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Biomedical subjects

I Hamilton

Publications and source records attributed to I Hamilton.

At least 55 records · Page 3Linked to original sources
PubMed1987

Abnormal intestinal permeability. An aetiological factor in chronic psychiatric disorders?

Abnormal intestinal absorption has been suggested as an aetiological factor in schizophrenia. A procedure for investigating intestinal permeability was carried out in a group of chronic psychiatric in-patients. A proportion of the subjects studied showed abnormal intestinal permeability which could not be attributed to established bowel disease. Patients who were receiving neuroleptic but not anticholinergic drugs were those most often showing abnormal intestinal permeability. This work is at an early stage of development but preliminary findings suggest that further investigations should be carried out to establish the circumstances in which changes in intestinal permeability may be associated with mental illness.

Celiac Disease↗
PubMed1986

Ultrasound detection of choledocholithiasis: prospective comparison with ERCP in the postcholecystectomy patient.

The role of ultrasound as a screening test for choledocholithiasis was prospectively assessed by comparing the results of upper abdominal ultrasound with direct cholangiography in 59 unselected symptomatic postcholecystectomy patients. Ultrasound detected duct stones in 13 of 29 patients (sensitivity, 45%) and their absence in 29 of 30 (specificity, 97%). A positive ultrasound diagnosis of choledocholithiasis was correct 13 times out of 14 (predictive value, 93%) whereas a negative diagnosis was correct on only 29 of 45 occasions (predictive value, 64%). No significant learning effect was seen. Intestinal gas obscuring the distal common duct was the most important factor limiting the ability of ultrasound to detect duct stones. Duct stones were present in 25 of 35 patients shown to have a dilated common duct on ultrasound, and in 4 of 24 with nondilated ducts; the predictive value of duct dilatation at ultrasound for duct stones was therefore 71% and that of nondilatation in excluding stones was 83%. Dilated intrahepatic bile ducts were demonstrated at ultrasound in only 17% of patients with choledocholithiasis. We conclude that ultrasound cannot reliably diagnose or exclude bile duct stones and is an inadequate screening test for the symptomatic postcholecystectomy patient.

Adult↗
PubMed1986

Healing and recurrence of duodenal ulcer after treatment with tripotassium dicitrato bismuthate (TDB) tablets or cimetidine.

Eighty patients with duodenal ulcer were randomly allocated to treatment with tripotassium dicitrato bismuthate (TDB) tablets or cimetidine. Ulcers healed in 78% of patients treated with TDB and in 74% treated with cimetidine, supporting previous observations that the efficacy of these two agents is similar. Duodenal ulcer recurred in 43% of patients in the 12 months after treatment with TDB and in 78% of patients treated with cimetidine, with a significantly greater incidence of recurrence 6-12 months after cimetidine treatment. Tripotassium dicitrato bismuthate tablets may be preferable to cimetidine in the initial management of duodenal ulcer, because they offer a smaller likelihood of recurrence in the 12 months after successful treatment.

Adult↗
PubMed1986

Collagenous colitis associated with small intestinal villous atrophy.

Two patients diagnosed as having small intestinal hyperplastic villous atrophy and being treated with a gluten free diet were investigated because of persistent watery diarrhoea. Both were found to have collagenous colitis. Previous reports of this condition have emphasised the presence of normal small intestinal mucosal architecture and the association of collagenous colitis with intestinal villous atrophy has not previously been reported. Both cases responded to oral steroid therapy, but not to other previously recommended treatment regimens.

Atrophy↗
PubMed1986

Pancreatic function and enzyme synthesis rates in mild chronic pancreatitis.

Incorporation of intravenous 75Se-methionine into duodenal juice proteins during pancreatic stimulation was measured as an index of pancreatic enzyme synthesis rates in 12 patients with a normal pancreatogram and in 6 with mild chronic pancreatitis. Isotope incorporation was significantly greater in subjects with mild chronic pancreatitis than in those with a normal pancreatogram. Thus in most patients in whom pancreatography demonstrates the characteristic radiological features of 'mild chronic pancreatitis' pancreatic acinar function is abnormal. The coexistence of morphological and functional abnormality implies that such patients do have chronic pancreatitis.

Bicarbonates↗
PubMed1985

Cellobiose/mannitol test: physiological properties of probe molecules and influence of extraneous factors.

