Biomedical subjects
Publications and source records attributed to G D Barr.
A case of early marked calcification of the arytenoid cartilages is presented in a patient with a suspected pharyngeal foreign body. The calcification on X-ray had the appearance of the expected foreign body. Calcification of the arytenoid cartilages is discussed.
Ten patients with bilateral moderate or severe otitis externa were studied. Following aural toilet each patient was subjected to two different treatments: one ear had alternate day dressings containing a topical antibiotic/steroid mixture, while the external canal of the other was filled with the same topical preparation (sump filling). Improvement in the severity of the otitis externa was assessed after 1 week. 9 out of 10 ear canals improved in each group. An estimate of the relative cost of each treatment was made and sump filling was found to be less expensive. The results suggest that sump filling is a low cost alternative to standard treatment in moderate and severe otitis externa.
Uncertainty exists concerning the exact aetiology of stomal recurrence following laryngectomy, although it is generally agreed that, when present, the prognosis is very poor. Fourteen cases of stomal recurrence were compared with 15 cases of other types of aggressive recurrence in the neck, for factors implicated in stomal recurrence. Similarities exist between the two groups and, although stomal recurrence has a greater association with subglottic tumour, this difference is not statistically significant. The possible mechanisms of recurrence are discussed, particularly in relation to aggressiveness, and it is concluded that factors involved in aggressive recurrences are similar. Stomal recurrence can be considered part of a group of aggressive neck recurrences associated with more advanced disease prior to laryngectomy.
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A case of severe airway obstruction due to laryngo-tracheal compression associated with achalasia is presented. Local anaesthetic tracheostomy has an important role in some cases.
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The colonic faecal and mucosal associated bacterial populations of five patients with ulcerative colitis and four control patients were studied in detail to assess their ability to produce IgA1-proteases. A total of 330 bacterial strains were isolated from the patients with ulcerative colitis and IgA1-protease activity was unable to be reliably shown in any. It is therefore unlikely that such enzyme production by colonic bacteria plays a significant role in the pathogenesis of ulcerative colitis.
Antral vascular ectasia is a rarely described condition; it is a cause of blood loss and iron deficiency anaemia, particularly in the elderly. Four cases of antral vascular ectasia ("watermelon" stomach) in elderly patients are reported. The clinical history, endoscopic and histological features are described.
The efficacy of a 5-day intensive intravenous regimen (IVR), used as treatment for severely active Crohn's disease in 49 patients, has been evaluated retrospectively. The value of such systemic therapy has not been reported before. Immediate remission was achieved in 38 (76%) patients with no significant difference between those with established disease and those seen for the first time. Patients with ileocolonic disease had the poorest response. There was no apparent change in the natural history of the Crohn's disease after IVR therapy. Nevertheless, this is a safe and effective method of achieving remission in most sick patients with severely active Crohn's disease.
Ulcerative colitis is not commonly associated with recognizable pulmonary disease and only four sporadic cases of sarcoidosis in association with ulcerative colitis have been previously reported. However, in a series of 680 patients with ulcerative colitis, pulmonary or extra-pulmonary sarcoidosis has at some stage been present in eight. These cases are reported in detail. The onset of either condition bore no relationship to the activity or the presence of recognized peripheral manifestations of the other, suggesting that the two diseases were independent. However, three of the patients had the HLA B8 DR3 phenotype which is a higher prevalence than seen in previous studies of either disease alone. Patients with ulcerative colitis who possess this HLA phenotype may possibly be more susceptible to developing sarcoidosis.
Olsalazine (azodisalicylate) is a new drug in which two molecules of 5-aminosalicylic acid are linked by an azo bond. Its role in the treatment of mildly active, distal ulcerative colitis was investigated. Sixty patients were randomly allocated to receive olsalazine 1 g or a placebo as a retention enema nightly for two weeks. Clinical improvement was seen in 19 (66%) and sigmoidoscopic improvement in 17 (59%) of the 29 patients receiving olsalazine compared with 12 (43%) and 11 (39%), respectively, of the 28 in the control group. These differences were not significant. In a second trial 40 patients were randomised to receive oral olsalazine 2 g daily or a placebo capsule for two weeks. Significant clinical and sigmoidoscopic improvement was seen in the patients receiving oral olsalazine compared with the patients receiving placebo capsules. Oral olsalazine may be valuable in the treatment of mildly active ulcerative colitis. Its role in maintaining remission is yet to be determined.
