Biomedical subjects
Publications and source records attributed to J F Fielding.
We report three cases of Morquio Brailsford Disease (Mucopolysaccharidosis Type IV A) in an Irish family. We are unaware of any previous similar report from this Country.
Gastrointestinal symptoms were present at the time of diagnosis in 81 (76%) of 107 patients with coeliac disease: 56% had diarrhoea/steatorrhoea, 32.7% abdominal pain and 15% constipation. Gastrointestinal symptoms were commonest in young adults (20-39 years) and less frequent in children (0-19 years). Anaemia, low serum levels of folic acid, albumin and calcium, and raised serum alkaline phosphatase may be of help in raising the index of diagnostic suspicion, but in over half of our patients with clinically and histologically active disease these values were within normal limits. In patients adhering to a gluten free diet remission of symptoms correlated well with histological response; the continuation of symptoms indicated a higher incidence of histological abnormality. No patient not complying to the diet had normal histology on repeat biopsy. Five patients died over the ten year period, one from a small bowel lymphoma.
The incidence of pneumothorax and role of post biopsy chest x-ray were assessed in a prospective study of 120 consecutive patients using a standard biopsy technique. The incidence of pneumothorax was 0.8%. Post biopsy chest x-ray was not found to improve accuracy of diagnosis compared with clinical findings. Patients over the age of 60 years were at greater risk of pulmonary complications following liver biopsy.
We present two cases of ulcerative jejunitis unassociated with coeliac disease. The condition is probably being underdiagnosed especially since the reduction in the investigative laparotomy.
Primary fibromyalgia (PFM) and the irritable bowel syndrome (IBS) are both common conditions which account for 30% or more of referrals to rheumatology and gastroenterology clinics. An association between symptoms in PFM and IBS has been suggested but the frequency with which they coexist has not been assessed. The aim of this study was to examine the prevalence of each condition in groups of patients with PFM and IBS compared to normal and disease control populations. We studied four patient groups, 20 patients in each group, with PFM, IBS, inflammatory arthritis, inflammatory bowel disease and also 20 normal controls. Using strict diagnostic criteria, each group was assessed by two investigators for symptoms and signs of PFM and IBS. Sigmoidoscopy was performed when indicated. Results indicate that 70% (14/20) of the PFM patients had IBS and 65% (13/20) of the IBS patients had PFM. This compared with the control groups where 12% (7/60) and 10% (6/60) had PFM and IBS respectively. In conclusion, these results indicate that PFM and IBS frequently coexist. A common pathogenetic mechanism for both conditions is therefore suggested.
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One hundred consecutive patients presenting with anaemia of at least 4 wks' duration were studied. This represents 3% of all patients seen at a medical service with a gastroenterology subspecialty interest. Forty-three men and 57 women were included; the mean age was 60 (SD 18) yr. Iron deficiency was the principal cause of anaemia in 49% of cases. Blood loss from the gastrointestinal tract was the most frequent cause of iron deficiency and was predominantly from the upper gastrointestinal tract. Patients in whom iron deficiency was the sole cause of anaemia all had a microcytic hypochromic blood profile; however, serum iron and iron binding capacity correlated poorly with the severity of anaemia. Chronic disease was the principal cause of anaemia in 39% of patients.
A prospective study to determine the presence or absence of any difference in skin temperature and electromyographic (EMG) activity in 20 patients with irritable bowel syndrome (IBS) compared with 20 age- and sex-matched controls was conducted. A representative digital temperature and EMG activity during 4 phases, baseline, mental activity (arithmetic), unpleasant thoughts and audio biofeedback relaxation, were recorded using standard biofeedback equipment. Results showed the IBS group to have a significantly lower digital temperature and significantly higher EMG activity during the baseline and arithmetic phases. No difference was found in EMG activity for the unpleasant thought or audio biofeedback relaxation phases. Indeed, the IBS group were able to achieve a level of EMG activity during the audio feedback relaxation phase that approximated very closely that of the control group. These results provide further evidence suggestive of altered autonomic nervous system function in IBS patients and indicate that further studies should be undertaken to determine whether the reduction achieved in EMG activity post-relaxation is sustained, and if so, if it is associated with a corresponding improvement in symptoms.
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Intravenously injected midazolam was associated with a greater degree of sedation, as assessed by 24-h retrograde amnesia, than the longer acting benzodiazepine, diazepam. No differences in the frequency of pain on injection or the occurrence of venous sequelae were noted between the two preparations.
We report massive acute haemolysis associated with hepatitis A in a 36 year old Irish woman. Although mild anaemia is not uncommon during viral hepatitis, haemolysis of the severity observed in this patient has previously been reported only in patients with glucose-6-phosphate dehydrogenase deficiency.
The relationship between the two granulomatous diseases sarcoidosis and tuberculosis is reviewed. Data from 14 published case series are presented in the form of a figure which indicates that case series collected earlier in time and with a high proportion of non-white patients show a higher prevalence of tuberculosis. This high prevalence was also found in other chronic diseases such as diabetes and rheumatoid arthritis. The more frequent presence of mycobacteria in sarcoid than in control tissue, the parallel changes in the prevalence of sarcoidosis and tuberculosis in a community and the presence of myocbacteria on culture if pursued with sufficient aggression, are consistant with a mycobacterial aetiology. Recent developments in the immunology of the two diseases are reviewed.
This report describes simultaneous autoimmune thyrotoxicosis and autoimmune haemolytic anaemia. Autoimmune haematological abnormalities should be excluded in patients with Graves' disease and thyroid function and thyroid antibody status should be evaluated in patients with autoimmune haemolytic anaemia.
No subjective or objective evidence of beneficial effect was observed from the use of Pirenzepine in irritable bowel syndrome (IBS) patients who had not responded to a high fibre diet.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.