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Biomedical subjects

J F MacKenzie

Publications and source records attributed to J F MacKenzie.

18 recordsLinked to original sources

Single-cell recombinant pharmacology: bovine alpha(1a)-adrenoceptors in rat-1 fibroblasts release intracellular ca(2+), display subtype-characteristic agonism and antagonism, and exhibit an antagonist-reversible inverse concentration-response phase.

Phe-activated Ca(2+) signals recorded from single rat-1 fibroblasts stably expressing the bovine alpha(1a)-adrenoceptor (AR) were characterized and used to analyze functional agonist-antagonist interactions. The response to Phe was initiated by the mobilization of stored Ca(2+) and subsequently sustained by receptor-regulated Ca(2+) influx. The selective alpha(1A)-AR agonist (R)-A-61603 was 141-fold more potent as an agonist than Phe. This potency ratio was consistent with the pharmacology of the native alpha(1A)-ARs. Functional responses evoked by concentrations of Phe of more than 0. 3 microM displayed fade, which could be explained by agonist-dependent depletion of Ca(2+) stores. The antagonists tested did not conform to the predictions of the Schild equation for competitive antagonism as expected from the nonequilibrium nature of the response. The antagonist potency series WB4101 > or = prazosin >> BMY7378, however, was consistent with alpha(1A)-ARs. Antagonism exhibited by WB4101 and prazosin was compatible with a model in which antagonists dissociate so slowly from the receptor that this is a major factor in their inhibition of the transient agonist-mediated response, leading to the appearance of insurmountable antagonism. A consequence of this phenomenon was that an inverse concentration-response relationship at high agonist concentrations was abolished by low concentrations of antagonists. Overall, the results indicate that quantitative pharmacology can be studied successfully in single cells even though equilibrium could not be achieved in the agonist-antagonist-response relationship in this particular cell phenotype. The study also showed a form of fade that could be readily explained.

Adrenergic alpha-1 Receptor Agonists↗

Push enteroscopy.

Push enteroscopy has superseded sonde enteroscopy principally because of its ability to provide therapy, as well as diagnosis. An overtube limits gastric looping and allows deeper jejunal insertion. A working channel allows therapeutic intervention. The technique is increasingly used to the diagnosis and treatment of small intestinal disorders, particularly in obscure gastrointestinal bleeding. The wider acceptance of push enteroscopy into routing practice requires further clinical effectiveness data.

Endoscopy, Digestive System↗

Push enteroscopy in the investigation of small-intestinal disease.

We report our experience with small-bowel push enteroscopy in 50 patients. The indications for push enteroscopy were: anaemia/occult gastrointestinal bleeding (22 patients); overt gastrointestinal bleeding (17 patients); abnormal small-bowel radiology (8 patients) and miscellaneous (3 patients). In those with undiagnosed gastrointestinal bleeding/anaemia, abnormalities were detected in 24/39 patients (62%): small bowel arteriovenous malformations (AVMs) were detected in 19 (49%), and five (13%) had lesions in the upper gastrointestinal tract. Seventeen patients had heater-probe ablation therapy of vascular lesions: nine patients had small-intestinal lesions, four patients gastric lesions, and four patients combined gastric and small-intestinal lesions. In those with abnormal small-bowel radiology, abnormalities were detected in 6/8 patients. We conclude that (i) push enteroscopy can establish a diagnosis in a high proportion of patients with gastrointestinal bleeding; (ii) heater-probe ablation therapy of vascular lesions can be performed routinely at the time of enteroscopy; (iii) a significant proportion of patients (9/50) referred for enteroscopy with undiagnosed gastrointestinal bleeding have lesions in the stomach/proximal duodenum missed at diagnostic endoscopy. Push enteroscopy is a valuable diagnostic and therapeutic endoscopic procedure.

Adult↗

Small bowel enteroscopy in undiagnosed gastrointestinal blood loss.

