Recommendations for pacing.
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Cardiac Pacing, Artificial↗
Biomedical subjects
A G Fraser
Publications and source records attributed to A G Fraser.
Antral vascular ectasia: the watermelon stomach.
Antral vascular ectasia (watermelon stomach) is an uncommon localised vascular abnormality which may cause occult gastrointestinal blood loss and iron deficiency anaemia. The endoscopic appearances are characteristic with well demarcated, often raised or nodular bright red streaks radiating from the pylorus back along the antrum. Endoscopic biopsies can be taken without risk of haemorrhage and may help distinguish this condition from gastritis. The aetiology remains obscure, but there is an association with achlorhydria, hypergastrinaemia, and cirrhosis of the liver. Four patients are described; two had antrectomy with long term control of their anaemia, and two were treated conservatively. The lesion may be diagnosed more frequently with more widespread recognition of the condition.
Aged↗
Effects of H2-receptor antagonists on blood alcohol levels.
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Absorption↗
Reversibility and benign recurrence of complete heart block in athletes.
In two patients, symptoms associated with complete heart block and physical training resolved with deconditioning. In one patient, symptoms recurred after resumption of training but she has remained well for 4 years without a pacemaker. This suggests that complete heart block induced by fitness is benign, even when symptomatic.
Adult↗
Short report: twenty-four-hour hyperpepsinogenaemia in Helicobacter pylori-positive subjects is abolished by eradication of the infection.
Twenty-four-hour plasma pepsinogen I and II concentrations were determined in 8 healthy subjects with antibody to Helicobacter pylori, before and after treatment with tripotassium dicitrato bismuthate, amoxycillin and metronidazole, Therapy was successful in the 5 subjects with active H. pylori infection. In these subjects, median integrated 24-h plasma pepsinogen I and II concentrations significantly decreased from 2288 and 357 micrograms.h/L before treatment, respectively, to 1811 and 171 micrograms.h/L at 4-6 weeks after treatment, and 1643 and 150 micrograms.h/L at 20-24 weeks. By contrast, in the 3 subjects without evidence of active H. pylori infection, pre-treatment plasma pepsinogen I and II concentrations were similar to values found in the H. pylori-infected subjects after successful therapy, and they did not change significantly in response to therapy. H. pylori infection is associated with reversible hyperpepsinogenaemia.
Adult↗
Short report: the effect of ranitidine on the post-prandial absorption of a low dose of alcohol.
Twenty healthy male subjects were studied twice using a double-blind, randomized placebo controlled, cross-over study design. Alcohol absorption (integrated 2-h plasma alcohol concentration, peak plasma alcohol concentration, and time to reach peak concentration) was measured after 8 daily doses of either placebo or 300 mg ranitidine. They were given alcohol, 0.15 g/kg of body weight by month after an evening meal. Compared with placebo, there was a trend towards higher integrated 2-h plasma alcohol concentrations (3.17 and 3.89 mg. h/dL, respectively, P = 0.07), and a statistically significant increase in mean peak plasma alcohol concentration after dosing with ranitidine (4.92 and 6.47 mg/dL, respectively, P = 0.05).
Adult↗
Comparison of one-day oral dosing with three bismuth compounds for the suppression of Helicobacter pylori assessed by the 13C-urea breath test.
Assessment of intragastric urease activity by the 13C-urea breath test was performed before and after one day of dosing with either De-Noltabs (tripotassium dicitrato bismuthate, one tablet 1 q.d.s.), Pepto-Bismol liquid (bismuth salicylate 30 ml q.d.s.), or Roter tablets (bismuth subnitrate, one tablet q.d.s.) in twelve Helicobacter pylori-positive patient volunteers. There was a significant decrease in the excess of 13CO2 after one day of dosing with each of the three bismuth compounds, but analysis of variance could detect no difference between the effects of the three compounds. Systemic absorption of bismuth following oral dosing with either Pepto-Bismol or Roter is minimal, yet both compounds have a suppressive effect on H. pylori similar to that of De-Noltab. This study suggests that the action of all three bismuth compounds is within the gastric lumen, and that systemic absorption of bismuth is not necessary for activity against H. pylori.
Adult↗
Ranitidine, cimetidine, famotidine have no effect on post-prandial absorption of ethanol 0.8 g/kg taken after an evening meal.
