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Biomedical subjects

J Wyatt

Publications and source records attributed to J Wyatt.

At least 73 records · Page 4Linked to original sources
PubMed1996

Symptomatic cerebral microangiopathy preceding initial manifestation of ulcerative colitis.

Focal white-matter lesions in the brain have been frequently found in patients with inflammatory bowel disease. These findings have been discussed as a novel extraintestinal manifestation of inflammatory bowel disease. In this case report we delineate the clinical relevance of such lesions by presenting a patient with ulcerative colitis and his associated neurological symptoms. The cerebral lesions were shown by magnetic resonance imaging, whereupon a successful treatment with corticosteroids was initiated.

Adult↗
PubMed1996

Relationship between the use of unconventional therapies and disease-related concerns: a study of patients with inflammatory bowel disease.

We studied the use of unconventional therapies of a well-defined population of 105 patients with inflammatory bowel disease (IBD; 72 with Crohn's disease and 33 with ulcerative colitis) who were attending a university out-patient clinic. The following items were used to compare those patients who used unconventional therapies with those who did not. We compared disease-related data, sociodemographic variables, patients' disease-related concerns, and their perceived level of information about IBD. Concerns were measured with the Rating Form of IBD Patient Concerns (RFIPC), inflammatory disease activity was assessed by physicians with the Crohn's disease activity index (CDAI) and the clinical activity index (CAI). Of the 97 (92.4%) patients who answered all questions, 33 (34%) reported using unconventional therapies in addition to conventional therapy. In their level of information about IBD and in their clinical and sociodemographic data, they were not different from the IBD patients who were not using alternative treatments. In their duration of disease, there was a significant difference (p < 0.0002). The longer the disease duration, the more often patients used unconventional therapies. The most important differences between users and nonusers were the following: patients who used unconventional therapies were more concerned about having surgery (p < 0.001), being treated as different (p < 0.04), and feeling out of control (p < 0.05). We conclude that there is a relationship between the use of unconventional therapies and some disease-related concerns, which should be considered in clinical practice. This may help these patients avoid using unproven and expensive alternative therapies.

Adult↗
PubMed1996

Intra-observer and inter-observer variation in the histopathological assessment of chronic viral hepatitis.

BACKGROUND/AIMS: The way in which liver biopsies showing chronic hepatitis are reported is undergoing re-evaluation. A related question is how the inflammatory and fibrotic changes in these liver biopsies can be semi-quantitatively assessed so that comparisons can be made between groups of patients and the effect of treatment on disease progression studied. METHODS: We have carried out a blinded trial in which 20 cases of chronic viral hepatitis were assessed by five histopathologists, using the Knodell and Scheuer scoring systems (two of the most commonly used systems), on two separate occasions. The results were analysed using Kappa statistics, and also by seeing for how many slides the pathologists showed no significant disagreement. RESULTS: While both systems produced good inter- and intra-observer variation when fibrosis was assessed the Scheuer system produced slightly higher Kappa values. The Scheuer system produced considerably better agreement when the severity of inflammation was examined. A multirater kappa analysis confirmed that both systems showed better agreement for fibrosis scores than for inflammation scores. CONCLUSION: We conclude that, while both systems produced reasonable agreement, this was greater using the Scheuer system. When any new scoring system is being developed, the question of reproducibility needs active consideration.

Chronic Disease↗
PubMed1996

Helicobacter pylori gastritis and serum pepsinogen levels in a healthy population: development of a biomarker strategy for gastric atrophy in high risk groups.

