Search PubMed⌕ Search

Biomedical subjects

H D Duncan

Publications and source records attributed to H D Duncan.

17 recordsLinked to original sources
PubMed2005

Thalidomide in the treatment of cancer cachexia: a randomised placebo controlled trial.

BACKGROUND: Proinflammatory cytokines, especially tumour necrosis factor alpha (TNF-alpha), play a prominent role in the pathogenesis of cancer cachexia. Thalidomide, which is an inhibitor of TNF-alpha synthesis, may represent a novel and rational approach to the treatment of cancer cachexia. AIMS: To assess the safety and efficacy of thalidomide in attenuating weight loss in patients with cachexia secondary to advanced pancreatic cancer. METHODS: Fifty patients with advanced pancreatic cancer who had lost at least 10% of their body weight were randomised to receive thalidomide 200 mg daily or placebo for 24 weeks in a single centre, double blind, randomised controlled trial. The primary outcome was change in weight and nutritional status. RESULTS: Thirty three patients (16 control, 17 thalidomide) were evaluated at four weeks, and 20 patients (eight control, 12 thalidomide) at eight weeks. At four weeks, patients who received thalidomide had gained on average 0.37 kg in weight and 1.0 cm(3) in arm muscle mass (AMA) compared with a loss of 2.21 kg (absolute difference -2.59 kg (95% confidence interval (CI) -4.3 to -0.8); p = 0.005) and 4.46 cm(3) (absolute difference -5.6 cm(3) (95% CI -8.9 to -2.2); p = 0.002) in the placebo group. At eight weeks, patients in the thalidomide group had lost 0.06 kg in weight and 0.5 cm(3) in AMA compared with a loss of 3.62 kg (absolute difference -3.57 kg (95% CI -6.8 to -0.3); p = 0.034) and 8.4 cm(3) (absolute difference -7.9 cm(3) (95% CI -14.0 to -1.8); p = 0.014) in the placebo group. Improvement in physical functioning correlated positively with weight gain (r = 0.56, p = 0.001). CONCLUSION: Thalidomide was well tolerated and effective at attenuating loss of weight and lean body mass in patients with cachexia due to advanced pancreatic cancer.

Aged↗
PubMed2002

Distal colonic motor activity in four subgroups of patients with irritable bowel syndrome.

With the aim of improving end organ treatment, we describe a new system of classifying irritable bowel syndrome (IBS) according to clinical features into four groups, spastic colon syndrome (SCS), functional diarrhea (FD), diarrhea-predominant spastic colon syndrome (DPSCS), and midgut dysmotility (MGD). The aim of the study was to investigate fasting and postprandial distal colonic motility in the four groups of patients and to compare the results with normal controls. Distal colonic motility studies were performed in the unprepared colon. 2.5-hr recordings were made from four channels with a standard meal administered at 0.5 hr. The intubated colon was treated as a study segment and data analyzed for study segment activity index (SSAI) and number and mean amplitude of pressure peaks over 30-min epochs. Patients with SCS had significantly higher (P < 0.05) mean amplitude of pressure peaks (60 min, 120 min) and SSAI (120 min) than controls and patients with FD, DPSCS, and MGD. In contrast, patients with FD and DPSCS had significantly (P < 0.05) lower postprandial SSAI than controls and patients with SCS (60 min, 120 min). With the exception of raised postprandial mean amplitude of pressure peaks (120 min), MGD patients had normal distal colonic motility. Division of IBS patients into subgroups has highlighted significant differences in distal colonic motility that provide insights into etiopathogenesis and should assist targeting of current and newly developed therapies, particularly receptor active agents.

Adult↗
PubMed2001

The effect of a polymeric enteral formula supplemented with a mixture of six fibres on normal human bowel function and colonic motility.

