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Biomedical subjects

J D Maxwell

Publications and source records attributed to J D Maxwell.

At least 73 records · Page 4Linked to original sources
PubMed1991

Impact of endoscopic duodenal biopsy on the detection of small intestinal villous atrophy.

Coeliac disease is underdiagnosed partly because of insufficient recognition of more subtle presentations and partly because of the relative difficulty of jejunal biopsy. We have compared new case detection of small intestinal villous atrophy in the 5 years following changing to endoscopic multiple biopsy with our preceding 9 year experience utilizing jejunal capsule suction biopsy. The detection rate for small intestinal disease doubled while the number of patients investigated by small bowel biopsy increased threefold. We recommend that endoscopic duodenal biopsy replace jejunal biopsy for routine diagnostic purposes.

Atrophy↗
PubMed1991

Risk of tuberculosis in immigrant Asians: culturally acquired immunodeficiency?

Study of the 620 Asian immigrants with tuberculosis notified in the Wandsworth area of south London between 1973 and 1988 showed a bimodal pattern of tuberculosis notifications: in 1977 there was a peak among Asians from East Africa, and in 1981 a peak among those from the Indian subcontinent. There was a mean lag time of five years between clinical presentation and immigration. Logit analysis showed that, although overall more men had tuberculosis than women, glandular tuberculosis was more common among women of all groups, and pulmonary tuberculosis was more common among Hindu women than Hindu men. Both subgroups of Asians had a substantially higher incidence of tuberculosis than white people, particularly at extrapulmonary sites. Hindus were also at a significantly greater risk of tuberculosis at all sites than Muslims (Hindu:Muslim risk ratio 5.5 for women and 3.7 for men). The increased susceptibility to tuberculosis of Hindus, particularly Hindu women, may be related to a culturally acquired immunodeficiency caused by vegetarianism and associated vitamin deficiency.

Adult↗
PubMed1990

Surface hydrophobicity of gastric mucosa in peptic ulcer disease. Relationship to gastritis and Campylobacter pylori infection.

The hydrophobicity of biopsy specimens of gastric mucosa in 228 dyspeptic subjects undergoing diagnostic endoscopy was assessed by measuring the plateau-advancing contact angle of saline drops using a goniometer. Subjects with duodenal ulcers (n = 49) and gastric ulcers (n = 17) had significantly lower mean contact angles than controls (n = 124) without ulcer (57 degrees in duodenal ulcer, 59 degrees in gastric ulcer vs. 66 degrees in controls; p less than 0.0001). There was no change in contact angle after healing with H2-receptor antagonists by comparison with pretreatment (59 degrees vs. 56 degrees for duodenal ulcer, n = 15; 57 degrees vs. 59 degrees for gastric ulcer, n = 5). Controls with gastritis had lower contact angles than those without (61 degrees, n = 50, vs. 70 degrees, n = 63; p less than 0.0001). The presence of Campylobacter pylori was associated with a significant decrease in contact angle in controls (59 degrees, n = 39, vs. 70 degrees, n = 75; p less than 0.0001).

Biopsy↗
PubMed1990

Thickened stomach--an ultrasound sign of portal hypertension.

Congestive gastrophy occurs with portal hypertension and is associated with vascular changes including dilatation and tortuosity of the submucous veins. Transabdominal ultrasound measurements of the stomach were made to determine whether these changes resulted in increased thickness of the stomach in patients with established cirrhosis and portal hypertension. Mean thickness of the antrum and body was 22.15 mm (range 13-31 mm) and 22.2 mm (range 13-31 mm) respectively in patients with portal hypertension: in the control group measurements of the antrum and body were 13.8 mm (range 8-20 mm) and 14.05 mm (range 11-19 mm) respectively (P less than 0.01 for both antrum and body). A thickened stomach may indicate the presence of portal hypertension.

Humans↗
PubMed1990

Detection of osteomalacia in British Asians: a comparison of clinical score with biochemical measurements.

1. In a prospective study of 160 Asian outpatients, plasma calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D and parathyroid hormone were compared with a clinical score to determine which measurements singly or in combination were most useful in the detection of osteomalacia. 2. Bone biopsies were performed in 45 of 48 patients considered to be at risk of osteomalacia. Of the 39 quantifiable bone biopsies, nine showed unequivocal osteomalacia, 13 were judged to be borderline and 17 biopsies were normal. 3. The clinical score was highly sensitive, identifying eight of nine patients with osteomalacia, but not specific, six of 17 normal patients having an abnormal score. 4. Plasma parathyroid hormone was the best single biochemical test for identifying osteomalacia. By using a discriminant function based on parathyroid hormone and alkaline phosphatase, it was possible to classify 96% cases correctly; a discriminant function utilizing calcium, phosphate and alkaline phosphatase was successful in 85% of cases. It was not possible to discriminate between histological groups on the basis of plasma 25-hydroxy-vitamin D values. 5. We confirm that the clinical score is a useful and inexpensive screening test for osteomalacia in British Asians. In those patients with an abnormal score we suggest that parathyroid hormone and alkaline phosphatase are measured. Where both parathyroid hormone and alkaline phosphatase are high, in the absence of hypercalcaemia, histological osteomalacia is extremely likely.

