Campylobacter pyloridis, peptic ulcers, and gastritis.
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Campylobacter↗
Biomedical subjects
R I Russell
Publications and source records attributed to R I Russell.
Therapeutic potential of choline magnesium trisalicylate as an alternative to aspirin for patients with bleeding tendencies.
We have compared the effects of acetyl salicylic acid (ASA, aspirin) and choline magnesium trisalicylate (CMT), a non-acetylated salicylate product, on platelet aggregation in human whole blood ex-vivo. Using a whole blood platelet counter, platelet aggregation was quantified by measuring the fall in the number of single platelets at peak aggregation in response to collagen, arachidonic acid (AA), as well as spontaneous aggregation. In double blind and random order, 12 healthy volunteers received, on two separate occasions 10 days apart, a single oral dose of 652 mg ASA or 655 mg CMT. Despite a comparable absorption of salicylic acid from the two drugs, ingestion of ASA resulted in a marked inhibition of platelet aggregation induced by collagen (p less than 0.005), AA (p less than 0.01) and spontaneous aggregation (p less than 0.01), whereas such effects were not observed after CMT ingestion. We suggest that CMT may have therapeutic potential as an alternative to aspirin when inhibition of platelet aggregation can induce bleeding complications.
Adolescent↗
Measurement of jejunal surface pH in situ by plastic pH electrode in patients with coeliac disease.
Attaching plastic pH electrodes to a Crosby capsule provides a means of measuring mucosal surface pH in the small intestine during jejunal biopsy. Plastic electrodes, with operating characteristics comparable to glass electrodes within the physiological pH range, were selected because of their mechanical flexibility. The sensing tip can be placed close to the capsule aperture to facilitate contact with the intestinal mucosa. Using this system, the jejunal mucosal surface pH was found to be 5.97 +/- 0.07 in 15 control subjects. In contrast, 13 coeliac patients had a significantly (p less than 0.001) higher jejunal surface pH of 6.73 +/- 0.15, subdivisible into 4 untreated patients with a mean value of 6.95 +/- 0.33 and 9 patients on a gluten-free diet with a mean value of 6.63 +/- 0.15, both higher (p less than 0.01, p less than 0.005) than the control value. An elevated jejunal surface pH in coeliac disease was associated with partial or subtotal villous atrophy and with low brush border enzyme activities. Confirming previous in vitro findings, the elevated surface pH in coeliac jejunum may affect digestive and absorptive processes occurring at the brush border.
Adolescent↗
Protective effects of the prostaglandins on the gastric mucosa.
Prostaglandins are a group of 20-carbon, oxygenated fatty acids derived from arachidonic acid. They are present in most mammalian cells and tissues, and since their half-life is short, they are considered to exert their actions in the tissues where they are produced. The gastrointestinal mucosa contains relatively large amounts of prostaglandin. Prostacyclin is the most common prostaglandin formed by the gastric mucosa, and this compound and prostaglandin E2, which is also present in the gastric mucosa, may affect gastric mucosal blood flow and acid secretion. Prostaglandins have been shown to protect against gastric and duodenal mucosal damage in animals and humans. This protection can occur independently of acid inhibition and may be direct or adaptive.
Animals↗
Haemorrhagic shock encephalopathic syndrome and neurodevelopmental delay.
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Brain Diseases↗
Collagenous colitis: possible response to sulfasalazine and local steroid therapy.
A patient with rheumatoid arthritis and collagenous colitis apparently responding to sulfasalazine and prednisolone enemas is reported. It is suggested that this form of therapy should be considered in patients with this rare disorder not only as a short-term measure but also, in the case of sulfasalazine, as long-term treatment in patients with chronic symptoms.
Administration, Oral↗
Intestinal adaptation to an elemental diet.
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Animals↗
Magnesium requirements in patients with chronic inflammatory disease receiving intravenous nutrition.
Assessment of magnesium (Mg) status by serum and 24 hr urine estimations has been used to study 25 patients with severe Crohn's disease. Mg depletion was found to be present in 21 (84%), of whom eight (32%) had both low serum and low urine Mg levels. Only four patients (16%) had normal serum and normal urine Mg. Fifteen of the 25 patients required intravenous nutrition (IVN). A combined low serum and urine Mg was found in five of 14 patient-weeks in which less than 5 mmol Mg/24 hr was given but in none of 42 patient-weeks in which 5-10 mmol/24 hr was given and none of 65 patient-weeks in which greater than 10 mmol Mg IV/24 hr was given. Mg deficiency was statistically significantly more likely to occur in patients taking less than 5 mmol IV Mg/24 hr. After discharge, five patients who had been treated with IVN were found to have recurrent low serum Mg levels over some months, and symptoms in this group were common--muscle cramps, tetany, and bone pain. A high dose of Mg supplements was required, of the order of 60 mmol oral Mg/24 hr, to prevent magnesium deficiency in these patients.
