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Biomedical subjects

R I Russell

Publications and source records attributed to R I Russell.

At least 73 records · Page 4Linked to original sources
PubMed1992

Crohn's disease & aflatoxins.

An investigation to examine the relationship between Crohn's disease and aflatoxins, a group of structurally related toxic and carcinogenic metabolites, was carried out on 24 patients. Extracts of serum and urine from the patients were assayed qualitatively by thin layer chromatography and the Aflatest method, and quantitatively by fluorimetry. There was evidence that some patients suffering from Crohn's Disease, together with some having coeliac disease and ulcerative colitis, did have varying amounts of aflatoxins in their serum and urine. The presence of aflatoxins may have been due to exposure to food containing these toxins or inability of the patient to excrete aflatoxins on account of some gastro-intestinal derangement. Only long-term investigation would establish the link between dietary history and the presence of aflatoxins in these patients.

Aflatoxins↗
PubMed1992

Helicobacter pylori and peptic ulcers in rheumatoid arthritis patients receiving gold, sulfasalazine, and nonsteroidal anti-inflammatory drugs.

The conflicting reports on gold and Helicobacter pylori could be related to the use of serological tests of unproven value in NSAID patients, and to the lack of the appropriate control groups. More important is the fact that the endoscopic consequences of the possible effect of gold on H. pylori have not been investigated. We therefore decided to assess the prevalence of H. pylori and peptic ulcers in rheumatoid patients being treated with gold sodium thiomalate (GST) plus NSAID, sulfasalazine plus NSAID, or NSAID only. Eighty-five patients receiving treatment for at least 6 months were endoscoped, and H. pylori was studied in gastric antral biopsies by both culture and histology. Endoscopic abnormalities were classified into ulcers (measuring 5 mm in diameter or more) and erosions (smaller lesions). H. pylori (and ulcers) were found in 17 (12 ulcers) of 31 patients on NSAID only and 21 (9 ulcers) of 27 patients on sulfasalazine plus NSAID, compared with nine (3 ulcers) of 27 patients receiving GST plus NSAID, p < 0.05, analysis of variance. Patients treated with GST and NSAID had the lowest prevalence of detectable H. pylori. This could explain the apparent reduction in the prevalence of peptic ulcers in this group and, if confirmed in larger randomized studies, might have therapeutic implications.

Aged↗
PubMed1992

Home sweet HEN--a guide to home enteral nutrition.

Initial experience of home enteral nutrition (HEN) was gained from malnourished patients with Crohn's disease. The rationale for HEN was to improve the patients' lifestyle by reducing the need for repeated admissions for nutritional support: this method is extremely useful in correcting nutritional problems. Over the past ten years the use of HEN has expanded to cover other clinical areas including correction of growth retardation secondary to gastrointestinal disease, cystic fibrosis, inborn errors of metabolism, congenital heart disease, and chronic renal failure, in addition to many types of neoplasia and chronic neurological diseases. At the present time, approximately 150 patients receive HEN within the catchment area of the Greater Glasgow Health Board (population 940,000). Despite the increasing availability of HEN many clinicians and dietitians are still reluctant to consider HEN as a 'routine adjunct' to clinical management, claiming that it is too dangerous or complicated. The aims of this article are to explain our method of running a HEN service, offer advice on practical problems and discuss further developments and potential difficulties.

Enteral Nutrition↗
PubMed1992

The fecal osmotic gap: technical aspects regarding its calculation.

The fecal osmotic gap is considered to be useful in the investigation of chronic diarrhea. However, two important questions regarding the calculation of the osmotic gap remain unanswered: the effect of the method of measuring osmolality and the most appropriate means for its calculation. In 41 patients with varying causes of diarrhea, stool osmolalities and electrolyte concentrations were measured. Measurement of stool osmolality by a dew point technique underestimated results by a variable factor, which makes it an inappropriate method. Fecal osmolality measured by freezing point depression gave reliable results and so was considered to be preferable. The osmotic gap was calculated by two methods: subtraction of the calculated osmolality from (1) stool osmolality and (2) plasma osmolality. The former approach was found to be inappropriate on the basis of large variations in results when consecutive stool samples were analyzed, a poor correlation with the severity of osmotic diarrhea, poor resolution between results from patients with secretory diarrhea and those with osmotic diarrhea, and practical difficulties in ensuring adequate collection of stool samples.

