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Biomedical subjects

N C Fisher

Publications and source records attributed to N C Fisher.

29 records · Page 2Linked to original sources
PubMed1998

A prospective, randomized controlled trial of sedation vs. no sedation in outpatient diagnostic upper gastrointestinal endoscopy.

BACKGROUND AND STUDY AIMS: The majority of gastrointestinal endoscopists in the United Kingdom routinely use intravenous sedation prior to diagnostic upper gastrointestinal endoscopy. We conducted a prospective, randomized controlled clinical trial to help determine whether the use of sedation influences the duration, safety, and tolerance of diagnostic upper gastrointestinal endoscopy. PATIENTS AND METHODS: Adults referred for outpatient diagnostic upper gastrointestinal endoscopy were invited to participate in the study. Patients with a history of previous upper gastrointestinal endoscopy or dysphagia were excluded. Patients were prospectively randomized to sedation with intravenous midazolam (5 mg for those under 65 years or 3 mg for those aged 65 or more), or no sedation. All patients were given topical oropharyngeal anaesthesia with 100 mg lignocaine spray. Outcome measures included duration of procedure, ease of procedure (as assessed by medical and nursing staff), tolerance of procedure (as assessed by patients), and incidence of complications. RESULTS: 100 patients were randomized to receive sedation or no sedation. The two groups were well matched for age, sex, and number of biopsies taken during the procedure. In the non-sedated group, the duration of endoscopy tended to be reduced and the procedure tended to be easier according to the endoscopists' assessment (neither of these observations was significant). The sedated group reported greater comfort for the procedure (P < 0.001), although both groups tolerated the procedure well, and the majority in both groups preferred to have any future procedure repeated in the same manner. There were no serious adverse events in either group. CONCLUSIONS: In patients who are willing to contemplate upper gastrointestinal endoscopy without sedation, the avoidance of sedation may lead to faster and easier endoscopies, without any increased risk of procedural difficulties or adverse events.

Adult↗
PubMed1998

Fungal colonisation and fluconazole therapy in acute liver disease.

BACKGROUND/AIMS: Fungal infection, particularly with Candida spp., has been identified as an important cause of morbidity and mortality in patients with acute liver failure. Fungal colonisation of superficial mucosal sites usually precedes invasive infection. We investigated colonisation patterns in patients with acute liver disease receiving fluconazole therapy in order to investigate the possibility of emergence of fluconazole-resistant C. albicans or other species. METHODS: During a 6-month study period, we studied all patients referred to our unit with acute liver disease by twice-weekly sampling and mycological analysis of specimens from superficial mucosal and other sites as appropriate. Patients were treated with prophylactic antimicrobials including 100 mg fluconazole daily in accordance with our usual protocol. RESULTS: Twenty-two patients with acute liver disease were studied, eight of whom underwent transplantation. Eighteen patients were colonised by fungi at presentation, and six developed secondary colonisation during fluconazole therapy. Four of these patients (all transplanted) became colonised by resistant species; one of these was Aspergillus fumigatus, which led to death. There were no other invasive fungal infections identified during the study period, and no fluconazole-resistant C. albicans were identified. CONCLUSIONS: Resistance to fluconazole is unlikely to develop in C. albicans during short-term fluconazole prophylaxis in acute liver disease, and in this study we did not find evidence of invasive disease from other Candida spp. during fluconazole therapy. However, in patients at particularly high risk, other strategies are required to prevent infection with Aspergillus spp.

Antifungal Agents↗
PubMed1997

Measles virus serology in Crohn's disease.

BACKGROUND: There is evidence that measles virus infection in early life may predispose to Crohn's disease. AIMS: To examine using serological methods a potential association between measles virus infection in early life and predisposition to Crohn's disease. SUBJECTS: Forty five patients with Crohn's disease and forty five healthy controls were studied prospectively. METHODS: Clinical data were recorded and serum was analysed for measles virus, cytomegalovirus (CMV), adenovirus and herpes simplex virus (HSV) antibody titres by a complement fixation test (CFT), and for measles virus IgM by enzyme linked immunosorbent assay (ELISA). RESULTS: Reciprocal CFT titres for measles virus were lower in patients with Crohn's disease compared with controls (p < 0.05); there was no significant difference in titres for other viruses. None of the subjects studied had a level of measles virus IgM suggestive of acute infection, and there was no significant difference in measles virus IgM levels between patients and controls. The measles virus CFT titres and IgM levels in the patients with Crohn's disease did not correlate with any of the clinical features recorded. CONCLUSION: This study does not provide supportive evidence for a role for measles virus in the aetiology of Crohn's disease.

Adenoviridae↗
PubMed1996

Expression of E-selectin and E-selectin ligands in human liver inflammation.

