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Biomedical subjects

M J Dew

Publications and source records attributed to M J Dew.

25 records · Page 2Linked to original sources
PubMed1982

Mortality in ulcerative colitis.

The pattern of mortality has been examined in a series of 676 patients with ulcerative colitis under long-term review to identify excesses or deficits in mortality for all causes of death in relation to the general population. The mortality risk for the whole series was 1.7 times that of the general population (p less than 0.001). Most of the excess mortality could be attributed to diseases of the digestive system. There was a heavy burden of mortality during the first year afer diagnosis and the first year after radical surgery. The significance of the excess of cancer deaths was due to the inclusion of patients who were diagnosed with cancer at first referral. In man there was a deficit of circulatory system deaths particularly those with early onset ulcerative colitis treated by panproctocolectomy after 40 yr of age. Mortality from all other causes including breast cancer showed no significant difference from that expected in the general population.

Adult↗
PubMed1980

Hepatotoxic effect of bile acids in inflammatory bowel disease.

Lithocholate, a secondary bile acid, is hepatotoxic in many animal species including nonhuman primates. The induced histologic changes resemble those observed in patients with hepatic damage associated with inflammatory bowel disease. Accordingly, we have examined the hypothesis that lithocholate is of etiologic importance in causing this association by measuring serum and biliary lithocholates in inflammatory bowel disease patients with and without liver disease. Serum and biliary lithocholates and isolithocholates were normal in all patients. Because defective sulfation in the nonhuman primate which allows lithocholate to accumulate in the enterohepatic circulation is thought to be responsible for inducing liver damage and because secondary bile acids are reduced after colectomy and in established liver disease, we examined thae capacity of all patients to sulfate labeled lithocholate. Effective sulfation of lithocholate was demstrated in all groups. Despite the hepatotoxic effects observed in nonhuman primates, we have found no evidence so far to implicate lithocholate as an etiologic factor in inflammatory bowel disease and hepatic dysfunction nor have we detected other potentially hepatotoxic bile acids in these patients.

Adult↗
PubMed1979

The spectrum of hepatic dysfunction in inflammatory bowel disease.

The spectrum and incidence of liver disease is described among a large series of patients with inflammatory bowel disease. The incidence of significant liver disease identified by the presence of serial biochemical abnormalities of liver function was 8.2 per cent. Transient peri-operative changes in liver function tests are common and usually relate to underlying intra-abdominal sepsis. Percholangitis, sometimes termed portal triaditis, is one of the commoner lesions, and is usually associated with extensive colitis and improves with resection of the underlying bowel disease. Cirrhosis of the liver is an important but uncommon complication and is usually associated with extensive long-standing disease. Stenosing cholangitis and biliary tract carcinoma are both important though rare associations. They are both associated with extensive disease of long-standing, but resection of the underlying inflammatory bowel disease does not necessarily protect the individual from these complications. Although stenosing cholangitis is a diffuse lesion of the biliary tree it is important to exclude strictures of the extra-hepatic biliary tree which may be amenable to surgical correction. Hepatic dysfunction is rarely the sole indication for advising surgery for the underlying bowel disease but the identification of the nature of the hepati- dysfunction provides a rational basis for such a decision and opportunities for the surgical correction of the hepatic lesion itself.

Adolescent↗