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Biomedical subjects

M Y Morgan

Publications and source records attributed to M Y Morgan.

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

A comparison of skinfold anthropometry and bioelectrical impedance analysis for measuring percentage body fat in patients with cirrhosis.

Percentage body fat was determined by skinfold anthropometry and bioelectrical impedance analysis in 60 patients with cirrhosis, 30 of whom had overt fluid retention, and in 60 age- and sex-matched healthy volunteers. In the control population the mean +/- 1SD percentage body fat assessed using bioelectrical impedance analysis, 22.6 +/- 6.5%, and skinfold anthropometry, 22.5 +/- 6.9%, were comparable. However, there was considerable variation in individual values such that measurements made using bioelectrical impedance analysis could be from 9% less to 8% more than the corresponding anthropometric values. In patients with cirrhosis the mean percentage body fat assessed using bioelectrical impedance analysis, 24.4 +/- 8.9%, was significantly greater than the value obtained using skinfold anthropometry, 20.3 +/- 8.4% (p < 0.01) for the whole group and for the subgroup of patients with fluid retention, 24.5 +/- 8.5% cf. 18.4 +/- 7.1% (p < 0.005); estimates of body fat in the subgroup of patients without overt fluid retention were comparable between methods, 24.4 +/- 9.4% cf. 22.1 +/- 9.2%. In the whole patient group individual measurements made using bioelectrical impedance analysis could be from 10% less to 18% more than the corresponding anthropometric values; similar degrees of variation in individual values were observed in the two patient subgroups. Bioelectrical impedance analysis should not be used interchangeably with skinfold anthropometry for assessment of percentage body fat in patients with cirrhosis, irrespective of their state of hydration.

Adipose Tissue↗
PubMed1994

Cerebral phosphorus-31 magnetic resonance spectroscopy in patients with chronic hepatic encephalopathy.

Cerebral phosphorus-31 magnetic resonance spectroscopy was undertaken in 33 patients with biopsy-proven cirrhosis: 6 had no evidence of neuropsychiatric impairment on standard clinical, psychometric and electrophysiological testing; 8 had evidence of subclinical hepatic encephalopathy; and 19 were classified as having overt hepatic encephalopathy. The reference population comprised 15 healthy volunteers. Unlocalized spectra were acquired from the entire head with a 45-degree pulse angle and repetition times of 1 and 5 sec. Spectra localized to the basal ganglia were acquired with a 45-degree pulse angle and a repetition time of 1 sec. Peak area ratios of phosphomonoesters, inorganic phosphate, phosphodiesters and phosphocreatine relative to beta-ATP were measured in the spectra acquired. We noted no consistent change in the ratios of inorganic phosphate to ATP and phosphocreatine to ATP. Mean values of the ratios of phosphomonoesters to ATP and phosphodiesters to ATP were significantly lower in the total patient population than in the reference population, and they correlated with the patients' neuropsychiatric status. Thus we found no significant reductions in the mean ratios of phosphomonoesters to ATP and phosphodiesters to ATP in patients who were neuropsychiatrically unimpaired, but significant reductions were observed in the mean ratios of phosphomonoesters to ATP and phosphodiesters to ATP in patients with both subclinical and overt hepatic encephalopathy. The most marked reductions in these metabolite ratios were observed in patients with overt encephalopathy.

Adult↗
PubMed1994

The prognosis and outcome of alcoholic liver disease.

Alcoholic liver disease evolves from fatty change through alcoholic hepatitis to alcoholic cirrhosis. Its development is associated with an excess mortality both in relation to the presence of liver disease and to other complications of alcohol abuse. In the majority of patients fatty liver is a benign lesion which will reverse completely following abstinence from alcohol. Continued drinking is associated with the eventual development of cirrhosis in approximately 20% of individuals. Survival rates of 70% are reported both at 2 years and at 10 years. Alcoholic hepatitis is a precirrhotic lesion; progression to cirrhosis is observed more commonly in women, in individuals with severe disease and in those who continue to drink. Thirty-day mortality rates of less than 20% are observed in patients with mild to moderate disease but exceed 40% in individuals with severe liver injury. Corticosteroids may improve short term survival in a small subgroup of patients with severe alcoholic hepatitis. Survival rates of 55 to 60% are reported both at 2 years and at 10 years. Survival is significantly reduced in women and in the elderly and is adversely affected by the presence of severe liver injury, evolution to cirrhosis and continued drinking. Two-thirds of patients with alcoholic cirrhosis present with decompensated disease; 15% will develop hepatocellular carcinoma. Survival rates at 5 years vary from zero to 80%; 60 to 90% of individuals die of their liver disease. Survival is adversely affected by the presence of decompensated disease, superimposed alcoholic hepatitis, continued drinking and the development of hepatocellular carcinoma. The advent of hepatic transplantation, which has a 5-year survival rate in excess of 70%, will influence these survival figures.