Lymphocyte recruitment to tissue is regulated by homing molecules expressed on subsets of leukocytes that bind to endothelial adhesion molecules termed addressins in target tissues. The addressins and homing molecules involved in recruiting lymphocytes to inflamed human liver are not known. E-selectin, which acts as an addressin for a subset of skin-infiltrating T cells that express a distinct E-selectin ligand called the cutaneous lymphocyte antigen (CLA), can be detected on endothelium in inflammatory liver diseases suggesting it might also act as an addressin for liver-infiltrating lymphocytes. To determine whether E-selectin does play such a role we looked for concomitant expression of E-selectin on hepatic endothelium and E-selectin ligands on infiltrating lymphocytes in liver sections from patients with primary biliary cirrhosis (PBC), acute allograft rejection, alcoholic liver disease, and normal liver. E-selectin was detected on vascular endothelium in association with lymphocytic infiltrates in all three liver diseases but not on normal endothelium. However, less that 10% of infiltrating lymphocytes expressed the only known lymphocyte E-selectin ligand, CLA. We used E-selectin chimeric fusion proteins to probe for novel E-selectin ligands on liver-infiltrating lymphocytes; however, less than 10% of lymphocytes had t he ability to bind the fusion proteins. Thus, E-selectin is unlikely to act as an addressin for liver-infiltrating lymphocytes, suggesting that other molecules are involved in lymphocyte recruitment to the liver. Despite the lack of binding to lymphocytes other structures in the liver expressed CLA and bound the E-selectin fusion proteins. Inflamed, but not normal, intrahepatic bile ducts expressed CLA and bound E-selectin, suggesting that they express activation dependent carbohydrate binding receptors. Furthermore, Kupffer cells did not express CLA but bound to both E-selectin fusion proteins, suggesting that they express potentially novel E-selectin ligands.

Antibodies, Monoclonal↗
PubMed1996

Haemochromatosis presenting with loss of libido and impotence.

Haemochromatosis may present in different ways according to the organ predominantly affected by iron overload. Presentation with symptoms caused by deficiency of pituitary gonadotrophins is recognized but rarely reported. We present such a case and argue that haemochromatosis may be a more common cause of impotence than is presently realized.

Biopsy↗
PubMed1983

A cellulose sandwich fluoroimmunoassay for Factor VIII-related antigen.

We describe a cellulose sandwich fluoroimmunoassay for Factor VIII-related antigen (FVIIIR:Ag). Plasma is incubated with cellulose-antibody for 2 hours, fluorescent-labelled antiserum is added and the samples are allowed to react for an additional 2 hours. The fluorescence associated with the cellulose-antibody is measured after the tubes have been centrifuged, and the deposit washed and then digested with sodium hydroxide. Ninety-seven samples are assayed and the results are compared with radioimmunoassay (correlation coefficient 0.960) or electroimmunoassay (correlation coefficient 0.882). Between-run coefficients of variation are 8.0% to 9.9%. The cellulose-antibody reagent and the fluorescent-labelled antiserum were both stable over a period of 1 year, demonstrating a major advantage of fluoroimmunoassay over radioimmunoassay.

Antigens↗
PubMedDate not supplied

A randomized trial of solvent/detergent-treated and standard fresh-frozen plasma in the coagulopathy of liver disease and liver transplantation.

BACKGROUND: Virus inactivation of pooled fresh-frozen plasma (FFP) by the solvent/detergent (SD) method results in a loss of approximately 20 percent of factor VIII. This study aimed to assess the efficacy of SD-treated plasma in correcting the coagulopathy associated with liver disease and liver transplantation. STUDY DESIGN AND METHODS: Forty-nine patients with coagulation deficits due to liver disease, who required FFP for invasive procedures or liver transplantation, were randomly assigned to receive either FFP or SD-treated plasma. Patients were assessed for side effects, correction of coagulopathy over 24 hours, and seroconversion for viral markers 6 to 18 months after treatment. RESULTS: In the liver disease group, equal correction of clotting factors and partial thromboplastin time was seen with FFP and SD-treated plasma, with a similar return to baseline values over 24 hours. There was greater correction of the International Normalised Ratio in patients receiving SD-treated plasma (p = 0.037), but this patient group had higher baseline values than recipients of FFP (p = 0.024). Liver transplant patients also showed equivalent correction of coagulopathy with the same dose of FFP and SD-treated plasma. The use of other blood components during transplantation was identical in the two treatment groups. No seroconversions were seen for HIV or hepatitis B or C virus. One patient who had received FFP seroconverted for human parvovirus B19. Apparent seroconversion for hepatitis A virus seen at 9 to 13 months in four other patients was probably due to detection of passively transferred antibodies, as later testing of these patients gave negative results. Minor side effects were rare in both groups. CONCLUSION: SD-treated plasma is an efficacious source of coagulation factors for patients with liver disease who are undergoing biopsy or transplantation. Assessment of seroconversion for viral markers in recipients of plasma-derived products and plasma components should include consideration of the possibility that passively transferred antibodies were detected.

Adult↗