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Biomedical subjects

M J Stewart

Publications and source records attributed to M J Stewart.

At least 19 recordsLinked to original sources
PubMed1992

Limitations of the triolein breath test.

Patients being investigated for intestinal absorptive capacity were classified as normals or malabsorbers on the basis of three fat absorption tests. Malabsorbers were further classified as mild, moderate, severe or gross according to severity of malabsorption. Using this classification system the triolein breath test was evaluated in 53 patients. Seventeen patients were excluded because their graph of percentage breath [14C]carbon dioxide versus time was exponential indicating that the peak [14C]-carbon dioxide may be occurring later than the six hour duration of the test. The sensitivity and specificity of the triolein breath test were found to be 100% and 96%, respectively and moderate correlations with the individual fat absorption tests were found. However, the breath test was limited in its capacity to predict the severity of malabsorption. Carbon dioxide output was also measured in order to determine the applicability of using an assumed value. The respiratory quotient and variability of results were high in nineteen patients indicating possible hyperventilation. In 32 patients with reproducible results and normal respiratory quotients the average carbon dioxide output was 8.66 mmol/kg per hour with a wide range of 5-12.4 mmol/kg per hour. Consequently the use of an assumed carbon dioxide output can introduce considerable errors in the triolein breath test. This study highlights drawbacks of the triolein breath test, particularly problems in using an assumed carbon dioxide output for its calculation, its inability to predict the severity of malabsorption and the nature of the dietary load used.

Adolescent↗
PubMed1992

Gene transfer in vivo with DNA-liposome complexes: safety and acute toxicity in mice.

DNA can be introduced into a variety of cell types after formation of liposomal complexes with cationic lipids. In this report, conditions have been established to optimize the production of DNA-liposome complexes that efficiently transfect cells. The safety and toxicity of this method of gene delivery have been assessed after in vivo administration, either by intravenous or direct intratumor injection. Nine to eleven days after intravenous injection, DNA was found primarily in heart and lung tissue by PCR analysis. No abnormalities were evident from histologic examination of tissue, examination of tissue-specific serum enzymes, routine biochemical parameters, or electrocardiographic monitoring. DNA-liposome complexes can therefore be used for the delivery of recombinant genes in vivo with minimal toxicity.

Animals↗
PubMed1992

Dilated cardiomyopathy associated with chronic overuse of an adrenaline inhaler.

Endogenous catecholamines in excess are known to cause dilated cardiomyopathy. A patient presented with dilated cardiomyopathy after many years of overusing an adrenaline inhaler. Pathological features and a considerable improvement in myocardial function after withdrawal implicated the exogenous catecholamine excess in the pathogenesis of the cardiomyopathy.

Adult↗
PubMed1992

Laxative induced diarrhoea--a neglected diagnosis.

A laxative screening service was established and offered to gastroenterologists in hospitals covering the West and Central belt of Scotland. The prevalence of laxative induced diarrhoea was assessed in two populations and was found to be 4% in new patients presenting to a gastroenterology clinic with diarrhoea and 20% in patients already under investigation of chronic idiopathic diarrhoea. A high rate of missed diagnosis of laxative induced diarrhoea (71%) and a low request rate (eight per annum) confirm the low clinical awareness of this diagnosis. We found potential savings of 80% of the cost of investigations subsequently ordered which could have been avoided by performing laxative screens on all patients presenting with diarrhoea. The introduction of such a screening policy is recommended as a cost-effective measure.

Cathartics↗
PubMed1992

Measurement of faecal ammonia.

A modified end-point enzymatic method for the measurement of ammonia in stool water is presented. A protein precipitation step was included in order to inactivate urease and faecal enzymes, which oxidise NADH. The modified method is reliable, with acceptable precision and accuracy, and is linear up to a concentration of 1.5 mmol/l.

Ammonia↗
PubMed1991

The role of CCAAT/enhancer-binding protein in the differential transcriptional regulation of a family of human liver alcohol dehydrogenase genes.

