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Biomedical subjects

C S Neumann

Publications and source records attributed to C S Neumann.

12 recordsLinked to original sources
PubMed1998

Continuous treatment with omeprazole 20 mg daily for up to 6 years in Barrett's oesophagus.

BACKGROUND: Because of the malignant potential of Barrett's oesophagus, an aim of treatment is to cause the columnar epithelium to regress. A logical approach is to decrease acid reflux which is an important aetiological factor in Barrett's oesophagus. Treatment with omeprazole 20-80 mg over 1-3 years has yielded conflicting but largely disappointing results. AIM: To determine if treatment of Barrett's oesophagus with omeprazole 20 mg daily for up to 6 years can cause regression of the Barrett's epithelium. PATIENTS AND METHODS: Forty-seven patients with Barrett's oesophagus were treated in an open prospective study. Nine patients were treated for 2 years, 12 for 3 years, 10 for 4 years, eight for 5 years and eight for 6 years. Patients were endoscoped at 1-2-year intervals and endoscoped at the end of the treatment period. RESULTS: No significant shortening of the length of the Barrett's segment was seen during any treatment period, although omeprazole controlled reflux symptoms and was well tolerated. Macroscopic squamous islands appeared in 55% of patients, mostly in the first 2-3 years although in five patients they appeared later in treatment. CONCLUSION: Treatment of Barrett's oesophagus with omeprazole 20 mg daily for periods of up to 6 years did not cause regression in the length of the Barrett's segment, but it did lead in over half of the patients to partial re-epithelialization in the form of squamous islands.

Adult↗
PubMed1997

An audit of bronchoscopy practice in the United Kingdom: a survey of adherence to national guidelines.

BACKGROUND: Both patient and staff safety are of major importance during the procedure of fibreoptic bronchoscopy. Patient safety depends partly on adequate disinfection of instruments and accessories used as well as careful monitoring during the procedure. Adequate facilities, manpower and training are also essential. Staff safety depends partly on adequate procedures to minimise any risks of sensitisation to agents such as glutaraldehyde. An audit was carried out of bronchoscopy procedures in hospitals in the UK and the findings were compared with published guidelines on good practice and clinical consensus. METHODS: A postal questionnaire was sent to 218 bronchoscopy units in the UK. Findings were then compared with published evidence of good practice in the areas of disinfection, including the use of glutaraldehyde, patient monitoring, manpower, facilities, and training. RESULTS: A 73% response rate was obtained. Recommended minimum disinfection times before and after routine bronchoscopies were not achieved by 35% of units. No disinfection was carried out in 34% of units before emergency bronchoscopies and in 19% of units after suspected cases of tuberculosis. Adequate rinsing of the bronchoscope with sterile or filtered water was not carried out by 43% of units. Contrary to recommendations, 31% of departments were still using glutaraldehyde in the patient examination room and inadequate room ventilation was common. Protective clothing was often not worn by staff during bronchoscopy. Inadequate intravenous access and use of supplementary oxygen were found in many units. Practice standards were higher in departments where dedicated bronchoscopy/endoscopy units of the hospital were used, and also where staff had been on external training courses. CONCLUSIONS: This audit has shown that many units do not adhere to guidelines on disinfection procedures and patient monitoring. Unnecessary potential risks due to staff exposure to glutaraldehyde were apparent. National guidelines on good practice are not being followed in areas which may potentially affect patient and staff safety.

Bacterial Infections↗
PubMed1995

Developmental pathways to schizophrenia: behavioral subtypes.

This study examined childhood behavior problems in schizophrenic patients and their healthy siblings. Childhood Behavior Checklist (T. Achenbach, 1991) ratings were obtained from retrospective maternal reports, for 4 age periods: birth to 4 years, 4 to 8 years, 8 to 12 years, and 12 to 16 years. The results indicated that the patients had a variety of childhood behavior problems when compared to their siblings and that the various types of problems differed in their developmental course. Cluster analysis was conducted on the childhood behavior ratings for the schizophrenic patients, and 2 subgroups emerged. Cluster I showed more pronounced behavioral problems than Cluster II, and some of these problems were apparent in early childhood and increased with age. Cluster I also demonstrated greater neuromotor abnormalities in childhood.

