Biomedical subjects
Publications and source records attributed to G Watkinson.
A case is reported of a patient known to have ulcerative colitis who developed atypical lichen planus. This did not resolve when the patient discontinued sulphasalazine treatment but became more extensive within 48 h of an exacerbation of colitis. This case supports the view that there may be an association between ulcerative colitis and lichen planus.
Sulphasalazine, devised by Dr Nana Svartz for the treatment of 'infective polyarthritis', has been used in the treatment of inflammatory bowel disease for more than 40 years. Many controlled trials have shown that sulphasalazine 4g daily will induce remissions in between one-half and three-quarters of patients with acute attacks of ulcerative colitis. When given in a dosage of 2g daily it will prevent relapses in quiescent colitis. Relapses are 5 times more likely in untreated patients. It is less effective in Crohn's disease, where it exerts only a transient benefit in patients with active colonic disease and fails to prevent relapse or recurrence. Sulphasalazine is absorbed from the small intestine, re-excreted in bile and carried to the colon, where its azo bond is split by bacteria to release sulphapyridine, which is absorbed and is responsible for most of the drug's side effects, and 5-aminosalicylic acid, which is the active therapeutic moiety of the drug and exerts a beneficial topical action on the colonic mucosa. Side effects are common but are mainly reversible and not serious. Those related to high concentrations of sulphapyridine and to poor acetylation of the drug include gastrointestinal intolerance, malaise, headache, arthralgia, drug fever, effects on red blood cells and reversible male infertility. More serious, idiosyncratic side effects are skin rashes, leucopenia and agranulocytosis. Rarely, neurotoxicity, hepatotoxicity, polyarteritis, pulmonary fibrosis, a lupus-like syndrome and haemorrhagic colitis are produced. It is possible to desensitise most patients with drug-induced skin rashes. A number of less toxic alternatives to sulphasalazine have been devised and are undergoing trial. They either convey 5-aminosalicylic acid in a coated tablet to the colon or, when conjugated to a non-toxic carrier, release 5-aminosalicylic acid by bacterial cleavage there. Sulphasalazine remains a most useful drug in the treatment of inflammatory bowel disease after 40 years of use.
The occurrence of extrahepatic malignancy was studied in 195 unselected patients who satisfied predetermined biochemical, immunological, and histological criteria for the diagnosis of primary biliary cirrhosis. The incidence of breast cancer in women with primary biliary cirrhosis was found to be significantly higher than in an age and sex matched control population from the same well defined geographical area (p less than 0.0015). The association of breast cancer and primary biliary cirrhosis remains unexplained, though diminished immunological surveillance, fat soluble vitamin deficiency, or endocrine dysfunction may play a part.
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Fifty patients have been treated for upper tract urinary calculi by extracorporeal shock wave lithotripsy (ESWL) at the Devonshire Hospital lithotripter centre since November 1984. The average stay for an inpatient was 3 X 7 days. All patients suffered minimal postoperative discomfort and nearly all resumed normal activity within one day after discharge. Complications requiring auxiliary procedures were few. The procedure was found to be safe, cost effective, extremely well received by patients, and superior to all other methods of removing renal stones. This study confirms that treatment by ESWL is a specialised urological procedure that requires operators who are also trained in open, percutaneous, and ureteroscopic surgery and with a back up of a radiological team skilled in percutaneous renal puncture.
A 75-year-old man required prolonged intravenous drug therapy for post-myocardial infarction arrhythmias and developed infection with Staphylococcus aureus at the site of his indwelling cannula. He received prompt antibiotic therapy but was readmitted to hospital five weeks later with a terminal illness which proved at post-mortem to be a staphylococcal pleuropericarditis. We consider that this fatal infection originated at his venous cannula site. The problems of diagnosis are discussed.
This presentation describes the progress during 1978-1982 of the O.M.G.E. Multinational Survey of patients with inflammatory bowel disease. After a brief description of the study design and protocol, and review of results up to 1978, the status of the survey in 1982 is presented. In all, 35 centres contributed 2,657 cases at that time; data collection being meticulous via previously designed proformata. Diagnostic criteria are next discussed. Little change between 1978 and 1982 is noted, with wide variation in the UC/CD ratio for individual centres, but continuing evidence of a congruence of diagnostic thought, now codified into a simple (and recommended) O.M.G.E. Scoring System. Patients seen prior to 1978 were reviewed in 1982. Where attempted, a follow-up of over 90% was achieved, usually more than four years after the original presentation. Interesting data resulted. The stability of diagnosis was high, only 3.4% of patient diagnoses changing between 1978 and 1982. The mortality of Crohn's disease patients, usually unrelated to surgery, was higher than that of ulcerative colitis patents, and the cancer risk identical in the two groups. Most patients were well at review; but--though asymptomatic--were usually on prophylactice therapy, most commonly with salazopyrine. Finally, problems in assessing severity and activity of disease are discussed, and joint studies between O.M.G.W. and the newly formed International Organisation for the Study of I.B.D. described. As regards Crohn's disease, several 'indices of activity' already exist; when tested on a set of 200 O.M.G.E. patients, indices did not correlate well with each other, or with patient prognosis. Further studies are suggested during 1982-1986.