BACKGROUND AND AIMS: Fibres with varying fermentability may improve bowel function during enteral feeding. Two studies in healthy volunteers aimed to 1) investigate effects of Nutrison Multi Fibre (NMF) on gastrointestinal function, and 2) compare effects of NMF administered orally and nasogastrically on distal colonic motor activity. METHODS: (1) Ten subjects were randomly assigned to 3x7 days self-selected diet (SSD), 2 litres Nutrison Standard (NS), or 2 l NMF. Objective and subjective indices were measured. (2) Two groups (n=6) received 2x250 ml boluses of NMF 2 hourly either nasogastrically or orally. Distal colonic motility was measured for 8 h (3 pre/5 post) first bolus. RESULTS: Whole gut transit time was prolonged during NS (P<0.05) compared with SSD or NMF. Stool wet weight was higher during SSD (P<0.05) than during NS or NMF. Bowel frequencies were comparable. NMF was well tolerated. 2. Colonic activity index was maintained after oral administration with no associated diarrhoea. Activity index decreased after nasogastric bolus (P<0.05), but recovered to higher than fasting levels (P<0.05). 5 subjects had watery stools. CONCLUSIONS: Oral NMF is well tolerated, normalises whole gut transit time and maintains colonic motility. Recovery of colonic activity after nasogastric bolus suggests a putative protective effect of NMF over a longer period of feeding.

Administration, Oral↗
PubMed2001

Enteral nutrition by nasojejunal tube in hyperemesis gravidarum.

We describe two cases in which self-propelling, blind placed nasojejunal tubes were placed in severe hyperemesis gravidarum. This method provides an alternative to parenteral nutrition and to percutaneous endoscopic tubes, is well tolerated, cost effective and with a low rate of complication. Both mothers were given nutritional support at home, had normal subsequent pregnancies and normal babies.

Adult↗
PubMed2001

Colonic lymphoid hyperplasia in melanosis coli.

We describe the case of a patient with Rett syndrome, a syndrome characterized by progressive infant encephalopathy, developmental delay, dementia, autism, ataxia, microcephaly, spastic paraparesis, and autonomic neuropathy with constipation. At colonoscopy, multiple foci of tiny white, sessile, polypoid lesions were seen throughout the colon and rectum, mimicking the appearances of small hyperplastic or adenomatous polyps, associated with generalized melanosis coli. This is the first case to our knowledge describing melanosis coli in a patient with Rett syndrome. As melanosis pigment deposition is characteristically not seen in lymphoid tissue, the lymphoid tissue was identifiable at endoscopy as multiple white nodules mimicking generalized colonic polyposis throughout the colon. We discuss the likely mechanisms of lymphoid hyperplasia and coexistent melanosis coli in Rett syndrome.

Abdominal Pain↗
PubMed2000

The 'cut and push' method of percutaneous endoscopic gastrostomy tube removal.

BACKGROUND AND AIMS: The standard method of removing percutaneous endoscopic gastrostomy tubes is by gastroscopy. This has implications for endoscopy time and resources, and we believe is not always necessary. Depending on the type of percutaneous endoscopic gastrostomy tube used we often used the 'cut and push' method. This involves cutting the catheter at skin level and allowing the tube and internal bumper to spontaneously pass. The cut and push method also represents a considerable resource saving compared to the endoscopic method that we think warrants further discussion. METHOD: We reviewed all the files of the percutaneous endoscopic gastrostomy tubes removed in our unit over the last 4 years. RESULTS: During the period of July 1995 to July 1999, we have inserted 384 percutaneous endoscopic gastrostomy tubes. Seven tubes have been removed endoscopically and 73 tubes have been removed with the cut and push method. Only two possible complications have been recorded (2.7%). CONCLUSIONS: We believe that we have provided further evidence that percutaneous endoscopic gastrostomy tubes can be removed safely using the cut and push method. Patients who are often frail and who have multiple medical problems are saved an often-long journey to the endoscopy unit as well as the hazards of an endoscopy. The saving in resources in what is already an overworked system by not performing endoscopies is also considerable.

Adolescent↗
PubMed2000

Assessment of the prevalence of infection with Helicobacter pylori in patients with inflammatory bowel disease.

