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Biomedical subjects

A W McKinlay

Publications and source records attributed to A W McKinlay.

13 recordsLinked to original sources
PubMed2004

Nutritional support in patients with advanced cancer: permission to fall out?

Data from the European Society for Parenteral and Enteral Nutrition Home Artificial Nutrition Survey suggest that the use of home parenteral nutrition (HPN) in patients with cancer as the primary diagnosis varies markedly between different countries in Europe, being highest in The Netherlands and low in the UK. This finding is difficult to explain on the basis of cancer incidence. The main indication for HPN remains malignant gastrointestinal tract obstruction, which occurs most frequently in gynaecological and colon cancers. The use of HPN should be planned in the light of the proposed cancer treatment and should be discussed beforehand with the patient. Before HPN is considered, a patient should typically require intravenous fluids to maintain hydration, be capable of self care, be able to control the treatment, have an expected survival of > or = 3 months and have no other available route of feeding. The effect of HPN on quality of life remains controversial, but nutrition is only one of the factors that influence the quality of life in cancer patients. The differing rates of HPN in Europe are probably related to cultural attitudes to incurable cancer as much as to meeting the nutritional needs of the patient.

Cachexia↗
PubMed1993

Opsonic requirements of Helicobacter pylori.

The opsonic requirements of Helicobacter pylori were investigated in a series of experiments with human polymorphonuclear leucocytes (PMNL). Pre-incubation of H. pylori with pooled normal human serum (NHS) in concentrations of 5-20% significantly increased the uptake of radiolabelled bacteria by PMNL. Treatment of the bacteria with NHS 30% caused the release of radiolabel and this effect was abolished by heating serum to 56 degrees C, suggesting that H. pylori is serum-sensitive and that complement is involved. Opsonisation of H. pylori with NHS concentrations of 10-30% significantly increased PMNL chemiluminescence. Removal of specific antibody had no effect. Removal of either the classical or alternative complement pathways produced no significant change in PMNL chemiluminescence, indicating that either pathway is sufficient for opsonisation on its own. The results confirm that complement is the most efficient opsonin for H. pylori.

Analysis of Variance↗
PubMed1990

Iron deficiency anaemia in patients with rheumatic disease receiving non-steroidal anti-inflammatory drugs: the role of upper gastrointestinal lesions.

Upper gastrointestinal lesions associated with non-steroidal anti-inflammatory drug (NSAID) treatment are commonly implicated as the cause for iron deficiency anaemia in patients with rheumatic diseases. Such patients, however, may also have other causes for iron deficiency, including blood loss from the intestine. One hundred and four patients (mean age 58 years; male 21, female 83; smokers 14) with rheumatic disease (rheumatoid 91, others 13) and absent bone marrow iron stores (mean haemoglobin 83 g/l) were examined. At endoscopy 47 of 104 (45%) had upper gastrointestinal lesions (oesophageal ulcer 4, gastric ulcer 25, gastric erosion 13, duodenal ulcer 4, gastric ulcer and duodenal ulcer 1). Endoscopic healing was assessed in 23 patients with upper gastrointestinal lesions. Eighteen of 23 (78%) lesions healed with treatment. An improvement of anaemia occurred in 10 of 18 (56%) patients with healed lesions. Twenty three of 104 (22%) patients had dyspeptic symptoms. Ten of 23 (43%) patients with dyspepsia had an upper gastrointestinal lesion as compared with 30 of 81 (37%) patients without dyspepsia. A faecal occult blood test result was available in 53 patients. Of these, 13 were positive while 40 were negative. An upper gastrointestinal lesion was present in seven of 13 (54%) patients positive for the faecal occult blood test as compared with 14 of 40 (35%) negative for the test. Thus upper gastrointestinal lesions have previously been overestimated as the cause of iron deficiency anaemia in patients receiving NSAIDs. A positive faecal occult blood test or the presence of dyspepsia is not associated with upper gastrointestinal lesions in such patients.

Adult↗
PubMed1990

Helicobacter pylori: bridging the credibility gap.

In summary, therefore, there are interesting associations between H pylori, duodenal ulcer, and non-ulcer dyspepsia. In type B gastritis there may be enough evidence to suggest a causal role. The relation between gastritis and upper gastrointestinal symptomatology, however, remains contentious. The relation between H pylori and acid secretion may be more intimate than was previously thought. 'Pylorites' must temper their enthusiasm and provide hard data; 'Schwartzians' must broaden their horizons.

Campylobacter Infections↗
PubMed1989

Campylobacter pylori and gastroduodenal disease. Is there a relationship?

Much has been discovered about Campylobacter pylori in the past 6 years. Yet, many questions remain: Is the organism commensal or is it a pathogen? What is its environmental source? How is it transmitted? What is its role in gastroduodenal disease? The authors of this article discuss these and other issues relating to this common organism.

Breath Tests↗
PubMed1987

The clinical and echocardiographic diagnosis of infective endocarditis.

We report the results of a series of 75 patients admitted to the East Birmingham Hospital between 1976 and 1984. Rheumatic heart disease is now an uncommon predisposing factor. The viridans streptococci are a decreasing cause of infection while staphylococcal infections are increasing and often occur on previously normal heart valves. The presenting symptoms of the disease are usually non-specific and the classical physical signs of endocarditis are uncommon. Blood culture and echocardiography are the most useful investigations in establishing the diagnosis. The diagnosis of endocarditis should be considered in all febrile patients, especially if they are ill, who have a cardiac murmur or persistent bacteraemia.

Aged↗
PubMed1985

Severe Chlamydia psittaci sepsis in pregnancy.

Two patients with severe chlamydial sepsis in pregnancy are described and compared with previously published case reports. The infections appear to have been zoonotic, the patients acquiring their infections as a result of exposure to enzootic abortion of ewes. This is an important but poorly recognised human infection which because of its severity in pregnancy deserves consideration in patients with an appropriate occupational history.

Adult↗
PubMedDate not supplied

Upper gastrointestinal bleeding in an open-access dedicated unit.

The open-access high dependency bleeding unit in Aberdeen admits all patients with suspected gastrointestinal bleeding from a stable adult population of 468,000. The aim is to reduce mortality, morbidity and hospital stay, and create a prospective whole community database. An agreed management protocol is based on prompt resuscitation and early diagnosis. From October 1991 to September 1993 there were 1,602 consecutive admissions with suspected upper or lower gastrointestinal haemorrhage. Bleeding was confirmed in 1,098 of 1,324 patients with presumed upper gastrointestinal haemorrhage, (117 bleeding episodes per 100,000 per year). The overall 30-day mortality was 3.9%, with all deaths attributable to significant concurrent illness. Mortality from peptic ulcer bleeding was 5.3%, with an operation rate of 17% and surgical mortality of 8%. Rapid diagnosis allowed 48% of 523 patients with trivial bleeds to be discharged after a median stay of 24 hours. Centralised expertise and equipment is the essence of the unit's success. The interests of patient care are better served, nursing skills are better developed and teaching opportunities better structured. The major improvement in clinical care, welcomed by hospital colleagues, management and general practitioners, makes the unit an indispensable part of acute medical provision.

Adult↗