A case of progressive dysphagia.
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Deglutition Disorders↗
Biomedical subjects
B Warren
Publications and source records attributed to B Warren.
Optimal total mesorectal excision for rectal cancer is by dissection in front of Denonvilliers' fascia (Br J Surg 2004; 91: 121-123).
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Dissection↗
Functional correlates of the interleukin-1 receptor antagonist gene polymorphism in the colonic mucosa in ulcerative colitis.
Association studies have identified the interleukin-1 receptor antagonist gene allele 2(IL-1RN*2) as a marker of susceptibility in ulcerative colitis (UC). This study investigated the significance of the IL-1RN genotype with respect to protein and mRNA expression in the colonic mucosa. Homogenates of rectal biopsies from 99 UC and 54 controls were assayed for cytokines IL-1ra, IL-1a and IL-1b using ELISA. IL1RN, IL1A and IL1B genotypes were determined using restriction-enzyme analysis. The ability of the two IL1RN alleles to generate steady-state mRNA accumulation was assessed in the colonic mucosa of seven heterozygous patients. Stepwise linear regression demonstrated that IL-1RN genotype (P=0.001), diagnosis (P<0.0001) and treatment (P<0.03) were independent factors associated with the IL-1ra protein level whilst IL1RN genotype (P=0.005) and macroscopic inflammatory grade (P<0.0001) were associated with the IL-1ra/ total IL-1 ratio. The IL1RN*2 correlated with reduced IL-1ra and IL-1ra/IL-1 ratio with a gene dosage effect. In heterozygous UC patients the ratio of allele 1 mRNA / allele 2 steady state mRNA was always greater than 1 (range: 1.2-3.1) (P=0.018). The IL-1RN*2 is associated with reduced levels of IL-1ra protein and IL-1RN mRNA in the colonic mucosa, providing a biologically plausible explanation for the observed association of the allele with the disease.
3' Untranslated Regions↗
How could pathologists improve the initial diagnosis of colitis? Evidence from an international workshop.
BACKGROUND: The taking of multiple colorectal biopsies is in widespread use although there is little research into their benefit for the pathological diagnosis of inflammatory bowel disease. There is also still debate about appropriate morphological criteria for interpreting these biopsies. AIMS: To determine the effect of single versus multiple biopsies on the accuracy of diagnosis and to study the accuracy and reproducibility of the different criteria used in the diagnosis of multiple biopsies by expert and non-expert pathologists. METHOD: Thirteen expert and 12 non-expert international diagnostic histopathologists attended a workshop. Sixty cases with full follow up were viewed, blinded, in two rounds. Diagnoses were made on rectal biopsies and then full colonoscopic series. RESULTS: Experts correctly identified 24% of Crohn's disease cases (non-experts, 12%) from the rectal biopsies. This improved to 64% (non-experts, 60%) with the full series. The accuracy of the diagnosis of ulcerative colitis also improved slightly with the full series from 64% to 74% overall. Experts had a similar (moderate) level of agreement and accuracy to non-experts. For Crohn's disease, the likelihood ratios (LR) for the most important individual features were 12.4 for granulomas and 3.3 for focal or patchy inflammation. Features favouring ulcerative colitis were diffuse crypt architectural irregularity (LR, 3.4), general crypt epithelial polymorphs (LR, 3.7), and reduced crypt numbers (LR, 2.9). CONCLUSIONS: A full colonoscopic series gave more accurate diagnosis than a rectal biopsy. Accurate pathologists used the same evidence based criteria for multiple biopsies as for single biopsies.
Biopsy↗
The personal construction of death in anorexia nervosa.
This paper reports a study concerned with an attempt to understand the manner in which individuals at high objective risk of death through their own behaviour, understand the phenomenon of death, and their own death. It is an extension of an earlier empirical study (Warren et al., 1994) which in turn, set out to test a hypothesis advanced by Jackson and Davidson (1986) that disturbed death ideation was aetiologically significant in anorexia nervosa; and an extension of earlier work on death constructions, and death education (Warren, 1984, 1989). Constructs were elicited from a sample of hospitalized sufferers of anorexia nervosa. These participants also completed the provided construct, Death Threat Index. Repertory grids were analysed for the information they yield concerning death constructions in sufferers of anorexia nervosa. Various quantitative measures were also derived and compared with similar measures from a control group.
Adolescent↗
Diversion colitis--new light through old windows.
