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Biomedical subjects

W T Cooke

Publications and source records attributed to W T Cooke.

At least 55 records · Page 3Linked to original sources
PubMed1976

The place of ileorectal anastomosis in Crohn's disease.

A study of 41 patients who underwent ileorectal anastomosis for Crohn's disease has shown this operation to be a relatively safe procedure with an immediate mortality of 2.5%. A defunctioning ileostomy may protect the patient against the consequences of anastomotic leakage. Ileorectal anastomosis is associated with a high early recurrence rate and on overall failure rate of up to 50% because of recurrence, intractable diarrhoea and exacerbation of perianal disease. However, half of the patients are able to retain the anastomosis and be restored to long-standing good health. The surgical philosophy in this Centre has largely evolved from treatment of small-bowel Crohn's disease, that is, resection of only the worst areas of involvement with the aim of symptomatic relief, and the results shown by this survey encourage us to pursue this policy by using ileorectal anastomosis for diffuse colonic disease, particularly if the rectum is uninvolved.

Adolescent↗
PubMed1976

Histocompatibility antigens in inflammatory bowel disease. Their clinical significance and their association with arthropathy with special reference to HLA-B27 (W27).

Histocompatibility (HLA) antigen phenotypes have been studied in 100 patients with ulcerative colitis, 100 with Crohn's disease, and 283 normal controls. In addition the incidence of ankylosing spondylitis, sacroiliitis, and "enteropathic" peripheral arthropathy was determined in the patients with inflammatory bowel disease (IBD). There was no significant difference in antigen frequency between patients and controls. However, the incidence of HLA-B27 was increased in the patients complicated by ankylosing spondylitis and/or sacroiliitis in both ulcerative colitis and Crohn's disease. In contrast, none of the 29 IBD patients with "enteropathic" peripheral arthropathy had B27 antigen. Furthermore, ankylosing spondylitis was found more frequently in ulcerative colitis bearing HLA-B27 compared with non-B27 patients (P less than 0-01). The same was found in Crohn's disease, although this difference was not statistically significant. In addition, 12 of 14 ulcerative colitis patients and five out of six Crohn's patients with HLA-B27 had total colitis, compared with the frequency of total colitis in non-B27 patients (P less than 0-024 and less than 0-03 respectively). The data suggest that B27 histocompatibility antigen could be a pathogenetic discriminator between the arthropathies in IBD and may be of prognostic significance with respect to extension and severity of the disease.

Arthritis↗
PubMed1976

Coeliac disease, gluten-free diet, and malignancy.

Two hundred and two patients with coeliac disease or idiopathic steatorrhoea previously reported from this unit have been reviewed after a further 10 years of follow-up. Of 20 more deaths, 10 were due to malignancy. A separate study was made of all patients with histologically confirmed coeliac disease seen to the end of 1972 and followed up to the end of 1974. Twenty-one of the 43 deaths in this series were due to malignant tumours, of which 13 were reticulum cell sarcomas. There was no evidence that patients showing sub-optimal clinical response to gluten withdrawal or persisting falt jejunal biopsies were more prone to die of cancer. A gluten-free diet did not appear to be effective in preventing malignant complications, but a longer follow-up of patients will be necessary to provide a final answer to this question.

Adult↗
PubMed1976

Anticonnective tissue and other antitissue 'antibodies' in the sera of patients with coeliac disease compared with the findings in a mixed hospital population.

Serum IgG specificities directed against various components of basement membrane and reticulin have been described, and their incidence in 138 patients with coeliac disease has been compared with that in 110 hospital inpatients, 100 normal blood donors, and 1441 other patients. A wide variety of antitissue specificities were observed but only a few appeared to be of any significance. The 'antireticulin' specificities have been subdivided into different groups according to their distinctive histological staining patterns. Specificity directed primarily against endothelial basement membrane was found most frequently in the sera of patients with hiatus hernia (35%) or coeliac disease (22%). The same specificity was also observed in patients with myasthenia gravis and to a lesser extent in Crohn's disease and in a mixed group of patients with unspecified organic gastrointestinal disease. An epithelial basement membrane reactivity was found in patients with rheumatoid arthritis but only rarely in other conditions. Staining of perivascular connective tissue represented a third type of 'antireticulin' specificity. It was found only rarely, although in coeliac disease this reactivity was found more frequently in combination with other connective tissue specificities.

Adult↗
PubMed1976

Serum lysozyme in inflammatory bowel and coeliac disease.

Serum lysozyme levels were determined by a turbidometric method using egg white lysozyme as standard in 100 patients with Crohn's disease, 86 with ulcerative colitis, 31 with coeliac disease, and in 38 normal control subjects. Though the levels in Crohn's disease were significantly higher than those in ulcerative colitis and in coeliac disease, there was marked overlap between the disorders and control subjects, and so they were of no value in differential diagnosis. There was some evidence that serum lysozyme levels reflected disease activity in Crohn's disease but not in ulcerative colitis.

Celiac Disease↗
PubMed1976

Malignancy in relatives of patients with coeliac disease.

A survey of 1329 relatives of 139 patients with coeliac disease demonstrated an overall increase of cancer deaths particularly in women, but this did not quite reach 5 percent significance in men. Evidence is insufficient to determine whether this was due to the occurrence of cancer in relatives with undetected coeliac disease or to the operation of independent factors.

