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Biomedical subjects

A M Hoare

Publications and source records attributed to A M Hoare.

At least 19 recordsLinked to original sources
PubMed1992

Improved maintenance of remission in ulcerative colitis by balsalazide 4 g/day compared with 2 g/day.

The efficacy of two doses of balsalazide for the maintenance of remission in patients with ulcerative colitis was compared in a double-blind multicentre trial. Sixty-five patients received a 2 g daily dose, and 68 a 4 g dose. The patient groups were similar at entry for sex, age, and disease distribution. Clinical assessment was carried out at 3-monthly intervals, with sigmoidoscopy, rectal biopsy, and blood tests on entry and at 26 and 52 weeks. Clinical relapse over twelve months was significantly less common on the 4 g dose (36%), than on the 2 g dose (55%), P less than 0.01. There were eight withdrawals on 2 g daily and 13 on 4 g daily, six and nine respectively being mainly due to gastrointestinal intolerance. It is concluded that balsalazide is a well-tolerated drug, and is effective for the maintenance of remission in patients with ulcerative colitis, the optimal dose being greater than 2 g daily.

Adult↗
PubMed1988

Does ulcerative colitis behave differently in the elderly?

The clinical course of all new patients with ulcerative colitis or indeterminate colitis aged 65 years or older diagnosed in one health district (population 274,000) between 1 January 1975 and 31 December 1984 has been compared with that of all new patients 55 years or younger diagnosed in the same period. Elderly patients were admitted more often in a first attack and were more likely to receive systemic steroids. No elderly patient required urgent surgery and no patient in either group died of ulcerative colitis or its complications. The mortality amongst elderly patients with ulcerative colitis was no greater than expected in a population of the same age. The prognosis for ulcerative colitis in elderly patients is the same as for younger patients.

Age Factors↗
PubMed1988

Sedation for endoscopy: midazolam or diazepam and pethidine?

One hundred patients received either diazepam given with pethidine, antagonized with naloxone, or midazolam alone in a double-blind randomized study of sedation for upper gastrointestinal endoscopy. Midazolam produced better amnesia for the procedure (P less than 0.0001) but diazepam and pethidine resulted in less retching during the procedure (P less than 0.01) and less sedation after the procedure, as judged by a simple performance test (P less than 0.02) and patient recall of results (P less than 0.02).

Adult↗
PubMed1988

Surveillance in ulcerative colitis: burdens and benefit.

A review of all patients with ulcerative colitis in one health district between 1975-84 revealed an incidence and prevalence of 7.1 and 84/100,000 population respectively. One hundred and ninety five new patients were diagnosed and 313 patients seen and followed up in the clinic for 1168 patient years. None of these patients died from colitis or a complication. On routine colonoscopy three cases had high grade dysplasia and two asymptomatic carcinomas (Duke's stage A and B). Eighty four patients were known to have ulcerative colitis, but were lost to follow up from the hospital clinic; the total time they were not under hospital surveillance was 315 patient years. At the end of the study these patients were contacted or clinical details obtained from their general practitioners. Five of these patients subsequently presented with symptomatic carcinomas (two Duke's B, one Duke's C and two with metastases); three of these five patients have died from their tumours. Of 48 patients thought to have only mild colitis on initial investigation 21 (43%) had substantial colitis (and two carcinomas) on colonoscopy after eight years of disease. Therefore, patients with apparently distal colitis should be followed in the clinic as well as those with known extensive colitis. For a surveillance programme in a district general hospital, eight patients per 100,000 population need to be seen weekly, 12 colonoscopies/100,000 population need to be carried out annually and the cost for each carcinoma detected is approximately 6015 pounds.

Adolescent↗
PubMed1987

Acute colitis in a district general hospital.

A review of all patients who had been admitted to hospital with acute ulcerative colitis in one health district between 1975 and 1984 showed that 96 had required 114 admissions with acute colitis: 42% (40) were admitted during their first attack, and 20% (19) required urgent surgery. A further nine patients underwent surgery after responding initially to intensive medical treatment that did not check the attack. There were no deaths from acute colitis. Thirteen patients underwent elective surgery for ulcerative colitis, and there were no deaths. The prognosis for acute colitis in district general hospitals has improved.

Colitis↗
PubMed1979

Cimetidine in bleeding peptic ulcer.

The effect of cimetidine on the risk of further bleeding shortly after acute gastrointestinal haemorrhage from peptic ulcer was investigated in a double-blind randomised trial. 34 patients were given cimetidine and 32 placebo, the two groups being matched for age, sex, and severity of haemorrhage. Further bleeding within a week of admission was detected clinically in 8 patients on cimetidine and 15 on placebo. Cimetidine had no effect on bleeding from duodenal ulcer, but only 2 of 14 patients with gastric ulcer treated with cimetidine bled again, compared with 10 of 19 patients on placebo. Cimetidine, therefore, may help to prevent haemorrhage from gastric ulcer but not duodenal ulcer.

