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Biomedical subjects

F P Ryan

Publications and source records attributed to F P Ryan.

17 recordsLinked to original sources

Autoimmunity, inflammatory bowel disease and hyposplenism.

The presence or absence of nine autoantibodies were assessed in 44 patients with ulcerative colitis (17 with hyposplenism) and 22 patients with Crohn's disease (eight with hyposplenism). The purpose of the study was to determine whether hyposplenism in inflammatory bowel disease is associated with an increased tendency to autoimmunity, or whether autoimmunity is linked not to hyposplenism itself but to the underlying bowel disease. The results strongly suggest that the latter hypothesis is correct. There was a much higher frequency of autoantibodies in patients with ulcerative colitis than in those with Crohn's disease (P < or = 0.01), suggesting that autoimmune factors are more important in the pathogenesis of ulcerative colitis than in Crohn's disease.

Adolescent↗

Gastric enzymes as a screening test for gastric cancer.

Levels of lactic dehydrogenase and beta-glucuronidase were measured in gastric wash samples obtained from 445 patients over 40 years old attending a routine diagnostic endoscopy clinic. An index was derived from the two levels and used as a test for the presence of gastric cancer. Of the 24 patients with an endoscopic diagnosis of gastric cancer, 21 (91.3%) proved positive on this test, including all four cases of early gastric cancer, which were found at repeat endoscopy. The specificity of the test for gastric cancer was 81.3%. Among those patients with false positive results who had endoscopic biopsy were four out of the five cases of severe dysplasia, and four out of the 13 cases of type 2B intestinal metaplasia. Atrophic gastritis alone or with intestinal metaplasia was found in 95.9% of the false positives who were biopsied.

Gastroscopy↗

A single night time dose of ranitidine in the acute treatment of gastric ulcer: a European multicentre trial.

Four hundred and twenty eight patients with endoscopically diagnosed gastric ulcers, randomly allocated to treatment with ranitidine 300 mg at night or ranitidine 150 mg twice daily, were evaluated in a double blind multicentre trial conducted in 10 European countries. After four weeks, complete ulcer healing was observed in 138 of 211 patients (65%) treated with ranitidine 300 mg nocte and in 155 of 217 patients (71%) receiving 150 mg bd. Cumulative healing rates at eight weeks were 90% and 93%, respectively. There was no statistically significant difference between the healing rates at either four or eight weeks. The treatment regimens were equally effective at rapidly reducing the incidence of ulcer related symptoms. Adverse events reported were minor and equally distributed between the two groups. The results of this trial show that 300 mg of ranitidine administered at night is an effective and safe alternative to the current twice daily regimen for the short term treatment of gastric ulcer.

Administration, Oral↗

Ranitidine in the prevention of gastric and duodenal ulcer relapse.

Prophylactic maintenance therapy for one year using ranitidine 150 mg at night or a placebo was assessed in 68 patients whose gastric or duodenal ulcers had previously healed after therapy with ranitidine 150 mg twice daily or placebo. Gastroscopy was carried out on symptomatic relapse and at the end of the year. Of the duodenal ulcer group, seven out of 20 relapsed on ranitidine compared with 15 out of 17 on placebo (p less than 0.001). Of the gastric ulcer group one of 15 patients relapsed on ranitidine compared with 11 of 16 patients on placebo (p less than 0.005). There were no adverse effects from ranitidine during the trial period. Ranitidine in low dose maintenance therapy is therefore reasonably effective in the prevention of relapse of duodenal ulcers and appears to be particularly effective in preventing relapse of gastric ulcers at least for one year. As gastric ulcers occur more frequently in the older patients in whom there are often medical contraindications to surgery, maintenance treatment may be appropriate for many such patients.

Adult↗

Healing of gastric ulcers after one, two, and three months of ranitidine.

Ranitidine (150 mg twice daily) was compared with placebo in 42 patients with gastric ulcer. The study was conducted as a double-blind trial for one month, followed by an open assessment of one, two, and three months of ranitidine in the patients with persistent ulceration. Thirty-eight patients completed the double-blind trial. Repeat endoscopy confirmed complete healing in 16 of the 21 who had received ranitidine and five of the 17 who had received placebo (p less than 0.01). The remaining 17 patients with persistent ulceration participated in the open assessment. The combined cumulative healing rates of ranitidine at four, eight, and 12 weeks were 73%, 88%, and 97%. There were no adverse effects or unusual reasons for withdrawal from the study (four patients). Ranitidine appears to be a safe and highly effective treatment of gastric ulceration, with about 90% of ulcers healed after eight weeks.

