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Biomedical subjects

M H Irving

Publications and source records attributed to M H Irving.

At least 37 records · Page 2Linked to original sources
PubMed1994

Reconstructive abdominal operations after laparostomy and multiple repeat laparotomies for severe intra-abdominal infection.

Between 1980 and 1993, 18 patients underwent formal laparotomy after laparostomy and healing of the peritoneal cavity by granulation. The majority (12 patients) were men and the median age was 47 (range 22-67) years. Intraabdominal infection following surgery for Crohn's disease (four patients) and necrotizing pancreatitis (six) was the most common primary condition requiring laparostomy. A total of 23 reconstructive operations were carried out on the 18 patients a median of 6 (range 1-18) months after laparostomy. The indication for surgery was for closure and/or resection of an enteric fistula in 13 patients. The site of the fistula included three gastric, two duodenal, 11 small bowel and seven colonic. A further four patients required operation for closure or refashioning of a stoma. Five patients subsequently required a second laparotomy: two for elective restoration of bowel continuity, two for recurrent fistula and one for an acute abdomen. After reconstructive surgery following laparostomy 16 patients were discharged home alive and well, one requiring home parenteral nutrition for short bowel syndrome. In contrast, the two oldest patients in the series died from multiple organ failure immediately after initial reconstructive surgery. Both had pre-existing medical problems and in neither was there evidence of further intra-abdominal infection after reconstruction.

Abdomen↗
PubMed1994

Change in bioelectrical impedance following laparoscopic and open abdominal surgery.

The effect of surgery, and in particular, the relative effects of open and laparoscopic abdominal surgery on whole body bioelectrical impedance (BI) has been investigated. Repeated measurements of BI were performed over a 60 h period in 12 patients undergoing laparoscopic surgery (group A) and in 12 patients undergoing elective open abdominal surgery for benign conditions (group B). Control measurements were performed upon 4 healthy adult subjects over the same time period. Attempts were made to relate postoperative changes in BI in group A and group B to changes in net postoperative fluid balance. The postoperative disturbance in BI was significantly greater in group B than group A (P < 0.001 Mann-Whitney-U test) and differed significantly from the minor fluctuations of BI observed in the control group (P < 0.001 Mann-Whitney-U test). The fluctuations in BI observed after laparoscopic surgery were not significantly greater than those seen in the control group (P = 0.1 Mann- Whitney U test). Changes in BI in both group A and B did not correlate with changes in net postoperative fluid balance, which suggests that the effect of surgery upon BI was related to changes of body water distribution rather than changes in total body water volume.

Journal Article↗
PubMed1994

Distribution of the matrix metalloproteinases stromelysin, gelatinases A and B, and collagenase in Crohn's disease and normal intestine.

AIMS: To investigate the role of the matrix metalloproteinases (MMPs) in the connective tissue changes seen in the intestine in Crohn's disease. METHODS: Indirect immunofluorescence microscopy using specific antibodies to the MMPs (collagenase, gelatinase A and B, and stromelysin) were used to assess the distribution of these enzymes in normal and diseased intestine. RESULTS: In normal intestine the matrix metalloproteinases were confined to a few isolated inflammatory cells, but in Crohn's disease, the inflammatory infiltrate was associated with increased numbers of polymorphonuclear leucocytes which stained positive for gelatinase B. Stromelysin was also detected extracellularly on the connective tissue matrix in regions of smooth muscle cell proliferation and mucosal degradation. Interestingly, in ulcerative colitis, another inflammatory bowel disease, stromelysin was localised in the lamina propria in regions of mucosal loss. CONCLUSIONS: The increased numbers of inflammatory cells containing gelatinase B, and the localisation of extracellular stromelysin in regions of fibrosis and mucosal degradation, suggest that these enzymes have a role in the pathological changes seen in Crohn's disease. In cases of ulcerative colitis stromelysin was also detected on the lamina propria in regions of mucosal loss, and seems to be associated with the connective tissue changes that precede mucosal loss.

Colitis, Ulcerative↗
PubMed1994

Thermogenic, hormonal, and metabolic effects of a TPN mixture. Influence of glucose and amino acids.

The thermogenic, hormonal, and metabolic effects of intravenous nutrition were examined by administering a complete total parenteral nutrition (TPN) mixture to 11 subjects, and the relative contributions of the glucose and amino acid components of the mixture were evaluated by administering these nutrients separately (n = 7 and n = 6, respectively). The complete TPN mixture caused a 22.9% rise in resting energy expenditure (REE), which significantly exceeded that associated with glucose (10.4% P < 0.02). The rise in REE produced by the amino acids (11.5%) did not differ significantly from that associated with administration of the TPN or glucose. The rise in REE associated with the TPN was almost exactly equal to the sum of the rises associated with the separate components of the mixture (22.9% and 22.0%, respectively), indicating that glucose and amino acids contributed equally to the thermogenic effect of the TPN mixture. In contrast, although the amino acid component of the TPN mixture was associated with small but significant reductions in plasma free fatty acid and glycerol concentration and with small increases in plasma insulin concentration, the effects of the complete TPN mixture were significantly greater and attributable to the glucose component.

Adult↗
PubMed1994

Total parenteral nutrition modifies the acute phase response to Crohn's disease.