Diversion proctocolitis is an iatrogenic disorder caused by surgical diversion of the faecal stream away from the colorectal mucosa. Such surgery may be necessary in cases of tumour, trauma or inflammatory conditions of the colorectum. Histopathological change is characterized by a chronic lymphoplasmacytic inflammatory infiltrate, and the hallmark feature, lymphoid follicular hyperplasia. Histological appearances are determined by the disease state of the colonic mucosa prior to faecal diversion. Macroscopic appearances may vary considerably, but often include aphthoid ulceration. The exact pathogenesis of the condition remains unclear, but the removal of short-chain fatty acids, present in the faecal stream, is considered an important aetiological factor. Current research areas, including the microbiology and cellular kinetics of diversion colitis, are discussed along with clinical features and treatments.
Bacteria↗
Death themes in anorexia nervosa: dimensions for a reply to Jackson et al.
OBJECTIVE: To provide a critical, theoretical response to some ideas argued initially by Jackson and Davidson (Int J Eat Dis, 5, 821-835, 1986). Those ideas developed an understanding of anorexia nervosa in terms of disturbed death ideation and the notion of the anorexia nervosa sufferer as a "survivor." This paper was intended to broaden the frame of reference for a consideration of the relationship between eating disorders and death ideation. METHOD: The approach is a reflection on three domains of thinking about death and destructiveness, two within psychology, the third a perspective provided by philosophy. Specifically, early post-Freudian work, personal construct psychology, and the philosophical tradition that makes death generally significant in human life, that is, Existentialism, are discussed in terms of their illumination of the ideas under review. RESULTS: The result is a series of speculative observations that constitute an argument that these three domains together provide a strong countercritical position to the idea of a universal, even a general significance of death, particularly etiologically, in anorexia nervosa. DISCUSSION: The discussion suggests that the particular significance of death ideation in a multidimensional condition like anorexia nervosa must be derived in each particular case where it will sometimes be more, sometimes less significant, and, importantly, will mean something different to each individual sufferer.
Anorexia Nervosa↗
Effect of carbohydrate substrate availability on ratings of perceived exertion during prolonged running.
The purpose of this study was to investigate the effects of carbohydrate substrate availability on ratings of perceived exertion (RPE) during prolonged submaximal running. Thirty marathon runners were recruited as subjects. A double-blind study design was used in which subjects performed an experimental trial that consisted of a 2.5-hr treadmill run at 75-80% VO2max. During the experimental trial, the subjects in the carbohydrate feeding group ingested a 6% glucose and fructose solution at a rate of approximately 60 g.hr, whereas subjects in the placebo group consumed an equal volume of artificially flavored placebo. Statistical analysis of RPE, respiratory exchange ratio, fat and carbohydrate oxidation rate, and blood glucose concentrations indicated that increased carbohydrate substrate availability attenuated the intensity of exertional perceptions during the later stages of prolonged running at 75-80% VO2max in marathon runners.
Adult↗
Complications and effectiveness of gastrostomy feedings in pediatric cancer patients.
PURPOSE: The objective of this study was to assess the complications and efficacy of gastrostomy (GT) feedings in pediatric cancer patients. PATIENTS AND METHODS: We reviewed the medical records of 33 pediatric cancer patients who received enteral nutrition via a GT. RESULTS: Median age was 9.4 years (range, 1-19.8 years), and 28 of the 33 patients had solid tumors. Seventeen patients had a significant weight loss (median, 8.5%) and therapy-related weight loss was anticipated in 16 patients. The GT device was placed an average of 5.5 months after diagnosis. Twenty-five patients were fed via a tube and eight via a button device. The tube was placed surgically in 21 cases (including all eight button types) and endoscopically in 12. Nutritional support lasted a median of 9.5 months. One or more complications occurred in 30 patients and were categorized as (a) insertion site reactions (inflammation, 23; infection/colonization, 14; exuberant granulation tissue, 6); (b) mechanical problems (leaking, 3; obstruction, 2; breakage, 1; accidental dislodgement, 2); (c) insertion site bleeding, 8; and (d) feeding intolerance, 12. Only one insertion site cellulitis progressed to a systemic infection. All eight patients with a button GT experienced insertion site complications, with local infection occurring significantly more often in patients with the button than in those with the tube GT. There were no significant associations between insertion technique and type of complication. Twenty-seven patients (82%) achieved or maintained ideal body weight with this intervention. CONCLUSIONS: GT feeding was associated with minor complications, but permitted effective nutritional support for pediatric cancer patients.
