Biomedical subjects
W G Thompson
Publications and source records attributed to W G Thompson.
Proctalgia fugax in patients with the irritable bowel, peptic ulcer, or inflammatory bowel disease.
One hundred forty-eight patients with gastrointestinal disease, 50 patients with the irritable bowel syndrome (IBS) and 49 each with peptic ulcer and inflammatory bowel disease, were interviewed to determine if they had proctalgia fugax (PF) and if the symptom was associated with the IBS. One-third of the patients had PF. It occurred in 51% of females and 12% of males (p less than 0.001). When corrected for sex, PF was no more prevalent in IBS than in peptic ulcer or inflammatory bowel disease. Only two of six previously described IBS symptoms were more prevalent in the PF patients. Attacks occurred in the day in 94%, and one-third of sufferers related them to defecation. The pain was localized in the anus in 90%, occurred less than five times a year in 51%, and lasted less than 1 min in 57%. In most, activity was not interrupted by this pain and only 20% had ever reported it to a physician. PF is very common among patients with abdominal symptoms, but is not related to the IBS. Since it is infrequent, benign, and transient, PF is usually not mentioned to the physician.
Inflammatory bowel disease or irritable bowel syndrome?
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Heartburn and globus in apparently healthy people.
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Does uncomplicated diverticular disease produce symptoms?
A questionnaire dealing with bowel symptoms was administered to 97 outpatients referred for air-contrast barium enema. Subsequently, the barium enema was interpreted by a radiologist who did not know the results of the questionnaire. Forty-nine had normal x-rays, and 27 had uncomplicated diverticular disease. Weight loss, rectal bleeding, abdominal pain, and pain at night were as common in those with a normal examination as in those with diverticula. Symptoms of colon dysfunction included abdominal pain relieved by defecation, altered stool frequency and consistency with pain onset, abdominal distension, feeling of incomplete evacuation after defecation, and mucus in the stool. These were equally prevalent in both groups. Therefore, no symptoms could be ascribed to the presence of diverticula.
Proctalgia fugax.
Proctaglia fugax is a sudden severe pain in the rectum lasting a few seconds or minutes. It seems to occur in about 14% of apparently healthy adults, and there is some evidence that it is associated with the irritable bowel syndrome. The pathogenesis of the pain is unknown. Attacks are usually too brief and infrequent to warrant treatment, and no prophylactic drug has been proven effective. It is incurable but harmless, and tends to become less frequent with age.
Simple and choice reaction time in dementia: clinical implications.
The present study investigated differences between normal elderly subjects matched for age and education and patients with dementia of the Alzheimer's type (DAT) on two measures of reaction time (RT). Statistically significant group differences clearly demonstrate that normal elderly subjects have faster RT than subjects with senile dementia on all RT tasks. The DAT patients were most clearly differentiated in terms of overall group means and clinical classification from their age-matched counterparts on the choice of RT task. Eleven of 12 (92%) DAT patients displayed choice RT's 2 or more standard deviations above those of age-matched normals. While both RT measures were discriminative between patients and normals, the overall results argue for increased sensitivity when choice is required in RT in accessing the cognitive deficits in DAT.
Vasopressin and conditioned flavor aversion in aged rats.
The effect of lysine vasopressin on the performance of young-adult and old rats subjected to a conditioned flavor aversion procedure was studied. Young rats maintained an aversion to a 0.1% saccharin solution significantly longer than did older rats. Treatment with lysine vasopressin ( 1 microgram/kg) during the recovery period prolonged the aversion in both age groups. A single injection of lysine vasopressin prior to the aversion procedure significantly reduced the age difference in extinction. These observations support the hypothesis that age-dependent changes in endogenous vasopressin synthesis or secretion underlie some of the behavioral deficits observed in old animals.
Laxatives: clinical pharmacology and rational use.
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Functional bowel disorders in apparently healthy people.
Symptoms of functional gastrointestinal disorder were sought by a questionnaire administered to 301 apparently healthy subjects in young, middle-aged, and elderly categories. Abdominal pain, a feeling of incomplete evaculation after defecation, urgency, scybala, runny stools, straining at stool, borborygmi, distension, heartburn, and laxative use were all very common. The typical symptom pattern of the spastic irritable bowel syndrome (IBS) occurred in 13.6% of subjects. Seven percent suffered noncolonic pain that was commonly associated with heartburn. A further 3.7% had painless diarrhea without the features of the spastic IBS. Six percent suffered painless constipation. Constipation seemed to increase with age. Thus four clinically distinct functional bowel syndromes existed in almost one-third of the subjects studied. Most of these had not consulted a doctor. Hospital-based studies of the IBS derive from a selected minority of patients and may not be applicable to all sufferers.