The transcription factor CCAAT/enhancer-binding protein (C/EBP) was found to selectively trans-activate one member of the human class I alcohol dehydrogenase (ADH) gene family. A comparison of the promoters for the three human class I ADH genes ADH1, ADH2, and ADH3 indicated a very similar pattern of binding sites (sites A-F) for rat liver nuclear proteins located between -10 and -210 base pairs (bp). In all three promoters site A consisted of two binding sites for the transcription factor C/EBP closely flanking both sides of the TATA box, but C/EBP bound with much greater affinity to site A of ADH2. C/EBP also bound at two locations which coincide with site D (-120 bp) and site E (-160 bp) of all three promoters. Cotransfection studies of human hepatoma cells using ADH-cat fusions and a C/EBP expression plasmid indicated that the human ADH2 promoter responded well to C/EBP trans-activation whereas the human ADH1 and ADH3 promoters, which bind C/EBP weakly, responded poorly. Individual mutations in several ADH2 nuclear factor-binding sites allowed the identification of four functional C/EBP-binding sites, i.e. two in site A as well as one each in sites D and E. Also, the ADH2 TATA box was found to be dispensable for C/EBP induction. Compared to ADH2 and ADH3, site A in ADH1 contains four extra base pairs between the two C/EBP motifs, and deletion of these nucleotides increased the C/EBP responsiveness of ADH1 presumably by changing the spacing of the two C/EBP motifs. Thus, sequence divergence of human class I ADH gene family members has led to forms which vary in their responsiveness to C/EBP. We suggest that C/EBP contributes to liver-specific expression of the human class I ADH gene family by selectively inducing the ADH2 gene via a TATA-independent mechanism during liver development.

Alcohol Dehydrogenase↗
PubMed1991

Retinoic acid response element in the human alcohol dehydrogenase gene ADH3: implications for regulation of retinoic acid synthesis.

Retinoic acid regulation of one member of the human class I alcohol dehydrogenase (ADH) gene family was demonstrated, suggesting that the retinol dehydrogenase function of ADH may play a regulatory role in the biosynthetic pathway for retinoic acid. Promoter activity of human ADH3, but not ADH1 or ADH2, was shown to be activated by retinoic acid in transient transfection assays of Hep3B human hepatoma cells. Deletion mapping experiments identified a region in the ADH3 promoter located between -328 and -272 bp which confers retinoic acid activation. This region was also demonstrated to confer retinoic acid responsiveness on the ADH1 and ADH2 genes in heterologous promoter fusions. Within a 34-bp stretch, the ADH3 retinoic acid response element (RARE) contains two TGACC motifs and one TGAAC motif, both of which exist in RAREs controlling other genes. A block mutation of the TGACC sequence located at -289 to -285 bp eliminated the retinoic acid response. As assayed by gel shift DNA binding studies, the RARE region (-328 to -272 bp) of ADH3 bound the human retinoic acid receptor beta (RAR beta) and was competed for by DNA containing a RARE present in the gene encoding RAR beta. Since ADH catalyzes the conversion of retinol to retinal, which can be further converted to retinoic acid by aldehyde dehydrogenase, these results suggest that retinoic acid activation of ADH3 constitutes a positive feedback loop regulating retinoic acid synthesis.

Base Sequence↗
PubMed1991

Assessment of theophylline compliance in general practice using a 'compliance index' based on apparent drug clearance.

The monitoring of compliance in outpatients using serum drug levels suffers from the difficulty of relating concentrations to changes in dosage. Clearance is independent of dose for most drugs, and may be predicted using a Bayesian based forecasting program. This paper describes how the apparent clearance obtained following a single drug analysis can be compared with the Bayesian population value to derive a Compliance Index. In compliant individuals with stable hepatic and renal function this index should remain constant. We evaluated the usefulness of the Compliance Index in general practice with patients prescribed theophylline. Of 54 patients examined on up to five occasions, only 12% were deemed to be fully compliant at all times. Compliance improved during the study, but worsened again once regular consultation ceased. The results indicate that such a Compliance Index is a viable method of assessing compliance with the aid of concentration measurements.

Adolescent↗
PubMed1991

Diagnosis of the abuse of magnesium and stimulant laxatives.