Adult↗
PubMed1990

Association of muscle strength with functional status of elderly people.

We have studied the association of muscle strength (quadriceps, biceps, handgrip), measured by a portable chair technique, with functional status (Barthel Index, manual dexterity, Mental Test Score, history of falls, fracture, prescribed drugs), in a sample of 92 elderly subjects attending a Local Authority Day Centre and Day Hospital. Anthropometric measurements and hand-grip strength were also measured in 30 young controls. Muscle area, mass and strength were significantly greater in young controls. Elderly men had significantly greater muscle area, mass and strength than elderly women. Muscle strength correlated with several measures of functional status. Using stepwise multiple regression, an independent association of muscle strength with manual dexterity, Barthel Index and receipt of domiciliary services is demonstrated.

Aged↗
PubMed1990

Gallbladder wall thickening (congestive cholecystopathy) in chronic liver disease: a sign of portal hypertension.

A thickened gallbladder wall is often seen with ultrasound in alcoholic cirrhosis. Hypoalbuminaemia is thought to be the cause since there is a strong association between bowel wall thickening and low serum albumin. To determine the role of portal hypertension in producing gallbladder wall thickening we studied 40 consecutive stable patients-37 with cirrhosis and three with portal hypertension due to primary biliary cirrhosis. Ultrasound assessment of the gallbladder wall was made after an overnight fast using a Technicare autosector. Wall thickness 4 mm or greater was considered abnormal. Twenty-seven patients had a thickened gallbladder wall and all had evidence of portal hypertension. Hypoalbuminaemia was not an important factor since it was only present in six cases with thickened walls. In two cases reduction in portal pressure with oral propranolol was associated with a decrease in gallbladder wall thickness. These results suggest that portal hypertension, not hypoalbuminaemia, is the dominant factor causing gallbladder wall thickening in cirrhosis. Ultrasound demonstration of gallbladder wall thickening in chronic liver disease should suggest the presence of portal hypertension.

Chronic Disease↗
PubMed1989

Vitamin D deficiency and muscle strength in male alcoholics.

1. Chronic alcoholism may be complicated by proximal muscle weakness associated with a selective atrophy of type II skeletal muscle fibres. The histopathological findings are non-specific as identical changes are seen in proximal muscle weakness associated with various metabolic myopathies, including osteomalacia. 2. The maximum voluntary contraction (MVC) of the dominant quadriceps and plasma 25-hydroxycholecalciferol [25-(OH)D] were measured in male alcoholics and control subjects to determine whether vitamin D deficiency contributed to proximal muscle weakness. 3. In both groups MVC declined with age and was related to body build. The distribution of plasma 25-(OH)D was skewed in alcoholics, with the mean significantly lower than in control subjects. Seventeen per cent of patients (but none of the control subjects) had pronounced biochemical deficiency [plasma 25-(OH)D less than 10 nmol/l]. 4. Alcoholics were significantly weaker than control subjects, even after correcting for the effects of age, height and weight. The severity of associated liver disease (cirrhosis vs no cirrhosis) did not influence muscle strength. Variation in plasma 25-(OH)D and albumin made an insignificant contribution to the difference in MVC observed between patients and control subjects. 5. We conclude that proximal muscle strength is reduced in chronic alcoholism but that this is not due to associated vitamin D [25-(OH)D] deficiency or alcoholic cirrhosis.

Adult↗
PubMed1989

Portal tract macrophages are increased in alcoholic liver disease.

Previous studies indicated decreased numbers and depressed clearance function of hepatic macrophages in alcoholic liver disease (ALD). We examined hepatic macrophages by immunohistochemical techniques in 45 liver biopsies from patients with a spectrum of ALD and compared them with 20 histologically normal biopsies from non-alcoholic patients. Antisera against lysozyme, alpha 1-antitrypsin (alpha 1AT) and a cytoplasmic molecule on macrophages (MAC-387) were used and the number of positively staining hepatic sinusoidal macrophages and portal tract macrophages assessed separately. Portal tract macrophage numbers were increased with all three markers in biopsies exhibiting only fatty change (P less than 0.05) and with MAC-387 in all ALD groups. In agreement with previous studies, lysozyme positive hepatic sinusoidal macrophages were decreased in all ALD groups. However, the other markers did not show any significant decrease and MAC-387 positive macrophages were increased in livers with cirrhosis plus hepatitis (P less than 0.01). The use of three markers revealed phenotypic heterogeneity of hepatic macrophages with antibodies to lysozyme and alpha 1 AT staining more hepatic sinusoidal macrophages than MAC-387, but MAC-387 and anti-lysozyme staining more portal tract macrophages than anti-alpha 1AT. Since hepatic macrophages appear to be heterogeneous and capable of diverse functions including the release of cytotoxic mediators, the finding of increased numbers, even in early ALD, suggests they may contribute to the increased numbers, even in early ALD, suggests they may contribute to the tissue damage.

