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Biomedical subjects

D Clements

Publications and source records attributed to D Clements.

At least 37 records · Page 2Linked to original sources
PubMed1993

Hormone replacement therapy prevents bone loss in patients with inflammatory bowel disease.

Patients with inflammatory bowel disease have an increased prevalence of osteoporosis, and suffer high rates of spinal bone loss. Hormone replacement therapy (HRT) is effective in the treatment and prevention of osteoporosis but has not been studied in patients with inflammatory bowel disease. A two year prospective study of HRT in inflammatory bowel disease was performed in 47 postmenopausal women aged 44 to 67 years with ulcerative colitis (25) or Crohn's disease (22). Patients had radial and spinal bone density measured annually by single photon absorptiometry and quantitative computed tomography respectively. The mean (95% confidence intervals) annual change in radial bone density was +1.42%/yr (+0.58 to +2.26; P < 0.005) and for spinal bone +2.60%/yr (+1.06 to +4.15; p < 0.005). There was no significant correlation between rates of change of bone density at the two sites, or between the rates of change and the initial bone density either in the radius or spine. Twelve patients were given prednisolone during the study, and their rates of change for spinal bone density were lower, but values were not statistically significantly different from those who did not receive corticosteroids. Changes in bone density for patients with ulcerative colitis and Crohn's disease were not significantly different. The change in bone density did not correlate with the patients' age or number of years after the menopause. It is concluded that HRT is effective in prevention of bone loss in postmenopausal women with inflammatory bowel disease.

Adult↗
PubMed1993

Hormone replacement therapy in chronic active hepatitis; a case report.

There is an increased incidence of osteoporosis in patients with chronic liver disease. Because patients with chronic active hepatitis (CAH) usually require corticosteroids for their liver disease prevention and treatment of bone loss presents a difficult problem. This case report describes a 41 year old female patient with CAH who had a high rate of bone loss. After an early menopause with noticeable menopausal symptoms, she was given transdermal oestrogen replacement therapy. The menopausal symptoms resolved completely, and there was no deterioration in her liver function tests or corticosteroid requirement. In addition, follow up quantitative bone mineral measurements over two years have shown improvement. This case shows the value of measurements of bone density, and oestrogen replacement therapy in CAH, even in the presence of continued corticosteroids.

Adult↗
PubMed1993

Bone loss in normal British women; a 5 year follow-up.

To assess the rates of loss, forearm and spinal bone mineral were remeasured in 16 out of 18 peri- and post-menopausal women aged 45 to 60 years who had taken part in a previously reported cross-sectional study. The mean interval between measurements was 4.8 years (range 4.2-5.3 years). The mean (95% confidence interval (CI)) annual change in radial bone mineral density was -0.78%/year (-1.73 to +0.18%; not significant) and in spinal bone mineral -2.41%/year (-3.55 to 1.27%; p < 0.001). There was considerable variation in the rate of change in radius and spine, and between individuals. There was no significant correlation between rates of bone loss at either site, or between rates of loss and the initial bone density at either the radius or spine. There was no significant correlation between the rates of change and the age or number of years post-menopause of the women. There was no significant change in the Z score for the forearm (mean -0.20; 95% CI -0.65 to +0.25) or for the spine (mean -0.04; 95% CI -0.30 to +0.22). There have been no previous longitudinal studies of the changes of bone density in normal British women. These results show considerable variation between individuals, and rates of change at one site cannot be predicted from measurements at another site. Untreated, some normal individuals have high rates of loss that cannot be predicted from baseline values, age or number of years post-menopause.

Absorptiometry, Photon↗
PubMed1992

Longitudinal study of cortical bone loss in patients with inflammatory bowel disease.

Bone mineral density of the radius was measured by single-photon absorptiometry in 50 patients with inflammatory bowel disease. Thirty-three had Crohn's disease and 17 ulcerative colitis; 25 were women. The mean age was 45 years (range, 18-70 years). Measurements were repeated in 39 of them after a mean follow-up period of 7.9 years (range, 7.1-8.2 years). In female patients the mean (95% confidence interval) annual change in radial bone mineral density was -0.74% (-1.34% to -0.14%) (P = 0.022), the greatest bone loss occurring in postmenopausal women (mean, -1.16% (-2.01% to -0.30%)). In male patients the mean annual rate of bone loss was -0.07% (-0.41% to 0.28%) (P = NS). Patients with abnormally low values at the first measurement remained osteopenic at the second measurement, whilst some others with normal values initially showed increased rates of bone loss and had a subnormal bone mineral density after the follow-up period. These results show increased rates of cortical bone loss in some patients with inflammatory bowel disease and emphasize the need to monitor bone mass in these patients so that prophylactic measures can be instituted.

Absorptiometry, Photon↗
PubMed1992

An improved 'interim discharge letter' a successful outcome from audit.

General practitioners were dissatisfied with this hospital's interim discharge letters. These were unstructured letters written by house officers shortly after the patient's discharge. A copy of the list of drugs prescribed on discharge was sent separately. After discussing the various needs with general practitioners a new form of discharge letter has been successfully introduced. The layout has been further modified in the light of feedback, and details of the new letter are presented. The new form has been well received by hospital staff and general practitioners. The paperwork for junior doctors has been reduced by the inclusion of the prescription in the discharge letter.