Carcinoma, Hepatocellular↗
PubMed1992

The effects of alcohol use on rebleeding and mortality in patients with alcoholic cirrhosis following variceal haemorrhage.

The effect of continued alcohol intake on prognosis in alcoholic cirrhotics who have already bled from varices is controversial. To investigate the effect of alcohol intake on prognosis we studied 189 consecutive alcoholic cirrhotics admitted, for the first time, to the Royal Free Hospital with variceal bleeding. Sixty-six died within 30 days of admission and 23 were excluded from the study for other reasons. Of the 100 remaining 15 remained 'probably abstinent' over long-term follow-up, 29 drank occasionally and 56 continued to misuse/abuse alcohol. The percentage survival probability at 2 years was 66% in the probable abstainers, 68% in the occasional drinkers and 63% in the alcohol abuse/misuse group. There were no significant differences in either mortality or rebleeding rates between the three groups. A rebleeding index (designed to take account of the number of rebleeds per patient and the total length of follow-up) also failed to show any significant difference between the three groups. The Cox proportional hazard model was used to study the effect of the following factors on rebleeding and mortality; age, sex, alcohol use, Pugh's score, acute treatment received for initial variceal bleed and long-term treatment received for prevention of recurrent variceal haemorrhage. Pugh's score was significantly related to risk of death during follow-up (p = 0.0122), but none of the other factors was significantly related to risk of rebleeding or mortality. Using conventional methods to determine alcohol use we were unable to demonstrate significant effects of alcohol intake on rebleeding or mortality in alcoholic cirrhotics who had bled from oesophageal varices.

Alcohol Drinking↗
PubMed1991

The treatment of chronic hepatic encephalopathy.

The neuropsychiatric abnormalities which accompany cirrhosis of the liver vary widely from subclinical impairment of psychometric performance to overt episodic or persistent changes in cerebral function. The pathogenesis of the syndrome is unknown although important rôles are ascribed to circulating gut-derived toxins of nitrogenous origin and to changes in central neurotransmission, particularly of the dopaminergic and GABA-ergic systems. Treatment is, therefore, based on mechanisms to reduce the production and absorption of gut-derived toxins such as decreasing and modifying dietary protein intake, altering the intestinal bacterial flora and bowel cleansing, and on mechanisms designed to modify central neurotransmitter balance either directly by use of dopaminergic agents or benzodiazepine antagonists or indirectly by use of amino-acid mixtures. Some treatment measures, such as use of non-absorbable disaccharides and vegetable protein diets, are known to be efficacious, and are the mainstays of management for all forms of the syndrome. Others are used in more specific circumstances, for example the antibiotic neomycin is effective during acute exacerbations of the syndrome, and the dopamine agonist bromocriptine provides benefit when symptoms are persistent and intractable. Certain treatments such as branched-chain amino acids and the benzodiazepine antagonist, flumazenil, are at present, of unproven value.

Amantadine↗
PubMed1990

Branched chain amino acids in the management of chronic liver disease. Facts and fantasies.

The liver plays a central role in protein and amino acid metabolism. It processes dietary amino acids and reprocesses amino acids released from muscle protein degradation. It utilises amino acids for protein synthesis and gluconeogenesis, regulates the supply of amino acids to peripheral tissues and converts excess amino acids to urea. In patients with liver disease the liver's ability to control both plasma and tissue amino acid fluxes may be seriously disturbed. The resultant changes in amino acid metabolism may be implicated in the genesis of the neuropsychiatric abnormalities and the deterioration in nutritional status commonly observed in patients with hepatic failure. Thus, on theoretical grounds, amelioration of these amino acid abnormalities might benefit patients with liver disease who have hepatic encephalopathy or are malnourished. However, there is, at present, no consensus as to the efficacy, practicality or cost-effectiveness of 'amino acid therapy' in patients with liver disease.

Amino Acids, Branched-Chain↗
PubMed1990

Pharmacokinetics of famotidine in normal subjects and in patients with chronic liver disease.