This study aimed to estimate the prevalence and type of chronic gastritis in an asymptomatic working population and to determine whether a combination of serum pepsinogen levels and Helicobacter pylori serology could be used to identify a subgroup with atrophic gastritis at elevated risk of gastric carcinoma. A 10% subsample of 544 male volunteer factory workers aged 18-63 years and participating in a larger study underwent endoscopy and biopsy. Of these men, 29 were seropositive for Helicobacter pylori; all but three (89.7%) had chronic gastritis. Serum pepsinogen A levels increased with progression from a corpus predominant pattern of gastritis through pangastritis to an antral predominant pattern. Nine subjects had corpus atrophy, which was in most cases accompanied by fasting hypochlorhydria and hypergastrinaemia. A combination of pepsinogen A below 80 ng ml-1 and Helicobaceter pylori seropositivity detected corpus atrophy with sensitivity 88.9% and specificity 92.3%. A second screening stage, using a pepsinogen A/C ratio of below 2.5 as a cut-off, resulted in a reduction in numbers requiring further investigation but with some loss of sensitivity (77.8%). Application of this two-stage screening programme to the original sample of 544 workers would have resulted in 11 (2.2%) men being selected for follow-up, excluding 25 (5.1%) false negatives. Our results suggest that a combination of serum pepsinogen levels and Helicobacter pylori serology could be useful as a biomarker strategy for detection of individuals at increased risk of gastric carcinoma and for non-invasive investigation of the natural history of Helicobacter pylori gastritis.

Adolescent↗
PubMed1996

Lymphocytic gastritis and gastric permeability in patients with celiac disease.

BACKGROUND & AIMS: Lymphocytic gastritis is associated with celiac disease. Gastric permeability can now be assessed by a sucrose test, and intestinal permeability measured by a lactulose/mannitol test is increased in untreated celiac patients. The aim of this study was to prospectively compare gastric and intestinal permeability with histological changes of the stomach and small bowel in patients with celiac disease. METHODS: Gastric and intestinal permeability were measured by oral or duodenal (during endoscopy) administration of a triple sugar solution containing 20 g sucrose, 10 g lactulose, and 5 g mannitol in 100 mL water in 43 adult patients with celiac disease (28 without diet) and in 30 healthy controls. Endoscopical biopsy specimens were taken from the antrum and distal duodenum and investigated for intraepithelial lymphocyte counts. RESULTS: Urinary sucrose excretion decreased after duodenal administration (n = 8) as opposed to oral administration and thus measured gastric permeability in celiac disease. Gastric permeability was elevated in 60% of the celiac patients and correlated with antral intraepithelial lymphocyte counts. Intestinal permeability (measured by a lactulose/mannitol test) was also elevated in 69% of the celiac patients and correlated with duodenal intraepithelial counts. CONCLUSIONS: There is a high prevalence of lymphocytic gastritis in untreated celiac disease associated with elevated gastric permeability. Celiac disease seems to be a general disorder of the gastrointestinal tract associated with disturbed permeability.

Adolescent↗
PubMed1996

Transplantation of human fetal retinal pigment epithelium rescues photoreceptor cells from degeneration in the Royal College of Surgeons rat retina.

PURPOSE: The Royal College of Surgeons (RCS) rat suffers from a well-characterized, early-onset, and relentless form of photoreceptor cell degeneration. It has been shown that allografts of retinal pigment epithelial cells from normal perinatal rats have rescue effects in this condition. In preparation for human application, the authors determined whether human fetal retinal pigment epithelium (RPE) grafts have a photoreceptor rescue effect in RCS dystrophic rat retinas. METHODS: Sheets of RPE from human fetal eyes (10 to 16 weeks gestational age) were isolated according to the authors' recently described method. Fragments of the RPE sheets were transplanted to the subretinal space within the superior hemisphere. Transplants were performed within the superior equatorial region of five dystrophic RCS rats, one eye per animal. A similar volume of vehicle was injected into the subretinal space of five age-matched control rats, again one eye per rat. All rats were immunosuppressed with daily injections of cyclosporine. Using light microscopy, photoreceptor cell nuclear profiles of superior equatorial (SE) and inferior equatorial (IE) regions of transplanted and sham-injected control animals were counted. RESULTS: Four weeks after transplantation, a dramatic rescue effect was observed. Microscopically, presumptive donor RPE cells were seen as single pigmented cells and as cell clusters in the subretinal space. An outer nuclear layer three to four profiles thick was present in the area of the RPE transplant but was nearly absent in the rest of the retina, as well as in the retinas of control rats. The number of photoreceptor nuclear profiles per 100 microns was 34.7 +/- 2.2 (mean +/- SEM) in the SE region of transplanted rats and 3.5 +/- 1.4 in the same region of sham-injected rats. There were 3.0 +/- 1.0 photoreceptor nuclear profiles in the IE region of transplanted rats and 3.5 +/- 1.2 in the IE region of sham-injected eyes. No evidence of graft rejection was seen. CONCLUSIONS: This study provides the first indication that transplanted human fetal RPE cells are able to rescue photoreceptor cells in a model of hereditary retinal degeneration.

