Clinical and diagnostic aspects of pancreatic cancer.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to R I Russell.
Explore the source record for details and available documents.
A direct test of lipid absorption has been developed using [3H]glycerol triether as a lipid marker and [14C]glycerol trioleate as the test lipid. Percentage absorption of triolein is calculated from the isotope ratio ingested and excreted in faeces. The test is independent of a complete faecal collection, reproducible and shows little day to day variation. Absorption in 25 normal subjects ranged from 96.4--100% (mean 98.6, S.D. +/- 1.15). In 24 patients with known pancreatic or small intestinal disease and steatorrhoea absorption ranged from 0.01% to 89.9%. The test has also been assessed by comparison with a standard Lundh test and faecal fat estimation in 34 patients.
Taurodeoxycholic acid increases the incidence of aspirin induced gastric bleeding in rats and in vitro is well bound by Aludrox (aluminium hydroxide) and poorly bound by Maalox (aluminium hydroxide and magnesium hydroxide). We studied the relevance of this binding, as demonstrated in vitro, by observing the effect of the antacids on the occurrence of taurodeoxycholic acid and aspirin-induced bleeding in vivo in rats. Six groups of fasting male Sprague-Dawley rats (n = 24) were intubated and given either water, Aludrox or Maalox and, 30 min later, aspirin or aspirin plus taurodeoxycholic acid. 4 h later the stomachs were examined and rats were scored positive if a lesion greater than 1 mm across was found (incidence of bleeding); a lesion scoring system was also used (severity of bleeding). The incidence of bleeding was increased from 63% with aspirin to 92% with aspirin plus taurodeoxycholic acid (P less than 0.05). The incidence was reduced to 33% and 67% respectively by Aludrox and to 29% (P less than 0.05) and 71% by Maalox. The severity of bleeding (median lesion score, quartiles in parentheses) was increased from 3 (1;6.5) (aspirin) to 10.5 (6;15) (aspirin plus taurodeoxycholic acid); P less than 0.001. These were reduced to 0.5 (0;3); P less than 0.02 and 5 (0.5;9.5); P less than 0.05 respectively by Aludrox and to 0 (0;3); P less than 0.02 and 3 (2;8); P less than 0.02 by Maalox. The severity of bleeding was reduced by both antacids but the effect appeared to be mainly on the aspirin rather than the bile acid component of the damage.
Fifty patients presenting sequentially with a history of recurrent aphthae were investigated for evidence of nutritional deficiencies and coeliac disease. In the group, two patients were found to have coeliac disease and their recurrent aphthae cleared soon after starting a gluten free diet. This study confirms the presence of an increased prevalence of nutritional deficiency and of coeliac disease in aphthous patients. However, it is recommended that jejunal biopsy be carried out in these cases only where there is evidence of malabsorption.
A case is reported of the isolation of Clostridium difficile from the stool of a patient with antibiotic-related pseudomembranous colitis.
A 35-year-old man, who had spent 10 1/2 out of 18 months in hospital, has required repeated courses of intravenous nutrition (IVN) because of nutritional failure due to severe inflammatory bowel disease. He has been maintained on a nocturnal pump-fed liquid diet supplementing his day-time oral diet for five months, four of which have been at home. The cost of such therapy is less than with an elemental diet and there are other advantages. This regime has been shown to be nutritionally adequate. The need to assess other cheaper liquid diets in patients with intestinal failure is recognised.
Explore the source record for details and available documents.
The effect of an elemental diet (Vivonex) together with a gluten-free diet on the absorption of water, sodium and chloride in the jejunum was studied in 4 patients with untreated adult coeliac disease before and after a 1-month course of therapy. The morphology of the jejunum was also studied by jejunal biopsy taken at the same time as the intestinal perfusion. The results were compared with those obtained in 4 patients with adult coeliac disease treated with a gluten-free diet alone. No marked improvement was noted in the transportation of water, sodium and chloride after either treatment with Vivonex and a gluten-free diet or after a gluten-free diet alone, and no marked histological changes were found. Clinical improvement occurred in both groups of patients, in that the diarrhoea improved in all patients and they generally felt better. There appears to be no additional advantage of using an elemental diet with a gluten-free diet in the initial management of adult coeliac disease.