Adolescent↗
Functional and structural changes of the human proximal small intestine after cytotoxic therapy.
The effects of cytotoxic therapy on the structure and function of the proximal jejunum were studied in six patients receiving intravenous cyclophosphamide (300 mg/m2), methotrexate (40 mg/m2), and 5-fluorouracil (600 mg/m2) as adjuvant therapy for breast cancer. Using a steady state, triple lumen tube perfusion system the absorption of water and electrolytes was measured before and 48 h after administration of the cytotoxic agents. Jejunal biopsies were obtained at each perfusion. Median (range) water absorption fell from 126 (40-142) to 84 (46-142) ml/h/30 cm, with parallel changes for electrolytes; none of the changes was significant. Brush border disaccharidases did not change at 48 h after chemotherapy, while mature enterocytes appeared normal by both light and electron microscopy. Crypt cells and immature enterocytes, however, showed focal vacuolation by light microscopy, corresponding to the occurrence of large residual bodies (secondary lysosomes) containing partially degraded fragments of damaged crypt cells. The confinement of ultrastructural changes to the immature cell population may explain the failure of this study to show a consistent change in the absorptive function of the jejunum 48 h after chemotherapy.
Adult↗
Home enteral nutrition with formula diets.
Home enteral nutrition can be successfully used on a long-term basis to maintain nutrition and a reasonably normal lifestyle in patients with chronic intestinal dysfunction. Patients can be easily taught the methods involved, a nocturnal regime allowing a more normal lifestyle. The use of a pump-controlled system is recommended. Side-effects are few, generally transient and not severe. Home enteral nutrition has advantages over home intravenous feeding with respect to ease of administration and organisation, fewer and less severe complications, and cost.
Crohn Disease↗
Oro-facial granulomatosis--a clinical and pathological analysis.
A study of 60 patients with oro-facial granulomatosis has been conducted and the clinical presentation of this disorder defined. It encompasses the previously recognised clinical entities of Melkersson-Rosenthal syndrome and cheilitis granulomatosa. The pathological features of the disease are lymphoedema and the presence of multiple non-caseating giant cell granulomata. These granulomata are histologically indistinguishable from those found in both gastrointestinal Crohn's disease and systemic sarcoidosis. Within this series of patients, nine had evidence suggestive of gastrointestinal Crohn's disease, and in six this was confirmed. A diagnosis of sarcoidosis was made in a further two patients. The relationship of oro-facial granulomatosis to these systemic granulomatous diseases is not yet clear. Patients with oro-facial granulomatosis who have gastrointestinal symptoms should be investigated for the presence of gastrointestinal Crohn's disease. Those without symptoms should be investigated for evidence of malabsorption or serological evidence of Crohn's disease. Within the present study, the erythrocyte sedimentation rate, full blood count, corrected whole blood folate, serum albumin and calcium were the most sensitive markers of gastrointestinal involvement. Sarcoidosis should be considered in all patients with oro-facial granulomatosis. The absence of clinical signs suggestive of sarcoidosis, a normal chest radiograph and normal levels of serum angiotensin-converting enzyme makes sarcoidosis unlikely.
Adolescent↗
Tracheobronchial foreign bodies--the position of the carina.
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Adult↗
Comparison of three adrenoreceptor blocking agents in patients with cirrhosis and portal hypertension.
The effects of different types of adrenoreceptor blocking agents on portal venous pressure were studied in patients with cirrhosis and portal hypertension. Oral atenolol (selective beta 1 blocker), propranolol (non-selective beta 1 and beta 2 blocker), and prazosin (alpha blocker) were compared in three groups of eight patients. Haemodynamic measurements were made before and after two or three and eight weeks of therapy. The dose of beta blockers was sufficient to reduce the exercise heart rate by more than 25%. Propranolol and prazosin produced a sustained reduction in the mean portohepatic venous pressure gradient of the order of 25% and 18% respectively. The cardiac index was significantly reduced by propranolol but not altered by prazosin. Atenolol produced an early reduction in portohepatic venous pressure which, although not sustained, showed a good correlation with reduction in cardiac index. No such relationship was found with propranolol. All three drugs were well tolerated by these patients with advanced cirrhosis. Therefore propranolol and prazosin have proved to be effective agents for the reduction of portal venous pressure.
Atenolol↗
A comparison of computed tomography, ultrasound and scintigraphy in the diagnosis of alcoholic liver disease.
