemental diet, whether previously treated patients respond as well, or how duration of remission using elemental diet compares with corticosteroid induced remission. Forty two patients with active Crohn's disease were stratified for nutritional state and randomised to receive Vivonex TEN 2.1 l/day for four weeks, or 0.75 mg prednisolone/kg/day for two weeks and subsequent reducing doses. Nine of 22 (41%) patients assigned to nutritional treatment were intolerant of the diet. Thirty patients completed four weeks treatment. Disease activity decreased on elemental diet from mean (SEM) 4.8 (0.9) to 1.7 (0.6), p < 0.05, and on prednisolone from 5.3 (0.5) to 1.9 (0.6), p < 0.05. For each treatment, nourished and malnourished patients responded similarly. Patients with longstanding disease responded as well as newly diagnosed patients. The probability of maintaining remission at six months was 0.67 after prednisolone, 0.28 after elemental diet, and at one year was 0.35 after prednisolone and 0.09 after elemental diet, p < 0.05. When tolerated, elemental diet is as effective in the short term as prednisolone in newly and previously diagnosed Crohn's disease, and its benefit is independent of nutritional state. The subsequent relapse rate after elemental diet induced remission, however, is greater than after treatment with prednisolone.

Adolescent↗
PubMed1992

Artificial nutrition support in hospitals in the United Kingdom - 1991: Second national survey.

Objective - to determine current clinical practice of nutrition support in hospitals in the UK and to determine whether there have been any apparent changes in practices since 1988. Design - An 81 question survey about enteral and parenteral nutriton was sent to all District Dietitians registered with the British Dietetic Association. Information was collected additionally from pharmacists and clinicians. Results - 61.2% of questionnaires distributed were completed and returned. 32.5% of respondents had access to nutrition support teams, compared with 27% in 1988. The documentation of usage of nutrition support was poor, only 33% being able to accurately quantify administation of enteral nutrition, and 53% parenteral nutrition. Since 1988 the number of respondents using peripheral parenteral nutrition had doubled to 15%. Those using percutaneous gastrostomies had increased from 6% to 74%. Those using respiratory enteral diet formulations had quadrupled to 33%. There have been no other apparent major changes in nutrition support practice in the UK, in the last 3 years. Conclusions - Despite increasing awareness about the role of artificial nutrition support, and the value of Nutrition Support Teams there has been little or no progress in the provision or monitoring of support in the last 3 years. This has important implications when considering audit of such practices.

Journal Article↗
PubMed1992

Short term benefits of post-operative oral dietary supplements in surgical patients.

The present study was undertaken to investigate the short term clinical efficacy of oral dietary supplements administered post-operatively to patients undergoing predetermined moderate to severe gastrointestinal surgery. Trial end points for comparison included effects of oral dietary supplements on nutritional intake, nutritional status and incidence of serious complications. 54 patients who were scheduled to undergo predetermined moderate to major gastrointestinal surgical procedures entered the study. They were randomly assigned to receive a normal ward diet post-operatively or the same diet supplemented ad libitum by an oral nutritional sip feed. The study period was defined as commencing from the day patients were adjudged to be capable of ingesting 'free fluids' to the day of hospital discharge. 40 patients (20 in each group) completed the study. The mean daily energy intake (KCal/day) assessed from 7 day food diaries was significantly higher in the treatment group (1833 +/- SEM 99) than in the control group (1108 +/- 56, p < 0.0001). This increase occurred not only as a consequence of energy intake from the oral dietary supplements (470 +/- 30) but also because more energy was consumed from the ward diet by the treatment than the control patients (1353 +/- 92 vs 1108 +/- 56, p < 0.02). The mean daily protein intake g/day in the treatment group (66.0 +/- 3.4) was also greater than in the control group (52.9 +/- 29 p < 0.0001). This difference was due solely to the intake in protein from the oral dietary supplements (15.7 +/- 1.0), protein intake from the ward diet being similar in the treatment (50.1 +/- 3.2) and control (52.9 +/- 29) groups. Patients in the treatment group maintained their pre-operative weight where as control patients had lostsignificant amount of their pre-operative weight by study day 3 (4.5 +/- 12 kg and by discharge (4.7 +/- 1.2 kg, p < 0.02). Pre-operative muscle function as evidenced by grip strength dynamometry decreased to a greater extent in the control than treatment group patients by study day 3 (14.6 +/- 2.2 KPa vs 2.8 +/- 2.4 < 0.03) and by discharge (10.4 +/- 3.1 KPa vs 0.10 +/- 1.9 p < 0.03). The incidence of serious infections (pneumonia, wound infection) was significantly higher in the control group (10) than in the treatment group (3, p < 0.02). It is concluded that the prescription of oral dietary supplements on an ad libitum basis to post-operative patients undergoing moderate to major gastrointestinal surgery results in clinically significant short term benefits.

