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Biomedical subjects

S Sherlock

Publications and source records attributed to S Sherlock.

At least 91 records · Page 5Linked to original sources
PubMed1985

Randomised controlled trial of adenine arabinoside 5'-monophosphate (ARA-AMP) in chronic hepatitis B virus infection.

A randomised controlled trial was conducted in 29 HBV carriers who had been HBs and HBe antigen positive for more than six months. Fifteen patients were treated with ARA-AMP 10 mg/kg/day given as intramuscular injections 12 hours apart for five days followed by 5 mg/kg/day for 23 days. The 14 controls received no treatment. Serum HBV-DNA polymerase, and HBV-DNA decreased in all patients during therapy. Six treated patients lost serum HBV-DNA polymerase, HBV-DNA and HBeAg, HBsAg concentrations decreased, and five developed anti-HBe. One of these six patients lost HBsAg and developed anti-HBs. No such changes were observed in the control group over a similar 18 month period of observation. A four week course of ARA-AMP inhibits HBV replication and in a significant minority of patients this is long lasting and is associated with a reduced level of inflammatory activity in the liver.

Adult↗
PubMed1985

Biliary sequelae of endoscopic sphincterotomy.

Twenty five patients were reviewed a mean of 36 months after successful endoscopic sphincterotomy for the removal of bile duct stones. All the patients had improved symptomatically but 20% had episodes of mild abdominal pain and a similar number had elevated serum gamma glutamyltranspeptidase activities (up to 3 times normal). In 12 patients (50%) biliary gas was demonstrated indicating reflux of duodenal contents. Clinical cholangitis did not occur. Aspiration liver biopsy revealed mild portal tract fibrosis and inflammation in patients with biliary reflux. Biliary reflux was significantly associated with mild upper abdominal pain (P less than 0.05). This study has shown that mild abnormalities of biliary function persist after endoscopic sphincterotomy. The long term consequence of these changes is unclear.

Adult↗
PubMed1985

Psychosocial impact of chronic infection with hepatitis B virus on British patients.

The effects of chronic infection with hepatitis B virus (HBV) on the lives of 40 British patients were studied by means of a questionnaire. The aspects considered were: social, sexual, and family life, physical and psychological health, and work. Thirty six patients considered their lives to have been affected, nine mildly, 14 moderately, and 13 severely. The aspects of life most affected were: sexual (13), psychological (11), physical (5), work (3), social (2), and family (2). Most of the problems encountered were related to infectivity. The availability of vaccines against HBV and of successful antiviral treatment have solved some of the problems, but it remains important for the medical profession to be aware of the multifaceted impact of the carriage of HBV.

Adult↗
PubMed1985

Double-blind controlled trial of bromocriptine, chlordiazepoxide and chlormethiazole for alcohol withdrawal symptoms.

Seventy-one patients undergoing withdrawal from alcohol were randomly assigned to treatment with oral bromocriptine, chlormethiazole or chlordiazepoxide. Forty-one percent had alcoholic hepatitis and/or cirrhosis. Patients were stratified into two groups: major and minor withdrawal symptoms. The latter group included a placebo tratment. Bromocriptine was ineffective in treating withdrawal symptoms, whilst chlormethiazole and chlordiazepoxide were equally effective. These findings do not support the evidence from animal and clinical studies suggesting that the disturbances in the dopaminergic system found in alcohol dependence and withdrawal can be reversed by dopamine agonists.

Adult↗
PubMed1984

Landmark perspective: Landmarks in viral hepatitis.

Developments in viral hepatitis have been traced from Saul Krugman's distinction of two types, MS1 and MS2 (A and B), and Baruch S. Blumberg's discovery of Australia antigen. Hepatitis A has been grown in tissue culture, the structure of the virus is known, and the acute disease can be diagnosed. Knowledge of the molecular biology of the more complex hepatitis B virion has allowed the development of an effective vaccine and distinction of replicative and nonreplicative stages of infection. Integration, in the hepatocyte, of hepatitis B viral DNA into host DNA is the precursor of liver cancer. The infection of hepatitis B carriers with another infectious agent, delta, has added a new dimension to the problem. Other unidentified causes of hepatitis have been lumped together as non-A, non-B, and these remain to be defined and accurately diagnosed.

Child↗
PubMed1984

Vitamin A treatment for night blindness in primary biliary cirrhosis.

Three patients with late stage primary biliary cirrhosis were found to have appreciable night blindness. Serum vitamin A concentrations were low in all three patients despite regular intramuscular supplementation in two. All patients responded dramatically to high dose oral supplementation, with full recovery of adaptation to dark and visual fields. Oral rather than intramuscular vitamin A supplementation seems appropriate in the prevention of ocular complications of vitamin A deficiency in biliary cirrhosis.

Administration, Oral↗
PubMed1984

Thrice weekly lymphoblastoid interferon is effective in inhibiting hepatitis B virus replication.

Six patients with chronic hepatitis B virus (HBV)-induced liver disease were treated with human lymphoblastoid interferon. Daily, alternate day or thrice weekly regimens were employed in two, one and three patients respectively. Thrice weekly intra-muscular injections of 7.5 to 10 megaunits of interferon/m2 appeared to be as effective as daily injections in producing inhibition of HBV replication, were associated with fewer side effects and could be continued for up to 3 months. The effectiveness of this regimen in producing long-term inhibition of viral replication must now be determined.

Adult↗
PubMed1984

Impaired oxidation of debrisoquine in patients with perhexiline liver injury.

