Biomedical subjects
I McColl
Publications and source records attributed to I McColl.
An investigation of psychosocial factors in patients with upper abdominal pain: a comparison with other groups of surgical outpatients.
The purpose of this study was to examine the personality patterns, levels of anxiety and the importance of life events in patients with upper abdominal pain and to compare these patients with other groups of patients attending a general surgical outpatient clinic. The relevance of age, sex and social class was also studied. The patient groups were compared on each of the psychological measures and no differences were found between the groups. In addition the data were subjected to principal component and discriminant analyses in order to determine whether the U.A.P. patients could be distinguished on the basis of a combination of indices. Both analyses failed to produce any distinguishing criteria for the U.A.P. patients. A number of other observations on these patients are also discussed but the overall results are more consistent with a non-specific model of stress and disease than with the idea of specific psychological factors being involved in the development of upper abdominal pain.
Transplantation of amniotic epithelial membranes in patients with mucopolysaccharidoses.
This paper reports the biochemical results of transplanting human amniotic epithelial cells in 3 children with Hunter's and 2 with Hurler's disease. A transient and modest increase of alpha-L-idurono-2-sulphate sulphatase or alpha-iduronidase was observed in the white cells collected from 1 patient with Hunter's and 1 with Hurler's disease. No variation in the excretion of glycosaminoglycans or oligosaccharides was detected in all 5 patients. There was no evidence of immune response towards the transplanted cells or the specifically deficient enzyme. Thus, in spite of the absence of the major histocompatibility antigens, HLA A, B, C and DR, on the surface of the amniotic epithelial cells, no long-term correction of lysosomal enzyme deficiencies was achieved by transplanting amniotic epithelial membranes collected at the end of the gestational period.
Rectal sparing in familial polyposis coli.
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The King's Fund and quality of medical care.
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The use of prophylactic subcutaneous heparin in patients undergoing hernia repairs.
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Comparative electron microscopic features of normal intermediate and metaplastic pyloric epithelium.
The ultrastructural appearance of surface epithelial cells of normal and abnormal pyloric epithelium is presented. In addition to areas of complete intestinal metaplasia (IM) an incomplete metaplasia is described which contains poorly differentiated mucous cells, goblet cells, an occasional immature absorptive cell as well as the mature mucus-secreting surface epithelial cells of normal pyloric epithelium. This type of epithelium frequently appeared hyperplastic and showed alterations in the surface microvilli, terminal webs, plasma membranes and mucin granules. Apical vesicles, small electron-dense bodies and larger electron-dense multivesicular bodies were also found in the intermediate cells of incomplete IM and in the mature absorptive cells of complete IM. The intermediate cells described here may be synonymous with the sulphomucin-secreting cells found in adenocarcinomas of the stomach and oesophagus.
Bleeding oesophageal varices: a scheme of management.
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Idiopathic intestinal pseudo-obstruction and contaminated small bowel syndrome--treatment with metronidazole, ileostomy, and indomethacin.
A 28-year-old Iranian man with chronic idiopathic intestinal pseudo-obstruction presented with gross features of contaminated bowel syndrome. Treatment with metronidazole reversed steatorrhea but exacerbated the gaseous distention of the small intestine, precipitating emergency surgical decompression and ileostomy. A chronic high volume ileostomy diarrhea ensued and was successfully treated with oral indomethacin.
Expression of HLA antigens, beta 2-microglobulin and enzymes by human amniotic epithelial cells.
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Experiments with audit at Guy's Hospital.
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Breakfast with McColl. Interview by John Best.
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Immunogenicity of human amniotic epithelial cells after transplantation into volunteers.
Human amniotic epithelial cells do not express on their surfaces HLA-A, B, C, and DR antigens, or beta 2-microglobulin. In vitro these cells synthesise the enzymes lacking in patients with selected enzymatic deficiencies: the survival of a transplanted monolayer of human amniotic epithelial cells was therefore investigated in seven volunteers. None of the volunteers showed clinical signs of acute rejection, and amniotic epithelial cells were demonstrated by biopsy up to 7 weeks after implantation. HLA antibodies were not detected in samples of serum from four volunteers thoroughly investigated, and there was no in-vitro lymphocyte reaction to the amniotic cells in two of them. The results suggest that acute immune rejection does not occur after the transplantation of human amniotic epithelial cells.