A reliable diagnosis of laxative abuse can only be reached by chemical analysis. We report a modified thin layer chromatography approach for the detection and confirmation of over-the-counter colonic stimulant laxatives. Potential interference by dietary and drug components chemically similar to anthraquinones was investigated and the method was found to be specific in this respect. The diagnosis of magnesium laxative abuse is more difficult since magnesium is a component of body fluids. By inducing diarrhoea with magnesium salts in volunteers we have established that the diagnosis can be made by measuring magnesium concentrations in stool water, with 30 mmol/L being an appropriate cut-off concentration.

Cathartics↗
PubMed1991

Ambulatory blood pressure monitoring in secondary hypertension.

The term 'secondary hypertension' includes a variety of aetiological processes with no obvious common feature apart, perhaps, from the loss of normal blood pressure regulatory factors. It has been suggested that all forms of secondary hypertension, including renal/renovascular, accelerated phase, glucocorticoid and mineralocorticoid excess, phaeochromocytoma and toxaemia in pregnancy are associated with the loss of the normal nocturnal fall in blood pressure. The evidence for this view appears strongest for glucocorticoid-induced hypertension, but for most other forms the available data are conflicting and are mostly based on small numbers of patients without adequate control populations. Sleep is a powerful determinant of the nocturnal fall in blood pressure but few studies have addressed the quality of sleep in groups of patients who are often sick and/or hospitalized. Abnormalities in sympathetic drive (e.g. autonomic neuropathy and phaeochromocytoma) can abolish the nocturnal blood pressure reductions, and activation of the sympathetic nervous system may be a critical factor in determining the normal diurnal changes in blood pressure. As approximately 20% of patients with 'essential hypertension' have a blunted fall in nocturnal blood pressure it seems unlikely that ambulatory blood pressure could ever be useful in screening for secondary hypertension.

Adrenal Gland Neoplasms↗
PubMed1990

The effect of doxorubicin on the glutathione content and viability of cultured human lung cancer cell lines A549 and GLC4 210.

Glutathione was measured in doxorubicin-sensitive cells from small cell carcinoma of lung (GLC4 210), and the levels compared with those of cells with acquired resistance and a line of resistant non-small-cell adenocarcinoma A549 (Alveolar type 2). The effect of different doxorubicin concentrations on glutathione were measured by HPLC. The effect of doxorubicin on the viability of the cell lines was studied using thiazole blue dye reduction. An increase in A549 sensitivity to doxorubicin was produced using buthionine-S,R-sulfoximine at a non-toxic dose.

Adenocarcinoma↗
PubMed1990

A hormone response element upstream from the human alcohol dehydrogenase gene ADH2 consists of three tandem glucocorticoid receptor binding sites.

The 5'-flanking region of the human gene encoding beta-alcohol dehydrogenase (ADH2) was shown by DNase I footprinting to contain three tandem binding sites for purified glucocorticoid receptor. The three binding sites lie very close together between nucleotide (nt) positions -245 and -171 with respect to the transcription start point. DNase I footprinting using a rat liver nuclear extract indicated a lack of protection of the glucocorticoid receptor binding sites, but protection of a sequence between nt -209 and -191 which partially overlaps the glucocorticoid receptor binding sites I and II. This site has homology with the known binding site for hepatocyte nuclear factor 1 (HNF1). ADH2 promoter DNA fragments containing various lengths of 5'-flanking sequences were fused upstream from the gene encoding chloramphenicol acetyltransferase (cat) and transfected into the HepG2 human hepatoma cell line. The resulting cat expression was subject to induction by dexamethasone in constructions containing ADH2 DNA between nt -272 and -171. This indicates that the glucocorticoid receptor binding sites identified by footprint analysis function as a glucocorticoid response element (GRE) in a liver cell line. Heterologous ADH-cat fusions, in which the ADH2-GRE was fused to the adenovirus major late promoter, exhibited glucocorticoid induction of cat expression in CV-1B cells when cotransfected with a glucocorticoid receptor expression vector. Glucocorticoid regulation in CV-1B was observed when either all three glucocorticoid receptor binding sites (sites 0, I, II) or the two distal sites (sites 0, I) were present. Overall, these results indicate that the ADH2 gene possesses a functional GRE which can potentially regulate expression transcriptionally.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol Dehydrogenase↗