Biomedical subjects
G D Barr
Publications and source records attributed to G D Barr.
Coeliac disease in adults. Presentation and management.
Coeliac disease, also known as gluten-sensitive enteropathy or non-tropical sprue, is a relatively uncommon condition. The dietary presence of gliadin, an alcohol-soluble subfraction of gluten, in immunologically susceptible hosts will lead to small intestinal mucosal inflammation and subsequent mucosal villous atrophy which results in nutrient and vitamin malabsorption. The symptomatic presentations of patients with coeliac disease are related to this malabsorption process which can be reversed in the vast majority of patients with a gluten-free diet.
Early marked arytenoid calcification in a case of suspected foreign body.
A case of early marked calcification of the arytenoid cartilages is presented in a patient with a suspected pharyngeal foreign body. The calcification on X-ray had the appearance of the expected foreign body. Calcification of the arytenoid cartilages is discussed.
A randomized prospective comparison of two methods of administering topical treatment in otitis externa.
Ten patients with bilateral moderate or severe otitis externa were studied. Following aural toilet each patient was subjected to two different treatments: one ear had alternate day dressings containing a topical antibiotic/steroid mixture, while the external canal of the other was filled with the same topical preparation (sump filling). Improvement in the severity of the otitis externa was assessed after 1 week. 9 out of 10 ear canals improved in each group. An estimate of the relative cost of each treatment was made and sump filling was found to be less expensive. The results suggest that sump filling is a low cost alternative to standard treatment in moderate and severe otitis externa.
Stomal recurrence: a separate entity?
Uncertainty exists concerning the exact aetiology of stomal recurrence following laryngectomy, although it is generally agreed that, when present, the prognosis is very poor. Fourteen cases of stomal recurrence were compared with 15 cases of other types of aggressive recurrence in the neck, for factors implicated in stomal recurrence. Similarities exist between the two groups and, although stomal recurrence has a greater association with subglottic tumour, this difference is not statistically significant. The possible mechanisms of recurrence are discussed, particularly in relation to aggressiveness, and it is concluded that factors involved in aggressive recurrences are similar. Stomal recurrence can be considered part of a group of aggressive neck recurrences associated with more advanced disease prior to laryngectomy.
Pneumatic otoscopy and tympanometry.
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Management of achalasia and laryngo-tracheal compression.
A case of severe airway obstruction due to laryngo-tracheal compression associated with achalasia is presented. Local anaesthetic tracheostomy has an important role in some cases.
Silver nitrate cautery and epistaxis.
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Colonic bacterial proteases to IgA1 and sIgA in patients with ulcerative colitis.
The colonic faecal and mucosal associated bacterial populations of five patients with ulcerative colitis and four control patients were studied in detail to assess their ability to produce IgA1-proteases. A total of 330 bacterial strains were isolated from the patients with ulcerative colitis and IgA1-protease activity was unable to be reliably shown in any. It is therefore unlikely that such enzyme production by colonic bacteria plays a significant role in the pathogenesis of ulcerative colitis.
Antral vascular ectasia--the "watermelon" stomach.
Antral vascular ectasia is a rarely described condition; it is a cause of blood loss and iron deficiency anaemia, particularly in the elderly. Four cases of antral vascular ectasia ("watermelon" stomach) in elderly patients are reported. The clinical history, endoscopic and histological features are described.
Use of an intravenous steroid regimen in the treatment of acute Crohn's disease.
The efficacy of a 5-day intensive intravenous regimen (IVR), used as treatment for severely active Crohn's disease in 49 patients, has been evaluated retrospectively. The value of such systemic therapy has not been reported before. Immediate remission was achieved in 38 (76%) patients with no significant difference between those with established disease and those seen for the first time. Patients with ileocolonic disease had the poorest response. There was no apparent change in the natural history of the Crohn's disease after IVR therapy. Nevertheless, this is a safe and effective method of achieving remission in most sick patients with severely active Crohn's disease.
Ulcerative colitis and sarcoidosis.
Ulcerative colitis is not commonly associated with recognizable pulmonary disease and only four sporadic cases of sarcoidosis in association with ulcerative colitis have been previously reported. However, in a series of 680 patients with ulcerative colitis, pulmonary or extra-pulmonary sarcoidosis has at some stage been present in eight. These cases are reported in detail. The onset of either condition bore no relationship to the activity or the presence of recognized peripheral manifestations of the other, suggesting that the two diseases were independent. However, three of the patients had the HLA B8 DR3 phenotype which is a higher prevalence than seen in previous studies of either disease alone. Patients with ulcerative colitis who possess this HLA phenotype may possibly be more susceptible to developing sarcoidosis.
Olsalazine in active ulcerative colitis.