Chronic Disease↗
PubMed1992

Who should log SHIPS? The accuracy of Scottish Hospital Morbidity Data for Wilson's disease.

We have studied the accuracy of the hospital diagnostic data for Wilson's disease (WD) in Scotland. The computerised records of the Scottish Hospital In-Patient Statistics provided information on 41 patients, coded as having been discharged from hospital with a diagnosis of WD. Review of the patients' case notes revealed that 12 (29.6%) did not have WD, although half of these cases had 'query Wilson's disease' on the discharge summary or letter. In the other six cases, errors arose due to miscoding by the medical records staff.

Abstracting and Indexing↗
PubMed1991

Gastroduodenal mucosal surface and luminal pH in gastric ulcer.

Gastroduodenal mucosal surface pH was measured in situ by electrode in endoscopically normal and gastric ulcer patients. With the exception of the antrum, mucosal surface pH in the ulcer group (GU) resembled that of the endoscopically normal group. In contrast, the antral mucosal surface pH of the GU group of 7.06 +/- 0.11 (22) was significantly (P less than 0.001) higher than that of 5.46 +/- 0.36 (34) for the endoscopically normal group. This difference was also evident when comparison was restricted to subjects in both groups having a fundal luminal fluid pH of less than 3. When the fundal luminal pH was below pH 3, antral mucosal surface pH was 4.79 +/- 0.41 (24) in endoscopically normal subjects and significantly less (P less than 0.001) than the value of 6.98 +/- 0.18 (12) for gastric ulcer patients. Mucosal surface alkalinity of the GU antrum may be a response to damage but seems inappropriate in view of the likelihood of acid dependent inhibition of gastric acid secretion.

Adolescent↗
PubMed1991

Review article: dietary and nutritional management of Crohn's disease.

The value of dietary alteration and the nutritional management of Crohn's disease is assessed in this review. Lactose restriction, low-fat diets and low-residue diets may be of value in specifically indicated clinical situations. A fibre-rich, unrefined carbohydrate diet has not been shown to alter the course of the disease, and the value of 'exclusion diets' remains to be confirmed in controlled, prospective studies. Nutritional insufficiency of varying degrees is common in Crohn's disease and can be corrected by the efficient use of enteral diets (usually with polymeric preparations) or intravenous nutritional support. Growth retardation in adolescents with Crohn's disease can usually be improved by enteral nutrition. Nutritional support of various kinds may be of value in the management of local complications of Crohn's disease; sub-acute obstruction, anal, perianal and rectal lesions, fistulas and ileostomy complications, and the management of bile acid-induced diarrhoea. The use of nutrition as 'primary therapy; in Crohn's disease is considered. Theoretical reasons why nutritional support and bowel rest may possibly induce remission of the disease are discussed. The evidence to date suggests that intravenous nutrition and bowel rest may not be effective in inducing a primary remission of the disease, and the possible value of elemental diets and polymeric diets in this respect are assessed. Further prospective controlled studies of elemental diets as primary therapy in Crohn's disease are required.

Crohn Disease↗
PubMed1991

Inhibition of human gastric cyclic AMP production by Helicobacter pylori protein--possible involvement of mucosal prostaglandin E2.

The effect of Helicobacter pylori protein on cAMP and prostaglandin (PGE2) production was studied in incubates of human gastric fundic mucosa. At 24 hours, specimens incubated in the control fluid had a median cAMP value of 81 pmol/mg protein, compared to 28 pmol/mg (P less than 0.05) when incubated in H. pylori protein, 155 pmol/kg (P less than 0.006) in histamine, and 23 pmol/kg (P less than 0.05) in histamine plus H. pylori protein. A similar trend was observed at 48 hours. Although H. pylori protein had no direct effect on mucosal PGE2, it intensified the inhibitory effect of indomethacin and prevented the stimulatory effect of histamine on both PGE2 and cAMP production. Given the role of cAMP in various physiological responses, these results suggest that H. pylori protein might alter those functional aspects of the human gastric mucosa which rely on cAMP as a second messenger. Assuming that PGE2 is involved in mediating such effect, its role would appear to be either partial or indirect.