The pharmacokinetics of famotidine were studied in seven healthy control subjects and in 14 patients with cirrhosis, following single oral and intravenous 20-mg dose administration, and after seven daily doses of 40 mg. Following intravenous (i.v.) administration, the mean (range) total plasma clearance values were not significantly different in the patients with compensated cirrhosis (n = 7), 337 (241-576) ml/min or in the patients with decompensated cirrhosis (n = 7), 270 (120-408) ml/min compared with the control group, 370 (154-612) ml/min. The mean half-life in the compensated cirrhotics, 2.86 (1.87-4.98) h, was similar to that in the control group 2.91 (1.86-6.03) h, but it was insignificantly prolonged in the decompensated cirrhotics 3.35 (2.00-5.77) h. The mean, maximum, plasma famotidine concentrations after single oral doses were comparable between the groups but there was considerable inter-subject variability, with individual values ranging from 17 to 139 ng/ml. Peak plasma concentrations were reached within 2-3 h, although more variability was observed among patients with decompensated cirrhosis. The mean systemic availability of the drug, estimated from urinary recovery, was 0.39 (0.15-0.64) in the healthy controls, 0.35 (0.14-0.51) in the patients with compensated cirrhosis and 0.38 (0.13-0.77) in the patients with decompensated cirrhosis. No significant increases were observed in plasma trough famotidine concentrations following multiple oral dosing in any of the subjects, and the kinetic variables after the seventh dose were not significantly different from those following the single oral dose. No significant changes were observed in psychometric performance in control subjects or in patients between the pre-study day and day seven of the multiple oral dose phase.

Administration, Oral↗
PubMed1990

Amino acid tolerance in cirrhotic patients following oral protein and amino acid loads.

Plasma amino acid and venous blood ammonia concentrations were measured in six patients with well-compensated cirrhosis and in six healthy volunteers, both in the fasting state and serially for 5 h following ingestion of 30 g mixed protein and 30 g amino acid mixture, administered on separate occasions. Mean fasting plasma concentrations of threonine, serine, proline, glycine, and of the three branched-chain amino acids, valine, isoleucine and leucine, were significantly reduced in the cirrhotic patients compared with the control subjects, while mean (+/- 1 s.d.) fasting venous blood ammonia concentrations were comparable 71.2 +/- 31.4 cf. 56.0 +/- 25.4 mumol/L. Following the oral protein and amino acid loads, increases were observed in plasma amino acid concentrations in the majority of subjects with a return to baseline values by the end of the study. Changes in the circulating concentrations of most amino acids were independent of their concentration in the oral protein and amino acid loads, and their relative distribution in the circulation varied over time. The increases in the concentrations of the three branched-chain amino acids did, however, reflect their concentrations in the two nitrogen loads and did remain constant, relative to one another, over time. There were wide intra- and inter-individual variations in plasma amino acid concentrations following protein and amino acid ingestion in both study groups, and in general no significant differences in responses were observed between them. Similarly, no significant inter-group differences were observed in the ammonia response to the two nitrogen loads. No fundamental differences exist in the ways in which patients with well-compensated cirrhosis handle oral protein or amino acid loads of the magnitude employed in the present study.

Adult↗
PubMed1989

Mortality from interpersonal violence in Great Britain.

Data accessed from both death certificates and police reports show that mortality from interpersonal violence is extremely uncommon in Great Britain, particularly in comparison with other countries; in 1985, it accounted for only 0.1 per cent of all deaths and 0.4 per cent of deaths among individuals under 65 years of age. Despite a steady increase in the rate of homicide over the past 20 years, homicide can only be considered to be a minor public health issue in Great Britain. In contrast, data accessed from the British Crime Surveys and from studies conducted both in accident and emergency departments and among individuals hospitalized with head injuries, show that morbidity associated with interpersonal violence may be relatively common in Great Britain. However, until more valid estimates of morbidity can be made, the overall importance of interpersonal violence as a public health issue in Great Britain cannot be assessed with accuracy.

Death Certificates↗
PubMed1989

Lactitol and lactulose for the treatment of subclinical hepatic encephalopathy in cirrhotic patients. A randomised, cross-over study.

