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Biomedical subjects

C L Corbett

Publications and source records attributed to C L Corbett.

13 recordsLinked to original sources
PubMed1989

Olsalazine or sulphasalazine in first attacks of ulcerative colitis? A double blind study.

Olsalazine (2 g/day) and sulphasalazine (3 g/day) were compared in a double blind three centre trial in 37 patients presenting with first attack of distal colitis. Sigmoidoscopic appearances, rectal biopsies, and symptom and stool diary records were used to assess benefit and adverse effects. Both groups showed a similar decrease in stool frequency (p less than 0.001). The proportion of unformed stools was also decreased, but to a lesser extent (p less than 0.05) in those taking olsalazine (78% v 55%; p less than 0.001) compared with those taking sulphasalazine (72% v 28%; p less than 0.001). There was a diminution in the proportion of stools containing blood in both groups (olsalazine: 61% v 22%; p less than 0.001/sulphasalazine: 67% v 37%; p less than 0.001). Sigmoidoscopic and histological appearances and clinical activity improved significantly and to a similar extent in both groups. Intolerance was encountered in two patients on olsalazine and four on sulphasalazine; intolerance to sulphasalazine being even higher (five of seven patients) in a preliminary study using a dose of sulphasalazine releasing the same amount of 5-aminosalicylic acid as 2 g olsalazine. Olsalazine was at least as effective as sulphasalazine in the treatment of new patients with distal colitis, and in a dose releasing an equivalent amount of 5-aminosalicylic acid was better tolerated.

Adult↗
PubMed1982

Forty years of diarrhoea in a patient with urticaria pigmentosa.

A patient with urticaria pigmentosa who gave a 40-year history of diarrhoea was found to have systemic mastocytosis with gut involvement. The radiological appearance of the gut in this disease, although not widely recognized, are specific and should be looked for carefully in patients with urticaria pigmentosa who complain of gastro-intestinal symptoms. Gastro-intestinal symptoms, due mainly to alterations in bowel motility or peptic ulceration, are said to occur in some 25-50% of cases of systemic mastocytosis (3, 6). These symptoms have usually been ascribed to generalized histamine release acting on the gut, although cases where mast cell infiltration of the bowel has occurred have also been reported (4, 5). In a review of the radiological features (2), increased gastric rugosity with or without evidence of peptic ulceration and nodular space-filling defects of the bowel mucosa were the most commonly found. Occasionally, diffuse thickening of the bowel wall was seen. It was concluded that these appearance were probably due to local release of vasoactive substances causing submucosal oedema following mast cell accumulation in the gut. Another result of such infiltration may be malabsorption (1).

Biopsy↗
PubMed1981

Urinary excretion of bile acids in cholestasis: evidence for renal tubular secretion in man.

1. The apparent renal clearance of intravenously injected [14C]glycocholate and [3H]chenodeoxycholate-3-sulphate was estimated in 22 patients with cholestasis. The degree of protein binding of the isotopes in serum from these patients was determined. The effects of pharmacological agents, changes in urine flow rate and pH on renal clearance was studied. 2. The mean renal clearance of [14C]glycocholate was 1 . 7 +/- 0 . 4 ml/min (mean +/- SEM), and that of [3H]chenodeoxycholate-3-sulphate was 6 . 4 +/- 0 . 9 ml/min. [14C]Glycocholate was 80 . 1% protein bound and [3H]chenodeoxycholate-3-sulphate 96 . 5% protein bound. 3. Comparisons of the observed clearance rates with those calculated on the basis of glomerular filtration of the unbound fraction suggest that whereas [14C]glycocholate is predominantly reabsorbed by the renal tubules, [3H]chenodeoxycholate-3-sulphate appears in the urine mainly as the result of tubular secretion. 4. Probenecid, ethacrynic acid, frusemide and bendrofluazide decreased the clearance of both bile acids, implying competition for secretion via the proximal tubular organic acid secretory pathway between these compounds and bile acids. 5. Passive non-ionic diffusion does not seem to be an important mechanism in the renal excretion of bile acids as changes in urine flow rate and pH did not influence bile acid clearance. 6. A greater affinity of the proximal tubular organic acid secretory pathway for sulphated than for non-sulphated bile acids may explain the higher observed renal clearance rate of sulphated bile acids.

Aged↗
PubMed1981

Electrochemical detector for breath hydrogen determination: measurement of small bowel transit time in normal subjects and patients with the irritable bowel syndrome.

A method is described for the measurement of hydrogen in expired air, using an electrochemical detector. The apparatus is simple to use and sensitive. Its application is illustrated by studies of small bowel transit time made by measuring the time between oral ingestion of the unabsorbable carbohydrate lactulose and a rise in the concentration of hydrogen in expired air. In 20 control subjects transit time was 93.0 +/- 6.6 minutes, while in 16 patients with diarrhoea due to the irritable bowel syndrome it was 54.1 +/- 6.3 minutes (P less than 0.001), suggesting an abnormality in small intestinal motility in these patients. Loperamide, a potent antidiarrhoeal agent, increased transit time in 12 of these patients from 56.3 +/- 6.7 to 100.0 +/- 10.2 minutes (P less than 0.001).

