Biomedical subjects
Publications and source records attributed to D Lovell.
Two West Indian parents and three of their seven offspring presented over a 12-yr period with identical systemic illnesses characterized by the development of granulomatous hepatitis. Granulomata were variably also found in muscle, lymph nodes, and pleura in some of these affected individuals. The usual causes of granulomatous hepatitis were absent, and this familial disease represents a hitherto undescribed entity.
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Twenty patients with symptoms and endoscopic changes of gastro-oesophageal reflux were randomly allocated to treatment with either ranitidine 150 mg bd, or 300 mg bd for 8 weeks. Symptoms, endoscopic appearances, histopathology of oesophageal biopsies and 22-h intra-oesophageal pH profile in ambulant patients on standard diets were recorded before and at the end of the treatment period. Symptoms improved rapidly and markedly on either dose of ranitidine. Both doses produced significant improvement of the endoscopic appearances, but there were no differences in symptomatic and endoscopic improvement related to the dose. Biopsy appearances and the 22-h oesophageal pH profile remained unchanged on either dose of ranitidine.
A combined morphologic and histochemical study of metaplastic polyps of the colorectum was undertaken. With increasing size, these lesions showed alterations in architecture and differentiation, increased secretion of carcinoembryonic antigen and a reduced secretion of O-acylated sialomucin. These functional changes are also observed in colorectal cancers, but not in tubular adenomas showing low-grade dysplasia. Since there is little clinical evidence for a metaplastic polyp-carcinoma sequence, it is suggested that the sets of factors which lead to adenoma and metaplastic polyp formation in the colorectum are both required to induce malignant transformation.
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Four patients who apparently had benign gastric ulcer (G.U.) were treated with cimetidine. The ulcers healed and their symptoms disappeared. However, when cimetidine was stopped the symptoms recurred. Intramucosal cancer was found only at histopathological examination of the resected stomachs in two of the four patients, and in all the cases malignancy had not been detected by the initial serial biopsies and brush cytology. Relief of symptoms of malignant gastric ulcers by cimetidine may delay diagnosis and appropriae treatment.
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Four patients with Felty's syndrome developed massive upper gastrointestinal bleeding due to oesophageal varices. The underlying hepatic pathology in all 4 was nodular regenerative hyperplasia. This appears to be a difficult histological diagnosis to make, having been initially reported as normal on percutaneous biopsy or as fibrosis or cirrhosis on wedge biopsy. This series brings the total number of cases reported in the English literature of this association to 12, suggesting a definite symptom complex. The portal hypertension seems to be due to a combination of increased splenic blood flow and postsinusoidal resistance. The clinical importance of this syndrome is that the appropriate therapy for bleeding oesophageal varices appears to be shunt procedure such as a splenorenal shunt with splenectomy, which should be well tolerated.
The rectal potential difference (PD) was measured in 27 patients with Crohn's disease, and in 16 subjects without gastrointestinal disease to establish a normal range. Sigmoidoscopic assessment and rectal biopsy were performed in all patients with Crohn's disease, and the mean resting rectal PD was significantly reduced in patients with sigmoidoscopically active disease and in those with abnormalities of the superficial epithelium on rectal biopsy. Patients with diarrhoea had a significantly lower mean resting PD than those with normal bowel habit, suggesting that an abnormality of rectal sodium transport may be contributing to the diarrhoea in these patients. The response of rectal PD to mineralocorticoid stimulation with oral fludrocortisone was measured in 13 patients. The PD failed to rise only with patients with sigmoidoscopically active disease, and the test proved to be a less sensitive indication of minor mucosal abnormalities than sigmoidoscopy of biopsy.
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The value of brush cytology under direct vision in the diagnosis of oesophageal cancer was evaluated and compared with other diagnostic procedures in a prospective study of 33 patients suspected of having an oesophageal lesion. Barium swallow correctly diagnosed cancer in 19 out of 20 patients, the remaining patient was diagnosed by both histology and cytology. In all, cytology was correct in 18 cases (90%), whereas histology confirmed the diagnosis in 10 (50%). In the 13 patients with benign lesions, barium swallow was correct in 12; cytology was benign in all 13; biopsy was only possible in 9, although the results of this procedure were always correct. Thus barium swallow is still the ideal screening procedure for patients with oesophageal symptoms, but per-endoscopic brush cytology seems to be the method of choice for confirmation of the diagnosis.
Gentamicin sulphate was administered to male Wistar rats by intramuscular injection at varying dosage and for varying periods. At high dosage (50-100 mg/kg/day) gentamicin causes tubular necrosis. At dosages equivalent to that given to man (5 mg/kg/day) obvious degenerative changes are produced. Similar changes are seen in human tubular epithelium and urine deposits of patients treated with gentamicin. There is increased excretion of urinary enzymes proportional to the degree of tubular damage. The importance of these changes in man is stressed.
A male West Indian patient developed a pleural effusion without radiographic evidence of intra-thoracic lymph node or pulmonary abnormality. A pleural biopsy showed non-caseating granulomas. The Kveim test was positive. During treatment with anti-tuberculosis drugs bilateral pulmonary nodular shadows appeared in the chest x-ray. Anti-tuberculosis chemotherapy was stopped and prednisone given. The nodular shadows resolved.