Fourteen patients with cirrhosis and subclinical hepatic encephalopathy were randomised to treatment with lactitol or lactulose for a 2-month period during which they were monitored clinically, by electroencephalography and by manually administered and computer-based psychometric testing. Following a washout period of 4-6 weeks patients were crossed-over to treatment with the alternative sugar for a similar period of monitoring. None of the patients showed evidence of overt hepatic encephalopathy and only one showed slowing of the electroencephalogram mean cycle frequency at the onset of the trial. However, significant impairment was observed in the group as a whole in the performance of all three manually administered psychometric tests and in four of the ten computer-based test variables. No changes were observed in clinical status or in electroencephalogram mean cycle frequency during treatment with either lactitol or lactulose. However, psychometric performance improved consistently, and to the same degree, during treatment with both sugars. Patients required a mean of 26 g (range 8-36) of lactitol and 25 ml (10-60) of lactulose to achieve two semi-soft stools per day. The majority of patients complained of flatulence during treatment with both sugars but this tended to resolve with continued treatment. Diarrhoea developed in a small number of patients during both treatment periods but this was invariably dose-related. Patients were equally divided in their preference for the two sugars. Patients with subclinical hepatic encephalopathy benefit from treatment with lactitol and lactulose in terms of their psychometric performance. The feasibility and benefits of long-term treatment for this condition need to be elucidated.

Clinical Trials as Topic↗
PubMed1989

The role of alcohol in mortality and morbidity from interpersonal violence.

Alcohol is regarded widely as a causal factor in interpersonal violence in Great Britain. However, much of the evidence used to support this association is anecdotal, or at best, based on descriptive studies. Data calculated from cross-sectional, case-control and cohort studies, undertaken in Great Britain, show that individuals who consume alcohol are several times more likely to perpetrate violence, or to be the victims of violence, than individuals who do not consume alcohol. If criteria for causality are used to assess these findings, then it would appear that alcohol is likely to be a causal factor in both violence perpetration and violence victimization. However, the proportion of interpersonal violence caused by alcohol and the levels of alcohol consumption associated with significantly increased risks of involvement in interpersonal violence cannot be identified from the data available to date.

Alcoholism↗
PubMed1989

Improving information on the role of alcohol in interpersonal violence in Great Britain.

In Great Britain, at present, no valid or reliable estimate can be made of the proportion of interpersonal violence caused by alcohol, nor can an assessment be made of the levels of alcohol consumption associated with an increased risk of involvement in interpersonal violence. A critical review of existing British studies and surveillance systems has been undertaken, which indicates that the role of alcohol in interpersonal violence could be defined more precisely, if new and better analytical studies were conducted, if ongoing logitudinal studies and existing surveillance systems were improved or better exploited, and if new surveillance systems were implemented.

Alcoholism↗
PubMed1989

The pharmacokinetics of caffeine and its dimethylxanthine metabolites in patients with chronic liver disease.

1. Serum and salivary concentrations of caffeine (1,3,7-trimethylxanthine) and its dimethylxanthine metabolites were measured in 10 healthy control subjects and in 19 patients with cirrhosis, for up to 96 h following a 400 mg oral caffeine load. 2. Serum and salivary caffeine concentrations correlated significantly (r = 0.954; P less than 0.001) and no significant differences were observed in the pharmacokinetic data derived from the respective concentration-time curves. 3. In the control subjects, basal salivary caffeine concentrations did not exceed 0.4 mg l-1. The median (range) basal salivary caffeine concentrations in patients with compensated cirrhosis (n = 10), 0.2 (0-0.7) mg l-1 and decompensated cirrhosis (n = 9), 0.7 (0-5.8) mg l-1, were not significantly different from control values, although three patients with decompensated cirrhosis had basal salivary caffeine values above 2.0 mg l-1. 4. In the patients with compensated cirrhosis, the median peak salivary caffeine concentration, 10.9 (8.2-16.5) mg l-1 was significantly greater than in controls, 7.1 (4.7-11.8) mg l-1 (P less than 0.01) and the median apparent volume of distribution was significantly reduced, 0.38 (0.19-0.49) vs 0.41 (0.23-0.63) l kg-1 (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Caffeine clearance and biotransformation in patients with chronic liver disease.

1. The clearance and biotransformation of caffeine (1,3,7-trimethylxanthine) were investigated in eight healthy control subjects and 16 patients with cirrhosis, by measuring serial serum caffeine concentrations and recoveries of methylxanthine metabolites in urine for 48 h after a 400 mg oral caffeine load. 2. In the control group, the mean (+/- SD) serum caffeine clearance was 1.3 +/- 0.4 ml min-1 kg-1 and a mean of 56.4 +/- 16.5% of the administered caffeine was recovered from the urine over 48 h as methyluric acids and methylxanthines. The majority of the metabolites were excreted in the first 24 h period and only 2.0 +/- 1.4% of the administered caffeine was excreted unchanged. 3. Patients with compensated cirrhosis (n = 10) metabolized caffeine similarly to the control subjects. Thus the mean serum caffeine clearance was 1.4 +/- 1.2 ml min-1 kg-1 and a mean of 57.2 +/- 11.7% of the administered caffeine was recovered from the urine over 48 h. The majority of the metabolites were excreted in the first 24 h; the pattern of metabolic excretion was unaltered and only 2.2 +/- 0.9% of the administered caffeine was excreted unchanged. 4. In the patients with decompensated cirrhosis (n = 6), significant changes were observed in caffeine metabolism. The mean serum caffeine clearance (0.4 +/- 0.2 ml min-1 kg-1) was significantly impaired compared with controls (P less than 0.01) and a significant delay was observed in metabolite excretion in the urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

The measurement of D,L-2,3-butanediol in controls and patients with alcoholic cirrhosis.