The influence of gastric emptying, intestinal transit, renal and hepatic function, and variations in the timing of urine collections, on the cellobiose/mannitol test of intestinal permeability has been studied. None of these extraneous factors influences the cellobiose/mannitol recovery ratio, and there is only a modest effect of renal function on urinary mannitol recovery. Cellobiose is almost totally recovered in the urine within 10 h of intravenous injection, whilst mannitol is less completely recovered, perhaps due to hepatic metabolism. The simultaneous administration of two probe molecules in the cellobiose/mannitol test, and the use of a ratio to express results, thus achieves the desired object of minimising the effect of extraneous factors on the test result. The cellobiose/mannitol test is therefore not subject to the limitations of previous tests of intestinal permeability using orally administered probe molecules, and is widely applicable as a screening test for coeliac disease.

Celiac Disease↗
PubMed1985

Bile duct calibre: the discrepancy between ultrasonic and retrograde cholangiographic measurement in the post-cholecystectomy patient.

The discrepancy between bile duct measurements obtained by ultrasound and retrograde cholangiography in post-cholecystectomy patients was prospectively evaluated by performing real-time biliary tract sonography on 50 patients 2-3 h prior to endoscopic retrograde cholangiography (ERC). A significant discrepancy was detected (P less than 0.001) which was greatest in 14 patients shown by cholangiography to have duct dilatation without evidence of biliary tract disease (P much less than 0.001). Factors contributing to the discrepancy included: measurement of different regions of the duct by the two techniques, loss of duct wall elasticity producing a 'floppy duct' phenomenon, the capacity of the biliary tract for rapid spontaneous change in calibre, radiographic magnification and ultrasonic underestimation of duct diameter. The sonographic diameters were significantly correlated to the diameters measured by ERC (r = 0.73). Although ERC generally agreed with ultrasound in the diagnosis of duct dilatation (specificity 90%), there was significant disagreement between the two techniques in the detection of non-dilatation, dilated or 'dilatable' systems being missed by ultrasound in 11 out of 21 (52%) of cases in which they were found by ERC. Our results suggest that, in the investigation of the symptomatic post-cholecystectomy patient, direct comparison of bile duct size measured by ultrasound and ERC is of limited clinical value.

Adult↗
PubMed1985

Double blind controlled trial of oral vancomycin as adjunctive treatment in acute exacerbations of idiopathic colitis.

A prospective double blind trial of vancomycin vs placebo was undertaken in 40 consecutive adult patients with exacerbation of idiopathic colitis (33 ulcerative colitis, seven Crohn's disease). Vancomycin or placebo (500 mg six hourly) was given for seven days in addition to routine medical therapy. Although there was no significant overall difference in outcome between the two groups, there was a trend towards a reduction in the need for operative intervention in patients with ulcerative colitis treated with vancomycin compared with controls. The efficacy of vancomycin was not attributable to its known action against C difficile, which was not isolated from any of the patients. The data suggest that microbiological factors may play a part in the pathogenesis of ulcerative colitis and that further studies using antimicrobials are desirable.

Adult↗
PubMed1985

Medium term complications of endoscopic biliary sphincterotomy.

One hundred and fifteen patients were reviewed between 18 months and five years after successful endoscopic biliary sphincterotomy for choledocholithiasis, postcholecystectomy in 93 (81%). Thirteen (14%) postcholecystectomy patients and 11 (50%, p less than 0.001) with intact gall bladders are dead (cause of death was ascertained in each case). Of the others, 43 were interviewed and 48 completed a postal questionnaire. Stone free common ducts had been documented in 69 (76%), presumed in 16 (17%), and not achieved in six (7%, excluded from analysis). None of the responding patients had developed serious new problems. Current symptoms of those with and without gall bladders and those with 'documented' and 'presumed' duct clearance are similar. In no case has an episode of cholangitis since sphincterotomy been confirmed and only one patient has had documented recurrent duct stones. Continued incompetence of the sphincter was shown radiologically by the presence of bile duct gas in 14 (41%) of 32 patients. These results suggest that medium term complications of endoscopic sphincterotomy are unusual.

Adult↗
PubMed1985

Small intestinal permeability in dermatological disease.

