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Biomedical subjects

R Liston

Publications and source records attributed to R Liston.

At least 19 recordsLinked to original sources
PubMed1998

Idiopathic bile acid malabsorption: qualitative and quantitative clinical features and response to cholestyramine.

BACKGROUND: Idiopathic bile acid malabsorption is a poorly recognized cause of chronic diarrhoea. The SeHCAT (75Selenium HomotauroCholic Acid Test) can accurately diagnose this condition. AIM: To identify patients with idiopathic bile acid malabsorption, to describe their clinical features, both qualitatively and quantitatively, and to assess the response to cholestyramine. METHOD: Idiopathic bile acid malabsorption was considered in all patients complaining of chronic diarrhoea. They were included in the study if their SeHCATs were positive (< 15% retention) and secondary causes of bile acid malabsorption were excluded. The response to therapy with cholestyramine was assessed. RESULTS: Nine patients were diagnosed with idiopathic bile acid malabsorption (median SeHCAT retention 8%, range 3-12.6). Their median daily faecal weight was 285 g (range 85-676) and median faecal fat output was 17 mmol/24 h (range 8.3-38.8). Six patients had an immediate response to cholestyramine. There was a marked reduction in stool frequency (median stool frequency pre-treatment 5/day vs. 2/day post-treatment, P = 0.03). Five patients had large volume diarrhoea (faecal weight > 200 g/day) and three had steatorrhoea. CONCLUSIONS: Idiopathic bile acid malabsorption, once suspected, especially by documenting true 'large volume' watery diarrhoea or steatorrhoea, is easily diagnosed and response to therapy is often very good. There is often a previous history of gastrointestinal infection and this condition should be considered in patients with chronic diarrhoea of undetermined origin, especially before they are labelled as having irritable bowel syndrome.

Absorption↗
PubMed1997

Transvaginal ultrasound in the prediction of preterm delivery: singleton and twin gestations.

OBJECTIVE: To compare, in singleton and twin pregnancies, the effectiveness of transvaginal ultrasound versus digital examination in predicting preterm delivery in women with suspected preterm labor. METHODS: Transvaginal ultrasound and pelvic examinations were performed on patients admitted with suspected preterm labor between 23 and 33 weeks' gestation. Ultrasound assessment of cervical length and the presence of funneling with fundal pressure were recorded for each patient, and the results were compared with dilatation and effacement as assessed by digital examination for the prediction of preterm delivery in the two groups (singletons and twins). RESULTS: One hundred sixty-two subjects were recruited (136 singletons and 26 twin pregnancies), with no significant demographic differences between the groups. Overall, 33% of the participants delivered preterm (27% of singletons, 62% of twins). Using receiver operating characteristics curves, the best cutoff points were 30 mm for endocervical length at ultrasound, 50% for effacement, and 1.5 cm for dilatation. Of these, the best predictor was endocervical length, which was a better predictor in singleton than in twin pregnancies. Of the potential predictors, including endocervical length, funneling, dilatation, and effacement, only endocervical length was an independent predictor of preterm delivery at less than 34 weeks' gestation for both singletons and twins by multiple logistic regression. When analyzed for delivery at less than 37 weeks' gestation, this relation held true for singletons but not twins. Endocervical length less than 30 mm had a sensitivity of 81% and 75%, specificity of 65% and 30%, positive predictive value of 46% and 63%, and negative predictive value of 90% and 43% for singleton and twin pregnancies, respectively, in predicting spontaneous birth at less than 37 weeks' gestation. CONCLUSION: Between 23 and 33 weeks' gestation, transvaginal ultrasound assessment of endocervical length is superior to funneling and digital examination in predicting preterm delivery in patients who present with suspected preterm labor, and is a better predictor in singletons than in twins.

Adult↗
PubMed1996

Reflux oesophagitis and Helicobacter pylori infection in elderly patients.

Helicobacter pylori is associated with gastritis, peptic ulcers and gastric malignancies. Little attention has been paid to the possibility that it may also have a role in the pathogenesis of reflux oesophagitis. This is especially true in elderly patients who have life-long infection and provide an ideal group to study the mucosal changes associated with the organism. The aim of this study was to determine if H pylori is associated with reflux oesophagitis in elderly patients. Consecutive gastroscopy patients were recruited. Multiple biopsies were taken from oesophagus, stomach, antrum and duodenum for histology and rapid urease tests. Patients also had IgG ELISA antibodies and 13C-urea breath tests performed. Patients with macroscopic or microscopic evidence of reflux oesophagitis were compared to patients with macroscopically normal upper gastrointestinal tracts and no microscopic evidence of reflux. A total of 114 patients were recruited, average age 78.9 years (+/- 5.4). There were 37 refluxers and 33 non-refluxers. We found no evidence for an association between the presence of H pylori and reflux oesophagitis in elderly patients. The high prevalence of H pylori in patients with reflux oesophagitis can be explained by the presence of incidental gastritis.