Plasma D,L-2,3-butanediol was measured in 53 controls and 50 patients with alcoholic cirrhosis, none of whom had measurable amounts of blood ethanol. Thirteen of 50 samples from patients with alcoholic cirrhosis had measurable D,L-2,3-butanediol. (range less than 5-154 microM). In one patient with alcoholic cirrhosis who had been abstinent from ethanol for over 5 years plasma levels of D,L-2,3-butanediol ranged between 154 and 211 microM over a one-year period. Only one of the 53 control subjects had detectable levels of D,L-2,3-butanediol. Although it has previously been reported that 2,3-butanediol is present in alcoholics consuming distilled spirits (Rutstein et al. (1983) Lancet ii, 534), this is the first report of the persistent presence of these compounds in alcoholics in the absence of ethanol. Clearly in abstinent alcoholics the presence of 2,3-butanediol is not due to the ingestion of undistilled spirits nor is it likely to arise directly from the metabolic products of ethanol. The presence of D,L-2,3-butanediol in patients with alcoholic cirrhosis and its absence in control subjects suggests that this compound may be a marker of some forms for alcoholism.

Biomarkers↗
PubMed1987

Validation of a computer based system for assessing dietary intake.

Dietary intake was assessed in 50 patients in hospital by using a dietary history method and computer based system for data collection and standard food tables to calculate the composition of nutrients. The results were compared with those from a weighed assessment that was calculated by using both food tables and manufacturers' food analyses. The use of the food tables overestimated mean (SEM) individual nutrient intakes by between 2.5% (1.5%) and 15.5% (3.0%). The mean errors associated with the dietary history assessment varied from -23% (7.8%) for fat intake to +21.4% (8.5%) for carbohydrate intake. Overall, 30% of the assessments of total nutrient intakes that were calculated using this method were within -20% to +20% of actual values; 18% were within -10% to +10%. The mean errors associated with the computer based assessment varied from -1.0% (4.3%) for carbohydrate intake to +8.5% (3.4%) for protein intake. Overall, 56% of the assessments of total nutrient intakes were within -20% to +20% of actual intakes; 31% were within -10% to +10%. The computer based system provides an accurate, reproducible, convenient, and inexpensive method for assessing dietary intake.

Data Collection↗
PubMed1987

Lactitol versus lactulose in the treatment of chronic hepatic encephalopathy. A double-blind, randomised, cross-over study.

Lactitol is a disaccharide analogue of lactulose which is available as a pure crystalline powder. The efficacy of lactitol in the treatment of chronic hepatic encephalopathy was assessed in 9 cirrhotic patients in a randomised, double-blind, cross-over comparison with lactulose. The sugars were dispensed in solutions, identical in taste and appearance and with similar physico-chemical properties, which contained either 66.7 g/100 ml of lactitol or 66.7 ml (44.5 g)/100 ml of lactulose syrup. Patients were treated for periods of 3 months with each sugar, during which time they were monitored frequently by use of a number of clinical, psychometric and laboratory variables. The sugar solutions were dispensed in an initial dose of 0.75 ml/kg which was adjusted, as necessary, in order to produce two semi-soft stools per day. An adequate catharsis was achieved with a mean (+/- 1 SD) equivalent daily dose of 31.9 +/- 11.2 g of lactitol or 32.9 +/- 16.7 ml (21.9 +/- 11.1 g) of lactulose syrup. Both sugars were equally as effective in the treatment of this condition, even though events likely to cause decompensation arose in 5 patients during treatment with lactitol but in only 1 during treatment with lactulose. Side effects appeared to be more frequent during treatment with lactulose, despite the fact that the parent sugar was diluted in the trial solution; thus 5 patients experienced excessive flatulence and 8 experienced diarrhoea on lactulose compared with only 2 and 4 on lactitol, respectively. In all cases the excessive flatulence occurred independently of sugar dosage whereas the development of diarrhoea was dose-related.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