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Biomedical subjects

J D Welsh

Publications and source records attributed to J D Welsh.

17 recordsLinked to original sources
PubMed1990

Recovery of phenytoin suspension after in vitro administration through percutaneous endoscopic gastrostomy Pezzer catheters.

Various methods of administering phenytoin suspension through a percutaneous endoscopic gastrostomy (PEG) Pezzer catheter were evaluated in vitro to determine which method resulted in the most complete recovery of phenytoin. To determine the effect of temperature on phenytoin recovery, 12 mL of phenytoin suspension (Dilantin-125, 125 mg/5 mL) was administered through three separate 35.5-cm 20 French latex PEG Pezzer catheters under each of three temperature conditions (suspension 11.8 degrees C and catheter 22 degrees C, suspension and catheter 22 degrees C, and suspension 22 degrees C and catheter 37 degrees C). To determine the effect of the administration method, 12-mL aliquots of phenytoin suspension were injected into the catheter by seven methods that varied with respect to catheter temperature, dilution of suspension, and irrigation of catheter. Each method was tested in triplicate, and samples were assayed by high-performance liquid chromatography. Varying the temperature of the catheter or suspension had little effect on the recovery of phenytoin. There was no appreciable loss of phenytoin when the suspension was undiluted, regardless of whether the catheter was irrigated. The greatest losses were seen when the suspension was diluted before administration. Irrigation also caused a decrease in recovery, but to a lesser extent than dilution. Until the effects of administering multiple doses of phenytoin through PEG Pezzer catheters are investigated, phenytoin suspension should not be diluted before administration because of decreased recovery and increased administration time.

Catheterization↗
PubMed1988

Comparative sequence analysis of the 5' noncoding region of the enteroviruses and rhinoviruses.

A comparative sequence analysis of the 5' noncoding region of a subgroup of the picornaviruses, including the polioviruses, coxsackie B3, and the human rhinoviruses, reveals the conservation of certain features despite the divergence of sequence. In this subgroup, for which nine complete sequences are available, two long stretches of sequence, two pyrimidine-rich regions, and 22 hairpins are conserved. Based on these results, similar secondary structures encompassing the entire 5' noncoding regions of these viruses are predicted. The fact that sequence divergence occurred only in a manner that allowed conservation of these structures implicates a biologically functional role for this region. The possible roles it may have in the picornavirus life cycle are discussed.

Base Sequence↗
PubMed1979

The visible vessel as an indicator of uncontrolled or recurrent gastrointestinal hemorrhage.

Although endoscopic examination in patients with bleeding of the upper gastrointestinal tract has improved diagnostic accuracy, it has not been useful in predicting clinical outcome and has not been shown to improve the patients' prognoses. This article describes a subgroup of patients with acute upper gastrointestinal bleeding whose clinical outcome can be predicted at the time of endoscopy. In 28 of 317 patients who underwent endoscopy, a "visible vessel" was seen in an ulcer presumed to be the bleeding site. All 28 were later recommended for operation because of recurrent (86 per cent) or uncontrolled (14 per cent) hemorrhage. In contrast, 75 per cent of the remaining 289 patients in whom vessels were not seen, whether or not bleeding from ulcers, had single bleeding episodes managed medically. Since patients with a "visible vessel" can be expected to have uncontrolled or recurrent hemorrhage, surgical treatment should be considered at the time of endoscopy if such a vessel is seen.

Acute Disease↗
PubMed1978

Adequacy of endoscopic biopsy specimens for disaccharidase assays.

Intestinal mucosa from 40 patients obtained by fiber-endoscopic biopsy was assayed for disaccharidases to determine suitability of this tissue for assay. The combined specimens from each patient provided 4.7-38.7 mg of tissue, adequate in all instances for duplicate determinations of protein, lactase, sucrase, and maltase. Tissue remained for assays of palatinase in 39 instances, trehalase and cellobiase in 37, and alkaline phosphatase in 22 cases. Twenty-four subjects had normal lactose tolerance tests and normal sucrase/lactase ratios. Thirteen patients with abnormal oral lactose tolerance tests were identified as having a primary low lactase activity on the basis of elevated sucrase/lactase ratios. This ratio was most helpful in making the diagnosis of a primary low lactase, since the mucosal specimens were not obtained from comparable areas. Tissue from three subjects with an abnormally low maltase was unsuitable for diagnosis. Endoscopic biopsy of mucosa appears to be satisfactory for disaccharidase assays in most instances.

Adult↗
PubMed1978

Diet therapy in adult lactose malabsorption: present practices.

Three hundred twenty-three of 473 questionnaires sent to hospital dietitians in 50 states and Puerto Rico concerning diet therapy for adult lactose malabsorption were returned and analyzed. Only 42% of the responding dietitians stated that their hospital diet manuals contained a diet for adult lactose malabsorption, with less than 1% having a diet specific for patients with peptic ulcer disease and lactose malabsorption. Physicians in almost half of these hospitals rarely considered lactose malabsorption when prescribing a diet for patients with peptic ulcer disease or rarely modified diets for suspected lactose malabsorption. The responding dietitians supplied pertinent portions of their diet manuals in 99 instances, which was 72% of those having such diets. Many of the submitted diets were too rigid, frequently restricting foods that did not contain lactose. On the basis of the survey and a review of the literature, a more reasonable approach to the therapy of adult lactose malabsorption is suggested.

