Biomedical subjects

S Holt

Publications and source records attributed to S Holt.

At least 163 records · Page 9Linked to original sources

PubMed1981

Early identification of alcohol abuse: 1. Critical issues and psychosocial indicators for a composite index.

Traditional approaches to the medical management of alcohol-related disorders have met with limited success in altering the prevalence of alcohol abuse. Evidence suggests that identifying early those who drink to excess and intervening with low-cost educational and motivational programs could significantly reduce the prevalence of alcohol-related disabilities. However, physicians must take systematic steps to detect alcohol abuse. Part 1 of this two-part series discusses the need for early identification of individuals who drink to excess and the factors that may either facilitate or hinder the development of effective programs for detecting alcohol abuse. A profile is given of important psychosocial indicators of alcohol abuse, including the classic signs of alcohol abuse, the early manifestations of heavy drinking, the predisposing or high-risk factors for alcohol abuse, and the precipitating events and correlated habits of excessive drinking.

Alcoholism↗

PubMed1981

Observations on the relation between alcohol absorption and the rate of gastric emptying.

Alcohol (ethanol) is absorbed slowly from the stomach and rapidly from the small intestine, and the rate of its absorption depends on the rate of gastric emptying. When gastric emptying is fast, the absorption of alcohol is fast. When gastric emptying is slow the absorption of alcohol is delayed and peak blood alcohol concentrations are reduced. Alterations of the gastric emptying rate, which may have a physiologic, pharmacologic or pathologic cause, markedly influence the rate of alcohol absorption. The gastric emptying rate makes an important contribution to inter- and intraindividual variations in the rate of alcohol absorption and therefore the timing and magnitude of the acute intoxicating effect of an oral dose of alcohol.

Alcoholic Beverages↗

PubMed1981

An evaluation of 99mTc pertechnetate scanning for the detection of coeliac disease and Crohn's disease.

To investigate the use of abdominal scintiscanning in the detection of small bowel pathology, the accumulation of pertechnetate (99mTc), following intravenous injection, has been studied in 21 patients with coeliac disease, 13 patients with Crohn's disease and in 83 control subjects without known small bowel disease. Although a trend for a greater accumulation of 99m Tc was noted in patients with coeliac disease and Crohn's disease compared with controls (P less than 0.025) there was a large overlap in individual studies. Under the conditions of this study the accumulation of 99mTc by the small bowel did not provide a reliable diagnostic test for coeliac disease or Crohn's disease of the small intestine. The accumulation of 99mTc pertechnetate by normal small bowel suggests that scintiscanning with this radiopharmaceutical does not provide a consistently reliable method for the detection of small bowel pathology.

Adult↗

PubMed1981

Acetaminophen absorption and metabolism in celiac disease and Crohn's disease.

To investigate further the conflicting results in reports of drug absorption in patients with small intestinal mucosal disease, gastric emptying and the disposition of acetaminophen were assessed simultaneously in 41 subjects (13 controls, 12 patients with Crohn's disease, and 16 with celiac disease). Acetaminophen absorption as judged by plasma concentrations and gastric emptying were slower in patients with celiac disease and Crohn's disease. Total drug absorption as indicated by urinary recovery did not differ, but plasma acetaminophen half-life was shorter and glucuronide conjugation was enhanced in the patients with Crohn's disease. Contrary to expectation, the mean rate constant for acetaminophen absorption from the small intestine was not decreased in Crohn's disease and celiac disease. The abnormally slow acetaminophen absorption in the patients with Crohn's or celiac disease could be explained by slower gastric emptying of the drug solution.

Acetaminophen↗

PubMed1981

Effect of nifedipine on oesophageal motility and gastric emptying.

Manometric studies have been performed to determine the effect of nifedipine on lower oesophageal sphincter (LOS) pressure and distal oesophageal motility in healthy subjects, in patients with diffuse oesophageal spasm, and in a patient with achalasia. Significant reductions in LOS pressure and in the amplitude of peristaltic oesophageal contractions were observed. In the patients with diffuse oesophageal spasm the amplitude and frequency of non-peristaltic (spasm) contractions were also reduced. Nifedipine did not significantly influence gastric emptying rates of solid and liquid components of a test meal in normal subjects nor in patients who had undergone gastric surgery.

Adolescent↗

PubMed1981

Myocardial ultrastructure and the development of atrioventricular block in Kearns-Sayre syndrome.