Aged↗
PubMed1996

Lack of association between helicobacter pylori and gastric atrophy or intestinal metaplasia in elderly patients.

Helicobacter pylori (Hp) is associated with gastritis and peptic ulcers. It may also induce gastric atrophy (GA) and intestinal metaplasia (IM), and these changes may be the precursors of gastric carcinoma. The aim of this study was to determine if GA or IM is associated with Hp infection in elderly patients. Consecutive patients admitted for gastroscopy were recruited. Multiple biopsies were taken for histology and rapid urease (CLO) tests along with IgG enzyme-linked immunosorbent assay antibodies and (13)C-urea breath tests. Statistical analysis was by chi(2) tests. 114 patients were recruited, the average age was 78.9 + or - 5.4 years. Histology was available on 105 patients, 80 (76.2%) had gastritis, and 61/80 (76.25%) had evidence of definite current Hp infection. Seven patients had reflux gastritis, and these were excluded from the analysis described below. 20 patients had GA and 24 IM. The relationship between Hp and GA or IM was investigated by dividing patients into four groups: Group 1 patients (n = 57) were taken to be definitely currently infected (GA 7 patients, IM 11, both 1). Group 2 patients (n = 18) had old infection (GA 2, IM 4, both 3). Group 3 patients (n = 16) have never been infected previously (GA 1, IM 1, both 3). Group 4 patients (n = 4) had a poor immunological response to Hp (GA 1, IM 1, both 0). There were no significant differences in the numbers of patients with GA or IM in any group as compared with any other, with the exception of less patients with histological evidence of combined GA and IM among patients with definite current infection as compared with those with either previous infection (p = 0.04) or 'never' infection (p = 0.03). We conclude that the mucosal changes of GA or IM are not consistently associated with Hp infection in the elderly.

Aged↗
PubMed1995

Compliance at night with low flow oxygen therapy: a comparison of nasal cannulae and Venturi face masks.

BACKGROUND: The factors that influence nocturnal compliance among patients prescribed low flow oxygen therapy were determined and tolerance of nasal cannulae and Venturi face masks compared. METHODS: Two studies were performed: (1) a prospective study of 99 hospitalised patients prescribed low flow oxygen therapy, 49 on nasal cannulae and 50 on Venturi face mask; and (2) a prospective study of 20 separate patients with an acute respiratory disorder requiring low flow oxygen therapy who were given nasal cannulae and Venturi face mask on successive nights in random order. RESULTS: In study 1, 49 patients dislodged their device at least once during the night. Those using Venturi face masks and those over 75 years of age had the most dislodgements. In study 2 patients also dislodged Venturi face masks more frequently (mean (SD) 2.0 (2.4)) than nasal cannulae (0.7 (1.4)). Most patients expressed a preference for nasal cannulae. CONCLUSIONS: Nocturnal tolerance of nasal cannulae is superior to Venturi face masks, and this factor should be considered when choosing the method of oxygen delivery.

Aged↗
PubMed1995

Haemodynamic effects of nasal continuous positive airway pressure in severe congestive heart failure.

Nasal continuous positive airway pressure (NCPAP) during sleep may be a useful adjunct to medical therapy in patients with stable severe congestive heart failure (CHF), particularly when there is a coexisting respiratory sleep disorder. However, the direct haemodynamic effects of NCPAP in patients with severe stable CHF have not yet been adequately assessed. Right heart catheter studies were performed in seven awake males (aged 51-75 yrs) with stable CHF, before, during and after the application of 5 cmH2O NCPAP over 3 h. All patients had left ventricular ejection fractions < or = 30% and baseline pulmonary capillary wedge pressures > 12 mmHg, and six patients were in atrial fibrillation. Cardiac index fell from baseline in all patients whilst on NCPAP, with the greatest fall at 2 h (from 3.3 +/- 0.3 (mean +/- SEM) at baseline to 2.8 +/- 0.2 l.min-1.m-2) and rose back to baseline after NCPAP withdrawal. Systemic vascular resistance (SVR) increased during NCPAP application (1,268 +/- 108 to 1,560 +/- 82 dyn.s-1.cm5), with baseline SVR showing a significant negative correlation vs percentage fall in cardiac index (CI) at 2 h on multiple linear regression analysis (r2 = 0.8). These data indicate that domiciliary nocturnal NCPAP should not be prescribed as part of the therapy in severe CHF without first determining the individual patient's cardiac response to such therapy.