Bacterial Proteins↗
PubMed1991

Protection from gastrointestinal side-effects by azapropazone by its incorporation into a glucose-sodium acid citrate formulation.

Addition of glucose and sodium citrate to azapropazone, in proportions of 1:1:1 by weight reduced gastric mucosal damage in rats and there was a trend towards reduction in radiolabelled faecal red cell loss in human volunteers compared with that with azapropazone alone. The glucose and citrate did not affect the pharmacokinetics of azapropazone, or its therapeutic efficacy. While no difference was observed in endoscopic injury and in symptomatic gastrointestinal complaints in a multicentre comparison in rheumatic patients, a striking reduction in symptoms was observed in those patients with a history of severe gastrointestinal intolerance to non-steroidal anti-inflammatory drugs.

Adolescent↗
PubMed1991

Increased intestinal permeability in ankylosing spondylitis--primary lesion or drug effect?

We have found increased small intestinal permeability to 51Cr-ethylenediaminetetra acetate in patients with ankylosing spondylitis compared with controls. There is no significant difference between patients with ankylosing spondylitis and patients with rheumatoid arthritis taking non-steroidal anti-inflammatory drugs (NSAID). The increased intestinal permeability in ankylosing spondylitis is independent of disease activity. These findings suggest that the increased permeability is caused by NSAID treatment and is probably not a primary lesion of small bowel mucosa.

Adult↗
PubMed1991

Wilson's disease in Scotland.

The prevalence and clinical features of Wilson's disease in Scotland were investigated. Thirty three cases were identified but adequate information was available on only 28. In 1989, the prevalence rate was 4 per million. Ten patients with a mean (SEM) age of 18 (1.9) years presented with neurological symptoms, 12 patients aged 14 (1.7) years presented with hepatic symptoms, and six patients aged 12 (0.9) years were asymptomatic siblings of patients with Wilson's disease. Nine (56%) of the 16 patients who underwent liver biopsy on presentation were found to have cirrhosis. Penicillamine treatment was stopped in nine patients because of: abnormal peripheral blood count (6), rash (2), and patient's own choice (1). Nineteen patients were alive in 1989 -12 were well, one had chronic liver failure, four chronic neurological disabilities, and two had both chronic liver failure and neurological disabilities. Twelve patients died from: complications of chronic liver failure (2), acute liver failure (4), pneumonia associated with immobility (4), and other causes (2). Several patients who died had received incomplete medical supervision.

Adolescent↗
PubMed1991

Spiral shaped microorganisms in the human duodenal mucosa.

A new spiral shaped microorganism, Gastrospirillum hominis, distinct from Helicobacter pylori, has recently been described in the gastric mucosa. We report a patient with duodenal erosions who was found to have these organisms in his duodenal mucosa. This bacterium is not necessarily specific to the stomach, and its association with peptic damage needs to be studied further.

Adult↗
PubMed1991

Hiatal hernial ulcers: clinical features and follow-up.

We describe the clinical features and therapeutic outcome in 49 patients in whom benign gastric ulceration of an hiatal hernia was demonstrated endoscopically. Hiatal hernia ulcers accounted for 10% of all benign gastric ulcers. The typical patient was an elderly female with a history of dyspepsia who was receiving non-steroidal anti-inflammatory drugs. Twenty-seven (55%) patients had evidence of haemorrhage (acute in 15; chronic in 12) from the hiatal hernial ulcer at presentation. In 16 (33%) patients, symptoms attributable to haemorrhage constituted the sole clinical evidence of the hiatal hernial ulcer. Acute haemorrhage from hiatal hernial ulcers was associated with non-steroidal anti-inflammatory drug (NSAID) treatment (P less than 0.05). Chronic blood loss from hiatal hernial ulcers was associated with female gender (P less than 0.005) but not with NSAID treatment. Hiatal hernial ulcers healed slowly in response to medical treatment with H2-receptor antagonists (median time to healing 12 weeks). Surgical treatment may be the therapy of choice for hiatal hernial ulcers because of the high complication rate, poor response to medical therapy, and the apparent predominance of mechanical aetiological factors.

Adult↗
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↗