A right ventricular endomyocardial biopsy specimen from a 30-year-old male with chromic progressive external ophthalmoplegia, retinal pigmentation and complete atrioventricular block (Kearns-Sayre syndrome) was examined in the electron microscope. There was a proliferation of mitochondria between the myofibrils and beneath the sarcolemma. Many of the mitochondria showed morphologic abnormalities not previously described in this condition. There were associated accumulations of glycogen. A similarly affected female with left anterior hemiblock developed complete atrioventricular block at age 26 years, Despite the ultrastructural changes, clinically detectable myocardial disease is not a feature of Kearns-Sayre syndrome. However, intraventricular conduction defects show an unusually rapid progression to potentially fatal complete atrioventricular block and are an indication for prophylactic cardiac pacing.

Adult↗

PubMed1981

Abnormal gastric emptying in primary anorexia nervosa.

The gastric emptying rate was measured in 10 female patients with primary anorexia nervosa and 12 healthy volunteers, using a scinti-scanning technique for the simultaneous study of the liquid and solid components of a test meal. The emptying rate of both the liquid and the solid phase components of the meal was significantly slower in patients with anorexia nervosa. The aetiological and therapeutic implications of this finding are discussed.

Adolescent↗

PubMed1980

Non-invasive estimation of duodenogastric reflux using technetium-99m p-butyl-iminodiacetic acid.

Post-gastrectomy symptoms of dyspepsia, epigastric pain, nausea, and bilious vomiting have been ascribed to duodenogastric reflux. A noninvasive method, using the radiopharmaceutical technetium-99m p-butyl-iminodiacetic acid, has been developed to observe biliary excretion scintigraphically and to monitor its excretion. 10 controls and 45 patients after stomach operations were given the radiopharmaceutical intravenously and were scanned every 5 min for an hour, after which the site of the stomach was determined by asking the patient to drink technetium-99m in solution. Reflux was noted in 1 control, in 4 of 13 patients after highly selective vagotomy, in 8 of 17 patients following truncal vagotomy and pyloroplasty, and in all of 15 patients after gastrectomy. The mean quantities of reflux in these four groups were 5%, 3.75%, 12.4%, and 44%, respectively. The study confirms that post-gastrectomy patients are more prone to enterogastric reflux and suggests that this form of scintigraphy may produce valuable clinical information.

Bile Reflux↗

PubMed1980

Alcohol and the emergency service patient.

To determine the prevalence of alcohol use in casualty patients breath-alcohol analysis was performed on 702 patients attending the accident and emergency department of a large teaching hospital during the evening. Forty per cent of patients had consumed alcohol before attending and 32% had a blood alcohol concentration exceeding 17.4 mmol/l (80 mg/100 ml). Clinical assessment of intoxication resulted in a false-negative diagnosis in 10% of inebriated patients, indicating that an objective measurement of the blood alcohol concentration by a test, such as breath-alcohol analysis, may be of additional value. These findings confirm that a high proportion of emergency-service patients are affected by alcohol and suggest that alcoholism treatment facilities need to be integrated with accident and emergency services.

Adult↗

PubMed1980

Benign gastric ulceration in pernicious anemia.

Benign gastric ulceration occurred in a patient with pernicious anemia in association with aspirin therapy. Previous reports of benign gastric ulceration in patients with achlorhydria are reviewed, and the potential role of aspirin in the pathogenesis of benign ulceration in the absence of acid is discussed.

Achlorhydria↗

PubMed1980

The prevalence of duodenal lesions in patients with rheumatic diseases on chronic aspirin therapy.

Peroral endoscopy was performed in 56 patients with rheumatic disease who had been taking 8 or more aspirin tablets daily for more than 3 months yet who had no major gastrointestinal symptoms or history of peptic ulcer disease. Duodenal mucosal lesions were observed in 16 patients; 15 (27%) had erythema, 7 (13%) had erosions, and 2 (4%) had ulcers. The prevalence of duodenal lesions was the same in patients taking regular, buffered, or enteric-coated aspirin preparations. Patients with duodenal lesions were more likely to have associated gastric lesions.

Adult↗

PubMed1980

The effect of posture on errors in gastric emptying measurements.