Passive small intestinal permeability was investigated in 62 patients with atopic eczema, 29 with psoriasis and 18 with dermatitis herpetiformis, using the cellobiose/mannitol differential sugar absorption test. Urinary recovery of cellobiose and mannitol in patients with both psoriasis and eczema were similar to values in a control population, and were not affected by the extent or activity of skin disease. The cellobiose/mannitol recovery ratio was abnormally high in seven patients with eczema, six of whom underwent jejunal biopsy. Jejunal mucosal morphology was normal in five, and one patient was found to have coeliac disease. Cellobiose/mannitol recovery ratio was also abnormal in seven patients with psoriasis, and in 11 with dermatitis herpetiformis, seven of whom had a normal jejunal biopsy. These findings demonstrate that the passive permeability of the small intestine is normal in the majority of patients with atopic eczema and psoriasis. Increased absorption of macromolecules from the gut lumen cannot be ascribed to defective intestinal integrity, and is unlikely to be relevant to the pathogenesis of eczema. Abnormal intestinal permeability may be a more sensitive manifestation of gluten-sensitive enteropathy than jejunal biopsy in dermatitis herpetiformis.

Adolescent↗
PubMed1984

Prospective comparison of three non-invasive tests for pancreatic disease.

Ultrasonography, computed tomography (CT), and an oral pancreatic function test were evaluated prospectively in 107 consecutive patients suspected of having pancreatic disease, the final diagnosis being made independently of these tests. Seventeen patients proved to have either chronic pancreatitis or a pancreatic neoplasm. Five had an unfused ventral pancreas and 10 had "minimal change" pancreatograms. Seventy five patients did not have pancreatic disease. Among the 17 patients with pancreatic disease the sensitivities of ultrasound, CT, and the pancreatic function test were 70%, 71%, and 76% respectively; among those without disease values of specificity of the three tests were 75%, 87%, and 72%. All three tests failed to detect most of the patients with unfused ventral pancreases or minimal change pancreatograms. The predictive values of a positive result for the three tests were 43%, 67%, and 34%. The predictive value of a negative result was greater than 90% for all the tests. Results improved when CT was combined with either of the two other tests. These findings show that CT is the most accurate of the three tests in diagnosing pancreatic disease but that a combination of ultrasound and the oral pancreatic function test offers a more widely applicable and almost as accurate alternative.

4-Aminobenzoic Acid↗
PubMed1984

A comparison of prednisolone enemas with low-dose oral prednisolone in the treatment of acute distal ulcerative colitis.

The therapeutic efficacy of prednisolone metasulphobenzoate enemas in the treatment of distal colitis has been compared with that of low-dose oral prednisolone, in a single-blind, cross-over trial. Treatment with steroid enemas resulted in symptomatic and sigmoidoscopic evidence of improvement more frequently than treatment with a dosage of oral steroid calculated to achieve similar plasma prednisolone levels. In addition to demonstrating, for the first time, that prednisolone metasulphobenzoate enemas are effective in the treatment of colitis, this study suggests that their efficacy is due to a local action rather than systemic absorption.

Acute Disease↗
PubMed1983

Acute pancreatitis following endoscopic retrograde cholangiopancreatography.

An analysis of endoscopic retrograde cholangiopancreatography (ERCP) examinations suggests that repeated contrast injection into the pancreatic duct during attempts to cannulate the bile duct is of major importance in the aetiology of acute pancreatitis after ERCP, even in the absence of pancreatic acinar opacification. The technique of ERCP can easily be modified to avoid repeated pancreatic duct injection and, by doing so, an increase in the incidence of acute pancreatitis has been reversed.

Acute Disease↗
PubMed1983

The endoscopic retrograde cholangiogram and pancreatogram in chronic liver disease.

The endoscopic retrograde cholangiogram and pancreatogram of 22 patients with primary biliary cirrhosis, 33 patients with other forms of chronic liver disease and 28 'normal' controls were compared. The incidence of radiological intrahepatic duct abnormality is similar in patients with primary biliary cirrhosis and in other forms of liver disease, but is present in only a minority of both groups. A 'notch' or smooth indentation on the extrahepatic bile ducts at the porta hepatis was present in 58% of patients with primary biliary cirrhosis but in none in either of the other two groups. Three out of seven patients with sclerosing cholangitis showed minimal-change pancreatitis. Pancreatic abnormalities were otherwise infrequent.

Cholangiopancreatography, Endoscopic Retrograde↗