OBJECTIVE: To determine the prevalence of Helicobacter pylori in patients with inflammatory bowel disease (IBD) and compare this to the prevalence in a control population with non-organic bowel symptoms, and to investigate the effect of sulphasalazine and other 5-aminosalicylic acid (5-ASA) drugs on the prevalence of H. pylori in IBD patients. DESIGN: Prospective, controlled trial. SETTING: Gastroenterology out-patient department, City General Hospital, North Staffordshire Hospitals NHS Trust, Stoke-on-Trent. PARTICIPANTS: The population comprised 51 patients with ulcerative colitis, 42 patients with Crohn's disease and 40 patients with irritable bowel syndrome as controls. Patients with X-ray- and/or biopsy-proven disease were eligible to be entered into the study. INTERVENTIONS: Subjects filled in a detailed questionnaire, were assessed for seropositivity of H. pylori and underwent a C13 urea breath test (UBT). MAIN OUTCOME MEASURES: Seropositivity for H. pylori and a positive C13 UBT result. RESULTS: A quarter of the irritable bowel syndrome controls were seropositive for H. pylori. Of the ulcerative colitis patients, 21.6% were currently H. pylori-positive on C13 UBT; 17.6% of the ulcerative colitis patients who had been previously treated with sulphasalazine were positive while 23.1% of the ulcerative colitis patients who had been treated with a non-sulphasalazine 5-ASA drug were positive. Of the Crohn's patients, 11.9% were currently H. pylori-positive; 3.6% of the Crohn's patients who had been previously treated with sulphasalazine were positive while 12.5% of the Crohn's patients who had been treated with a non-sulphasalazine 5-ASA drug were positive. CONCLUSIONS: Patients with IBD and Crohn's disease in particular were less likely to be H. pylori-positive than controls. Sulphasalazine treatment further decreased the prevalence of H. pylori, although the reduced prevalence of H. pylori in IBD patients could not be accounted for by this alone.

Adult↗
PubMed1998

Intestinal motility.

This review covers the recent advances that have been made in intestinal motility. Failure to stimulate the cephalic response when enteral tube feeding via the nasogastric route is important in contributing to enteral tube feeding related diarrhoea, which cannot be initially overcome by the use of fibre containing feeds. Dysfunction of the nervous system and visceral hypersensitivity appear to be important in contributing to the symptoms associated with irritable bowel syndrome.

Colonic Diseases, Functional↗
PubMed1997

Collagenous colitis and cimetidine.

We report a case of a 62-year-old man who developed watery diarrhoea after starting treatment with cimetidine for dyspepsia. Macroscopically, sigmoidoscopy and colonoscopy were normal. Histology revealed features consistent with a diagnosis of collagenous colitis. The diarrhoea is responding to treatment with prednisolone and withdrawal of cimetidine. We conclude that the collagenous colitis may have been drug induced.

Antidiarrheals↗
PubMed1997

The safety of diagnostic and therapeutic ERCP as a daycase procedure with a selective admission policy.

OBJECTIVE: To assess if therapeutic endoscopic retrograde cholangiopancreatography (ERCP) as a daycase procedure with a selective admission policy is safe and cost-effective. DESIGN: An audit of case notes of patients who attended as a daycase for either a therapeutic or diagnostic ERCP over a 20-month period. SETTING: Stoke-on-Trent District General Hospital. PATIENTS: Case notes of all patients who had an ERCP as a daycase were audited. INTERVENTIONS: Therapeutic procedures performed as daycases included papillotomy, stent insertion, balloon dilatation or a combination of these procedures. Patients are discharged home 2 h after diagnostic or therapeutic ERCP. MAIN OUTCOME MEASURES: Thirty-day morbidity and mortality of daycase patients. RESULTS: During the 20-month period audited, 550 ERCPs were performed, of which 240 attended initially as daycases. There were 97 successful daycase therapeutic ERCPs. Ten patients were admitted immediately after ERCP including one who subsequently died from a myocardial infarction (known severe ischaemic heart disease); 87 patients were discharged 2 h after ERCP; none were admitted between 2 and 48 h after ERCP; 4 were admitted between 48 h and 30 days after ERCP with complications. There were 117 successful daycase diagnostic ERCPs; 4 patients were admitted immediately due to frailty, 4 were admitted between 2 and 48 h and 1 at 28 days after ERCP with complications. There were 24 failed diagnostic and 2 failed therapeutic ERCPs. CONCLUSION: Daycase ERCP with a selective admission policy is safe and cost-effective.

Adult↗
PubMed1997

Two phase randomised controlled clinical trial of postoperative oral dietary supplements in surgical patients.