Forty-seven healthy male subjects were studied twice using a randomized, placebo-controlled design. Each subject took an 8-day course of two of the following four regimens; 300 mg ranitidine, 800 mg cimetidine, 40 mg famotidine or placebo (identical either to 300 mg ranitidine or 800 mg cimetidine). The systemic bioavailability of ethanol (integrated 6-h plasma ethanol concentration, peak plasma ethanol concentration, and the time to peak plasma ethanol concentration) was measured after the oral ingestion of 0.8 g of ethanol per kg body weight, given one hour after an evening meal on Day 8 of each regimen. There was no significant difference of integrated 6-h plasma ethanol concentration, peak ethanol concentration, or time to reach peak ethanol concentration after dosing with either ranitidine, cimetidine or famotidine or placebo.
Absorption↗
Duodenal perforation in primary systemic amyloidosis.
Spontaneous duodenal perforation in two patients with primary systemic amyloidosis associated with multiple myeloma is described. Bowel perforation is a rare and often fatal complication of amyloidosis, and duodenal perforation has not been previously described. Both patients survived the bowel perforation with conservative management. Bowel perforation should be suspected in patients with amyloidosis presenting with acute abdominal pain, and active non-surgical management can be associated with prolonged survival.
Aged↗
DNA fingerprints of Helicobacter pylori before and after treatment with omeprazole.
AIMS: To test whether a hypoacidic environment may potentially "stress" Helicobacter pylori DNA, encouraging the emergence of strain variation. METHODS: This hypothesis was tested by inducing prolonged hypoacidity with omeprazole, a potent antisecretory drug. The genomic DNA of H pylori was studied by electrophoretic separation of restriction endonuclease fragments followed by rRNA gene hybridisation in seven patients infected with H pylori before and after treatment with omeprazole 20-40 mg daily for six to eight weeks. DNA was isolated and purified using the guanidium thiocyanate reagent method. DNA samples were digested with Hae III, electrophoresed, vacublotted, and hybridised using a biotinylated cDNA probe prepared from 16S and 23S rRNA from H pylori NCTC 11638. Isolates were compared using their ribopatterns (DNA fingerprints). RESULTS: A total of 26 isolates were obtained; all DNA isolates were cut by Hae III, which was the enzyme that gave the best resolved hybridisation patterns for analysis. No two patients harboured the same strain. The isolates from two patients showed evidence of subtypic variation; one patient had two distinct strains and four patients had their own indistinguishable strains before and after treatment with omeprazole. For each patient, the paired ribopatterns of H pylori DNA were not affected by treatment with omeprazole for six to eight weeks. CONCLUSION: The H pylori genome is relatively stable when exposed to the conditions of prolonged hypoacidity that result from treatment with omeprazole.
DNA Fingerprinting↗
Acute myocardial infarction related to smoke inhalation and myocardial bridging.
A previously healthy 26 year old woman who was exposed to smoke during a house fire developed acute anterior myocardial infarction complicated by ventricular fibrillation. Subsequent left ventriculography confirmed anterior infarction, but coronary arteriography was normal apart from myocardial bridging over a segment of the left anterior descending artery. The development of acute myocardial infarction in this patient suggests that, in the presence of bridging, carbon monoxide inhalation may cause regional infarction.
Adult↗
Gastric epithelial cell proliferation and histological damage after hypertonic sodium chloride: the effect of variation in the strain of rat.
Two strains of rat, Sprague-Dawley and inbred Piebald Virol Glaxo pigmented (PVG) strain, were dosed orally with hypertonic sodium chloride at a dose of 0.25, 0.5, 1.0 or 1.33 g/kg. Gastric epithelial cell proliferation was compared 16 hours after a single dose. The rats were given intraperitoneal bromodeoxyuridine (20 mg/kg) 1 hour before sacrifice, and cells undergoing DNA synthesis (S-phase) were assessed using a monoclonal antibody to bromodeoxyuridine. The number of labelled cells per gastric gland was counted using video image analysis, assessing ten low-power fields (160-180 gastric glands) per rat. Tissue injury was graded for submucosal oedema, inflammation and necrosis; it was minimal after dosing with 0.25 and 0.5 g/kg of sodium chloride. The PVG rats were more susceptible to tissue injury after dosing with 1.0 or 1.33 g/kg of sodium chloride: submucosal oedema, 80% in the PVG and 10% in the Sprague-Dawley; inflammation, 70% compared with 10%; necrosis, 70% compared with 20%. The number of labelled cells per fundic gland increased with increasing dose concentration of sodium chloride and the response was similar for both strains of rat. Plasma gastrin concentration at the time of sacrifice was significantly higher in the PVG rat for the 0.5, 1.0 and 1.33 g/kg doses. These strain differences may be useful in the further evaluation of the mechanisms of sodium chloride-induced tissue damage and repair.
Animals↗
Surgery for Ebstein's anomaly: the clinical and echocardiographic evaluation of a new technique.