Adult↗
PubMed1988

Triolein breath test of fat absorption in patients with chronic liver disease.

We have compared the [14C]triolein breath test for fat malabsorption with fecal fat excretion corrected for marker pellet recovery in 23 subjects with chronic liver disease. The breath test identified 15 of the 17 subjects with abnormal fecal fat excretion (sensitivity 88%). However, four of the six subjects with normal fecal fat excretion gave abnormal breath test results (specificity 33%). While three of the four subjects with falsely abnormal breath tests had alcoholic liver disease, the explanation for the low specificity is unclear and may not be confined to patients with alcohol-related disease. We are therefore unable to recommend the breath test as a screen for steatorrhea in patients with chronic liver disease.

Breath Tests↗
PubMed1988

Ultrasound detection of oesophageal varices--comparison with endoscopy.

In a prospective study of 100 patients for the detection of oesophageal varices, real-time ultrasound was both sensitive (sensitivity 82%) and specific (specificity 91%) compared with upper gastrointestinal endoscopy. All patients with large and medium sized varices were correctly identified by ultrasound. Ultrasound should be considered as an alternative to endoscopy and radiology for detection of oesophageal varices.

Esophageal and Gastric Varices↗
PubMed1988

Use of endoscopic biopsy for diagnosing congestive gastropathy.

The specificity of endoscopic biopsy specimens in diagnosing congestive gastropathy in 20 patients with portal hypertension, 20 patients with liver disease without portal hypertension, and 20 patients with a normal stomach at endoscopy without liver disease was examined. Histological assessment, which was performed without knowledge of the clinical details, showed changes previously reported to be indicative of congestive gastropathy in 9 (47%) of patients with portal hypertension. Similar changes were also seen in 17 (85%) of patients with liver disease without portal hypertension and in 16 (84%) of patients with normal endoscopies without liver disease. These results show that the histological changes seen in endoscopic biopsy specimens of congestive gastropathy are not specific for this condition and therefore cannot be used to diagnose objectively the disease or assess management.

Biopsy↗
PubMed1987

Muscle strength in healthy white and Asian subjects: the relationship of quadriceps maximum voluntary contraction to age, sex, body build and vitamin D.

1. The maximum voluntary isometric contraction (MVC) of the dominant quadriceps muscle was measured in 136 healthy White and 172 healthy Hindu Asian subjects resident in London, using a specially designed chair equipped with a force measuring load cell. 2. Males were stronger than females, and for both sexes MVC declined with age. From age 20 to 60 the annual decline in MVC ranged from 0.56% in White males to 1.5% in female Asians. 3. White subjects were stronger than Asian subjects even after correcting for the effect of age, height, weight and sex in a multi-factorial analysis. 4. Only in males did MVC correlate with height and weight. Asian women were more obese than any other group, and showed an increase in body mass index with age. 5. Twenty-two per cent of Asian subjects had marked vitamin D deficiency (plasma 25-hydroxycholecalciferol less than 10 nmol/1). There was no correlation between MVC, and plasma 25-hydroxycholecalciferol.

Adult↗
PubMed1986

Ultrasound scanning in the detection of hepatic fibrosis and steatosis.

Hepatic steatosis and fibrosis produce abnormal echo patterns on ultrasound scanning, but the potential of ultrasound scanning for diagnosing these conditions in routine clinical practice is uncertain. A prospective comparative study of 85 patients with histologically assessed liver conditions was performed, and specificity was assessed in 76 patients with functional bowel disease who were presumed to have normal livers. Histological examination showed steatosis ranging from mild to severe in 48 patients and fibrosis ranging from increased fibrous tissue to established cirrhosis in 35 patients. Ultrasound scanning accurately identified steatosis, recognising 45 cases (sensitivity 94%) with a specificity of 84%. Fibrosis was less reliably detected (sensitivity 57% and specificity 88%). Of the 50 patients with alcoholic liver disease, 47 (94%) yielded abnormal results on scanning. In the 76 patients with functional bowel disease there was only one false positive result, giving a specificity of 99% in this group. As hepatic steatosis is the earliest change in alcoholic liver disease and seems to be of prognostic importance for the development of cirrhosis, ultrasound scanning provides an effective screening procedure, particularly in the occult alcoholic, who often presents with non-specific gastrointestinal complaints.

Fatty Liver↗