Biomedical subjects
Publications and source records attributed to J F Fielding.
Patients with the irritable bowel syndrome have significantly more rapid and significantly greater slowing of the pulse rate than do age-, sex-, and stressor-matched controls when their pulse rate is measured at initial outpatient clinic attendance. These findings provide further evidence that altered autonomic function exists in patients with the irritable bowel syndrome.
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Patients overall had a one in seven chance of having curative surgery in any of the first ten years following diagnosis. Cumulative surgical recurrence rates are similar to those in America. The higher cumulative surgical recurrence rates are similar to those in America. The higher cumulative risk of surgical recurrence in patients with macroscopic disease of the large bowel probably relates to a conservative surgical approach in such patients. There was no operative mortality.
We describe a patient with hypertrophic osteoarthropathy secondary to regional enteritis, and review the literature on their association. The apparent different distribution of hypertrophic osteoarthropathy secondary to other causes may be artifactual and related to inadequate radiological investigation. Hypertrophic osteoarthropathy does not appear to be related to regional enteritis activity.
Siblings of patients with Crohn's disease are 17-35 times more likely to develop the disease than members of the general population. Parents of patients with Crohn's disease are 35-70 times more likely to develop Crohn's disease than the general population. The crude risk of siblings or parents of patients with Crohn's disease developing ulcerative colitis may be half that of developing Crohn's disease; their relative risk may be a quarter that of developing Crohn's disease.
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Irish men and women are at equal risk of developing Crohn's disease. Age at diagnosis (12--mean 30.5-75 yr) and duration of symptoms before diagnosis (1--mean 35.7-444 months) are similar to those for Crohn's disease in other countries. The proportion of patients with macroscopic involvement of the large bowel at diagnosis (68%) is increasing and this is probably a true increase. At the same time the incidence of perianal disease is probably decreasing. Extraintestinal manifestations probably occur more frequently than previously recognized. Crohn's disease and psoriasis, which occurred in 7% of the patients, are probably associated disorders.
Hepatitis D virus (delta agent) markers were present in 111 (36%) of 308 intravenous drug abusers who were positive for hepatitis B surface antigen (HBsAg), 52 of these having hepatitis D virus antigenaemia. IgM antibody to hepatitis B core antigen (anti-HBc IgM) was present in 92 out of 95 subjects tested, indicating that hepatitis D virus and hepatitis B virus infections had been acquired simultaneously. Hepatitis D virus markers were present in three out of four patients with fulminant hepatitis, and in 80 of 223 (36%) with mild or moderate hepatitis compared with four of 29 (14%) of those who were asymptomatic. These proportional differences were significant (p less than 0.001). Hepatitis D virus markers were present in twice as many patients positive for anti-HBc IgM requiring admission to hospital with acute hepatitis compared with outpatients attending a drug treatment centre. Tests on one patient showed complete disappearance of HBsAg, but hepatitis D antigen (HDAg or delta antigen) and hepatitis B e antigen (HBeAg) were still present in serum samples. All five patients with chronic active hepatitis had hepatitis D antibody (anti-HD) compared with seven of 24 (29%) with chronic persistent hepatitis (p = 0.008). Blocking anti-HD persisted for long periods after simultaneous infections with hepatitis B virus and hepatitis D virus but at lower titres than in patients with chronic liver disease.
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