Biomedical subjects
Publications and source records attributed to A M Dawson.
Severe hypoalbuminaemia developed in two patients on long-term dapsone treatment for dermatitis herpetiformis. The patients had been treated with dapsone for 3 and 11 years before the syndrome developed and both recovered completely when dapsone was withdrawn. Albumin-turnover studies revealed a great increase in intravascular albumin catabolism and a modest decrease in synthesis.
Twenty-eight patients, thought to have coeliac disease and on gluten free diets, were put on a normal diet to confirm their diagnoses. Nineteen had been diagnosed in adult life (ACD) and nine in childhood (CCD). Patients were assessed on jejunal, morphological, and symptomatic parameters. Eighteen patients with ACD relapsed within seven weeks. Nine patients with CCD relapsed at variable times but five took longer than seven weeks, the longest period beint 10 months. Seven patients had no symptoms despite morphological deterioration during challenge and one patient, with ACD, did not relapse and was HLA B8 negative. This patient with ACD had subtotal villous atrophy on two jejunal biopsies and later showed morphological improvement on a gluten free diet. There was no correlation between the relapse time and time spent on a gluten free diet.
Three patients with coincident coeliac disease and inflammatory bowel disease are described. In 2 patients with known coeliac disease the recurrence of diarrhoea was not due to dietary deviation but to an additional large bowel pathology.
Little is known about the factors controlling somatostatin secretion in man, and data are not available on the changes in circulating levels in various human physiological or pathophysiological states. This is mainly a consequence of the technical difficulties involved in measuring somatostatin in plasma. In the presence of plasma, binding of somatostatin tracer to antibody was consistently decreased by about 20%, and this could not be abolished by the addition of EDTA and aprotinin or by the use of specially prepared somatostatin-free plasma. Furthermore, in the presence of plasma, endogenous somatostatin does not dilute in parallel with synthetic cyclic somatostatin standard. We have, therefore, developed and validated a radioimmunoassay for somatostatin using prior extraction of the peptide onto leached silica glass. Tyrosine-II somatostatin was iodinated using lactoperoxidase and purified on ODS silica. This method is superior to iodination using chloramine-T with CMC cellulose purification, and gives a highly purified preparation with a shelf-life of at least eight weeks. Using this tracer and a specific antiserum, the limit of sensitivity of the assay was 10 pg/ml, with an intra-assay coefficient of variation of 12% (n = 16) and inter-assay coefficient of variation of 15% (n - 10). Parallelism has been demonstrated between standard synthetic cyclic somatostatin and all extracted plasma samples. The mean recovery of exogenous somatostatin from plasma was 78%. The fasting level of immunoreactive somatostatin at 0,900 hours in 40 normal subjects ranged from 17 to 81 pg/ml. Care is needed, however, when comparing these values with those obtained from other laboratories since standard preparations of somatostatin vary considerably in their immunopotency.
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51 patients with Crohn's disease who were in good health while taking azathiprine, 2 mg/kg body-weight/day, for at least six months were allocated either to a group in which azathioprine was continued or to one in which a control tablet was substituted. The trial lasted one year unless relapse recurred earlier. The cumulative probability of relapse was nil at six months and 5% (+/-5 S.D.) at a year among those on azathioprine, compared with 25% (+/-9 S.D.) at six months and 41% (+/-11 S.D.) at a year among those in the control group (P less than 0.01). 1 patient in whom azathioprine was continued died of pancytopenia in the fourth month of the trial. Azathioprine is potentially toxic but appears to reduce the relapse-rate in Crohn's disease.
Eighty-five outpatients with Crohn's disease who knew their diagnosis and that the disease was subject to relapse were interviewed. The personalities of the women as measured by the Eysenck personality questionnaire were similar to those of a control group, but the men were more neurotic and introverted. Most patients continued to live optimistic, useful lives; they felt well, continued to work, hoped that their disease would not deteriorate in the future, and often had an improved relationship with their spouse despite less frequent sexual intercourse. We found that the successful adaptation of patients to this chronic disease was more closely related to their personality than to the activity or extent of the disease.
Ewes were vaccinated two to three weeks prior to mating with a formalin-treated preparation of lamb rotavirus. The colostrum and milk produced by vaccinated ewes after the subsequent pregnancy were shown to contain significantly higher titres of antibody to the virus than did mammary secretions from non-vaccinates. The virus neutralising antibody activity was associated with IgG in both colostrum and milk. However, IgG concentrations in the mammary secretions of vaccinates and non-vaccinates did not differ. It is suggested that vaccination of the dam may be of value in protecting the suckled neonatal lamb against rotavirus infection.
Fifty ileostomy and 50 colostomy patients were questioned as to which foods upset their stoma function. Most patients had no problem in finding a suitable diet and 70 per cent would eat any food on occasions, although half the patients found that side effects with particular foods were a nuisance. Only a small range of foodstuffs seemed to produce symptoms in a significant proportion of patients. We feel that no particular foodstuff should be eliminated from a diet without an adequate trial as most patients are able to eat entirely normally.
Disturbance of ammonia metabolism is an important but not the only factor in the genesis of hepatic coma. In this review mechanisms controlling the concentration of ammonia in the blood other than disturbed liver function have been discussed. The key function of ammonia in the pyridine nucleotide cyde has been outlined and it is suggested that the function of this cycle in patients with liver disease would repay further study.
An intestinal perfusion technique has been used to study absorption of glucose from free glucose and the disacchairde maltose in a patient with congenital glucose-galactose malabsorption. Minimal absorption of glucose occurred from high luminal concentrations of either free glucose (100 mmole/liter) or maltose (50 mmole/liter). Glucose diffused into the intestinal lumen during perfusion of a 2 mmole/liter glucose solution. These observations offer no support for nutritionally important glucose absorption in congenital glucose-galactose malabsorption by either passive diffusion or via a "disaccharidase-related" transport system.
18 454 men and 5471 women attending a screening centre had serum-bilirubin concentrations measured. 2.0% of men and 0.6% of women had concentrations of 25 micronmol/1 (1-5 MG/DL) or above. Both sexes showed skewed distributions for bilirubin concentration, but analysis of the data showed no evidence of bimodality for either sex. This suggests that people who are now diagnosed as having Gilbert's disease may constitute upper end of the normal range rather than a disease state. The term "constitutional hyperbilirubinaemia" is preferable, and its use can be coupled with reassurance to the patient that the condition causes no symptoms.
Plasma androgen and gonadotrophin concentrations have been measured before and during treatment of 23 men with gluten enteropathy. Before treatment, there was marked rise in total plasma-testosterone, free testosterone concentration (as assessed by the free testosterone index), and plasma-luteinising-hormone concentration. In contrast, 5 alpha-dihydrotestosterone concentrations were lower than normal. All these abnormalities reverted towards normal with successful treatment of the jejunal mucosal lesion. These data are consistent with a reversible tissue resistance to circulating plasma-testosterone in men with gluten enteropathy and subtotal villous atrophy.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Salbutamol was administered intravenously to 14 patients in premature labour. Inhibition of uterine contractions occurred on 22 out of 23 occasions. The mean increase in maternal and fetal heart rate and blood pressure were within clinically acceptable limits but there were wide individual variations. The mean delay achieved when the intravenous regime was supplemented with oral salbutamol was greater than that achieved by intravenous salbutamol alone, but the difference was not statistically significant.