Journal Article↗
PubMed1992

Medical management of severe inflammatory disease of the rectum: nutritional aspects.

It is clear that the nutritional state of patients with inflammatory bowel disease is often impaired and can be improved by the provision of nutritional support. Improvement in nutritional status can be achieved as effectively with enteral as with parenteral nutrition. Nutritional support appears to have no primary therapeutic effect in patients with ulcerative colitis. With regard to nutritional support in Crohn's disease, parenteral nutrition should be restricted to use as supportive rather than primary therapy. Available information now seems to suggest that most of the benefits of parenteral nutrition in Crohn's disease are related to an improvement in nutritional state rather than as primary therapy, and its use should be restricted to the treatment of specific complications of Crohn's disease, such as intestinal obstruction related to stricture formation or short bowel syndrome following repeated resection. Although some doubt exists over the efficacy of oligopeptide-containing elemental and polymeric enteral diets, the present evidence indicates that chemically defined free amino acid-containing elemental diets have primary therapeutic efficacy in the management of acute exacerbations of Crohn's disease. As such, these diets are worthy of therapeutic trial in patients with severe Crohn's disease involving the distal colon and rectum, particularly in those patients who are malnourished and who prove to be resistant to treatment with a combination of topical corticosteroids and 5-aminosalicylic acid-containing compounds. Clinicians should be aware, though, that the beneficial effects are likely to be restricted to the short term, with high relapse rates by 1 year, this being particularly so in patients with distal Crohn's proctocolitis (Teahon et al, 1988). Volatile fatty acid enemas clearly have potential in the management of patients with severe steroid-resistant proctitis. Finally, one of the most important observations made in recent years is the one concerning the large losses of nitrogen that will occur in patients with inflammatory bowel disease treated with corticosteroids in the absence of adequate protein intake (O'Keefe et al, 1989). Hopefully the days of treating patients with severe inflammatory bowel disease with high dose corticosteroids and a peripheral dextrose or dextrose-saline drip have passed into history.

Colitis, Ulcerative↗
PubMed1992

Topical nonsteroidal anti-inflammatory gel for the prevention of peripheral vein thrombophlebitis. A double-blind, randomised, placebo-controlled trial in normal subjects.

A double-blind, randomised, placebo-controlled study was undertaken to determine whether topical application of a nonsteroidal anti-inflammatory gel to skin overlying peripheral vein cannula sites has a role in reducing the incidence or delaying the onset of peripheral vein thrombophlebitis. Fifty normal subjects had intravenous cannulae placed in right and left arms. Subjects were randomised to receive twice daily application of either active nonsteroidal anti-inflammatory gel or placebo gel to each cannula site. Cannula sites were observed and signs and symptoms of inflammation recorded up to 108 h. If any site had signs extending beyond 2 cm then the cannula was removed. Cannula sites that had 'active' gel applied had half the incidence of marked signs at 108 h (44% vs 22%, p less than 0.05). These results suggest that local application of topical nonsteroidal anti-inflammatory gel to cannula sites may have a significant role to play in the prevention of peripheral vein thrombophlebitis.

Administration, Topical↗
PubMed1992

Glycine nitrogen in total parenteral nutrition: two prospective clinical trials comparing the efficacy of high and low glycine containing amino acid solutions.

Glycine has been regarded as a poor source of nitrogen for total parenteral nutrition. Two prospective randomised cross over controlled clinical trials were undertaken to compare the efficacy of high and low glycine containing amino acid solutions in parenterally fed malnourished hypoalbuminaemic patients with gastrointestinal disease. In the first study (n = 9), amino acid solutions in which glycine accounted for 23% and 4% of total nitrogen were compared. No statistically significant difference was found in urea nitrogen/total urinary nitrogen excretion (mean (SEM) 83.4 (1.4) v 81.6 (1.7)%, p = 0.31), nitrogen balance (-1.9 (2.4) v -0.6 (2.0) g/day, p = 0.31) or plasma protein concentrations and blood urea nitrogen. In the second extended study (n = 5), there was no significant difference in net whole body protein synthesis (+1.3 (4.7) v-0.2 (3.7) mg/kg/hour, p = 0.69) or fractional (0.403 (0.070) v 0.480 (0.41)%/hour, p = 0.68) and absolute albumin synthesis rates (6.0 (0.9) v 7.2 (0.06) mg/kg/hour, p = 0.22), on comparing solutions of 25% and 8% glycine nitrogen. In addition, a significantly higher proportion of total urinary nitrogen comprised urea when patients received the low glycine containing amino acid source (81.4 (2.5) v 83.8 (3.2)%, p = 0.04). It is concluded that there are no apparent short term nutritional or metabolic disadvantages to using amino acid solutions that contain up to 25% of nitrogen as glycine in total parenteral nutrition.

Adult↗