Adult↗
PubMed1979

Comparison of brush cytology before or after biopsy for diagnosis of gastric carcinoma.

A randomized trial has compared the results of brush cytology before or after biopsy in patients with solitary gastric lesions. One hundred and eleven carcinomas were identified in 324 patients. False positive histological reports were recorded in 2 patients but there were no false positive cytology results. The cumulative accuracy of biopsy and cytology in patients with carcinoma was 97 per cent, which was significantly better than biopsy alone (83 per cent, P less than 0.001) or cytology alone (87 per cent, P less than 0.001). The cumulative results of brushing before biopsy were significantly better than results obtained by brushing after biopsy (P less than 0.05) and indicate that brush cytology should normally be performed before biopsy.

Biopsy↗
PubMed1979

Cimetidine effects on prolactin release and production.

The effect of cimetidine 1600 mg. daily for three months on prolactin and related hormones is reported. Basal prolactin levels rose slightly but not significantly. There was no change in basal thyroid and sex hormone levels nor in the prolactin, gonadotrophin or thyrotrophin responses to releasing hormone stimulation. Since intravenous cimetidine induces a transient hyperprolactinemia it appears that cimetidine may facilitate release of prolactin but has no effect on its synthesis.

Adult↗
PubMed1979

A study of the aetiology of gastritis following gastric surgery. I. Immunofluorescent studies of the gastric mucosa.

The gastritis which follows surgical trauma is probably not of autoimmune origin. Although identical with the gastritis of pernicious anaemia (PA) upon routine histological examination, immunofluorescent examination of post-operative gastritis differs in that IgA-containing plasma cells alone are found, in contrast to the predominantly IgG-containing plasma cells in PA.

Adult↗
PubMed1978

The reasons for failure of endoscopic retrograde cholangio-pancreatography in patients with jaundice.

The results of 100 attempts at endoscopic retrograde cholangio-pancreatography (ERCP) performed in patients with jaundice have been reviewed. The examination provided a diagnosis in 75% of cases. The reason for failure to cannulate the correct duct was obstruction at the lower end of the common bile duct in 15 patients and distortion of the duodenum in seven. There was no cause for the failure in only two patients. Even with a perfect technique it will not always be possible to obtain an endoscopic cholangiogram. However, as the commonest cause of failure is obstruction, transhepatic cholangiography should usually succeed when ERCP fails.

Adult↗
PubMed1978

Selection of patients for bile diversion surgery: use of bile acid measurement in fasting gastric aspirates.

Eighteen patients with dyspepsia and vomiting which followed surgery for peptic ulcer have completed a study to examine the role of diverting bile from the stomach by a Roux-en-Y procedure. Bile regurgitation and mild epigastric pain relieved by vomiting were abolished. Measurements of bile acids in the fasting gastric aspirate were useful in predicting the outcome of surgery; good results were obtained when initially there was reflex into the stomach of more than 120 mumol/hour of bile acids. A wider group of patients than those selected in previous series may benefit from this operation, as good results can be obtained in patients with dyspepsia relieved by alkali and without achlorhydria or gastritis. Endoscopy was repeated one year after Roux-en-Y operation. Erythema of the mucosa was improved, but gastritis did not improve.

Adult↗
PubMed1978

Measurement of bile acids in fasting gastric aspirates: an objective test for bile reflux after gastric surgery.

We measured the concentration of bile acids in gastric aspirates from patients who had had operations for peptic ulcer. Some patients were asymptomatic and some had postoperative symptoms of the type that have been attributed to duodenogastric reflux. Samples were obtained via a nasogastric tube when the patients were fasting, after food, after pentagastrin, and overnight. We related the concentration and amount of bile acid and the volume aspirated to the presence or absence of symptoms and compared the results with radiological and endoscopic assessments of duodenogastric reflux. The most useful index to discriminate between symptomatic and asymptomatic patients was the amount of bile reflux in half an hour's aspiration from the fasting stomach; this we have termed 'fasting bile reflux' (FBR) and expressed as mumol bile acids refluxing/hour. A figure greater than 120 mumol/h was present in 17 of 22 symptomatic patients and in all who complained of bile regurgitation or bile vomiting. The FBR was less than 120 mumol/h in all of 20 asymptomatic patients, although some of them had reflux detected radiologically and endoscopically.

Adult↗