Towards positive diagnosis of the irritable bowel.
A questionnaire to establish the presence of 15 symptoms thought to be typical of the irritable bowel syndrome (IBS) was given to 109 unselected patients referred to gastroenterology or surgery clinics with abdominal pain or a change in bowel habit or both. Review of case records 17--26 months later established a definite diagnosis of IBS in 32 patients and of organic disease in 33. Four symptoms were significantly more common among patients with IBS--namely, distension, relief of pain with bowel movement, and looser and more frequent bowel movements with the onset of pain. Mucus and a sensation of incomplete evacuation were also common in these patients. The more of these symptoms that were present the more likely was it that the patient's pain or altered bowel habit, or both, was due to IBS. We conclude that a careful history can increase diagnostic confidence and reduce the amount of investigation in many patients with chronic abdominal pain.
Villous adenoma with hyponatremia and syncope: report of a case.
A case of villous adenoma of the colon with hyponatremia, hypovolemia, and syncope is presented. The correct diagnosis was delayed because of the prevailing idea that villous adenomas are associated with hypokalemia. The patient recovered fully after surgical removal of one of the largest villous adenomas reported in the literature. Sodium loss may be the dominant feature of this syndrome. Villous adenoma has to be included among the causes of hyponatremia.
Wilson's disease: a common liver disorder?
In two sibships 7 of 24 siblings were homozygous for Wilson's disease. In family A, the largest kindred of this recessively inherited disease thus far reported, the proband presented with chronic active hepatitis, one sibling died of cirrhosis, a second had clinical evidence of chronic liver disease and two others had biochemical and histologic changes in liver biopsy specimens. In family B the proband had cirrhosis and portal hypertension and one sibling had biochemical and histologic evidence of liver disease. All six living patients had low serum concentrations of ceruloplasmin and copper and a high 24-hour urinary excretion of copper, which was greatly increased by administration of D-penicillamine. None showed neurologic abnormalities and only one had Kayser-Fleischer rings (detectable only by slit-lamp examination). Each patient had an erythrocyte sedimentation rate (ESR) of 8 mm/h or less. After 3 and 2 years, respectively, of D-penicillamine therapy the conditions of the two probands had improved. Liver function became normal in three siblings, and no abnormalities developed in the remaining one. Thus, since Wilson's disease may present with chronic active hepatitis or cirrhosis with a normal ESR and without ocular or neurologic signs, it may be a more common cause of liver disease in young people than has been appreciated.
University of Ottawa modified systems program.
A modified systems program has been developed at the University of Ottawa which incorporates advantages of the systems approach into whole-class teaching without increasing demands on staff. Basic science instruction is given in the first two years in preclinical departments. A total of 387 lecture and laboratory hours previously assigned to organ pathology and clinical departments are allocated to committees representing 12 systems. This program emphasizes pathology and pathophysiology and is supervised by a Coordinating Systems Committee. It begins in November of the second year and continues one year concurrently with instruction in clinical skills and basic science. A clinical clerkship occupies the final 18 months of the curriculum. Program effectiveness is measured by student evaluation of each lecture, multiple-choice examination, lecture monitoring, handout surveillance, and annual review of each system. This organization coordinates teaching of a single subject by many disciplines, and evaluation exposes flaws in teaching.
The relation between ileal resection and vitamin B12 absorption.
Over 15 years, 33 patients, who had had 36 ileal resections that included the terminal ileum, had Schilling tests to measure the absorption of vitamin B12. In 11 patients who had 60 cm or more of ileum removed, only one test was normal, while in 25 patients with less than 60 cm resected, 17 tests were normal. Seven of the patients with over 60 cm of ileum resected had stool-fat estimations and none were normal. Eight of 10 patients who had less than 60 cm of ileum resected had normal stool-fat estimations. Results of the Schilling test, but not of the stool-fat estimations, are proportional to the length of ileal resection, up to 60 cm. Retention of terminal ileum tends to preserve vitamin B12 absorption capacity. Thus, if more than 60 cm of terminal ileum is removed, fat and B12 malabsorption are likely. The Schilling test is an indicator of the degree of terminal ileal dysfunction.