Adolescent↗
PubMed1976

Familial aspects of coeliac disease.

The incidence of coeliac disease amongst first-degree relatives of 115 patients with coeliac disease aged between nine and 75 years has been studied. Of 689 relatives 526 were living of whom 324 were willing to be investigated. One hundred and eighty-two relatives underwent jujunal biopsy. Forty-one were considered to have coeliac disease, 22 per cent of those biopsied, or 11-2 per cent of the available relatives. One-third of the relatives discovered to have coeliac disease were asymptomatic but all had at least one abnormal result amongst the laboratory indices used. Twenty-two per cent of the relatives with haemoglobin less than 13-0 g, 43 per cent with serum folate less than 3-0 pg/ml, 24 per cent with serum albumin less than 4-0 g/100 ml, with serum iron less than 60 mug/100 ml or with serum alkaline phosphatase above 13 K.A. units had coeliac disease. Less than 5 per cent of relatives with H.L.A. antigens other than H.L.A. 8 had coeliac disease compared with one in four of those with H.L.A. 8. The high percentage of relatives with H.L.A. 8 antigens or with anticonnective tissue antibodies, amongst those with non-specific biopsy appearances suggests that these groups also contain a number of relatives with varying degrees of gluten intolerance.

Adolescent↗
PubMed1976

Fibrogenesis imperfecta ossium.

The case history, clinical course and laboratory findings in a 66-year-old woman with fibrogenesis imperfecta ossium are reported, the sixth case in the literature. The condition is characterized clinically by intractable skeletal pain and progressive immobility. Though serum alkaline phosphatase has been raised in all patients, there are no specific haematological or biochemical findings. The radiological features of coarse and dense trabecular pattern with symmetrical and diffuse involvement of all bones without expansion or change of shape, together with periosteal reactions and soft tissue calcification are characteristic. The macroscopic appearance of bone shows large areas of opaque white and brittle trabeculae. The histological findings mimic those of osteomalacia unless examined under polarized light which shows the loss of normal birefringence. On electron microscopy the normal lamellar pattern made up of orientated collagen fibrils all about 80 nm diameter is replaced by a random tangled pattern of much thinner irregularly curved fibrils, some as thin as 5nm. The condition appears to be acquired, leading to erosion of the normal skeleton and replacement with an abnormal fibre deficient matrix. There is no definitive therapy at present.

Aged↗
PubMed1976

Cell-mediated immunity to gluten fraction III in adult coeliac disease.

Peripheral blood lymphocytes were obtained from twenty-seven healthy control subjects, twenty-one coeliac patients on a gluten-free diet and fourteen patients on a normal diet. When the cells were cultured in vitro in the presence of 2 and 4 mg of gluten fraction III, there were significant increases in the mean ratios of response for lymphocytes from gluten-free coeliacs compared to healthy controls after 4, 5 and 6 days of culture, but for those on a normal diet significant increases were found only when using 4 mg of gluten on the 4th and 5th days of culture. When three further patients were changed from a normal to a gluten-free diet, the ratios of response for their lymphocytes increased. The results suggest that certain coeliacs may exhibit a weak delayed hypersensitivity reaction to gluten. Its more ready demonstration in patients on a gluten-free diet could be explained on the release of sensitized lymphocytes from the intestinal mucosa into the peripheral circulation after gluten withdrawal.

Antigens↗
PubMed1975

Preparation of the bowel by whole-gut irrigation.

Experience with whole-gut irrigation as a method of bowel preparation in eightyone patients is described. The mean (+/-S.D.) weight-gain during irrigation was 1-9 +/- 0-8 kg; potassium losses in the effluent after one hour (4-0 +/- 2-5 g) were not significantly altered by adding potassium chloride to the irrigant. Eight irrigations were unsatisfactory, three being due to unrecognised obstructive neoplasms. The method provided excellent preparation for colonoscopy and large-bowel resection with anastomosis and was well tolerated by the patients.

Aged↗
PubMed1975

Changes in the bidirectional sodium flux across the intestinal mucosa in Crohn's disease.

Bidirectional sodium flux across the intestinal mucosa was measured in a group of 10 patients with Crohn's disease treated in the past by panproctocolectomy with ileostomy and compared with a similarly treated group of 11 patients with ulcerative colitis. All of them were in good health at the time of the study and a recent radiological examination of the small intestine was normal. A significant reduction in bidirectional sodium flux was found in those patients with Crohn's disease and suggests that the intestinal mucosa is involved to a greater extent than can be judged by radiological appearances alone. This adds weight to the concept that Crohn's diseases is a diffuse rather than a focal lesion of the gastrointestinal tract.

Colitis, Ulcerative↗
PubMed1975

A study of the cellular infiltrate of the proximal jejunal mucosa in ulcerative colitis and Crohn's disease.

The cellular infiltrate of the proximal jejunum has been compared between 20 subjects without gastrointestinal disease, 20 subjects with ulcerative colitis, and 26 subjects with Crohn's disease. A significant increase (P smaller than 0.001) in the plasma cell infiltrate was noted in subjects with ulcerative colitis and a more marked increase in subjects with Crohn's disease (P smaller than 0.001). Such increases may be relevant to raised serum IgA levels following panproctocolectomy for ulcerative colitis or recurrence in the small intestine in Crohn's disease.

Biopsy↗