The purpose of this report was to study the types of complications of Crohn's disease which may benefit from the use of elemental diets. The elemental diet Vivonex was used in the management of patients with Crohn's disease with local complications but without nutritional deficiency. Sole treatment of this kind was found to be of value in promoting healing of perianal or anal ulceration and anal fissures; it was also of value in allowing subacute ileal obstruction to settle, thus postponing surgery and allowing better bowel and nutritional preparation for surgery. Patients with bile acid-induced diarrhoea associated with severe ileal Crohn's disease noted improvement in the diarrhoea on the elemental diet, and the treatment was also useful in reducing ileostomy output and helping ileostomy skin lesions to heal in a patient with severe skin excoriation related to leakage of excessive ileostomy fluid output.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
1. Rats were fed with the elemental diet Vivonex for 1 or 3 months and their jejunal histology was compared with that of an equal number of rats fed on a normal diet. 2. After 1 month of Vivonex feeding a significant reduction in the ratio of crypt height: villus height (CH:VH) was found in the Vivonex-fed rats (n = 4) compared with the control rats (n = 4) (P less than 0.05). 3. After 3 months the CH:VH ratio was also reduced in the Vivonex-fed rats (n = 18) compared with control rats (n = 18) (P less than 0.002). Villus height was significantly increased (P less than 0.002) and crypt height decreased (P less than 0.05). 4. Jejunal protein content, alkaline phosphatase and disaccharidase activity were also determined in 12 control and 12 Vivonex-fed rats from the 3 months study. 5. Alkaline phosphatase activity was increased from a control value of 201 +/- 8 to 243 +/- 15 munits/cm in the Vivonex-fed rats (n = 12) (P less than 0.05) but no significant changes in lactase, sucrase or maltase activites were found. The observed decrease in the CH:VH ratio suggested an improved survival of the mature enterocyte population during elemental diet feeding.
Explore the source record for details and available documents.
A patient is described who presented with the classical symptomatology and profound electrolyte disturbance of the Verner-Morrison syndrome due to a pancreatic apudoma secreting vasoactive intestinal polypeptide (VIP). Diagnosis was confirmed by plasma VIP as measured by a radio-immunoassay technique now available. It is suggested that the cyclical nature of the symptoms in this case was due to cyclical release of VIP from the tumour in response to an unknown stimulus. Perfusion studies confirmed the excess secretory state of water, sodium and chloride in the small intestine. Symptoms were completely abolished by surgery and the progress is being monitored by means of serial plasma VIP estimations to detect any early recurrence of metastatic disease.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A double-blind controlled trial was performed to assess the effectiveness of cholestyramine in treating severe continuous postvagotomy diarrhoea. Each patient and a clinician assessed the results, and those treated with cholestyramine showed a considerable improvement over those given placebo. There were no significant side effects or changes in laboratory values in the cholestyramine group. Although the numbers were too small for statistical analysis, these results suggest that cholestyramine may be of value in the management of some patients with severe continuous postvagotomy diarrhoea who are unresponsive to other forms of treatment.
The incidence of mucosal hemorrhage induced in rats by the oral administration of taurocholic acid (TCA) and hydrochloric acid (HCl) both singly and in combination was investigated. The effect of prostaglandin 15 (R) 15 methyl-PGE2 methyl ester (Me-PGE2) on the occurrence of hemorrhage induced by TCA with HCl was also studied. The incidence of hemorrhage induced by TCA (10 mM) alone and HCl (160 mM) alone was minimal and not different from that induced by the control solution. The combination of TCA (10 mM) and HCl (160 mM) produced bleeding in 67.7% of animals. The addition of 15 (R) 15 methyl-PGE2 methyl ester (9.9 micronM, corresponding to 50 microng/Kg) significantly reduced the incidence of hemorrhage induced by the combination of TCA with HCl from 67.7% to 31.3%. This suggests that this synthetic prostaglandin may be of value in conditions thought to be associated with reflux of bile into the stomach.