Sixty five of 70 consecutive patients with undiagnosed gastrointestinal blood loss were examined using the new technique of small bowel enteroscopy. Using a balloon driven sonde enteroscope (SIF-SW) extended views of the small bowel were obtained as far as the distal ileum. Medium length of small bowel examined was 140 cm (range (30-200 cm). All patients studied had a normal upper gastrointestinal endoscopy. Nineteen (41%) of 46 anaemic rheumatoid arthritis patients taking non-steroidal antiinflammatory drugs (NSAID) and three (27%) of 11 patients with unexplained iron deficiency, were found to have small bowel lesions to account for their anaemia. Small bowel lesions were found in a further three of eight (37%) patients with acute gastrointestinal bleeding. The procedure failed or was terminated in five patients. Small bowel enteroscopy has considerable potential in the investigation of undiagnosed gastrointestinal blood loss and deserves more widespread application.

Anemia, Hypochromic↗

Enteroscopic diagnosis of small bowel ulceration in patients receiving non-steroidal anti-inflammatory drugs.

15 patients with rheumatoid arthritis who were receiving non-steroidal anti-inflammatory drugs (NSAIDs) and who had chronic occult gastrointestinal bleeding underwent extended small bowel examination with a Sonde enteroscope. 7 patients (47%) were found to have jejunal or ileal ulceration. Small bowel enteroscopy may be a valuable technique for the investigation of undiagnosed gastrointestinal bleeding.

Adult↗

Achalasia-like syndrome in systemic sclerosis.

Two methods of quantifying oesophageal emptying for liquids have been used to assess the dysphagia of patients with systemic sclerosis: the oesophageal infusion scintiscan and the timed Gastrografin swallow. Upper gastrointestinal endoscopy and oesophageal manometry were also performed. Thirteen patients with oesophageal symptoms were studied. Eight had dysphagia, and all of these had endoscopies with no evidence of oesophagitis or stricture. Four of these eight subjects had gross delay of oesophageal emptying for fluids, and manometry showed absence of oesophageal peristalsis and incomplete relaxation of the lower oesophageal sphincter. This abnormality is similar to achalasia. Two of these four patients have benefited from pneumatic dilatation with improvement in their severe dysphagia. We believe that pneumatic dilatation should be considered in patients with systemic sclerosis and severe dysphagia where reflux oesophagitis is not apparent.

Adult↗

Decreased oesophageal blood flow in patients with Raynaud's phenomenon.

Cold-induced vasospasm seen in systemic sclerosis (SS) and Raynaud's phenomenon (RP) has previously been thought to be limited to peripheral skin sites. However, the oesophageal problems seen in SS cannot be sufficiently explained by connective tissue damage/abnormal motility alone. We wondered if temperature dependent ischaemia could occur in the oesophageal microcirculation. We have measured oesophageal temperature variation following oesophageal cold challenge: 50 ml of water at 7 degrees C and 17 degrees C, with 37 degrees C used as control, were introduced into the mid-oesophagus at a rate of 2 ml/s. Temperature was recorded using a thermocouple probe 5 cm above the gastro-oesophageal junction. The test was performed on 14 SS patients, eight patients with Raynaud's disease and 21 controls. The control's rewarming pattern followed a simple exponential curve. This did not vary with temperature or after repeated challenge. In the SS patients the time constant was significantly longer after cold challenge.

Adult↗

Can 111indium autologous mixed leucocyte scanning accurately assess disease extent and activity in Crohn's disease?

111Indium autologous mixed leucocyte scanning has recently been used for the investigation of Crohn's disease. Nineteen patients had indium scans to assess disease extent and activity. The scans were compared with conventional imaging techniques and indices of disease activity including clinical scores, ESR, CRP, and GI protein loss. In five patients with active disease the scans were negative and overall there was poor correlation between the scan scores and the other indices of disease activity. Indium scanning correctly located extent of disease in only 58% of patients. 111Indium mixed leucocyte scanning may be more suited for the assessment of disease extent and activity in severely ill patients with Crohn's disease.

Adolescent↗

Specific food intolerance: its place as a cause of gastrointestinal symptoms.

Thirteen out of 49 patients suspected of having specific food intolerance after withdrawal and reintroduction of specific foods, were further subjected to double blind placebo controlled food challenges. Only three of these subjects were thus shown to have proven specific food intolerance. Of the remaining 10, nine were strong 'placebo reactors'. The study suggests that a small number of patients with gastrointestinal symptoms have verifiable specific food intolerance but that a greater number have symptoms attributable to psychogenic causes.

Adult↗

Neodymium yttrium aluminium garnet laser photocoagulation for major haemorrhage from peptic ulcers and single vessels: a single blind controlled study.