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In the present studies we have simultaneously measured changes in medial basal hypothalamic (MBH) leutenizing hormone-releasing hormone (LH-RH) and in plasma LH by radioimmunoassay in female rats at various hours during the 4-day estrous cycle and under experimental conditions known to alter pituitary LH secretion. In groups of rats decapitated at 12.00 h and 15.00 h on estrus and diestrus, plasma LH remained at basal levels (5-8 ng/ml) and MBH-LH-RH concentrations showed average steady state concentrations of 2231 +/- 205 pg/mg. On the day of proestrus hourly measurements of MBH-LH-RH between 12.00 h and 21.00 h suggested rhythmic rises and falls in the decapeptide concomitant with rises and falls in plasma LH. In a second group of pentobarbital-anesthetized proestrous rats a significant decline in MBH-LH-RH occurred (to 573 +/- 137 pg/mg) which then remained at low concentrations between 14.00 h and 18.00 h proestrus. Following bilateral preoptic area (MPOA) electrochemical stimulation of pentobarbital-treated proestrous rats, LH was significantly increased by 30 min, peaked between 90-120 min and returned to basal levels by 210 min poststimulation. In the same animals within 15 min poststimulation, MBH-LH-RH increased from the basal concentrations noted after pentobarbital anesthesia to elevated levels comparable to those observed throughout estrus, diestrus and on proestrous morning. Further, as plasma LH rose to peak concentrations and declined to basal plasma values, rhythmic rises and falls in MBH-LH-RH were observed with intervals between pulses of approximately 60 min. Seemingly, hypothalamic LH-RH is released as pulsatile pulses from a releasable pool; this pool is replenished and again LH-RH is discharged in response to constant stimulation by the preoptic brain.
The concentration of hemoglobin in blacks was found to be 0.5 to 1.0 g/dl lower than that of income-matched whites in several large surveys. This difference could be a racial characteristic of blacks, or it might be due to a higher frequency of genetic traits such as thalassemia minor and hemoglobinopathies, or to environmental factors such as iron deficiency. To help in making this distinction, we analyzed the data from multiphasic examinations (1973 to 1975) on 1718 white, 741 black, and 315 Oriental healthy, nonindigent children between 5 and 14 years of age. In the entire population, the median hemoglobin concentration averaged 0.5 g/dl lower in blacks than in whites of both sexes (t test, P less than 0.001). The differences still averaged 0.5 g/dl (P less than 0.001) after exclusion of all those with abnormal hemoglobin by electrophoresis (Hgb S and C) and those whose mean corpuscular volume was more than 5% below the normal mean for age (to exclude iron deficiency or thalassemia minor). The data strengthen the impression that blacks normally have a concentration of hemoglobin averaging about 0.5 g/dl less than in whites. If this is the case, about 10% of normal blacks will be mistakenly designated anemic, if the same norms are applied.
Women judged to be at high risk of delivering low-birth-weight infants were assigned to one of three supplements--high-protein beverage, low-protein beverage, or a vitamin-mineral preparation--to determine the effect these nutritional supplements would have on the outcome of pregnancy. In comparing prenatal nutrient intake and the birth weight of their infants, no significant associations were found. However, since the women were well nourished and since the sample size was small, changes in birth weight may have gone undetected. Nevertheless, a trend of increased birth weight with higher protein intake was observed.
Women judged to be at high risk of delivering low-birth-weight infants were assigned to one of three supplements--high-protein beverage, low-protein beverage, or a vitamin-mineral preparation--to determine: (a) The acceptability of a liquid dietary supplement to pregnant women. (b) The effect of the dietary supplement on diets normally eaten by pregnant women. Acceptance of the high-protein beverage by the women in this study was low. Fifty per cent of the dropouts indicated a dislike for the beverage because of either poor flavor or an inability to tolerate it. The women generally consumed "adequate" diets, although there were variations. Increases in intakes of calories and protein in Group 1 were statistically significant, suggesting the high-protein beverage served as a supplement for both calories and protein; that is, these nutrients were added to the women's existing intake. For the low-protein beverage women (Group 2), statistics revealed the beverage was used as a substitute.
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