BACKGROUND: Previous work has shown that the administration of oral dietary supplements to patients who have undergone gastrointestinal surgery results in clinically significant short term benefits. AIMS: This study aimed firstly to re-evaluate these short term effects, and secondly to establish whether there are any long term benefits. SUBJECTS: One hundred patients admitted for elective moderate or major gastrointestinal surgery. METHODS: In the inpatient phase, patients were randomised to receive a normal ward diet postoperatively, or the same diet supplemented with an oral dietary supplement. In the outpatient phase, patients were further randomised to receive their home diet, or their home diet supplemented with the oral dietary supplement for four months. RESULTS: During the inpatient phase, patients treated with oral supplements had a significantly improved nutritional intake and lost less weight (2.2, 95% confidence interval (95% CI) 0.9 kg) compared with control patients (4.2 (0.78) kg, p < 0.001). Supplemented patients maintained their hand grip strength whereas control patients showed a significant reduction in grip strength (p < 0.01). Subjective levels of fatigue increased significantly above preoperative levels in control patients (p < 0.01) but not in the supplemented group. Twelve patients in the control group developed complications compared with four in the supplemented group (p < 0.05). In the outpatient phase, supplemented patients had improved nutrient intakes but there were no significant differences in indices of nutritional status or wellbeing between the groups. CONCLUSIONS: The prescription of oral dietary supplements to patients who have undergone gastrointestinal surgery results in clinically significant benefits. These benefits, however, are restricted to the inpatient phase.

Adult↗
PubMed1996

Clinical evaluation of a newly designed nasogastric enteral feeding tube.

Concerned with reports in the literature of a rising incidence of enteral feeding tube clogging, we initiated a design programme in an attempt to improve the clinical efficacy of nasogastric and nasoenteric enteral feeding tubes. Tube design has been based on a remodelling of the outflow part of a polyurethane feeding tube previously developed in our unit. The tip of the newly designed 8F enteral feeding tube is shorter in length with a rounded end to minimize discomfort during intubation. The port itself incorporates a tapered outflow design with the side walls now extending below the mid-point of the internal flow lumen resulting in a 28% increase in port area compared to the equivalent and originally designed tube. The performance of the newly designed polyurethane feeding tube was assessed under controlled trial conditions using as references two widely used 8F polyurethane nasogastric feeding tubes whose design has been based on different principles (Flexiflo, weighted tip, open-ended with two side ports; Freka, occluded tip, two simple large side ports). Eighty-eight of 90 patients entered into the study were successfully intubated with no significant differences being noted in intubation times in the three groups. Significantly less discomfort occurred during intubation of patients with the Radius tube as compared to the Freka tube (P < 0.05). Although there were no clear differences between the Flexiflo and Freka tubes either in regard to the number of attempts required for intubation or aspiration or discomfort during intubation or ease of aspiration, fewer attempts at insertion and aspiration were needed and intubation and aspiration were easier for patients randomised to the Radius group than those to the Flexiflo and Freka groups (P < 0.05). We conclude that the clinical performance of the newly designed Radius enteral feeding tube compares favourably with that of the reference tubes. Only one of the new tubes (3.3%) blocked during the course of the study. High rates of non-elective extubation were observed in the three study groups (Radius 80.0%, Flexiflo 73.3%, Freka 73.3%). Design modifications are unlikely to influence non-elective nasogastric feeding tube extubation rates which remain a major clinical problem.

Journal Article↗
PubMed1996

Prospective randomized comparison of two different sized percutaneous endoscopically placed gastrostomy tubes.

We performed a prospective randomised study of two different sized percutaneous endoscopic gastrostomy (PEG) tubes to determine if tube size influenced the incidence of PEG-related complications. Patients were given prophylactic cefuroxime, if not already on antibiotics at the time of PEG insertion. Fifty-two PEGs were successfully placed, 26 in each group. Most patients who required a PEG had suffered a cerebrovascular event (82.7%). There were no procedure-related deaths. The mean ages (standard deviation) for the 12 and 20 French Gauge (FG) groups were 78.7 (8.9) and 73.9 (14.4) years, respectively, with no statistical difference. There were no significant differences in mortality (9 deaths in the 12 FG and 11 deaths in the 20 FG groups), number of peristomal infections (8 infections in the 12 FG and 12 infections in the 20 FG groups), episodes of leakage (12 leakages in the 12 FG and 17 leakages in the 20 FG groups) or tube blockage (2 blockage episodes in the 12 FG and 1 blockage episode in the 20 FG groups) between the two groups over a follow-up period of 190 days. The incidence of insertion- and feeding-related complications was thus not influenced by tube size. As the smaller PEG tubes were easier and less traumatic to insert we conclude that there are grounds for considering the more widespread use of the narrower diameter 12 FG PEG tubes.

Journal Article↗
PubMedDate not supplied

Diagnosis and treatment of malnutrition.

Artificial nutritional support may be supplied by several routes. Its many potential complications can be avoided if they are anticipated and help sought early from the nutrition team.

Adolescent↗