Search PubMed⌕ Search

Biomedical subjects

D W Bullimore

Publications and source records attributed to D W Bullimore.

At least 19 recordsLinked to original sources
PubMed2004

Does surgical removal of mucosal associated lymphoid tissue protect against adult coeliac disease? A case controlled study.

BACKGROUND AND AIMS: Surgical resection of mucosa associated lymphoid tissue has been suggested as a protective mechanism against the development of inflammatory bowel disease. Mucosal T-cell activity plays a pivotal role in coeliac disease pathogenesis. We aimed to determine if the development of adult coeliac disease is influenced by appendectomy or tonsillectomy. METHODOLOGY: Three hundred patients over 16 years of age with biopsy proven coeliac disease were identified from two hospital databases in South Yorkshire. From these databases, appendectomy and tonsillectomy status was determined and compared with 1033 coeliac disease antibody-negative controls (volunteers recruited from general practice). Logistic regression was performed to correct for the age differences between the two groups; cross-table analysis was performed. RESULTS: Thirteen percent of coeliac disease patients and 12.2% of controls had previous appendectomy (P = 0.71; odds ratio 1.08; 95% confidence interval 0.72-1.62). 20.7% of coeliac disease patients and 24.5% of the controls had previous tonsillectomy (P = 0.17; odds ratio 0.80; 95% confidence interval 0.59-1.10). CONCLUSIONS: No significance was demonstrated in either the appendectomy or tonsillectomy group. Surgical removal of mucosal associated lymphoid tissue does not appear to prevent the development of adult onset coeliac disease.

Adolescent↗
PubMed2003

Endometriosis is sustained by tumour necrosis factor-alpha.

Endometriosis is a common gynaecological disorder causing pain, infertility, and emotional distress. Evidence presented here suggests that abnormal production of tumour necrosis factor-alpha (TNF-alpha) is required for the establishment and maintenance of endometriosis and also is responsible for the associated infertility through its effect on sperm motility and function and oocyte development. Infliximab, which blocks TNF-alpha function, could be used in the treatment of endometriosis to reverse the above effects.

Animals↗
PubMed1990

Soluble interleukin-2 receptor in Crohn's disease: relation of serum concentrations to disease activity.

Serum concentrations of soluble interleukin-2 receptor (sIL-2R) were measured as a marker of immune activation in a group of 30 patients with Crohn's disease. sIL-2R concentrations were determined by enzyme linked immunosorbent assay during periods of active and inactive disease and correlated with standard parameters of disease activity. Serum concentrations of sIL-2R were significantly raised in patients with active Crohn's disease compared with patients with inactive disease (p less than 0.001) and control subjects. There was a significant correlation between serum sIL-2R concentrations and disease activity as assessed by the Harvey-Bradshaw index (r = 0.42, p less than 0.01), platelet numbers (r = 0.49, p less than 0.01), and orosomucoid (r = 0.47, p less than 0.01), alpha 1 antitrypsin (r = 0.44, p less than 0.01), and C reactive protein concentrations (r = 0.48, p less than 0.001) but not with the erythrocyte sedimentation rate. Measurement of serum sIL-2R concentration is a simple and useful laboratory means of assessing disease activity. Raised concentrations in patients with active Crohn's disease is further evidence for in vivo immune activation occurring in this disease.

Adult↗
PubMed1989

Reduction in accident injury severity in rear seat passengers using restraints.

A prospective study of 441 rear seat occupants seen following road traffic accidents compared injury severity in the 411 unrestrained and 30 restrained subjects. Using ridit analysis, the injury severity score showed far less injury among restrained subjects (P = 0.0001). All 11 deaths and 176 of the 178 most severe injuries occurred in the unrestrained group. One restrained (3 per cent) subject was admitted overnight and 64 unrestrained (16 per cent) subjects required admission; two-thirds required a prolonged admission (mean = 13 days). Fractures, major bruises, abrasions and lacerations were almost confined to unrestrained passengers, 221 events compared with two among restrained passengers. Twenty-three unrestrained subjects were ejected, nine of whom were killed. We conclude that the use of rear seat restraints greatly reduces injury severity and should be compulsory for rear seat occupants as it is for front seat occupants.