Ten consecutive patients (age range 4 to 44 years, mean 22) underwent surgical repair of Ebstein's anomaly by vertical plication of the right ventricle and reimplantation of the tricuspid valve leaflets. No patient died during or after operation. Intraoperative postbypass echocardiography documented a good result in nine patients but severe tricuspid regurgitation in one patient, who then underwent prosthetic valve replacement during a second period of cardiopulmonary bypass. Two of four patients who had had right ventricular papillary muscle dysfunction in the early postoperative period showed improved papillary muscle function with concomitant reduction of tricuspid regurgitation 6 months later. All patients were evaluated clinically and by echocardiography 2 to 23 months later. All patients showed clinical improvement, seven by one functional class and three by two classes. All were in sinus rhythm. The mean cardiothoracic ratio decreased by 6% (p less than 0.05). On bicycle ergometry performed in six patients, peak oxygen consumption exceeded 20 ml/kg per min in five. Tricuspid regurgitation diminished in eight patients (by three grades in two patients, by two grades in five and by one grade in one patient); it remained unchanged in two. Comparison of preoperative and postoperative pulsed Doppler flow velocities across the pulmonary valve showed an increase in the peak velocity of flow across the valve (mean 83 +/- 14 versus 97 +/- 11 cm/s, p less than 0.005) and a decrease in the time to peak velocity (mean 130 +/- 16 versus 91 +/- 23 ms, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Intestinal pseudoobstruction secondary to amyloidosis responsive to cisapride.
A case of chronic intestinal pseudoobstruction secondary to systemic amyloidosis in a patient with multiple myeloma is described. Gastrointestinal symptoms and indices of nutrition improved markedly after commencing treatment with cisapride, which may have been responsible for relatively prolonged survival compared with similar reported cases.
Amyloidosis↗
The effect of ranitidine, cimetidine or famotidine on low-dose post-prandial alcohol absorption.
Plasma alcohol concentration following oral ingestion of 0.3 g/kg of alcohol (ethyl alcohol), one hour after an evening meal, was measured in four groups of 12 healthy subjects. Each group had a control study and a repeat study after 7 days dosing with either placebo or an H2-receptor antagonist (300 mg ranitidine nocte, 800 mg cimetidine nocte, or 40 mg famotidine nocte). There was no significant difference between the control and post-dosing studies in the integrated 4-h plasma alcohol concentration, peak plasma alcohol concentration, or time to reach peak alcohol concentration. This study shows that post-prandial alcohol absorption after 0.3 g/kg of alcohol is not affected by ranitidine, cimetidine or famotidine.
Adult↗
Left ventricular outflow tract obstruction after mitral valve repair assessed with intraoperative echocardiography: noninterventional treatment.
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Aged↗
The Graham Steell murmur: eponymous serendipity?
On 7 March 1888 Dr Graham Steell addressed the Manchester Medical Society in the premises of the Literary and Philosophical Society in George Street, Manchester. He chose as his subject 'The auscultatory signs of mitral obstruction and regurgitation', and later that year published two papers on the same theme in the Manchester Medical Chronicle. In one he wrote: 'I wish to plead for the admission among the recognised auscultatory signs of disease of a murmur due to pulmonary regurgitation, such regurgitation occurring independently of disease or deformity of the valves, and as the result of long-continued excess of blood pressure in the pulmonary artery'. His observations were later confirmed by pathological correlation, and more cases were reported, notably by Paul White. The early diastolic murmur of pulmonary incompetence caused by pulmonary hypertension is now associated eponymously with Dr Graham Steell. We review the life and work of this physician and conclude that the original source of the observation, subsequently validated by modern techniques, was probably George Balfour of Edinburgh, and that Graham Steell was fortunate to have this physical sign attributed to him.
England↗
The spectrum of systemic candidiasis at Auckland Hospital.
Systemic candidiasis is uncommon. We reviewed our experience with this disease from the infectious disease unit, Auckland Hospital, between 1982 and 1988, because many of these patients are referred to us. We then selected 11 of them to highlight particular presentations, diagnostic or management issues. We included both compromised and noncompromised patients from medical and surgical services. Candida albicans was the most common cause, but we also saw patients infected with C glabrata, C parapsilosis, and C tropicalis and present them to exemplify their different clinical presentations. Demonstrable fungaemia is uncommon in patients with systemic candidiasis, serological techniques are both insensitive and nonspecific and patients are often too ill from underlying disease to allow for invasive diagnostic procedures. Thus diagnosis is often difficult. Parenteral amphotericin B with or without 5-fluorocytosine is still the main antifungal treatment. Triazole antifungals may change that in the future. Systemic candidiasis retains a high mortality: careful individualised management of patients may improve mortality and morbidity.
Adult↗