Aged↗
PubMed1995

Prevalence of hearing problems, and use of hearing aids among a sample of elderly patients.

BACKGROUND: Deterioration of hearing with advancing age is well documented. However, the proportion of elderly people with hearing problems who wear hearing aids is low. AIM: The aim of this study was to assess the prevalence of hearing disability in a group of elderly patients in hospital and to determine their attitudes to hearing difficulties and the wearing of hearing aids. METHOD: A random sample of patients who were convalescing were interviewed. A detailed questionnaire was administered to patients regarding their hearing difficulties. RESULTS: A total of 79 patients were recruited. Twenty two patients were excluded because of low mental test scores, hence 57 patients (72%) were eligible for inclusion into the study. Thirty eight patients were women (mean age 81 years) and 19 were men (mean age 79 years). Thirty patients (53%) reported difficulties with their hearing, of whom 12 had hearing aids. Seventeen patients had consulted their general practitioner about their difficulties, 15 of whom had been referred for audiological examination. Thirteen patients chose not to consult about their hearing problems, to 'suffer in silence'. Of the 12 patients with hearing aids three reported discomfort or pain and five reported problems such as an ill-fitting hearing aid and excessive amplification. Six patients said they wore their hearing aid for less than four hours a day. CONCLUSION: Almost all patients consulting their general practitioner with hearing problems were referred for audiological examination but subsequent follow up, especially of problems with hearing aids, was poor. Better health education and case finding is indicated and patients with hearing aids must be questioned specifically about problems when they consult health professionals. Proper assessment, screening and follow up has implications for resources and training, especially of practice nurses.

Aged↗
PubMed1994

Acute pneumothorax: a comparison of elderly with younger patients.

This report compares the presentations and outcome of pneumothorax in 11 patients aged over 65 with 15 patients aged 20-35 years. Information was retrospectively collected from the charts regarding modes of presentation and the course of the illness. A questionnaire was sent to the general practitioners of the older group asking about the long-term outcome relating to functional status. Older patients were more likely than younger to present primarily with dyspnoea. The classical symptom of acute onset of pleuritic chest pain was present in ten of the 15 younger patients but in only two of the older patients. There were also statistically significant associations of the elderly patients with the following: radiological evidence of pre-existing lung disease; absence of pleuritic chest pain on admission; atypical or absent pain; a major delay from symptom onset to presentation; the diagnosis being clinically missed prior to chest radiography; and prolonged hospitalization. Nine of the 11 elderly patients were eventually independent at home.

Acute Disease↗
PubMed1994

Role of respiratory sleep disorders in the pathogenesis of nocturnal angina and arrhythmias.

This report documents how respiratory sleep disorders can adversely effect ischaemic heart disease. Three male patients (aged 60-67 years) with proven ischaemic heart disease are described. They illustrate a spectrum of nocturnal cardiac dysfunction, two with nocturnal angina and one with nocturnal arrhythmias. Full sleep studies were performed in a dedicated sleep laboratory on all patients, and one patient had 48 hours of continuous Holter monitoring. Two patients were found to have obstructive sleep apnoea with apnoea/hypopnoea indices of 57 and 36 per hour, respectively, the former with nocturnal arrhythmias and the latter with nocturnal angina. In both cases, nasal continuous positive airways pressure successfully treated the sleep apnoea, with an associated improvement in nocturnal arrhythmias and angina. The third patient who presented with nocturnal angina, did not demonstrate obstructive sleep apnoea (apnoea/hypopnoea index = 7.2) but had significant oxygen desaturation during rapid eye movement (REM) sleep. This patient responded to a combination of nocturnal oxygen and protriptyline, an agent known to suppress REM sleep, and had no further nocturnal angina. All patients were considered to be an optimum cardiac medication and successful symptom resolution only occurred with the addition of specific therapy aimed at their sleep-related respiratory problem. We conclude that all patients with nocturnal angina or arrhythmias should have respiratory sleep abnormalities considered in their assessment.

Aged↗
PubMedDate not supplied

Use of an age related admission policy in establishing a new department of medicine for the elderly.

Possible admission policies when initiating new Departments of Medicine for the Elderly are discussed. We report the results of a new acute unit where an age related policy was used in an area with no prior contact with the speciality. Six hundred and fifty-one acute medical admissions aged 80 years and over were treated in the unit's first year. Average age was 84.6 years with an average stay of 8.6 days. 54% were discharged directly home with a further 17% going home after rehabilitation. Only 12% eventually needed continuing nursing care. 9.4% of the patients died. We conclude that Medicine for the Elderly is highly effective if allowed access to patients from the point of admission rather than on a take-over basis. It is suggested that an age-related policy is appropriate when setting up new departments unless there is a clear indication for an alternative policy.

Aged↗