Animals↗
PubMed1996

Medical informatics, artefacts or science?

Successful and productive medical informatics research is evidently a combination of luck, creative art, and science, but some researchers focus too much on building computer artefacts and writing anecdotal reports of their experience. They need to adopt a less technology-fixated approach, be willing to evaluate their systems and publish failures as well as successes, and attempt to generalise their results as hypotheses for others to test. It does appear that medical informatics is a distinct discipline, and one based on scientific principles, but it is less clear whether these principles originate within the discipline or elsewhere. If elsewhere, it is usually unclear whether their validity has been tested with the atypical information, decisions and context that medicine represents. This article has presented some criteria for judging such scientific principles, and described a process which would lead to such principles, if they exist, being uncovered more rapidly. If our discipline is to thrive and take root in firm ground, such activities need to be taken seriously by all, otherwise we could end up building edifices on sand.

Delivery of Health Care↗
PubMed1995

The intensity of the pupillary light reflex does not correlate with the number of retinal photoreceptor cells.

The purpose of this study was to determine if the pupillary light reflex (PLR) can serve as an indicator of the number of photoreceptor cells present in the rat retina to a sufficient degree of precision to be useful for testing the functional effects of retinal transplantation. The PLR was measured as percentage constriction of normal Fischer 344 rats (n = 14) and compared to the PLR of light-damaged (1300 luxes/30 days exposure) Fischer rats (n = 13). Additionally, the PLR of RCS-rdy+ (congenic) rats (n = 8) was compared to the PLR or RCS dystrophic rats (n = 7). Three eyes from each group were randomly chosen for morphometry. The number of photoreceptor nuclear profiles per 60 microns of retinal length was counted at six predetermined loci and averaged. The mean PLR of Light-Damaged F344 group (64%) was significantly different from the mean PLR of the Normal F344 group (75%) (P = 0.003). However, the mean PLR of the RCS Dystrophic group (72%) did not differ from the mean PLR of the RCS Congenic group (71%) (P = 0.82). Morphometry revealed that the mean number of photoreceptor nuclear profiles within each group of animals was vastly different: Normal F344 = 138, Light Damaged F344 = 19, Congenic RCS = 93, and Dystrophic RCS = 1. No correlation was found between intensity of PLR and number of photoreceptors present (r = 0.11, P = 0.78).(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed1995

Acquisition and use of clinical data for audit and research.

Acquisition of adequate patient data for clinical management is hard enough, but higher quality patient data are needed for clinical audit and research. This article discusses some of the problems of using routine clinical data for audit and research, aspects of data quality, sources of audit or research data and their problems, methods for improving data quality, the benefits and problems of computer-based systems and current trends in the capture and processing of clinical data.

Bias↗
PubMed1995

Screening for celiac disease in first-degree relatives of patients with celiac disease by lactulose/mannitol test.