Measurements of the acute phase proteins, C-reactive protein (CRP) and orosomucoid are widely used to monitor the activity of Crohn's disease. The effect of TPN upon the levels of acute phase proteins is unknown. Serum levels of CRP and orosomucoid were measured simultaneously over a four year period in 13 patients receiving TPN for Crohn's disease, nine patients with noninflammatory causes of intestinal failure, and 16 patients with Crohn's disease treated without TPN. An acute phase response was found with a similar frequency in both groups of patients with Crohn's disease (73.6% and 83.9% for Crohn's with and without TPN respectively), but was less prevalent in patients receiving TPN for non-inflammatory causes of intestinal failure (56.1%, P < 0.01). In this latter group, the acute phase response consisted primarily of an isolated elevation of orosomucoid (78.4%), compared with patients with Crohn's disease alone (21.1%, P < 0.001) and with Crohn's disease and TPN (46.6%, P < 0.05). Liver function abnormalities were seen on 68.8% of occasions in patients with noninflammatory causes of intestinal failure who had elevated levels of orosomucoid, compared with 34.9% of occasions on which orosomucoid levels were normal (P < 0.001). TPN may lead to isolated elevation of serum levels of orosomucoid, reducing the value of this acute phase protein in monitoring the activity of Crohn's disease in patients receiving TPN.

Acute-Phase Proteins↗
PubMed1994

Catheter-related morbidity in patients on home parenteral nutrition: implications for small bowel transplantation.

Until recently, Home Parenteral Nutrition (HPN) has been the only real option for patients with intestinal failure. Small bowel transplantation (SBT) is advancing rapidly, however, and may soon provide an alternative for these patients. One of the arguments in favour of SBT is the alleged morbidity of prolonged parenteral nutrition. We have assessed the catheter-related morbidity in a large cohort of patients on HPN. A total of 88 central venous catheters were required in 50 patients. The main complications were sepsis (24 episodes) and occlusion (18 episodes). The overall incidence of catheter-related morbidity was one episode per 46 patient-months of HPN.

Adolescent↗
PubMed1993

Surgical management of perineal and metastatic cutaneous Crohn's disease.

Skin lesions are the commonest extraintestinal manifestation of Crohn's disease. Lesions that develop at sites remote from the gastrointestinal tract and have granulomas on histological examination are termed metastatic cutaneous Crohn's disease. Management is difficult as medical treatment is often ineffective. This report describes the use of surgical debridement of areas of perineal metastatic cutaneous Crohn's disease in five patients, all of whom had failed to improve after a variety of medical treatments. One patient had a poor result with continuing mild perineal discharge and four had a good outcome with complete resolution of symptoms and satisfactory cosmetic results.

Adult↗
PubMed1993

The incidence and management of catheter occlusion in patients on home parenteral nutrition.

For patients on Home parenteral nutrition (HPN), catheter-related problems are the major source of morbidity and occlusion of the central venous catheter is one of these. We have managed 17 episodes of catheter occlusion in 10 patients on HPN. The median time from insertion to occlusive episode was 23 months. 10 catheters (59%) were saved by the used of thrombolytics (one by thrombolytics and ethanol) and 7 were replaced. The recent incidence of catheter occlusion in this cohort was one episode per 150 patient-months of HPN (0.08 episodes per year). Patients with Crohns disease appear to be at greater risk of developing catheter occlusion (p = <0.05).

Journal Article↗
PubMed1993

Plasma NE concentrations do not accurately reflect sympathetic nervous system activity in human sepsis.

Plasma norepinephrine concentrations ([NE]) when raised in patients with sepsis are thought to indicate increased activity of the sympathetic nervous system (SNS). However, increased SNS activity may occur without a concomitant rise in plasma [NE]. Measurement of NE kinetics (clearance and spillover) is a more accurate and direct assessment of SNS activity. In the present study plasma [NE] and NE kinetics were measured in six patients with intra-abdominal sepsis (septic) using tritiated NE infused to achieve a plateau plasma concentration. The measurements were repeated in the same patients after they had recovered (nonseptic). NE clearance and spillover were both significantly higher (P < 0.05) in the septic compared with the nonseptic state. However, there was no statistically significant difference in plasma [NE] between the two conditions. Plasma [NE] indicates no alteration in SNS activity during the septic state, whereas NE kinetics indicate increased activity of the SNS during sepsis. The results suggest that plasma [NE] is a poor indicator of SNS activity during septic illness.

Adult↗
PubMed1992

Human gut hormone profiles in patients with short bowel syndrome.

We have studied gut hormone profiles in a small number of patients on treatment with home parenteral nutrition following near-total enterectomy who had no evidence of inflammatory bowel disease and who were otherwise healthy. These and age- and sex-matched controls had gut hormone profiles measured after an overnight fast and a standard test meal. Circulating pancreatic glucagon concentrations and profiles were the same in both groups as were the neurotensin and VIP. Peptide YY (PYY) concentrations and profiles were markedly raised in the short bowel group. It is suggested that the normal glucagon responses reflect the integrity of the remaining duodenum and pancreas. Circulating neurotensin and VIP originate largely from outside the bowel and so the removal of the gut source does not significantly affect their profiles. Enteroglucagon and PYY are secreted from terminal ileum and colon in response to unabsorbed food residues. The elevated circulating levels and profiles are consistent with those observed by others in patients with jejunoileal bypass or major resections in whom unabsorbed nutrients reach the colon.

Adolescent↗
PubMed1992

Correspondence.

Explore the source record for details and available documents.

Letter↗
PubMed1992

The role of home parenteral nutrition in the management of intestinal failure - report of 400 cases.

Between 1977 and January 1991, 400 patients were entered on the United Kingdom Home Parenteral Nutrition (HPN) Register. Almost half suffered from Crohn's disease. Most commenced HPN while between 20-50 years of age. In terms of life quality while on HPN, most (63%) were able to work or look after their families unaided. A further 89 (22%) were able to cope with HPN independently. 221 patients ceased HPN during the study period, mostly (41%) due to intestinal adaptation. Of 69 patients who died, over half (57%) did so due to disease progression. Complications of HPN resulted in death in 22% of this subgroup. In terms of specific disease groups, those with Crohn's disease had the lowest mortality rate (8%).

Journal Article↗