Adolescent↗
PubMed1980

Double-blind cross-over study comparing loperamide, codeine and diphenoxylate in the treatment of chronic diarrhea.

As no adequate comparison of these widely used drugs has been made, we have performed a double-blind cross-over trial in 30 individuals with chronic diarrhea. Each underwent three randomized treatment periods of 4 wk duration. Patients were instructed to increase the daily dose gradually until control was achieved or side effects became intolerable. Stool frequency, consistency, urgency, and incontinence were then compared when a stable dose was reached. Though 2.3 capsules (4.6 mg) of loperamide, 2.3 capsules (103.5 mg) of codeine and 2.5 capsulses (12.5 mg) of diphenoxylate all reduced stool frequency to the same extent, diphenoxylate was significantly less effective in producing a solid stool. Before treatment 95% of patients experienced urgency, sometimes associated with fecal incontinence, often as their major diability. Loperamide and codeine were more effective in relieving this than was diphenoxylate. Side effects, particularly central nervous effects, were greatest with diphenoxylate and least with loperamide. Approximately equal numbers discontinued each preparation; poor control and central-nervous-system side effects were the usual reasons for stopping diphenoxylate and codeine, and abdominal pain and constipation for stopping loperamide. We conclude that both loperamide and codeine phosphate are superior to diphenoxylate in the symptomatic treatment of chronic diarrhea.

Antidiarrheals↗
PubMed1979

The delayed appearance of an antinuclear factor and the diagnosis of systemic lupus erythematosus in glomerulonephritis.

In 11 patients who presented with apparently idiopathic glomerular disease the antinuclear factor (ANF) was absent initially but was eventually detected during observation extending over 6 years. In 4 patients a diagnosis of systemic lupus erythematosus (SLE) has now been made and the disease treated. Of the remaining 7, 2 had conditions known to be associated with a positive ANF, and in 4, drug therapy induced the ANF. Clinical features, complement studies and measurement of anti-DNA antibody were of value in distinguishing those patients with SLE from the others.

Adolescent↗
PubMed1977

Human intestinal ion transport in vitro.

The transport of sodium and chloride across human jejunal and ileal mucosa was studied using an in vitro technique. Specimens of mucosa removed at operation were stripped of muscle coats, mounted in specially designed Perspex flux chambers and bathed in warmed oxygenated and stirred buffer solutions. Evidence was obtained for the active transport of sodium in both jejunum and ileum and of chloride in the ileum. Sodium absorption was enhanced by glucose in both regions of the gut but net chloride transport was unaffected. Glucose had a greater effect on sodium transport in the ileum than the jejunum. The electrical potential difference and resistance was greater and undirectional ion fluxes smaller in jejunal than ileal mucosa. Many of these results with human intestine are similar to results reported with in vitro animal intestine. Apparent discrepancies between the behavior in vivo of human intestine and in vitro of animal intestine are thus likely to be due predominantly to technical rather species differences.

Biological Transport, Active↗
PubMed1977

Diaphragmatic flutter.

A case is reported of diaphragmatic flutter with an unusually long duration of symptoms. The patient described demonstrates many of the classical features of this disorder.

Adolescent↗
PubMed1976

In vitro behavior of human intestinal mucosa. The influence of acetyl choline on ion transport.

The possibility that the autonomic nervous system may influence the function of intestinal mucosa was investigated by assessing the effect of acetyl choline on ion transport in human intestine. Isolated pieces of stripped ileal mucosa were mounted in Perspex flux-chambers and bathed in isotonic glucose Ringer's solution. Acetyl choline caused a rise in mean potential difference (8.8-12.3 mV, P less than 0.002) and short circuit current (287.7-417.2 muA-cm-2, P less than 0.01) (n = 12), observable at a concentration of 0.01 mM and maximal at 0.1 mM. This effect was enhanced by neostigmine and blocked by atropine. Isotopic flux determinations revealed a change from a small mean net Cl absorption (58) to a net Cl secretion (-4.3mueq-cm-2-h-1P less than 0.001) due predominantly to an increase in the serosal to mucosal unidirectional flux of Cl (10.63-14.35 mueq-cm-2-h-1P less than 0.05) and a smaller reduction in the mucosal to serosal flux (11.22 to 10.02 mueq-cm-2-h-1P less than 0.05). Unidirectional and net Na transport was unaffected. A similar electrical and ion transport response was observed in a single study of two pieces of jejunal mucosa. In the absence of glucose net chloride secretion was produced and again an insignificant effect on net sodium transport was noted. Acetyl choline did not provoke a sustained effect on mucosal cyclic adenine nucleotide levels although a short-lived cyclic adenine nucleotide response was seen in some tissues 20-30 s after drug addition. These studies demonstrate that acetyl choline does influence human intestinal ion transport by stimulating chloride secretion and suggest a possible mechanism by which the parasympathetic nervous system could be concerned in the control of ion transport.

Acetylcholine↗