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Biomedical subjects

I T Gilmore

Publications and source records attributed to I T Gilmore.

At least 73 records · Page 4Linked to original sources
PubMed1982

Cholecystokinin cholecystography, sonography, and scintigraphy: detection of chronic acalculous cholecystitis.

Because the efficacy of cholecystokinin cholecystography in the detection of chronic acalculous cholecystitis remains in doubt, the procedure is rarely used in clinical practice. However, the ability to observe gallbladder contraction with sonography and 99mTc-para-isopropylacetanilido-iminodiacetic acid cholescintigraphy (PIPIDA) offers a possibility to improve the sensitivity of the test. To determine if the degree of gallbladder contraction after cholecystokinin is the same as measured by the three techniques and if it differs in symptomatic patients compared to the normal population, cholecystokinin cholecystography, cholecystokinin sonography, and cholecystokinin PIPIDA were performed in 10 symptomatic patients and 10 normal volunteers. The mean maximum contraction of the gallbladder during the three studies was 63%, 61%, and 68%, respectively, for the volunteers, and 72%, 63%, and 73%, respectively, for the patients. The mean maximum gallbladder contraction during all three procedures was 64% +/- 26% SD in the volunteers and 74% +/- 17% SD in the patients. The differences were not statistically significant. Although there was good correlation in the degree of maximum gallbladder contraction among cholecystokinin cholecystography, cholecystokinin sonography, and cholecystokinin PIPIDA, marked variation in both the volunteers and the patients makes it unlikely that the degree of contraction as observed by any of these techniques can be used to indicate the presence of chronic acalculous cholecystitis.

Biliary Dyskinesia↗
PubMed1982

Half-life time or clearance of indocyanine green in patients with liver disease.

The clearance, half-life time, fractional elimination rate and distribution volume of indocyanine green (10 mg . m-2) were measured in 20 control subjects and 63 patients with histologically confirmed liver disease. Mean clearance was significantly impaired only in the patients with alcoholic and primary biliary cirrhosis; in those with active chronic hepatitis, with or without cirrhosis, or with acute hepatitis, clearance was normal. However, half-life time and fractional elimination rate were impaired in all but one group of patients. This discrepancy arose because of a significantly increased distribution volume in all groups with chronic liver diseases except primary biliary cirrhosis. Thus, in chronic liver disease, half-life times and fractional elimination rates do not necessarily reflect hepatic uptake; measurement of clearance is therefore to be preferred.

Adult↗
PubMed1981

A comparison of two methods of whole gut lavage for colonoscopy.

Two forms of bowel preparation for colonoscopy were compared--19 patients were given 5 per cent mannitol solution orally while a further 19 were infused with isotonic saline via a nasogastric tube. Both methods proved equally acceptable to the patients and endoscopists. Saline led to a rise in body weight (+0.75 +/- 0.35 kg) and blood pressure (+7.5 +/- 2.8 mmHg) while mannitol caused a significant fall in both body weight (-0.74 +/- 0.28 kg) and blood pressure (-3.8 +/- 2.9 mmHg). Plasma volume measurements were carried out on 17 patients; 8 receiving saline showed a rise (+0.22 +/- 0.08 l) while 9 taking mannitol experienced a fall (-0.17 +/- 0.08 l). Twelve further subjects prepared with a combination 10 per cent mannitol and isotonic saline showed a small fall in plasma volume (-0.08 +/- 0.05 l). Mannitol proved an acceptable preparation for colonoscopies but a fall in body weight, blood pressure and plasma volume posed a small risk to the elderly subject and in view of the known risks of mannitol during diathermy this form of preparation was not considered a suitable alternative to isotonic saline.

Administration, Oral↗
PubMed1981

Direct measurement of hepatic extraction of bile acids in subjects with and without liver disease.

1. The hepatic extraction ratio of 14C-labelled bile acids has been measured directly by hepatic vein catheterization in five patients without liver disease (glycocholic acid, three; cholic acid, two) and in 16 patients with histologically confirmed liver disease (glycocholic acid, seven; cholic acid, nine). 2. After intravenous administration of [14C]-glycocholic acid by bolus injection (two control subjects) or constant infusion (one control subject), directly measured hepatic extraction ratio was 0.91, 0.84 and 0.88, greater than that for indocyanine green. The extraction ratio of [14C]cholic acid in two subjects was 0.72 and 0.70, confirming a lower extraction of the unconjugated bile acid. 3. The hepatic extraction ratio of both bile acids was reduced in patients with chronic liver disease (range 0.07-0.69), although the extraction ratio of glycocholic acid remained normal in one patient with viral hepatitis. 4. Estimates of liver flow calculated from the extraction of [14C]glycocholic acid, but not cholic acid, correlated with those calculated from indocyanine green kinetics, although numbers were small. 5. Measurement of the hepatic extraction of individual bile acids, not previously reported in man, allows a more accurate description of the enterohepatic circulation.

Adult↗
PubMed1981

Effects of a meal on plasma clearance of [14C]glycocholic acid and indocyanine green in man.