Adult↗
PubMed1978

Disaccharidase deficiency in infants with cow's milk protein intolerance. Response to treatment.

7 infants, aged 5 weeks to 11 months, with clinically documented intolerance to cow's milk protein, chronic diarrhea, and failure to thrive, underwent small intestinal (peroal, suction) biopsy before and after withdrawal of milk proteins. Mucosal specimens were examined by light microscopy and assayed for disaccharidase activities. In all patients, moderate to severe mucosal changes were presented, associated with marked inflammation of lamina propria and damages to the brushborder. Disaccharidase activities (lactase, sucrase, maltase and palatinase) were markedly depressed in all. Follow-up biopsies were obtained in 6 infants, after 3-5 months on a milk-protein-free diet. At the time of the second biopsy, the disaccharidase activities had risen significantly and histologic improvement had occurred in each instance. In infancy, intestinal mucosal lesions due to intolerance to cow's milk protein are histologically indistinguishable from those seen in gluten-sensitive enteropathy and are associated with marked secondary disaccharidase deficiencies. Following therapy, the activity of the disaccharidases become normal or near normal prior to the complete morphologic recovery of the small intestinal mucosa.

Animals↗
PubMed1978

Intestinal disaccharidase activities in relation to age, race, and mucosal damage.

Studies were undertaken to determine the relationship of intestinal disaccharidase activity to age and race, and the relationship of mucosal damage to a primary low lactase activity. The first study consisted of data on 399 persons (339 whites, 53 blacks, and 7 American Indians) ages 1 month to 93 years, with normal intestinal histology. Among whites, all 117 children 5 years old or under had high lactase levels, whereas low levels were found only in subjects over 5 years of age. No low lactase levels were identified among the 11 black children 3 years old or under, but in comparison to coetaneous white children, their mean lactase activity was signficantly less. The majority of older blacks had low lactases. In whites and blacks alpha-disaccharidases did not participate in the age-related changes demonstrated with lactase. Of the 7 American Indians, none under 26 months old had low lactase levels, whereas the 4 over 10 years old had low activities. Heterozygotes for sucrase-isomaltase deficiency were identified only among whites. Low lactase levels developed during childhood in all races studied, however, many for unknown reasons maintained their lactose tolerance until adulthood. In the second study of 13 additional children with secondary disaccharidase deficiencies, emergence of a primary low lactase was related to age and race, rather than to mucosal damage. It appears that primary low intestinal lactase levels are absent or rare in whites under 5 and blacks under 3 years of age, and the deficiency is not related to mucosal damage.

Adolescent↗
PubMed1978

Hemostatic defect in endoscoped upper gut bleeding.

In an effort to assess the role of salicylate ingestion in upper gastrointestinal bleeding, one observer obtained a blood specimen for salicylate determination, performed a Duke bleeding time, and obtained a detailed drug history at the time of diagnostic endoscopy. Although a salicylate ingestion history was common, other variables did not correlate with it. Prolonged bleeding time occurred in 21 of the 81 patients, versus 1 of 22 controls. It was strongly associated with liver disease, with the alcohol habit by history, and with endoscopically severe gastritis, but was not correlated with plasma salicylate levels or evidence of salicylate ingestion by history, or with thrombocytopenia. Additional relationships linked liver disease and gastritis with prolonged bleeding time. There was no direct evidence from this study that salicylate ingestion occurred more frequently among gastrointestinal bleeders than among controls, and there was no evidence that the hemostatic defect increased the magnitude of bleeding.

Alcoholism↗
PubMed1977

Gastric emptying of lactose and milk in subjects with lactose malabsorption.

Six lactose absorbers (LA) and 5 lactose malabsorbers (LM) had tests of gastric emptying with 750-ml meals of glucose in water, lactose in water, plain milk, and chocolate milk. The glucose and lactose meals emptied in a similar fashion in LA and LM subjects with a significant decrease in gastric emptying as the osmolarity of the meals was doubled. If the data are normalized by dividing lactose emptying by the emptying of glucose meals of twice the osmolality in each individual, the lactose malabsorbers empty significantly more lactose. Both LA and LM subjects emptied comparable amounts of milk meals having similar osmolarity. Chocolate milk, which had a higher osmolality than plain milk, emptied more slowly than plain milk in both groups, and this difference was significant in the LM group.

Adult↗
PubMed1977

Effects of age on lactose malabsorption in Oklahoma Native Americans as determined by breath H2 analysis.