Family Practice↗
PubMed1991

Total body calcium in patients with inflammatory bowel disease: a longitudinal study.

1. Serial measurements of total body calcium have been made by prompt gamma-neutron activation analysis in 13 patients with inflammatory bowel disease over a mean period of 23 months. Changes in spinal trabecular bone mineral density and radial shaft bone mineral content were also assessed by using quantitative computed tomography and single photon absorptiometry, respectively. 2. The mean annual decreases (95% confidence intervals) were: total body calcium, 7.8% (-12.0 to -3.7%; P less than 0.001); spinal trabecular bone mineral density, 2.5% (-5.0 to +0.1%; 0.05 less than P less than 0.1), radial bone mineral content, 2.1% (-3.4 to -0.8%; P less than 0.01). 3. No significant correlations were found between rates of change of the three variables. However, there were significant positive correlations between the baseline values for total body calcium and radial bone mineral content (r = 0.638, P less than 0.05), spinal bone mineral density and radial bone mineral content (r = 0.854, P less than 0.01), and total body calcium and spinal bone mineral density (r = 0.876, P less than 0.001). 4. These results demonstrate rapid decreases in total body calcium in patients with inflammatory bowel disease which, in conjunction with the significant decrease in radial shaft bone mineral content, indicate increased rates of cortical bone loss. Whilst values for bone mass at different skeletal sites showed positive correlations within individuals, no relationship was found between the rates of change in bone mass at these sites. 5. The rapid bone loss observed in some subjects emphasizes the importance of early detection of osteoporosis by bone densitometry and the need for effective prophylactic measures to be established in this group of patients.

Absorptiometry, Photon↗
PubMed1991

Pseudomonas syringae pv. phaseolicola genomic clones harboring heterologous DNA sequences suppress the same phaseolotoxin-deficient mutants.

Cosmid cloning and mutagenesis were used to identify genes involved in the production of phaseolotoxin, the chlorosis-inducing phytotoxin of Pseudomonas syringae pv. phaseolicola, the causal agent of halo blight of bean (Phaseolus vulgaris L.). Eight stable clones were isolated from a genomic cosmid library by en masse mating to 10 ethyl methanesulfonate (EMS)-induced Tox- mutants. In cross-matings, each suppressed all 10 mutants as well as an additional 70 EMS-induced Tox- mutants (and one UV-induced Tox- mutant). On the basis of restriction endonuclease analysis and hybridization studies, the clones were grouped into three classes. Clones in a particular class shared common fragments, whereas clones in different classes did not. Clones from class I (but not classes II and III) also suppressed Tn5-induced Tox- mutants. Interposon mutagenesis and marker exchange of a representative clone from class III into the wild-type genome did not alter its Tox+ phenotype, indicating that this clone does not harbor structural or regulatory genes involved in phaseolotoxin production. We suggest that the genome of P. syringae pv. phaseolicola contains a "hot spot" in one of the functions involved in toxin production which is affected by EMS and UV and that heterologous clones are able to suppress the Tox- phenotype because their inserts encode products that are able to substitute for the product of the mutated gene. Alternatively, the inserts may contain sequences which titrate a repressor protein. In either case, the data suggest that suppression of EMS- and UV-induced mutants occurs when heterologous clones are present in multiple copies.

Base Sequence↗
PubMed1991

Preliminary study of indocyanine green clearance in primary biliary cirrhosis.

Indocyanine green clearance was measured in 23 symptomatic patients with primary biliary cirrhosis who were followed up for 6 months. Ten patients either died (n = 4) from their primary biliary cirrhosis or underwent liver transplantation (n = 6) during the follow-up period. Indocyanine green clearance and other liver function test results were compared between the survivors (n = 13) and those who had died or undergone transplantation (n = 10). Indocyanine green clearance, bilirubin, bile acids, albumin, and prothrombin ratio differed significantly between the two groups, whereas age, alkaline phosphatase, globulin, and aspartate aminotransferase did not. Indocyanine green clearance gave better discrimination between the two groups than the other liver function tests, including bilirubin. There was a close correlation between indocyanine green clearance and bilirubin in patients who died or were transplanted. Further studies are necessary to define whether indocyanine green clearance is clinically useful in selecting patients for transplantation and in the timing of intervention.

Adult↗
PubMed1991

Acute upper gastrointestinal haemorrhage in a district general hospital: audit of an agreed management policy.

All patients from an unselected population admitted with acute upper gastrointestinal (GI) haemorrhage to a District General Hospital (DGH) were studied prospectively over one year. Before the study period a management policy was agreed between physicians and surgeons. One-hundred-and-nine patients were admitted. Sixty-eight per cent were over 60 and 17% over 80 years of age. Sixty patients bled from peptic ulcers and seven patients rebled. Endoscopic stigmata (visible vessel, adherent clot, and oozing) were useful in identifying those at increased risk of rebleeding but not as an indication for surgery. Six patients underwent surgery for peptic ulceration with one postoperative death. There were four deaths among the other patient groups giving an overall mortality of 4.6%. This audit shows a low mortality after acute upper GI haemorrhage can be achieved even in an elderly population in a DGH without the establishment of a specialist unit but with an agreed policy of management.

Acute Disease↗