Adolescent↗
Pigbel-like syndrome in a vegetarian in Oxford.
Enterocolitis necroticans or pigbel is a rare condition characteristically affecting chronically malnourished people who abruptly increase their intake of protein. The classic presentation of the disease as seen in the highlands of Papua New Guinea is that of a necrotising enterocolitis after the ritual ingestion of contaminated pork. In this context, the presentation of the same disease in a well nourished white vegetarian in Oxford was all the more intriguing.
Adult↗
Heart rate response during handball singles match-play and selected physical fitness components of experienced male handball players.
Limited information is available concerning the exercise response during handball (HB) singles match-play. Also, few studies exist that have examined VO2 peak and body composition of HB players. The purpose of this study was to examine the heart rate (HR) response during match play and peak physiologic responses and relative fat in twelve experienced HB players. Peak physiologic responses were measured during treadmill running and body composition was assessed via hydrodensiotometry. During HB match-play, HR was measured and stored every five seconds using a Polar Vantage XL heart watch. Physical characteristics and peak physiologic responses included the following: Age (yrs) 47.2; BW (kg) 78.0; height (cm) 178.9; % fat 18.9; VO2 peak (ml.kg-1.min-1) 48.0; RER peak 1.03; HR peak (bpm) 183.1 and lactic acid peak (mmol.l-1) 10.3. During HB match-play, HR averaged 85% of peak during one hour of play. Moreover, 67% of match-play time, HR was > 80% of peak. When HR responses were examined over one hour of match-play (twelve, five minute blocks) only the first five minutes were significantly different (lower) than the other 55 minutes. The exercise intensity and the relatively stable HR response observed during HB suggests that this activity appears to be appropriate for meeting the American College of Sports Medicine guidelines to develop and maintain cardiorespiratory fitness.
Adult↗
Stapled ileal pouch-anal anastomosis with resection of the anal transition zone.
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Anal Canal↗
Expression of mucin genes in ulcerative colitis.
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Amino Acids↗
Guidelines for the optimal management of chemotherapy-induced nausea and vomiting: a consensus.
Nausea and vomiting are the most frequently reported adverse effects of cancer chemotherapy and have a significant impact on patients' daily functioning, quality of life and compliance with chemotherapy. Summarized in this article are the recommendations for the optimal management of nausea and vomiting developed by a multidisciplinary group of health care professionals. Issues relating to chemotherapy-induced nausea and vomiting are discussed; general principles of treatment are reviewed; treatment algorithms based on emetogenicity and types of chemotherapy are presented; and the importance of issues including non-pharmacological approaches, patient education and pharmacoeconomic perspectives are considered. The goal of antiemetic therapy should be no episodes of vomiting or retching and minimal or no nausea. Data from clinical trials support the clear superiority of 5-HT3 receptor antagonists in a variety of clinical situations. Their cost must be considered not only as an isolated item from the institutional perspective, but also from the perspective of the impact of successful therapy on the patient.
Algorithms↗
Comparison of a simulated 16.1-km time trial, VO2max and related factors in cyclists with different ventilatory thresholds.
Differences in cycling performance have been observed in cyclists with similar VO2max values yet different lactate thresholds. The purpose of the current study was to compare a simulated 16.1-km cycling time trial, VO2max and related factors in cyclists who significantly varied in ventilatory threshold. From an original group of 18 category III or IV cyclists, two groups of 6 cyclists were formed based on ventilatory threshold values as high (77 +/- 4% of VO2max-Group H) or low (68 +/- 2.8% - Group L). VO2max and a 16.1-km time trial were completed on a Velodyne trainer. No significant difference (p > or = 0.05) was noted between groups in VO2max (Group H 4.00 +/- 0.281.min-1, Group L 4.15 +/- 0.671.min-1), however significant differences (p < or = 0.05) were found in ventilatory threshold and time trial scores. Group H completed the time trial in 16.29 +/- 2.08 min while Group L averaged 20.93 +/- 3.03 min. Group H completed the time trial 28% more quickly by working at a significantly higher percentage of VO2max, a higher power output and a faster pedal rate than Group L. From a battery of physiologic and body composition parameters, the ventilatory threshold expressed as VO2 (l.min-1) was the best predictor (r = -0.76) of time trial performance in the 12 cyclists. The findings of this study indicate that the ventilatory threshold was superior to VO2max in discerning performance differences in a 16.1-km cycling time trial, and was the best predictor of the simulated time trial performance.