Adolescent↗

Impaired immunity in patients with inflammatory bowel disease and hyposplenism: the response to intravenous phi X174.

Eight patients with inflammatory bowel disease were tested for their ability to mount a serological response to the intravenous particulate antigen phi X174. Seven patients had extensive ulcerative colitis and one patient extensive Crohn's colitis, four having severe hyposplenism and four normal splenic function. The antibody response to phi X174 was grossly impaired in those with hyposplenism.

Antibodies, Viral↗

Further experience of hyposplenism in inflammatory bowel disease.

We have reported previously the association between hyposplenism and inflammatory bowel disease. Our study has now been extended to a total of 65 patients with ulcerative colitis and 42 with Crohn's disease so that the incidence of hyposplenism could be more accurately determined. Hyposplenism rarely complicated distal ulcerative colitis, but was found in 15 of 37 patients with total colonic disease. Hyposplenism occurred in 11 out of 31 patients with Crohn's disease of the colon, but in none of 11 individuals with isolated ileal disease. In order to determine whether hyposplenism has any prognostic implications, the peri-operative course of 12 hyposplenic individuals who underwent colectomy was compared with that of 12 controls who required surgery and who had normal splenic function. Four of the hyposplenic subjects became severely shocked after operation and developed disseminated intravascular coagulation. In contrast, the post-operative course in the control patients was uneventful.

Adolescent↗

Hyposplenism in inflammatory bowel disease.

Splenic function was assessed in 35 patients with ulcerative colitis and 20 patients with Crohn's disease. Hyposplenism was diagnosed if there were Howell-Jolly bodies in the peripheral blood film or if there was prolongation of clearance from the peripheral blood of injected 51-Cr-labelled heat-damaged red blood cells. Thirteen of the patients with ulcerative colitis had hyposplenism as compared with only one patient with Crohn's disease. Conversely, heat-damaged red cell clearance values faster than the normal range were found in six out of the 20 patients with Crohn's disease. Four patients with hyposplenism and ulcerative colitis developed life-threatening septicaemia in the early postcolectomy period, two of these being further complicated by disseminated intravascular coagulation.

Colectomy↗

Relationship between splenic size and splenic function.

The rate of clearance of 51Cr labelled heat-damaged red cells from the circulation has been compared with the dimensions of the posterior scan of the spleen in 79 cases including nine controls. A strong negative correlation was found between the clearance half-time and the parameters of the scan but, as there was a large variation about the regression line, in the assessment of hyposplenism determination of the rate of clearance of heat-damaged red cells cannot be replaced by the easier determination of spleen size by scanning.

Erythrocyte Aging↗

Cerebral involvement with disseminated intravascular coagulation in intestinal disease.

Over a two-and-a-half-year period at the Sheffield Royal Infirmary, six patients developed disseminated intravascular coagulation as a serious complication of intestinal disease. There was clinical evidence of cerebral involvement in all six patients, and small vessel thrombi were demonstrated in the brains of all three cases examined post mortem. Where the true significance of the cerebral disorder was not recognised, this led to delay in the diagnosis with serious risk to the patient. In the single case in which the diagnosis was made early, the intravascular coagulation was completely reversed with heparin therapy.

Adult↗

Pulmonary adenocarcinoma metastatic to the adrenal gland mimicking normal adrenal cortical epithelium on fine needle aspiration.

Fine needle aspiration (FNA) of enlarged adrenal glands detected by computed tomography is a valuable method for extrathoracic staging of pulmonary carcinomas. This paper presents the case of a middle-aged man with pulmonary adenocarcinoma metastatic to the adrenal glands, the FNA sample of which closely resembled normal adrenal cortical epithelium. Through review of the case and comparison with cytologic preparations from normal adrenal glands, the aspiration cytologic features suggesting carcinoma are described.

Adenocarcinoma↗