Olsalazine (azodisalicylate) is a new drug in which two molecules of 5-aminosalicylic acid are linked by an azo bond. Its role in the treatment of mildly active, distal ulcerative colitis was investigated. Sixty patients were randomly allocated to receive olsalazine 1 g or a placebo as a retention enema nightly for two weeks. Clinical improvement was seen in 19 (66%) and sigmoidoscopic improvement in 17 (59%) of the 29 patients receiving olsalazine compared with 12 (43%) and 11 (39%), respectively, of the 28 in the control group. These differences were not significant. In a second trial 40 patients were randomised to receive oral olsalazine 2 g daily or a placebo capsule for two weeks. Significant clinical and sigmoidoscopic improvement was seen in the patients receiving oral olsalazine compared with the patients receiving placebo capsules. Oral olsalazine may be valuable in the treatment of mildly active ulcerative colitis. Its role in maintaining remission is yet to be determined.
Comparison of colloidal bismuth subcitrate tablets and liquid in duodenal ulcer healing.
A double-blind trial using 51 outpatients was aimed at comparing the effectiveness of colloidal bismuth subcitrate (C.B.S.) in tablet and liquid form in the healing of duodenal ulcer. Criteria of entry included endoscopically proven duodenal ulcer, duration of symptoms greater than 4 weeks, and the absence of other major systemic disease. Patients were given either C.B.S. tablets (1 four times daily) or C.B.S. liquid (5 ml four times daily) for 4 weeks. Ulcer symptoms and their relief were recorded by patients, along with data on cigarette, alcohol, and drug intake. Endoscopy was performed after 4 weeks to assess healing. By 4 weeks, 18 of 26 patients taking tablets (69%) and 19 out of 25 patients taking liquid (76%), had healed (p = 0.82). Symptomatic improvement was similar with both tablets and liquid. Smoking and analgesic ingestion did not influence healing rate. We conclude that C.B.S. tablets and liquid are equally effective in healing duodenal ulcer.
Comparison of ranitidine and cimetidine in the treatment of chronic gastric ulcer. A double-blind trial.
The aim of the study was to compare the effectiveness of ranitidine and cimetidine in accelerating the healing of chronic gastric ulcer. 44 outpatients with endoscopically proven gastric ulcer whose duration of symptoms was greater than 4 weeks and who were without major systemic disease were studied. Patients were randomly allocated to receive either ranitidine, 150 mg twice a day or cimetidine, 200 mg three times a day and 400 mg at night for 4 weeks. If the ulcer had not healed, treatment was continued for a further 4 weeks, when patient assessment and endoscopy were repeated. By 4 weeks, 13 of 22 patients taking ranitidine (59%) and 14 of 22 patients taking cimetidine (64%) had healed (p2 = 1.0, 95% confidence interval - 20%, 38%). At 8 weeks, 91% on ranitidine and 91% on cimetidine had healed (p2 = 1.0, 95% confidence interval - 18%, 18%). Symptomatic improvement was similar with both drugs. Smoking did not influence healing rates. There were no major side effects with either medication. It is concluded that ranitidine and cimetidine are of similar efficacy in accelerating the healing of chronic gastric ulcer.
A two-year prospective controlled study of maintenance cimetidine and gastric ulcer.
The aim of the study was to determine the effectiveness of cimetidine in a dose of 400 mg twice daily in the prevention of gastric ulcer recurrence over a 2-yr period. The trial was double-blind and placebo-controlled; 24 patients received cimetidine and 25 received placebo. All had had a gastric ulcer within the prior 6 wk, and healing was demonstrated by endoscopy or by barium meal. The patients were contacted at monthly intervals, and if symptoms were present, investigations were performed. Annual barium meal examinations or endoscopy were also performed in all except 7 patients. In the placebo group, there was rapid recurrence within the first 12 mo; 12 of the 13 recurrences that occurred in this group over the 2-yr period took place within the first 12 mo. In the cimetidine-treated group, there were eight recurrences over the 2-yr period, five of which occurred in the first year. Log rank comparison showed a significant benefit due to cimetidine at 1 yr, but not over the 2-yr period.
Comparison of ranitidine and cimetidine in duodenal ulcer healing.
A single-blind trial in 50 outpatients was aimed at comparing the effectiveness of ranitidine (150 mg twice a day) and cimetidine (200 mg three times a day and 400 mg at night) in the healing of endoscopically proven duodenal ulcer. Patients were reassessed after two weeks of therapy, and then after four weeks immediately before repeat endoscopy. If the ulcer had not healed, treatment was continued for a further two weeks when patient assessment and endoscopy were repeated. By four weeks, ulcers had healed in 72% of patients receiving ranitidine and in 64% of those receiving cimetidine (P = 0.76). At six weeks, the healing rate was 92% in both groups. Symptomatic improvement was similar with both drugs. It is concluded that ranitidine and cimetidine are equally effective in healing duodenal ulcer.