Adolescent↗
PubMed1995

Long term continuous omeprazole treatment of patients with Barrett's oesophagus.

BACKGROUND: The metaplastic columnar epithelium in Barrett's oesophagus has malignant potential. AIM: To determine whether decreasing acid reflux leads to regression of Barrett's epithelium. METHOD: Twenty-four patients with Barrett's oesophagus were treated with omeprazole 20 mg o.m. in an open, prospective study; 11 were treated for 12 months, and 13 for 24 months. Another group of 17 patients with Barrett's oesophagus was treated with an H2-receptor antagonist in standard dosage for 12-36 (mean 23) months. Patients were assessed endoscopically. RESULTS: No evidence of significant shortening of the length of Barrett's oesophagus was seen in any patient treated for 12 or 24 months with omeprazole. Similarly, no shortening of the length of Barrett's oesophagus was seen in any patient treated with an H2-receptor antagonist. However, 6 of 11 patients treated with omeprazole for 12 months, and 7 of 13 treated for 24 months, developed macroscopic squamous islands visible below the squamo-columnar junction. This was not seen in any patient treated with an H2-receptor antagonist. CONCLUSION: Although there can be reappearance of squamous epithelium in Barrett's oesophagus of some patients during treatment with omeprazole 20 mg o.m. over 12-24 months, a significant shortening of the columnar lined segment is not seen.

Adult↗
PubMed1994

24 hour ambulatory oesophageal pH monitoring in uncomplicated Barrett's oesophagus.

The aim of this study was to compare acid reflux in 16 patients with uncomplicated Barrett's oesophagus with 37 patients with reflux oesophagitis and 10 control subjects of comparable age. All patients had 24 hour ambulatory pH monitoring within one week of endoscopy. The controls differed significantly from the other groups in all indices of reflux but there was no difference between the Barrett's oesophagus patients and the reflux oesophagitis patients in any index of reflux over the total 24 hour period. Barrett's oesophagus patients differed significantly, however, with respect to the percentage time pH < 4 and the number of reflux episodes of > five minutes during the supine period when compared with patients with grade I reflux oesophagitis, but not when compared with patients with grade II and III reflux oesophagitis. Barrett's oesophagus patients with associated grade II reflux oesophagitis had more reflux than those with no oesophagitis or grade I reflux oesophagitis. Within each disease group patients > or = 50 years had more acid reflux than patients < 50 years. The severity of acid reflux in patients with uncomplicated Barrett's oesophagus was no greater than in patients with reflux oesophagitis of comparable age. It seems probable that other factors must be important in the development of Barrett's oesophagus.

Ambulatory Care↗
PubMed1993

Visual pattern integration as a function of antidepressant medication in depressed patients.

On the basis of an earlier study that reported depressed patients to be superior to normal control subjects in visual iconic integration, the present investigation sought to determine if this finding was replicable and if medication produced it. Newly admitted depressed patients entering drug treatment, depressed patients already in drug treatment, and healthy control subjects were twice tested, with a 5-week interval between sessions. Fully medicated depressed patients, whether newly admitted or already in drug treatment, were superior to normal control subjects in visual integration, and healthy control subjects were superior to depressed patients just entering treatment. At the first testing, the number of days of medication treatment was significantly correlated with the adequacy of visual integration.

Adult↗
PubMed1988

Acute upper gastrointestinal haemorrhage in patients aged 80 years or more.

We report a series of 103 admissions of patients aged 80 years or more with acute upper gastrointestinal haemorrhage to one hospital over a four-year period. A cause was eventually found during 81.5 per cent of admissions and of these, 57 per cent had bled from chronic peptic ulcers. After 64 per cent of admissions, the patient received a blood transfusion and in 25 per cent, the blood transfusion exceeded 5 units. Nine patients had surgery for peptic ulcer during admission but no operations were performed in patients with other causes of upper gastrointestinal haemorrhage. Patients with peptic ulcer, when compared to patients with other causes for haemorrhage, were more likely to have symptoms of upper gastrointestinal disease before presentation. They were also more likely to continue to bleed, to bleed again, to require surgery, and to die as a consequence of haemorrhage. Eighteen admissions (17.5 per cent) ended with death but in only 11 (10.5 per cent) did the patient die directly because of haemorrhage. Nine of these bled from a peptic ulcer, one from oesophageal varices and one from an unknown cause. Patients who died from haemorrhage, when compared to all others, were more likely to have bled from a peptic ulcer and to have significant co-existing disease, to have ingested non-steroidal antiinflammatory drugs or aspirin before admission, to have raised blood urea level and low systolic blood pressure at admission and to have required blood transfusion of more than 5 units. Our study has shown that upper gastrointestinal haemorrhage secondary to peptic ulceration is a serious and often fatal condition in the elderly. Identification and effective monitoring of those at particular risk of death may be essential if mortality is to be reduced.