Adult↗
Illiteracy among Medicaid recipients and its relationship to health care costs.
Poor literacy is associated with poor health status, but whether illiteracy is also linked to higher medical care costs is unclear. We characterized the literacy skills of 402 randomly selected adult Medicaid enrollees to determine if there was an association between literacy skills and health care costs. Each subject's literacy skills were measured with a bilingual (English/Spanish) reading-assessment instrument. We also reviewed each subject's health care costs over the same one-year period. The mean reading level of this Medicaid population was at grade 5.6. Mean annual health care costs were $4,574 per person. There was no significant relationship between literacy and health care costs. While there are compelling reasons to improve poor reading skills among Medicaid enrollees, illiteracy in this population does not appear to contribute to the high cost of providing government-sponsored care.
Adolescent↗
Association of protein kinase C activation with induction of ornithine decarboxylase in murine but not human keratinocyte cultures.
The goal of this study was to compare the response of mouse epidermal keratinocytes (MEKs) and human epidermal keratinocytes (HEKs) to 12-O-tetradecanoylphorbol-13-acetate (TPA) with respect to the activation and downregulation of protein kinase C (PKC), the expression of c-jun and c-fos, and the expression and induction of ornithine decarboxylase (ODC) activity. Keratinocytes from adult CD-1 mice and from discarded adult human skin were grown in primary culture in a high-calcium serum-free medium that supported proliferation and differentiation. Immunoblotting of freshly isolated and cultured MEKs and HEKs for isozymes of protein kinase C revealed that fresh HEKs contained PKC alpha, PKC beta, and PKC delta; no PKC gamma, PKC epsilon, or PKC zeta were detected. In fresh MEKs, PKC alpha, PKC beta, PKC delta, and PKC zeta were observed, but not PKC gamma or PKC epsilon. After 2 wk in culture, the isozyme profiles of MEKs and HEKs were similar except that PKC gamma was noticeably present in HEK cultures. Activation of partially purified total PKC by TPA was similar in freshly isolated and cultured MEKs and HEKs, indicating that the two species were similar in this regard and that 2 wk of culture did not alter this characteristic. When MEK and HEK cultures were treated with TPA for 3 h, less than 30% of the control level of PKC activity was detected, indicating that TPA-induced downregulation of PKC was similar in MEKs and HEKs. After treatment with TPA, MEK cultures produced a large induction of both c-jun and c-fos mRNA by 60 min, as determined by northern blot analysis, and a large induction of ODC mRNA and enzyme activity by 6 h. TPA treatment of cultured HEKs, however, did not induce ODC activity; in fact, less activity, compared with that of control cultures, was observed. Northern blot analysis also revealed no increase in c-jun, c-fos, and ODC mRNA in HEKs. However, c-jun and c-fos mRNA and both ODC mRNA and enzyme activity were induced in HEKs fed growth factors after several days of deprivation. This suggests that the lack of ODC induction by TPA in HEKs is probably due to species differences in downstream steps in PKC signal transduction.
Adult↗
Helicobacter pylori infection in elderly people: correlation between histology and serology.
A hundred elderly dyspeptic patients were studied to assess the prevalence of Helicobacter pylori infection and the correlation between histological and serological findings. Eighty-one per cent of the patients with gastritis and 63% with gastric ulcer were H. pylori positive. All patients who had H. pylori negative gastritis and gastric ulcers were on nonsteroidal anti-inflammatory drugs (NSAIDs). There were 24 patients who had evidence of H. pylori infection and were on NSAIDs. H. pylori positive patients had more dyspeptic symptoms in comparison with those who were H. pylori negative. In patients who were taking NSAIDs, the presence of severe active gastritis seemed to correlate with the presence of H. pylori but not with the use of NSAIDs. Serology had a sensitivity of 90% and a specificity of 93% with a negative predictive value of 86%. There was a significant correlation between IgG titre and the degree of inflammation and H. pylori infection. We conclude that H. pylori gastritis is the commonest histopathological finding in elderly dyspeptic patients. H. pylori infection may be an important risk factor in elderly patients who take NSAIDs, increasing their risk of gastric ulcer. H. pylori serology in elderly people has a high sensitivity and specificity comparable with those in young age groups.
Aged↗