Scintigraphic gastric emptying measurements were made with subjects supine and upright using a dual-detector rectilinear scanner. Previously reported variations of the depth of activity during the course of a study were again found with both postures. Although there was no significant mean depth change in the group when upright, some individual variations were substantial. Measurements with a gamma camera demonstrated similar changes of depth of stomach contents with seated subjects. The resulting variations of attenuation of the emergent radiation lead to appreciable errors in the emptying rates determined by unilateral detection. In about half the cases the mean movement of a 99Tcm-labelled solid phase marker exceeded 1 cm; such a movement led to an average 20% error in emptying rate determination by an anterior detector. Depth changes of a liquid marker were less marked, exceeding 0.5 cm in half the subjects; this movement gave rise to an average 6% error when 113Inm was used as the tracer.

Diagnostic Errors↗

PubMed1980

Alcohol absorption, gastric emptying and a breathalyser.

1 The value of a portable breathlyser (Alcometer AE-M2) in the assessment of gastric emptying after alcohol ingestion was investigated by comparing breath and venous blood alcohol concentrations with simultaneous scintigraphic measurements of gastric emptying rate. 2 Alcohol absorption, as determined by the area under the venous blood alcohol concentration-time curve during the first 30 min, correlated with gastric emptying during the same period, implying dependence of the rate of alcohol absorption on gastric emptying rate. 3 There was no correlation between breath and venous alcohol concentrations during the first 15 min after alcohol ingestion, but a significant correlation was observed thereafter. 4 Breath alcohol measurements may be sufficient to detect gross alterations in gastric emptying but measurements of venous blood alcohol are likely to be more reliable.

Breath Tests↗

PubMed1980

Correlation between medical and behavioral data in the assessment of alcoholism.

Using the Munich Alcoholism Test, this study examined the prevalence and interrelationships of medical and sociobehavioral disorders in a nonhospitalized sample of 106 males who had been referred to a medical officer for "suspected" problems related to drinking. A further objective was to evaluate measurement properties of the Munich Alcoholism Test (MALT), a new diagnostic instrument for alcoholism. Self-report items focusing on the recognition of drinking problems formed a homogeneous and quite reliable scale. However, clinical signs and symptoms of disorders related to alcohol abuse occurred with relative independence of each other. In this predominantly young group of subjects, many individuals recognized that they had sociobehavioral problems, but few had clinical or laboratory manifestations of diseases associated with chronic alcohol abuse. These findings underscored the advantages of including both biomedical and sociobehavioral data for the early identification of alcohol abuse and dependence.

Adolescent↗

PubMed1980

Identification of alcohol abuse: thoracic fractures on routine chest X-rays as indicators of alcoholism.

In a retrospective study, rib and thoracic vertebral fractures were found to be present on posteroanterior and lateral routine chest x-rays of 57 (28.9%) of 198 alcoholic male patients and in 4 (1.8%) of 218 nonalcoholic male control subjects. The magnitude of the increased prevalence (16-fold; p < 0.001) of rib and vertebral fractures in alcoholics suggest that routine chest x-rays should be useful in the identification of problem drinking and may be used, along with other indices, in population screening for alcoholism.

Adult↗

PubMed1980

Dynamic imaging of the stomach by real-time ultrasound--a method for the study of gastric motility.

The use of real-time ultrasonic imaging of the stomach for the study of gastric contractions in response to a liquid test meal is described. Gastric contractions in the pyloric antrum and distal body of the stomach were observed on closed circuit television, recorded on to cassette tape and also imaged on polaroid and ciné film. Gastric contractions were recorded from the pyloric antrum by longitudinal scanning in the lower epigastrium and reproducible motility tracings were obtained on a fibreoptic chart recorded. Intravenous metoclopramide enhanced the magnitude and frequency of antral movement, which was abolished by intravenous propantheline. Real-time ultrasonic imaging permits the non-invasive study of gastric contractions. It is safe, may be repeated as required, and provides a method for the study of the effect of drugs and disease states on gastric motility.

Food↗

PubMed1980

Dermatitis herpetiformis and diabetes mellitus.

Three out of 4 patients with coexistent diabetes mellitus and dermatitis herpetiformis (DH) developed severe renal failure which resulted in death in 2 of them. Diabetes mellitus and DH may coexist more frequently than would occur by chance, and such patients may run an increased risk from severe renal complications of diabetes.

Adult↗

PubMed1980

Raynaud's phenomenon induced by sulphasalazine.

Sulphasalazine-induced Raynaud's phenomenon is reported in a patient who showed no other features of a drug-induced lupus syndrome. The vascular disturbance disappeared when the drug was withdrawn on 3 occasions. A simple technique for assessing the circulatory abnormality in Raynaud's phenomenon is described.

Adult↗