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Biomedical subjects

N McIntyre

Publications and source records attributed to N McIntyre.

At least 163 records · Page 9Linked to original sources
PubMed1969

Pathophysiology of post-gastrectomy hypoglycaemia.

The blood glucose and plasma insulin response to oral glucose and slow intravenous infusion of glucose was determined in seven patients who had undergone partial gastrectomy or gastroenterostomy. Similar studies were conducted in normal subjects; in these experiments oral glucose administration was replaced by infusion of glucose direct into the jejunum in order to simulate the rapid gastric emptying which occurs after gastric surgery.Peak insulin levels were much higher after oral or intrajejunal glucose, though peak blood glucose levels were higher after intravenous glucose. Despite the high insulin levels occurring with oral administration the late fall in blood glucose below fasting levels was not significantly greater after oral or intrajejunal glucose than after intravenous administration of the sugar. This does not support the concept that hyperinsulinaemia alone is responsible for reactive hypoglycaemia.

Blood Glucose↗
PubMedDate not supplied

Plasma lipid and lipoprotein response to fat feeding in alcoholic liver disease.

Serum lipids and lipoproteins were analyzed after an overnight fast, and following a fatty meal in 10 patients with cirrhosis, 5 with fatty liver, and 5 normal subjects. Cirrhotic patients were divided into two groups of five on the basis of serum lecithin-cholesterol acyltransferase activity. Fasting triglyceride levels were similar in all four groups. In all but cirrhotic patients with low lecithin-cholesterol acyltransferase activity, most fasting triglyceride was found in very low density lipoproteins; in the latter group, most of it was found in low density lipoproteins. We confirmed that patients with fatty liver have a higher serum triglyceride response to fat feeding than normal subjects, but we did not find higher levels in cirrhotic patients. Cirrhotic patients with "normal" lecithin-cholesterol acyltransferase activity had a normal triglyceride response to dietary fat. In patients with cirrhosis and low lecithin-cholesterol acyltransferase activity, the increase in triglyceride was less than in normal subjects. In this group, most of the extra triglyceride was carried in low density lipoprotein, and not in chylomicrons and very low density lipoprotein, as in the other groups.

Adult↗
PubMedDate not supplied

Prognostic significance of the white nipple sign in variceal bleeding.

The prognostic significance of the white nipple sign in variceal bleeding was evaluated prospectively in 203 separate admissions for bleeding esophageal varices in 145 cirrhotic patients. During all admissions a standardized protocol of management defined the failure of transfusion and vasoactive drugs (conservative measures) to stop bleeding and the occurrence of early rebleeding, at which time either emergency sclerotherapy or a staple transection of the esophagus was used. The finding of a white nipple in 18 admissions (9%) did not have predictive value as regards the failure of conservative measures to stop bleeding within 24 hours or rebleeding within 5 days, and there was no association with increased mortality. In one case, a white nipple was seen to occur after spontaneous cessation of a variceal venous spurt, suggesting it is a platelet-fibrin plug. The white nipple sign is diagnostic of a varix that has bled but has no adverse prognostic significance.

Aged↗
PubMedDate not supplied

[Association of plasma ammonia and GABA levels and the degree of hepatic encephalopathy].

Several toxic factors have been implicated in the pathogenesis of hepatic encephalopathy (PSE) among which ammonia plays a dominant role. More recently, the gamma-aminobutyric acid (GABA) hypothesis in which an increase in the GABA-ergic tone and the presence of one or more GABA/benzodiazepine receptor ligands which interact with that receptor, has been proposed. We investigated the levels of GABA and ammonia in plasma of patients with acute PSE to test the hypothesis that elevated plasma GABA levels would be found in acute encephalopathy and that GABA levels would correlate with the degree of hepatic encephalopathy. We measured plasma levels of GABA and ammonia during an acute episode of PSE, spontaneous or precipitated by gastrointestinal bleeding or sepsis, and performed assessments of PSE by the PSE index. Patients were evaluated before and two days after standard treatment with lactulose. We also measured plasma GABA levels in the hepatic vein of a selected group of patients undergoing hemodynamic studies. Plasma GABA levels were significantly higher in patients with acute PSE (458 +/- 108 pmol/mL) when compared with normal subjects (110 +/- 23 pmol/mL) (p < 0.01) although no correlation was found between plasma GABA concentration and the degree of PSE. Changes in plasma ammonia, however, correlated with improvements in the PSE index (r = 0.56; p < 0.02) and with abnormalities in the EEG (r = 0.65; p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMedDate not supplied

The BCAA/AAA ratio of plasma amino acids in three different groups of cirrhotics.

We studied the plasma amino acid profiles in the postabsorptive period in three groups of cirrhotic patients: stable, unstable, and with acute portal systemic encephalopathy (PSE), and compared them with a healthy control group in order to investigate the differences among the different groups and reevaluate the use of the branched-chain amino acid/aromatic amino acid (BCAA/AAA) ratio. Although plasma amino acid levels were similar to the control group, stable cirrhotics had a significantly decreased BCAA/AAA ratio (2.9 +/- 0.2) compared to the control group (3.9 +/- 0.3) (p < 0.05). Unstable cirrhotics had differences in plasma amino acid levels and the BCAA/AAA ratio was even lower (1.7 +/- 0.3) compared with stable cirrhotics and controls, respectively (p < 0.05 and p < 0.01). Patients with PSE had extreme elevations of most amino acids and showed the lowest BCAA/AAA ratio of all four groups (0.8 +/- 0.07) (p < 0.001 compared with controls). We conclude that it is possible to detect differences in plasma amino acid concentrations in different groups of cirrhotics, and that the BCAA/AAA ratio is a good index for the assessment of liver impairment. The latter could be used in the follow-up of a selected group of patients such as those undergoing major surgery or liver transplantation in whom the BCAA/AAA ratio could be used to help determine the best time for the transplant.

Adult↗
PubMedDate not supplied

Pathogenesis and management of ascites in chronic liver disease.

The diagnosis and management of ascites related to liver diseases is discussed. We emphasize that although treating ascites improves the symptoms, it does not influence prognosis, whereas injudicious treatment may cause life-threatening side effects.

Ascites↗