Biomedical subjects
Publications and source records attributed to F I Lee.
A 57-year-old woman with rheumatoid arthritis and alpha 1-antitrypsin deficiency (PiMZ phenotype), recovering from intraabdominal sepsis in association with gastric ulcer perforation, had portal hypertension. An operative liver biopsy specimen showed a distinctive elastosis of the portal tracts without cirrhosis.
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A 13-year-old boy presented when his weight gain fell behind that of his monozygous twin brother. Following investigation, he was found to have gluten-sensitive enteropathy on jejunal biopsy. Investigation of his symptom-free brother showed biopsy evidence of the condition with changes similar to those of the clinically affected boy. Following treatment with a gluten-free diet, the boys achieved a similar weight after 15 months.
Three patients presented with acute pericarditis. No cause was found and, in each case, the pericarditis was recurrent. Investigation revealed evidence of malabsorption due to adult celiac disease. Two of the patients responded to a gluten-free diet and cortiscosteroid therapy. The third patient responded to a gluten-free diet alone and remains well. Celiac disease is a multisystem disorder in which extraintestinal involvement is common. Recurrent pericarditis may be such a manifestation.
Treatment of duodenal ulcer with the H2-receptor antagonist ranitidine, 150 mg twice daily has been assessed in a double-blind, placebo controlled study at seven centres in the United Kingdom. One hundred-and-twenty-nine patients entered the trial with endoscopically confirmed duodenal ulcer. Five patients did not comply with the protocol and were excluded from the analysis. Nine patients (1 ranitidine, 8 placebo) did not complete the initial 4 weeks' treatment due to poor symptomatic response; one hundred-and-fifteen (58 ranitidine, 57 placebo) were endoscopically assessed after 4 weeks. The average 4-week healing rate among patients on ranitidine (83%) was significantly greater than that for the placebo group (32%, p less than 0.01). Forty-four patients whose ulcers had not healed received further treatment with ranitidine 150 mg b.d. on an open basis. After a total of up to 8 weeks' active treatment only three patients had not healed. Ulcer symptoms resolved or improved in a greater proportion of patients on ranitidine, and this was associated with a significantly lower antacid consumption. There was no serious unwanted effect associated with ranitidine treatment, and the twice daily dose of 150 mg is apparently a safe and effective short-term treatment for duodenal ulceration.
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Two elderly women presented with ischaemic necrosis of the tongue. In both there were typical features of cranial arteritis. The importance of early recognition is emphasised so that appropriate therapy may be prescribed to minimise further complications.
A 27-year-old man with severe infantile kyphoscoliosis suffered from recurrent respiratory tract infections during childhood and early adult life. He deteriorated and was found to have pernicious anaemia and common variable immunodeficiency with hypogammaglobulinaemia and impairment of cell-mediated immunity. Marked clinical improvement has followed the institution of effective gamma-globulin replacement.
Five patients with smooth muscle tumours of the stomach are presented. In 3 cases, histological identification of the lesion was made pre-operatively on biopsy material obtained under direct vision at gastroscopy.
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Following the occurrence of hepatic fibrosis and angiosarcoma in polyvinyl chloride autoclave workers, a screening programme was set up for workers at risk in a large production plant. There was no significant difference in liver function tests between workers and a control group of men in the same factory, not exposed to vinyl chloride. Four exposed workers out of 422 were found to have enlarged spleens compared with none out of 202 controls. Liver biopsies from selected cases showed no significant pathological changes, although there was minimal increase in portal tract and sinusoidal fibrosis in exposed workers.
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