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Biomedical subjects

D Clements

Publications and source records attributed to D Clements.

At least 19 recordsLinked to original sources
PubMed1992

Longitudinal study of cortical bone loss in patients with inflammatory bowel disease.

Bone mineral density of the radius was measured by single-photon absorptiometry in 50 patients with inflammatory bowel disease. Thirty-three had Crohn's disease and 17 ulcerative colitis; 25 were women. The mean age was 45 years (range, 18-70 years). Measurements were repeated in 39 of them after a mean follow-up period of 7.9 years (range, 7.1-8.2 years). In female patients the mean (95% confidence interval) annual change in radial bone mineral density was -0.74% (-1.34% to -0.14%) (P = 0.022), the greatest bone loss occurring in postmenopausal women (mean, -1.16% (-2.01% to -0.30%)). In male patients the mean annual rate of bone loss was -0.07% (-0.41% to 0.28%) (P = NS). Patients with abnormally low values at the first measurement remained osteopenic at the second measurement, whilst some others with normal values initially showed increased rates of bone loss and had a subnormal bone mineral density after the follow-up period. These results show increased rates of cortical bone loss in some patients with inflammatory bowel disease and emphasize the need to monitor bone mass in these patients so that prophylactic measures can be instituted.

Absorptiometry, Photon↗
PubMed1992

An improved 'interim discharge letter' a successful outcome from audit.

General practitioners were dissatisfied with this hospital's interim discharge letters. These were unstructured letters written by house officers shortly after the patient's discharge. A copy of the list of drugs prescribed on discharge was sent separately. After discussing the various needs with general practitioners a new form of discharge letter has been successfully introduced. The layout has been further modified in the light of feedback, and details of the new letter are presented. The new form has been well received by hospital staff and general practitioners. The paperwork for junior doctors has been reduced by the inclusion of the prescription in the discharge letter.

Family Practice↗
PubMed1991

Total body calcium in patients with inflammatory bowel disease: a longitudinal study.

1. Serial measurements of total body calcium have been made by prompt gamma-neutron activation analysis in 13 patients with inflammatory bowel disease over a mean period of 23 months. Changes in spinal trabecular bone mineral density and radial shaft bone mineral content were also assessed by using quantitative computed tomography and single photon absorptiometry, respectively. 2. The mean annual decreases (95% confidence intervals) were: total body calcium, 7.8% (-12.0 to -3.7%; P less than 0.001); spinal trabecular bone mineral density, 2.5% (-5.0 to +0.1%; 0.05 less than P less than 0.1), radial bone mineral content, 2.1% (-3.4 to -0.8%; P less than 0.01). 3. No significant correlations were found between rates of change of the three variables. However, there were significant positive correlations between the baseline values for total body calcium and radial bone mineral content (r = 0.638, P less than 0.05), spinal bone mineral density and radial bone mineral content (r = 0.854, P less than 0.01), and total body calcium and spinal bone mineral density (r = 0.876, P less than 0.001). 4. These results demonstrate rapid decreases in total body calcium in patients with inflammatory bowel disease which, in conjunction with the significant decrease in radial shaft bone mineral content, indicate increased rates of cortical bone loss. Whilst values for bone mass at different skeletal sites showed positive correlations within individuals, no relationship was found between the rates of change in bone mass at these sites. 5. The rapid bone loss observed in some subjects emphasizes the importance of early detection of osteoporosis by bone densitometry and the need for effective prophylactic measures to be established in this group of patients.

Absorptiometry, Photon↗
PubMed1991

Pseudomonas syringae pv. phaseolicola genomic clones harboring heterologous DNA sequences suppress the same phaseolotoxin-deficient mutants.

Cosmid cloning and mutagenesis were used to identify genes involved in the production of phaseolotoxin, the chlorosis-inducing phytotoxin of Pseudomonas syringae pv. phaseolicola, the causal agent of halo blight of bean (Phaseolus vulgaris L.). Eight stable clones were isolated from a genomic cosmid library by en masse mating to 10 ethyl methanesulfonate (EMS)-induced Tox- mutants. In cross-matings, each suppressed all 10 mutants as well as an additional 70 EMS-induced Tox- mutants (and one UV-induced Tox- mutant). On the basis of restriction endonuclease analysis and hybridization studies, the clones were grouped into three classes. Clones in a particular class shared common fragments, whereas clones in different classes did not. Clones from class I (but not classes II and III) also suppressed Tn5-induced Tox- mutants. Interposon mutagenesis and marker exchange of a representative clone from class III into the wild-type genome did not alter its Tox+ phenotype, indicating that this clone does not harbor structural or regulatory genes involved in phaseolotoxin production. We suggest that the genome of P. syringae pv. phaseolicola contains a "hot spot" in one of the functions involved in toxin production which is affected by EMS and UV and that heterologous clones are able to suppress the Tox- phenotype because their inserts encode products that are able to substitute for the product of the mutated gene. Alternatively, the inserts may contain sequences which titrate a repressor protein. In either case, the data suggest that suppression of EMS- and UV-induced mutants occurs when heterologous clones are present in multiple copies.

Base Sequence↗
PubMed1991

Preliminary study of indocyanine green clearance in primary biliary cirrhosis.

Indocyanine green clearance was measured in 23 symptomatic patients with primary biliary cirrhosis who were followed up for 6 months. Ten patients either died (n = 4) from their primary biliary cirrhosis or underwent liver transplantation (n = 6) during the follow-up period. Indocyanine green clearance and other liver function test results were compared between the survivors (n = 13) and those who had died or undergone transplantation (n = 10). Indocyanine green clearance, bilirubin, bile acids, albumin, and prothrombin ratio differed significantly between the two groups, whereas age, alkaline phosphatase, globulin, and aspartate aminotransferase did not. Indocyanine green clearance gave better discrimination between the two groups than the other liver function tests, including bilirubin. There was a close correlation between indocyanine green clearance and bilirubin in patients who died or were transplanted. Further studies are necessary to define whether indocyanine green clearance is clinically useful in selecting patients for transplantation and in the timing of intervention.

Adult↗
PubMed1991

Acute upper gastrointestinal haemorrhage in a district general hospital: audit of an agreed management policy.

All patients from an unselected population admitted with acute upper gastrointestinal (GI) haemorrhage to a District General Hospital (DGH) were studied prospectively over one year. Before the study period a management policy was agreed between physicians and surgeons. One-hundred-and-nine patients were admitted. Sixty-eight per cent were over 60 and 17% over 80 years of age. Sixty patients bled from peptic ulcers and seven patients rebled. Endoscopic stigmata (visible vessel, adherent clot, and oozing) were useful in identifying those at increased risk of rebleeding but not as an indication for surgery. Six patients underwent surgery for peptic ulceration with one postoperative death. There were four deaths among the other patient groups giving an overall mortality of 4.6%. This audit shows a low mortality after acute upper GI haemorrhage can be achieved even in an elderly population in a DGH without the establishment of a specialist unit but with an agreed policy of management.

Acute Disease↗
PubMed1990

Squamous carcinoma in the liver.

Squamous carcinoma of the liver has only rarely been reported. We present a case which highlights not only the difficulties in diagnosis but also how it can closely mimic sclerosing cholangitis.

Aged↗