Measuring the quality of clinical performance with hernia and myocardial infarction patients, controlling for patient risks.
This article describes a method for measuring the performance of clinicians treating patients with unilateral inguinal hernia or myocardial infarction. The scoring was based upon the percentage of occasions when appropriate education was given and acute conditions resolved in accordance with clinical expectations. The method was applied to patients of general surgical and general medical firms at two London teaching hospitals in 1972 and 1975. Scores for samples of each diagnosis correlated significantly with subjective evaluations of care by clinicians. Multiple regression was used to identify and weight the patient risk factors (physiological and demographic) significantly associated with lower scores in each disease. Score of patients with these risks were adjusted upward to compensate for the difficulty of achieving good clinical results when these risks were present. Comparison of firms was based upon adjusted scores. Being older and being single, widowed or divorced were significant in both diseases. High blood pressure and anemia were also significantly associated with lower scores for hernia patients, as were the number of cigarettes smoked for infarction patients. The range of scores was wide in surgical firms in both years. While relatively narrow in the medical firms, scores suggest that there is still scope for improvement in some firms. The authors discuss a plan for using these data to arrive at score standards for each disease which could be used to screen clinical care routinely.
Colonoscopy: a survey of its value in a teaching hospital surgical unit.
A survey has been undertaken of the diagnostic, therapeutic and economic value of colonoscopy in a teaching hospital surgical unit. Provided it is undertaken in conjunction with a good clinical history and double contrast barium enema, colonoscopy provides a high yield of information bearing upon the patient's subsequent management. Therapeutic polypectomy was undertaken in 21% of examinations. Its value in acute colonic disease is discussed, and the importance of training colonoscopists for the future is emphasized.
Permeability of the amniotic membrane and its potential application for transplantation purposes.
Uncertainty still exists as to the immunologic and physiologic properties of human amnion. It is clear, however, that these cells have a unique function and ultrastructure and may lack histocompatibility antigens. This raises the possibility of using the amnion for the replacement of a defective tissue or to protect an incompatible graft. In addition, the amniotic epithelial cells could be used to treat patients with inborn errors of metabolism. With this in mind, we have investigated the in vitro transfer of a number of compounds across the human amniotic membrane and furthermore have assessed the suitability of the amnion for transplantation purposes in an experimental model.
Problem Orientated Medical Recording of patients with myocardial infarction.
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In vitro studies on the effect of salicylates on the synthesis of proteins by guinea pig gastric mucosal tissue.
In the work reported in this paper we have studied the effect of salicylates on protein synthesis by (A) intact guinea pig gastric mucosa, (B) isolated gastric epithelial cells of guinea pig stomach and (C) cell-free homogenates of the isolated cells. In experiments on intact gastric mucosa, (A), secretion of newly-synthesised proteins into the mucosal media was also investigated and the nature of the effected, secreted proteins examined by isopycnic CsCl gradient fractionation. Results indicate that synthesis of proteins, as assessed by incorporation of L-[U-14C]leucine into trichloroacetic acid-insoluble proteins, is significantly impaired in the presence of salicylates in all three systems investigated. In experiments using isolated epithelial cells and cell-free homogenates of these cells, the effect was found to be dose-dependent and not associated with a corresponding reduction of the uptake of the precursor from the medium into the acid-soluble intracellular pool. The inhibitory effect of salicylates on protein synthesis was found to be reversible in experiments using both the intact gastric mucosa, as also the isolated epithelial cell preparations. In all experiments it was found to last for the duration of exposure of the tissue to the action of the drug. In experiments using intact gastric mucosa secretion of the newly-synthesised radioactive proteins into the mucosal medium was also impaired by O-acetyl salicylic acid. Isopycnic CsCl gradient fractionation of the secreted proteins did not reveal any qualitative differences between the salicylate-treated samples and the control samples, indicating non-specific inhibition of protein synthesis by the drug.