Biomedical subjects
Publications and source records attributed to C S Probert.
We describe a case of paraproteinaemia in which there were high concentrations of four monoclonal bands shown on qualitative, and confirmed by quantitative, techniques. The disorder followed a pneumococcal infection and resolved spontaneously with the complete disappearance of all four bands.
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A pilot study to estimate the incidence of inflammatory bowel disease in Fiji is reported. Data from 1985 and 1986 for Indian migrants, Melanesians and other groups show the incidence of ulcerative colitis was 1.7/10(5)/year, in Indians, 0.15/10(5)/year in Melanesians and 1.4/10(5)/year in others. The minimum incidence of Crohn's disease is 0.14/10(5)/year. Indians are at significantly greater risk than Melanesians of developing ulcerative colitis.
A group of 70 patients with inflammatory bowel disease were asked to complete a questionnaire about their disease counselling preferences, 59 replied. Seventy-five per cent wanted further advice about their disease. Of these, 60% wished to receive the advice by discussion with a trained advisor. Seventy-six per cent wanted this person to be a hospital specialist, but 50% would accept advice from a specialty trained nurse. Eighty-six per cent would like this in conjunction with 'same day' telephone advice from a hospital specialist and 85% of patients wish to be taught how to adjust their own therapy. There is an increasingly important role for nurse counsellors in the management of these diseases.
To investigate patients' views and expectations when attending outpatient clinics a questionnaire-based study was performed. The questionnaires asked about appointment systems, continuity of care, staff appearance, chaperons and medical students. Patients wanted fixed appointment times, to see the same doctor on successive visits, for the staff to be formally dressed and to have chaperons during examination. The number of medical students should be restricted especially for women patients. Staff should be sensitive to patients' needs.
Fifty consecutive patients with inflammatory bowel disease of the colon who presented at the University Hospital Rotterdam/Dijkzigt were assessed by four methods: clinical diagnosis, criteria defined by Lennard-Jones and by the Organisation Mondiale de Gastroenterologie (O.M.G.E.) scoring systems, and histologic slide review. All cases were classified into three diagnostic groups: established Crohn's disease (CD), indeterminate colitis, or definite ulcerative colitis (UC). The classifications were compared by kappa analysis. Eighteen of the 50 patients were classified as having established CD by the O.M.G.E. scoring system and Lennard-Jones criteria; 17 were so classified by clinicians, and only 8 by histologic slide review. The agreement among clinician's diagnosis, Lennard-Jones criteria, and the O.M.G.E. scoring system was good (Fleiss-Cohen-weighted kappa; p less than 0.001). Agreement among histology, Lennard-Jones criteria, and the O.M.G.E scoring system was less good (p less than 0.05) and not significantly associated with clinical diagnosis. Histology was less prone to diagnose established CD or established UC and more likely to diagnose indeterminate colitis. This study has shown that the systems of disease definition set out by Lennard-Jones and the O.M.G.E. are comparable and agree well with each other and clinicians's diagnosis, but biopsy specimens have a limited diagnostic value in disease differentiation in inflammatory bowel disease.
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Patients with Crohn's disease want information about the condition. "So you've got Crohn's disease", an information booklet written by a patient was sent to patients for evaluation. Most found it useful, particularly in the practical advice, and suitable for all patients with Crohn's disease. Patients can be a valuable source of information for other patients and doctors. They should be encouraged to share their experiences.
The potential role for video tape education in gastroenterology is discussed. The need for material to inform patients about their diagnoses is widely acknowledged and educators need to take advantage of modern techniques. Studies in general practice, diabetes care, and asthma care have found that videos have significant benefits when compared with conventional techniques. There are few such video tapes available to gastroenterologists. It has been shown that patients are keen to accept educational material in this form provided it is shown at a suitable time and in a suitable venue.
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Heart disease responsive to steroids is well described in many disorders, including sarcoidosis, systemic lupus erythematosus, polyarteritis nodosa, myocarditis and Churg-Strauss syndrome. The underlying disorder is often obvious and the response is usually slow. We describe a woman who had severe left ventricular failure, cardiac dilatation and pericardial effusion which were rapidly rectified by steroid therapy. Steroid withdrawal led to recurrence of signs, which were reversed by recommencing steroids. The aetiology was not determined.
39 missionaries working at 38 separate mission hospitals or clinics in Bangladesh. India, Nepal and Pakistan completed questionnaires about their clinical practice during the previous year, 1980. Data were collected about gastrointestinal disorders, including coeliac disease, tropical sprue, bloody diarrhoea, amoebiasis, typhoid, cholera, inflammatory bowel disease and diverticular disease. More than 386,000 out-patients and over 56,000 in-patients were treated with an estimated 12,272 cases of bloody diarrhoea, 7,310 of amoebiasis, 2,113 of typhoid and 872 cases of intestinal tuberculosis, 74 cases of inflammatory bowel disease were diagnosed, of which 56 were ulcerative colitis and the remainder were said to have Crohn's disease. Surgery was performed in 28 hospitals, but only 10 (26%) had a histology service. Inflammatory bowel disease appears to be a relatively more common cause of diarrhoea in the Indian subcontinent than in sub-Saharan Africa (z = 5.47, p less than 0.001). The proportion of patients with bloody diarrhoea who have ulcerative colitis Crohn's disease was similar throughout the region. The rate of cases having ulcerative colitis rather than Crohn's disease was greater in India (z = 3.1, p less than 0.005), and in Bangladesh (z = 3.2, p less than 0.005), than in Pakistan (z = 1.28, NS) or Nepal and Bhutan (z = 0, NS). The relative risk of Indians developing ulcerative colitis rather than Crohn's disease is 2.6 (95% confidence limits 1.4-4.8, NS). This may reflect diagnostic difficulties in distinguishing Crohn's disease from intestinal tuberculosis, but it may also shed light on similar differences now being reported in migrant groups in Western Europe.
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There is now substantial evidence that coeliac sprue is associated with infertility both in men and women. In women it can also lead to delayed menarche, amenorrhoea, early menopause, recurrent abortions, and a reduced pregnancy rate. In men it can cause hypogonadism, immature secondary sex characteristics and reduce semen quality. The real mechanism by which coeliac sprue produces these changes is unclear, but factors such as malnutrition, iron, folate and zinc deficiencies have all been implicated. In addition in men gonadal dysfunction is believed to be due to reduced conversion of testosterone to dihydrotestosterone caused by low levels of 5 alpha-reductase in coeliac sprue. This leads to derangement of the hypothalamic-pituitary axis. Hyperprolactinaemia is seen in 25% of coeliac patients, which causes impotence and loss of libido. Gluten withdrawal and correction of deficient dietary elements can lead to a return of fertility both in men and women.
Two-hundred and twenty-three Asian patients with inflammatory bowel disease were sent a questionnaire about smoking and betel nut chewing habits. The 116 responses from patients with ulcerative colitis were compared with answers from 79 healthy members of the community. Twelve per cent of male patients were currently smokers compared with 31% of healthy controls (chi 2 = 20.9 P < 0.05). No such differences existed between female patients and controls. Thirteen per cent of male patients regularly used betel nut compared with 20% (chi 2 = 3.9 P < 0.05). Both smoking and betel nut chewing appear to reduce the risk of developing ulcerative colitis, although these effects may be linked.