Accidents, Traffic↗
PubMed1989

The prognosis of elderly subjects with oesophageal varices.

Discharge survival following variceal bleeding was similar in 27 elderly subjects, aged 65-93 years, and 125 younger subjects, aged under 65 (63% versus 70%, p greater than 0.05). Of 39 elderly subjects with varices which were not bleeding on admission, 82% were discharged alive but subsequent mortality was higher and long-term survival was similar (median 1 year) on life-table analysis. The overall long-term survival in the 66 elderly subjects was far worse than in the comparable group of 269 subjects under 65 (p less than 0.001). However, the excess deaths were from causes unrelated to hepatic failure or bleeding (e.g. stroke). Considering only deaths from hepatic failure or bleeding, long-term survival in the elderly and young was similar (p greater than 0.5). We conclude that elderly subjects with varices should be managed as actively as younger subjects since the majority are discharged alive and prolonged survival is common (25% at 3 years).

Actuarial Analysis↗
PubMed1989

Gastric mucosa in patients with portal hypertension: prevalence of capillary dilatation and Campylobacter pylori.

To determine whether the "congestive" gastropathy associated with portal hypertension showed distinctive histological features independent of inflammatory gastritis, endoscopic biopsy specimens of gastric mucosa from 23 patients with portal hypertension and 25 patients with non-ulcer dyspepsia were examined. Active chronic gastritis associated with Campylobacter pylori was found in three patients with portal hypertension compared with 13 patients with non-ulcer dyspepsia. The changes of reflux gastritis were seen in nine patients with portal hypertension compared with three patients with non-ulcer dyspepsia. Mucosal capillary dilatation, assessed on sections stained for factor VIII related antigen, a specific marker for endothelial cells, was significantly greater in biopsy specimens from patients with portal hypertension but this difference was not apparent on sections stained conventionally. The degree of capillary dilatation was unrelated to the presence of histological gastritis. These observations support the view that portal hypertension is associated with a distinctive gastropathy characterised by prominence and dilatation of mucosal capillaries.

Adolescent↗
PubMed1987

Comparison of the effectiveness of midazolam and diazepam in lipid emulsion as sedation during upper gastrointestinal endoscopy.

In a study of 101 patients undergoing upper gastrointestinal endoscopy, 90% of patients had complete amnesia for the procedure after intravenous midazolam (average dose 10 mg), but only 61% had complete amnesia after intravenous diazepam in lipid emulsion (average dose 18.4 mg) (P = 0.0006). However, when assessed by two different tests, recovery within the first hour was significantly more rapid after diazepam (P less than 0.0001). Prolonged sedation (over 20 hours after injection) was reported occasionally by patients who had received either drug. Thus, as with patients who have been sedated with diazepam, those who have been sedated with midazolam should also be advised to avoid driving or operating machinery for at least 24 hours after injection.

Diazepam↗
PubMed1987

Raised parathyroid hormone levels in the milk alkali syndrome: an appropriate response?

A case of the 'milk alkali syndrome' associated with grossly elevated levels of amino terminal parathyroid hormone is described. The hypercalcaemia (calcium 4.09 mmol/l) and hyperparathyroidism settled on conservative measures. Factors in the milk alkali syndrome which might stimulate the release of parathyroid hormone include parathyroid gland hyperplasia secondary to suppression of ionized calcium, alteration in sensitivity of calcium receptors on the cells of the parathyroid glands, the stimulation of an intermittent alkaline tide in the blood and the high intake of phosphate and bicarbonate. We suggest that high levels of parathyroid hormone in the milk alkali syndrome may be appropriate rather than paradoxical.

Adult↗
PubMed1985

Bleeding oesophageal varices: referral bias and survival.

The survival of subjects with varices and gastrointestinal bleeding transferred to a referral centre from outside hospitals was compared with the survival of those admitted directly. The clinical features of the two groups were very similar and survival was 72 per cent. This suggests that the bias introduced by including such external referrals in series from regional centres studying survival in these patients is small and that they provide information relevant to patient management in smaller units. Of the referrals 79 per cent were from within 30 miles, transfer occurred rapidly and early mortality was low (7 per cent by one week). These factors help to minimise bias.

Esophageal and Gastric Varices↗