Breath H2 excretion was used to determine lactose malabsorption in 30 health females and 30 healthy males between the ages of 3 and 64 yr who were at least 7/8 Native American. The test meal consisted of 5 ml reconstituted nonfat dry milk (0.25 g lactose) per kg of body weight. On the basis of breath H2 tests in 15 control subjects with normal oral lactose tolerance tests, a response factor of 20 ppm was selected as the upper limit for lactose absorbers. Of the 60 subjects in the study group, 36 (60%) were classified as lactose malabsorbers since they had a response factor of 20 ppm or greater of breath H2. Only 3 of 20 children (15%) who were under the age of 12 yr were nondigesters of the small lactose dose used in this study. Approximately 82 percent (82.5%) of subjects who were 13 yr and older were lactose malabsorbers. Adolescence appears to be the period in which malabsorption of lactose becomes evident in Native North Americans.

Adolescent↗
PubMed1977

Lactose malabsorption in adult Vietnamese.

Because of the traditional "nonmilking" attitude in Vietnam, a high incidence of lactose malabsorption would be expected in Vietnamese. However, confirming data are not available, and for this reason 31 adult Vietnamese were studied by obtaining diet histories and performing oral lactose tolerance tests. Twenty-three had drunk from one glass of milk a month to three glasses a day as adutls in Vietnam, and eight had noted milk-related symptoms. Since arrival in the United States, 30 had drunk milk and six had experienced symptoms. All 31 adult Vietnamese tested had flat lactose tolerance tests, signifying lactose malabsorption, with 20 subjects having symptoms during or after the tests.

Adult↗
PubMed1977

Milk and lactose-hydrolyzed milk.

Seven females 18 to 26 years old (mean 23 years) who were lactose malabsorbers as determined by a lactose tolerance test were given two different test meals: 5 ml/kg body weight reconstituted nonfat dry milk and 5 ml/kg body weight reconsituted nonfat dry milk in which 92% of the lactose had been hydrolyzed to glucose and galactose. Lactose malabsorption was determined by the breath H2 test. Tests were done in duplicate for a total of 28 tests. Whether a 3-hr test period of a 5-hr test period was used, the average breath H2 response after the lactose-hydrolyzed nonfat dry milk test meals was significantly lower (P less than 0.002) than the average breath H2 response after the nonfat dry milk test meals. There were significant differences among individual responses (P lless than 0.06 for the 3-hr test period and P less than 0.09 for the 5-hr test period), and no significant differences between duplicate test days.

Adolescent↗
PubMed1977

Diet therapy of peptic ulcer disease.

Information from 326 dietitians representing 50 states and Puerto Rico on the diet therapy of peptic ulcer disease (PUD) in their hospitals was analyzed. There were 74 teaching, 65 teaching/private, 46 private, 120 Veterans Administration, and 21 miscellaneous hospitals. A bland diet was the most commonly used diet for PUD in 250 (77%) of the hospitals. Of the 161 providing information on the type of bland diet, 72% used a bland I or II. Milk was given routinely or usually in 55% of the 326 hospitals. On discharge, dietitians in one-half of the hospitals instructed patients on a bland diet, usually a bland IV, whereas the remaining dietitians instructed their patients on a regular or modified regular diet. Outpatient PUD instruction was similar. Review of bland diets in 105 manuals revealed marked variation in nomenclature and composition of even supposedly similar diets. Uniformity would benefit patients, dietitians, and physicians.

Animals↗
PubMed1976

Relationship between the changes in gastrin levels and intestinal properties in the starved rat.

Intestinal DNA, RNA, and protein content were decreased to a greater extent than was body weight when rats were starved for 3 days. Specific lactase and maltase activity increased with progressively longer periods of starvation. Antral and serum gastrin concentration significantly decreased during the 3 days of starvation. Pentagastrin (250 mug/kg 3 times daily) was injected into a group of rats for the duration of a 3-day starvation period and caused a small but significant increase in the relative intestinal RNA and protein content and decreased lactase and maltase specific activities in comparison with the levels of 3-day starved controls. Pentagastrin thus partially reversed some of the starvation-induced changes toward fed levels. Thus, a deficiency in the trophic hormone gastrin may be partially responsible for the disproportionate changes in intestinal tissue during starvation.

Animals↗
PubMed1976

Hepatitis BS antigen, malaria titers, and primary liver cancer in South Vietnam.

A total of 306 individuals from South Vietnam were studied: 61 had a diagnosis of primary liver cancer (38 had a tissue diagnosis, and 23 had a clinical diagnosis and a positive alpha-fetoprotein); 9 had viral hepatitis; 101 were hospitalized patients (60 with various other forms of liver disease and 41 without liver disease); 94 were blood donors; 29 were drug users, and 12 were medical students. Alpha-fetoprotein was present in 45 of 61 (74%) of those with a diagnois of primary liver cancer (PLC) and in none of the other patients. Using immunoelectroosmophoresis, hepatitis BS antigen (HBSAg) was found no more frequently in those with PLC than in the other groups studied. In contrast, using a radioimmunoassay technique HBSAg was present 3 to 8 times as frequently in the PLC patients as in other subjects without viral hepatitis. There was a close relationship between the presence of alpha-fetoprotein and HBSAg in the patients with PLC. Malaria seropositivity rates were no different in the PLC groups than the other groups. It appears that in South Vietnam PLC is associated with an increased frequency of HBSAg.

Adolescent↗