Although transmission of hepatitis B virus (HBV) infection has long been recognised as a potential hazard of gastrointestinal endoscopy, there has been little evidence of direct patient-to-patient cross-infection after such procedures. We wish to report a case of type B viral hepatitis almost certainly acquired at endoscopy from an instrument sterilised in the conventional manner, but which had been used on the previous day on a patient with bleeding oesophageal varices who was incubating type B viral hepatitis.
A 45-year-old man is described in whom there is currently ERCP and histological evidence of primary sclerosing cholangitis (PSC). A liver biopsy obtained 29 years ago shows similar histological features confirming that he had PSC at that time. This case indicates that PSC may follow a relatively benign course.
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A study of 510 patients in Scotland and northeastern England with histological evidence of alcohol-induced liver disease showed no difference in the age of presentation between males and females. Single men and widowed females were particularly susceptible to alcoholic liver disease. The social class distribution was similar to the population in general. Women were more reluctant to volunteer a history of alcoholism than men, they had a higher incidence of previous psychiatric illness (usually due to alcohol abuse) and they developed liver disease at lower consumption thresholds of alcohol than men. Patients under 40 years of age were more likely to have alcoholic fatty liver and less likely to have active cirrhosis than those over 40. Most often, the presenting symptoms were non-specific and tended to be related to the gastrointestinal system, particularly in women. Five per cent of patients were asymptomatic and 14% came to hospital for conditions other than alcoholic liver disease. Important clues to asymptomatic alcoholic liver disease included hepatomegaly, clubbing of the fingers and abnormal liver function tests. Gastro-oesophageal varices accounted for 40% of instances of haemorrhage and the mortality from upper gastrointestinal bleeding was 17%. Anaemia was the most common haematological abnormality. Alcoholic hepatitis was observed more frequently in the Glasgow area then elsewhere.
Members of three families had primary sclerosing cholangitis and chronic ulcerative colitis. In each family, two siblings were affected; in one instance, they were twin brothers. All six individuals had primary sclerosing cholangitis and five also had ulcerative colitis. These cases represent the first reported instances of the familial occurrence of both primary sclerosing cholangitis and chronic ulcerative colitis; illustrate the typical clinical, laboratory, radiologic, and pathological features of primary sclerosing cholangitis; and support the hypothesis that genetic factors may play a role in the etiology of this obscure disorder.
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Inflammatory bowel disease is being studied by the World Organisation of Gastroenterology (OMGE) Research Committee in a survey (currently) affecting 1696 patients presenting to 30 hospitals in 16 countries. A computer-aided diagnostic prediction system (when tested in 1056 patients) showed an accuracy of match between computer prediction and clinical diagnosis in 94% of these patients. Most centres, however, do not possess appropriate computing facilities. A simple diagnostic "scoring system", based on likelihood ratios, has therefore been developed, using a series of numbers set out on a single sheet of paper. The overall accuracy of the simple scoring system in the same 1056 patients was equivalent (93%) to the computer-aided system. In a further series of 510 "new" patients from eight fresh centres the diagnostic scoring system made a firm prediction in 490 cases (96%). Where made, the accuracy of match between the scoring system prediction and clinical diagnosis was 96%. It is suggested that this simple system, which requires no analytical resource and could be used by any gastroenterologist, might be of some value in clinical research and clinical practice.
Successful methods of ultrasonic characterisation of alcohol-induced diffuse liver disease using texture analysis (Lerski et al. 1979, 1980a, b) have studied the radiofrequency (RF) A-scan ultrasonic signal. In the present paper the Fourier spectra of such signals have been partitioned and a statistical analysis implemented to determine the diagnostic usefulness of certain frequency groups present in the signal. Although this method has not, of itself, been found to compared favourably with texture analysis it has shown that useful information is present in the high frequency portion of the frequency spectra. This information would not be available if the smoothed and denodulated A-scan signal were studied.
To test the hypothesis that psoriasis is associated with Crohn's disease and ulcerative colitis, 204 patients with inflammatory bowel disease (116 with Crohn's disease and 88 with ulcerative colitis) and 204 age and sex matched controls were interviewed and examined. The prevalance of psoriasis in Crohn's disease (II.2%) and in ulcerative colitis (5.7%), was significantly greater than in the control group (1.5%). The prevalence of psoriasis in first degree relatives of patients with inflammatory bowel disease was also increased. It is suggested that there is a relationship between psoriasis, ankylosing spondylitis, sacroiliitis, peripheral arthropathy and inflammatory bowel disease, which may be explained by common genetic factors.
The use of isotope scanning of the spleen in conjunction with 51Cr-labelled red blood cells has become an established technique in the evaluation of patients with hypersplenism. As far as we are aware the similar technique using labelled white blood cells to demonstrate splenic sequestration in a neutropenic patient has not been described. We report a case where this technique proved valuable in confirming the diagnosis and in predicting a favourable response to splenectomy.