In 35 alcoholics with histologically proven liver disease, computed tomography (CT), grey scale ultrasonography and liver scintigraphy were evaluated for their abilities to detect an abnormal liver and to identify the patients with cirrhosis. Abnormal studies were present on CT in 83% of patients, in 64% on ultrasound and in 94% on scintigraphy. In 10 control patients specificity was 90% by CT, 100% by ultrasound and 70% by scintigraphy. CT and ultrasound were poor in identifying the alcoholics with cirrhosis. Scintigraphy suggested cirrhosis in all but one of the patients with this diagnosis. Similar images were obtained in half of the patients with fatty change without cirrhosis but, with the exception of one patient, this appeared to be due to co-existent hepatitis. The results suggest that scintigraphy is the best of the imaging tests for screening alcoholics for cirrhosis.
Fatty Liver, Alcoholic↗
Effect of wheat bran on zinc absorption.
The effect of wheat bran on zinc absorption was studied in normal volunteers using a zinc tolerance test (ZTT) and whole-body monitor to measure the 7-day percentage retention of 65zinc (65Zn). Twenty-three subjects (age 21-26 years) were randomized into three groups. All were given 5 microCi of 65Zn orally in a 10 ml solution of zinc sulphate which contained 15 mg of elemental zinc. In addition, Group A were given 20 g wheat bran, Group B 20 g Rice Krispies (a low-fibre food) and Group C had zinc alone. The differences between the retention of 65Zn in the three groups were all statistically significant (A vs B P less than 0.005; B vs C and A vs C P less than 0.001). Similarly the differences in the areas under the ZTT curves in the three groups were all statistically significant (A vs B P less than 0.005; B vs C and A vs C P less than 0.001). We conclude that wheat bran leads to a significant reduction in zinc absorption which could eventually induce a state of zinc deficiency.
Adult↗
Studies on the protective effect of deglycyrrhinised liquorice against aspirin (ASA) and ASA plus bile acid-induced gastric mucosal damage, and ASA absorption in rats.
By per-oral intubation of the stomach, four groups of rats (n = 22) received ASA 64 mg/kg, alone or with taurodeoxycholic acid (TDC, 5 mM), DGL (2000 mg/kg) or TDC plus DGL. At four hours the severity of bleeding was assessed by a lesion scoring system and expressed as medians and quartiles. In a separate study two groups of rats (n = 7) received ASA (128 mg/kg) or ASA plus DGL (2000 mg/kg) and salicylate levels measured in serial tail blood samples at 20, 40, 60 and 80 minutes. Lesion scores were increased from 6(3;10) with ASA alone to 12(5;16) by TDC (p less than 0.05) and reduced by DGL to 1(0;3.5) for ASA alone and 3.5(0;6) for ASA plus TDC (p less than 0.0005 in both cases). In the second study a slight reduction of ASA absorption was found only at 20 minutes with a median level of 0.9 mmol/l for the DGL treated rats and 1.2 mmol/l for the ASA alone group (p less than 0.05). No differences were found at the other times. We have also demonstrated that although DGL diminished ASA (128 mg/kg)-induced gastric mucosal damage from 17(12;25) to 8(3;14) (p less than 0.005) when the two were given together it did not do so significantly when DGL was given before ASA--15(20;22). Intraperitoneal DGL reduced lesion scores from ASA (128 mg/kg) from 14(11;24) to 7(1;19) (p less than 0.03), thus indicating a systemic as well as a local effect of the drug.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Neodymium yttrium aluminium garnet laser photocoagulation for major haemorrhage from peptic ulcers and single vessels: a single blind controlled study.
A prospective single blind controlled trial was performed to assess the efficacy of the neodymium yttrium aluminium garnet laser in the management of patients bleeding from peptic ulcers and single vessels. Over 20 months 184 patients were found at endoscopy to be bleeding from peptic ulcers and single vessels; 130 of these failed to meet the criteria for entry into the study, but their bleeding stopped with conservative management. Forty-five patients entered the study: in all 25 who were bleeding from ulcers with spots the bleeding stopped irrespective of the treatment allocated. Twenty patients were bleeding from arteries. Eight were allocated to placebo treatment, and all later underwent emergency surgery for further haemorrhage. Twelve were allocated to receive laser treatment, and only one of eight who actually received it required surgery (p less than 0.002). It is concluded that laser treatment reduces the incidence of further haemorrhage and the need for emergency surgery, but the technique is difficult and not always applicable.
Adult↗
A study of zinc metabolism in alcoholic cirrhosis.
1. Zinc metabolism was studied in 11 patients with alcoholic cirrhosis and 13 healthy volunteers using the isotope tracer 65Zn. 2. Intestinal absorption, whole-body content and total daily elimination of zinc were all increased in alcoholic cirrhosis, but the biological half-life of zinc did not differ from controls. 3. Hepatic zinc concentration was reduced in alcoholic cirrhosis and correlated with changes in hepatic alcohol dehydrogenase activity. 4. Patients with alcoholic cirrhosis in this study were not demonstrated to be zinc-deficient.
Adult↗