OBJECTIVES: In first-degree relatives of celiac patients, the risk of oligosymptomatic celiac disease is elevated. These individuals therefore also have a higher potential for malignancy or nutritional deficiencies. Lactulose/mannitol permeability is increased in untreated celiac patients and has been recommended to screen for celiac disease. We investigated the usefulness of a lactulose/mannitol home test kit for screening first-degree relatives home test kit for screening first-degree relatives of celiac patients. METHODS: The lactulose/mannitol test was performed at home by 111 first-degree relatives. These subjects received the test kit from celiac index patients, were instructed by an information sheet how to carry out the test, and were asked about their symptoms by questionnaire. When lactulose/mannitol permeability was abnormal, endomysial antibodies were tested by immunofluorescence. Any relatives with positive endomysial antibodies were then biopsied. To investigate the specificity of the lactulose/mannitol test for celiac disease, 40 patients with nonspecific gastrointestinal symptoms were tested. RESULTS: Lactulose/mannitol permeability was elevated in 34 (31%) relatives, but only nine (8%) of those relatives showed positive endomysial antibodies. Flat mucosa was found in all nine relatives after biopsy. The prevalence of celiac disease was much higher (42%) among 12 relatives who contacted the outpatient clinic themselves because of symptoms. Seventy-one percent of the remaining 21 relatives with elevated permeability demonstrated normal intestinal permeability at a control test within 1 yr. CONCLUSION: By combining the lactulose/mannitol test with endomysial antibody testing, we have developed a good strategy for use in screening for celiac disease among first-degree relatives.

Adolescent↗
PubMed1995

Screening for celiac disease: a prospective study on the value of noninvasive tests.

OBJECTIVE: Celiac disease is frequently diagnosed in patients with nonspecific abdominal symptoms. Therefore, highly sensitive, specific, and simple noninvasive screening tests are needed. METHODS: This study compared the usefulness of IgG- and IgA-antigliadin antibodies, IgA-endomysial antibodies, and intestinal permeability in diagnosing celiac disease in 102 adult patients with nonspecific abdominal symptoms. In addition, all patients underwent small bowel biopsy as a gold standard for the diagnosis of celiac disease. RESULTS: Forty-nine patients were ultimately diagnosed as having celiac disease because of flat mucosa. Flatulence and signs and symptoms dating back to childhood were more frequent and abdominal pain less frequent (p < 0.05) in celiac disease but were not helpful for screening. IgA-endomysial antibodies showed a sensitivity and specificity of 100%; an altered intestinal permeability had also a 100% sensitivity, but only 55% specificity. IgG- and IgA-antigliadin antibodies' sensitivity (73% and 82%, respectively) and specificity (74% and 83%, respectively) were much lower. Combining the two antigliadin antibodies did not significantly improve the sensitivity and specificity. CONCLUSIONS: Our data show the advantage of IgA-endomysial antibodies for screening of celiac disease except in the case of patients with IgA-deficiency or dermatitis herpetiformis. In these patients, the permeability test could improve noninvasive differential diagnosis.

Adult↗
PubMed1995

Disease-related worries and concerns: a study on out-patients with inflammatory bowel disease.

OBJECTIVE: To investigate the relationship between inflammatory bowel disease (IBD) patients' disease-related worries and concerns and their disease-related data, sociodemographic variables and perceived information level with respect to IBD. STUDY DESIGN: Prospective evaluation of disease-related concerns. SETTING: Out-patient IBD clinic of a university hospital. STUDY POPULATION: The study included 105 patients with IBD (72 with Crohn's disease and 33 with ulcerative colitis). MEASUREMENTS: Worries and concerns were measured using the standardized 25-item rating form of IBD patient concerns; actual disease activity was assessed by physicians using the Crohn's disease and clinical activity indices. Sociodemographic and other disease-related data were collected using a structured questionnaire. Patients' perceived information level was measured using a visual analogue scale. RESULTS: The issues of greatest concern to our patients were, in descending order of importance, having an ostomy bag (mean score +/- SD 63.6 +/- 38), the effects of medication (53.1 +/- 34), having surgery (51.6 +/- 36), the uncertain nature of the disease (46.5 +/- 32) and energy level (41.5 +/- 34). Patients with ulcerative colitis scored higher with respect to concern about loss of bowel control (P < 0.03). Disease-related worries and concerns correlated poorly with disease-related data (actual disease activity, severity of the course of IBD, diagnosis, disease duration or location, medication) but showed a significant negative correlation with patients' perceived information level about IBD (t = 0.2, P < 0.004). Lower information-level scores were associated with greater concerns. CONCLUSION: We conclude that the patients' information level about IBD and disease-related concerns have to be considered in clinical practice. Better information about IBD and psychosomatic counselling for patients who show high levels of concern may improve their quality of life and clinical care.

Adolescent↗