1. The fasting plasma disappearance curve of [14C]glycocholic acid after intravenous injection was compared in nine normal subjects with that obtained 100 min after a standard liquid test meal. 2. Plasma disappearance curves of indocyanine green were determined in 13 normal subjects under the same conditions. 3. Plasma clearances were significantly increased after the meal for both [14C]glycocholic acid (median 455 ml min--1 m--2, range 376--672 increased to 704, 528--1968; P less than 0.01) and indocyanine green (359, 227--473 increased to 435, 358--985; P less than 0.01). 4. Median initial volume of distribution was unaltered, but in four subjects it was greatly increased after the meal, although no alteration in plasma volume, measured with Evans blue dye, was observed. 5. The increased postprandial plasma clearance of glycocholic acid is probably due to an increase in liver blood flow, and suggests that in health this part of the enterohepatic circulation of bile acids also varies with meals.

Adult↗
PubMed1981

Screening for occult gastrointestinal bleeding in hospital patients.

Stools have been tested for occult gastrointestinal bleeding in 278 outpatients and 170 hospital inpatients using the Haemoccult and Haemastix methods. Seventeen outpatients (6.1%) and 42 inpatients (24%) were positive with the Haemoccult technique. Thirty-three outpatients (11.9%) and 93 inpatients (54.7%) were positive with the Haemastix test. Following investigation of the Haemoccult-positive patients, only 2 cases (3.4%) were considered false positive. However, the false positive rate with Haemastix was 22.9% which is unacceptable in a screening test. Haemoccult may be useful as a screening test for asymptomatic general practice patients, but a test of greater sensitivity is needed for hospital patients.

Adolescent↗
PubMed1980

Plasma clearance of oral and intravenous cholic acid in subjects with and without chronic liver disease.

The apparent plasms clearances of tracer amounts of radiolabelled cholic acid given orally or intravenously were compared in 14 control subjects and 20 patients with chronic liver disease. The clearance after oral administration was the more sensitive in detecting chronic liver disease and correlated better with the fasting levels of endogenous serum bile acid. This agrees with the predicted effects on clearance of hepatocellular damage and portal-systemic shunting of blood after the two routes of administration. The estimated hepatic extraction ratio, calculated from the ratio of the oral and intravenous clearances, was 0.77+/-0.02 (mean+/-SEM) in control subjects, 0.64+/-0.03 in patients with anicteric chronic liver disease, and 0.46+/-0.05 in those with icteric chronic liver disease.

Administration, Oral↗
PubMed1978

Kinetics of 14C-glycocholic acid clearance in normal man and in patients with liver disease.

The plasma clearance of a tracer dose of 14C-glycocholic acid, and fasting total serum bile acid concentrations were measured in 14 control subjects and in 38 patients with acute and chronic liver disease. In controls plasma clearance was 415 +/- 24 ml min-1 m-2 (mean +/- SEM), equivalent to a 'first-pass' extraction by the liver of 85%. Clearance was not significantly different from controls in patients with acute hepatitis or active chronic hepatitis, nor in anicteric patients with primary biliary or alcoholic cirrhosis. Thus bile acid clearance was impaired only in icteric chronic liver disease. In contrast, serum bile acid concentrations were abnormal in all but seven patients, six of whom had active chronic hepatitis in complete biochemical remission. The pattern of plasma disappearance of injected 14C-glycocholic acid was biexponential in controls and patients with liver disease, and computer analysis of the curves suggested that there was significant distribution of bile acid outside the vascular space. The preservation of bile acid clearance in anicteric chronic liver disease confirms that it is dependent more on liver blood flow than on liver cell function.

Adult↗
PubMed1977

Acute leukaemia during azathioprine therapy.

Various tumours, in particular lymphomas, have been reported in association with azathioprine treatment, both after renal transplantation and in other conditions. A case is reported here of acute myeloid leukaemia associated with azathioprine therapy for rheumatoid arthritis, and this is now the third case reported in the world literature of leukaemia arising during azathioprine therapy for a non-malignant condition.

Aged↗
PubMedDate not supplied

General practice nurses' knowledge of alcohol use and misuse: a questionnaire survey.

Nurses in general practice (termed practice nurses) are an under-utilized resource for the detection and management of patients with alcohol misuse. However, little is known about their knowledge and attitudes towards alcohol use and misuse. We therefore conducted a postal questionnaire survey of 132 practice nurses in Liverpool (UK). The results of our survey (response rate 77%) show that a knowledge and skills gap exists in the delivery of effective advice on alcohol-related issues. Indeed, our results suggest that only one in two women and one in three men are receiving correct advice on sensible limits of alcohol consumption, this despite the fact that alcohol histories are taken. Further training was requested by most nurses to develop their screening and health promotion roles, and to become involved in the management of patients with alcohol-related problems in primary care. We suggest practice nurses should be encouraged to become involved in screening for, and management of, alcohol-related problems. However, it is important to ensure that the nurses receive appropriate training and have adequate back-up facilities from doctors and other workers involved in the care of patients with alcohol-related problems.

Alcoholism↗