A prospective single blind controlled trial was performed to assess the efficacy of the neodymium yttrium aluminium garnet laser in the management of patients bleeding from peptic ulcers and single vessels. Over 20 months 184 patients were found at endoscopy to be bleeding from peptic ulcers and single vessels; 130 of these failed to meet the criteria for entry into the study, but their bleeding stopped with conservative management. Forty-five patients entered the study: in all 25 who were bleeding from ulcers with spots the bleeding stopped irrespective of the treatment allocated. Twenty patients were bleeding from arteries. Eight were allocated to placebo treatment, and all later underwent emergency surgery for further haemorrhage. Twelve were allocated to receive laser treatment, and only one of eight who actually received it required surgery (p less than 0.002). It is concluded that laser treatment reduces the incidence of further haemorrhage and the need for emergency surgery, but the technique is difficult and not always applicable.

Adult↗

Hepatic granulomas: experience over a 10-year period in the West of Scotland.

A survey of all patients in whom liver biopsy showed epithelioid granulomas was undertaken at two major teaching hospitals in Glasgow for the period 1970-1979. Seventy-seven patients with hepatic granulomas were studied retrospectively. In 53 cases (69 per cent) a clear-cut clinical diagnosis was established, which included sarcoidosis (eight cases), tuberculosis (eight), extrahepatic biliary obstruction (seven), primary liver diseases (11), neoplasm (six), bacterial infection (five) and miscellaneous (eight). In 24 patients (31 percent) no cause was found. Seventeen patients from this idiopathic group were studied prospectively and single examples of the following conditions were subsequently diagnosed; pulmonary tuberculosis, primary biliary cirrhosis, ulcerative colitis, adenocarcinoma of rectum, primary hepatocellular carcinoma, alpha-one antitrypsin deficiency and pulmonary fibrosis, sarcoidosis, pulmonary fibrosis alone, gallstones, rheumatic heart disease, unexplained hepatosplenomegaly and one death from mesenteric artery thrombosis. Only six cases remained truly idiopathic. Three of these patients recovered and in two liver biopsy became normal. The other three have persistent granulomas associated with continuing illness.

Adolescent↗

The effect of pH on folic acid absorption in man.

1. Pteroylmonoglutamic acid (PteGlu) absorption has been measured by using the technique of small-intestinal perfusion with tritiated PteGlu in normal subjects and in patients with coeliac disease. 2. At similar intrajejunal pH, patients with untreated coeliac disease have significantly less PTEGlu than normal subjects and patients with treated coeliac disease. 3. The "resting" pH in the jejunum did not differ markedly between normal subjects and patients with coeliac disease. 4. Increasing pH decreased PteGlu absorption in patients with coeliac disease and in normal subjects. 5. These findings suggest that PteGlu malabsorption in coeliac disease is not due to abnormally high pH in the jejunum.

Celiac Disease↗

The effect of frusemide on water and electrolyte absorption from the human jejunum.

1. Frusemide, in a dose of 120 nmol (40 mg) administered intravenously, significantly reduced the absorption of water and electrolytes from the human jejunum, a double-lumen perfusion system with proixmal occluding balloons being used. Net secretion of water and electrolytes occurred in some subjects. 2. No significant change in water and electrolyte absorption was observed with 60 nmol (20 mg) of frusemide. 3. These findings may explain the diarrhoea which may be induced by fursemide in some patients.

Furosemide↗

Mg deficiency in chronic inflammatory bowel disease and requirements during intravenous nutrition.

Assessment of magnesium (Mg) status by serum and 24-hr urine estimations has been used to study a group of 17 patients with severe Crohn's disease, 10 of whom have required intravenous (IV) nutrition. Mg depletion was present in 15 (88%) and severe enough to cause symptoms in two. Urine levels were low in most patients and would appear to be a more sensitive indication of Mg depletion than serum levels alone. Serum Mg levels were significantly lower in the Crohn's group than in a group of hospital controls; 5-10 mmol of IV Mg were required daily to prevent Mg depletion during IV nutrition and some patients required higher intakes. Three patients with particularly severe malabsorption required oral Mg supplements in the long-term. The rationale for using our method of assessing Mg status, and the importance of recognizing and treating chronic Mg deficiency are presented.

Adolescent↗