Perhexiline maleate is an antianginal agent which depends on hepatic oxidation for its elimination. Its use may be complicated by the development of peripheral neuropathy and liver damage. The majority of patients with perhexiline neuropathy have an impaired ability to effect metabolic drug oxidation which is genetically determined. Information has not been available on drug oxidation capacity in patients with perhexiline liver injury. Drug oxidation was measured using an oxidation phenotyping procedure in four patients with perhexiline liver injury and in 70 patients with chronic liver disease serving as a control group. All four patients with perhexiline liver damage showed a substantial metabolic defect; three of the four patients (75%) showed a genetically determined impairment of oxidation capacity. The incidence of severely impaired oxidation capacity in the perhexiline group was significantly greater than in the patients with chronic liver disease (6/70; 8.6%) and in the healthy population (9%) (F = 0.0048). A clear association exists between perhexiline liver injury and diminished drug metabolic activity, suggesting that the propensity to develop perhexiline liver injury is, at least in part, genetically determined.

Adolescent↗
PubMed1984

Bacteriuria and primary biliary cirrhosis.

Significant bacteriuria was found in 19% of 87 women with primary biliary cirrhosis, whereas in 89 women with other types of chronic liver disease bacteriuria was present in only 7%. In 74 women with rheumatoid arthritis 8% were bacteriuric. Midstream urine specimens obtained from 144 consecutive women with primary biliary cirrhosis attending hospital over a two year period showed that 50 (35%) developed bacteriuria during 12 months of follow up. Bacteriuria was unrelated to age, raised serum bilirubin, drug therapy or urinary pH but was more common in patients with late stage (fibrotic) disease as judged by histological criteria. Fifty seven per cent of bacteriuric primary biliary cirrhosis patients suffered more than one urinary infection. Fifty nine per cent of the 156 bacteriuric episodes were asymptomatic. The types of organism isolated, the antibiotic sensitivity patterns and cure rate were similar to those reported in bacteriuric women without other underlying disease. The reinfection rate (34%), however, was double that reported for bacteriuric episodes in 'problem' women with recurrent bacteriuria, indicating a special susceptibility to urinary infection. The most common isolates were E coli (70%), which did not show abnormal adhesiveness to uroepithelial or buccal cells of normal women, or to those of primary biliary cirrhosis patients. Patients with primary biliary cirrhosis have not been reported to be more susceptible to infection in general. Bacteriuria, however, was common throughout all clinical stages of primary biliary cirrhosis. Thus there may be a unique association between bacteriuria and primary biliary cirrhosis.

Adult↗
PubMed1984

Recurrent bacteriuria and primary biliary cirrhosis: ABO blood group, P1 blood group, and secretor status.

Patients with primary biliary cirrhosis have an abnormally high incidence of urinary tract infection (35%). Susceptibility to urinary infection and other infectious diseases has been linked with certain blood group antigens and secretor status. We have therefore studied these characteristics in patients with primary biliary cirrhosis. We were unable to show any abnormal distribution in blood groups or secretor status in patients with primary biliary cirrhosis (compared with a normal population) which might reflect their predisposition to urinary infection. The distribution of blood groups and secretor status in patients with primary biliary cirrhosis with a history of urinary infections was not significantly different from patients without such a history. Escherichia coli strains isolated from patients with primary biliary cirrhosis did not bind in any greater numbers to the uroepithelial cells of primary biliary cirrhosis patients than to the cells of a normal healthy control. We therefore conclude that blood group distribution, abnormal secretor status, and epithelial cell type are not important factors in the predisposition of primary biliary cirrhosis patients to urinary infections.

ABO Blood-Group System↗
PubMed1984

Percutaneous transhepatic endoprosthesis for bile duct obstruction. Complications and results.

Sixty-two patients with bile duct obstruction were referred for the percutaneous transhepatic insertion of an endoprosthesis. This procedure was successful in 53 of the 62 patients. Insertion was possible through 28 of 30 periampullary obstructions, but only through 19 of 26 at the hilum. Eighteen patients suffered complications, but in only 3 cases were these serious, including two procedure-related deaths. Bile duct obstruction was relieved completely in 34 of 46 patients with planned long-term drainage, and was partially relieved in 8 patients. The survival of 40 patients with malignant disease was poor, but none of the 6 patients with benign stricture has died. In 7 of 20 long-term survivors, the endoprosthesis eventually became partially or totally blocked. This technique is an alternative method of relieving itching and jaundice in patients with irresectable tumors or poor operative risk. In patients with benign stricture, the early results are encouraging, but longer follow-up is necessary to evaluate this therapeutic approach.

Adult↗
PubMed1983

Controlled trial of propranolol for the prevention of recurrent variceal hemorrhage in patients with cirrhosis.

We conducted a prospective randomized trial of propranolol for the prevention of recurrent variceal bleeding in 48 patients with cirrhosis of the liver. During a follow-up period of up to 21 months, 12 of 26 patients in the propranolol group and 11 of 22 in the control group had rebleeding from esophageal varices. There was no significant difference in rebleeding between the two groups. This contrasts with a previous report of the efficacy of propranolol in preventing recurrent gastrointestinal bleeding in alcoholic cirrhosis. The difference in results may be due to the inclusion in our study of patients with other causes of cirrhosis and more severe liver disease. Propranolol may not be indicated for the prophylaxis of variceal rebleeding in such patients, and we advocate that its use be limited at present to controlled clinical trials.

Adult↗