Acute Disease↗
PubMed1986

Upper gastrointestinal endoscopy in patients aged 80 years or more.

A retrospective study of 208 upper gastrointestinal endoscopies (including 56 therapeutic procedures) performed over a 3-year period on 150 patients aged 80 years or more has shown that endoscopy is safe and well tolerated in this age group. Only 10% of first endoscopies were normal. If endoscopies performed for therapy or assessment of peptic ulcer healing are excluded, 79% of endoscopies were considered helpful in revealing the cause of the patients symptoms and/or aiding the patients' management. Endoscopy was particularly helpful in patients with gastrointestinal haemorrhage or dysphagia. Of 63 emergency endoscopies for acute upper gastrointestinal haemorrhage, a source of bleeding was found in 82%. Out-patient diagnostic endoscopy and even out-patient endoscopic oesophageal dilatation was safe in the more robust elderly patient. Patients aged 80 years or more made up 5% of all upper gastrointestinal endoscopies and 10% of all emergency endoscopies performed in our unit. The study emphasizes the important contribution of sophisticated investigative techniques to the care of the elderly.

Aged↗
PubMed1981

Clinical trial value of trimipramine versus placebo in duodenal ulcer healing.

Thirty-two patients with duodenal ulceration took trimipramine 50 mg or placebo. Fifteen patients on each treatment completed the study. Endoscopy at four weeks showed ulcer healing in seven (46%) patients on trimipramine, compared with only two (15%) on placebo (P less than 0.05). However, by eight weeks there were eight (53%) patients in both groups with healed ulcers. There were no significant differences between the two groups in ulcer symptoms. Drowsiness was reported by eight patients on trimipramine compared with only one on placebo. Trimipramine 50 mg appears to increase the rate of ulcer healing in the short term. Side-effects at the dose used may limit its long-term usefulness.

Adolescent↗
PubMed1980

Gastric cancer detection in gastric ulcer disease.

A retrospective study has been performed of all cases of gastric ulcer diagnosed or investigated within the Endoscopy Unit of the Department of Medicine, Bristol, over a three year period (1974-76). The average length of follow-up was two years. Two hundred and sixty five cases of gastric ulcer were studied of which 37 proved to be malignant (14%). Presenting complaints of anorexia, weight loss, nausea and/or vomiting, and multiple (greater than 3) symptoms, were commoner in the malignant ulcer group. Ulcer site and the presence of coexisting duodenal ulceration were largely unhelpful in deciding the status of an ulcer. Malignant ulcers tended to be large (greater than 1 cm diameter). Radiology was highly unreliable in distinguishing benign from malignant ulcers. Visual inspection at endoscopy was more reliable, but associated with a tendency to over-diagnose malignancy. False positive biopsies were uncommon (two cases). Three cases of clinically unsuspected superficial gastric carcinoma were revealed. Repeated endoscopy and biopsy of all gastric ulcers until they are completely healed is advised.

Adult↗
PubMed1979

Adhesion of commensal bacteria to the large intestine wall in humans.

Biopsies taken during colonoscopic examination of the human large bowel were used to examine the relationship of the commensal bacterial to the mucosal epithelial cell surface. Bacteria were seen adhering to the exposed epithelial cell surface and also to the mucus sheet. Isolation of aerobic organisms showed that Escherichia coli are closely associated with the gut wall throughout the large intestine. One strain of E. coli predominated in each biopsy, and this strain was present along the whole length of bowel. Adhesion of bacteria to the gut wall does occur in vivo and may be one of the factors involved in the ability of an organism to colonize and persist.

Escherichia coli↗