Biomedical subjects
Publications and source records attributed to R Shepherd.
The results of percutaneous endoscopic gastrostomy in 25 patients who required enteral alimentation when feeding by mouth was not possible is reported. The procedure was successful on 30 occasions, with a low incidence of major complications. Endoscopic gastrostomy is a simple, less expensive alternative to surgical gastrostomy with a lower morbidity and mortality.
We describe a child born to unrelated parents who developed severe protracted secretory type diarrhea associated with subtotal villus atrophy and intestinal inflammation at the age of 19 months. No infectious, metabolic, or anatomical basis for this condition was identified and the child required total parenteral nutrition for a period of 18 months despite trials of special enteral formulas, steroids, and anti-inflammatory agents. This refractory "enteropathy" responded dramatically to the introduction of cyclosporin, with cessation of the secretory diarrhea, recovery from the enteropathy, and cessation of parenteral nutrition. The symptoms relapsed when cyclosporin was briefly discontinued and improved following reintroduction of this drug. This experience suggests a role for immune factors in the pathogenesis of the enteropathy in this case and that a trial of cyclosporin is worthy of consideration in similar cases.
Sixteen subjects, all of whom had said in a preliminary questionnaire that they normally added table salt to foods, were fed standard meals in the laboratory over 10 days. The meals were identical, except that on 5 days the meal had no added salt (containing 0.46 g sodium chloride) or had salt added to a level of 5.09 g. They were allowed free access to salt pots with the meals and used an average of 1.40 g table salt with the unsalted meal and 0.36 g with the salted meal, thus compensating for 22% of the difference in salt content of the meal. There was no difference in water consumption between the two types of meal. Nutrient intake from the rest of the diet did not differ between periods with high and low salt meals. The failure to compensate more fully for reduced salt in the foods can be attributed to the greater availability of table salt for perception; less table salt than salt incorporated in the foods is therefore required. Reduction of salt concentrations in purchased foods would be unlikely to be fully replaced by the consumer adding table salt.
From 10% to 15% of school-aged children experience recurring abdominal pain. This study evaluated the efficacy of a cognitive-behavioral program for the treatment of nonspecific recurrent abdominal pain (RAP) using a controlled group design. The multicomponent treatment program consisted of differential reinforcement of well behavior, cognitive coping skills training, and various generalization enhancement procedures. Multiple measures of pain intensity and pain behavior were conducted, including children's self-monitoring, parent observation, teacher observation, and observation by independent observers. Results showed that both the experimental and the control groups reduced their levels of pain. However, the treated group improved more quickly, the effects generalized to the school setting, and a larger proportion of subjects were completely pain-free by 3-months follow-up (87.5% vs. 37.5%). There was no evidence for any negative side effects of treatment.
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Freshly isolated bovine adrenocortical cells were pretreated with various concentrations of cholesterol and of high- (HDL) and low-density lipoprotein (LDL) fractions of known cholesterol content and then incubated in medium alone with and without angiotensin II. Preincubation with cholesterol (323 mumol/l) caused basal aldosterone synthesis to increase from 0.89 +/- 0.08 to 2.77 +/- 0.22 pmol/10(6) cells per hour (+/- S.E.M.) but did not significantly affect angiotensin-stimulated synthesis. Human HDL containing cholesterol at a final concentration of 129-647 mumol/l increased both basal and angiotensin-stimulated aldosterone synthesis. In HDL-treated cells, both the threshold response and responses to increasing concentrations of angiotensin were raised. Human LDL had no effect on basal or stimulated aldosterone synthesis nor did LDL alter the effects of HDL when cells were incubated with HDL and LDL in combination. Qualitatively similar results were obtained with bovine lipoproteins. These studies show that, in short-term incubations of fresh tissue, the supply of cholesterol may be a limiting factor in aldosterone synthesis and that HDL rather than LDL is the preferred source. These observations are discussed in relation first to the mechanisms by which cholesterol/HDL might augment steroid responses and secondly to other studies with cultured cells which have demonstrated a role for LDL.
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Two groups of patients with cystic fibrosis were compared. The screened group, detected with an improved neonatal screening assay for immunoreactive trypsin, developed fewer chest infections requiring treatment and gained more weight than the unscreened group. Early diagnosis by screening seems to affect early morbidity.
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With the advancement of medical technology, hospitals are facing a serious problem--providing patients with the most advanced technology available, while at the same time, controlling costs. Trading off between quality and cost Is a difficult decision, and whoever makes that decision--physicians, or the hospital--needs to evaluate all available data to make informed choices. Hospitals that can provide this needed data will better ensure their financial viability while providing patients with the best quality of care.
Fifteen patients undergoing haemodialysis tasted soup varying in salt concentration and apple puree varying in sucrose concentration, immediately before and after dialysis. Matched controls tasted the same foods with a similar interval between tastings. The samples were rated for intensity, and on a relative-to-ideal scale. For the salt, the slopes of the functions plotted against log (concentration) were higher after dialysis than before, whilst the most preferred concentration was lower. There were no effects found for the sweetness ratings or for the controls. Likewise there were no overall differences in the ratings between the patients and controls. Thirst was found to increase on dialysis, and there was a trend of this being higher for the patients than for the controls. The reduction in preferences for salt by dialysis would make compliance with a reduced salt diet easier, but the increase in thirst would make compliance with reduced fluid intake more difficult.
If an unselected sample includes individuals whose blood pressure is sensitive to their salt intake and individuals whose blood pressure is not sensitive, then the superposition of these two sub-populations in a scatterplot of individuals' blood pressures against their salt intakes could give a triangular distribution. The non-correlation in the insensitives would obscure the correlation expected in the sensitives. This hypothesis justifies truncation of such data to test for correlation between blood pressure and salt intake among only the individuals in the higher range of blood pressures observed. No criterion of salt sensitivity is needed. The analysis should succeed if salt intake makes a major contribution to hypertension and would be improved if other putative causes were factored out.