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Biomedical subjects

J H Bond

Publications and source records attributed to J H Bond.

At least 19 recordsLinked to original sources

The National Polyp Study. Design, methods, and characteristics of patients with newly diagnosed polyps. The National Polyp Study Workgroup.

The National Polyp Study (NPS) is a multicenter prospective randomized trial designed to evaluate follow-up surveillance strategies in patients who have undergone polypectomy for the control of large bowel cancer. The study design was developed by a joint research committee from American Gastroenterological Association, the American Society for Gastrointestinal Endoscopy, and the American College of Gastroenterology. Subjects who met the eligibility criteria were randomized into two different treatment arms. Eligibility criteria included: removal of one or more adenomas; complete colonoscopy; no prior polypectomy, inflammatory bowel disease, or familial polyposis; and no history of colon cancer. The treatment arms consisted of a frequent follow-up (1 and 3 years after initial polypectomy) and a less frequent follow-up (3 years). Follow-up examinations included fecal occult blood tests, air-contrast barium enema, and colonoscopy. The latter was done on 9112 referred patients at the seven participating centers from November 1980 until February 1990 who had no history of polypectomy, colon cancer, familial polyposis, or inflammatory bowel disease. Of these patients, 4763 (52.3%) had no polyps; 549 (6.0%) had an invasive cancer; 776 (8.5%) had nonadenomatous polyps; 208 (2.3%) had incomplete examinations; 184 (2.0%) had other findings; and 2632 (28.9%) had one or more adenomas, of which 1418 (53.9%) were randomized to one of the two treatment arms. This article reports the background, rationale, objectives, methods, and organization of this study and includes patient characteristics on initial presentation. Future data provided by the NPS may help in the development of recommendations for surveillance guidelines for such patients. This study also provides a framework to address questions regarding the natural history of adenomas and their relationship with colorectal cancer.

Adenoma

Sensitivity, specificity, and positive predictivity of the Hemoccult test in screening for colorectal cancers. The University of Minnesota's Colon Cancer Control Study.

Data are presented on the sensitivity, specificity, and positive predictivity of the Hemoccult test based on the experience of the Minnesota Colon Cancer Control Study, a randomized clinical trial to determine whether the use of the Hemoccult test can reduce mortality from colorectal cancer. Rehydrating the slides with a drop of water before processing resulted in an increase in positivity (2.4% to 9.8%), and sensitivity (80.8% to 92.2%) but a decrease in specificity (97.7% to 90.4%) and positive predictivity (5.6% to 2.2%). The effects of age and sex were also evaluated. The test was less specific for men than women (p = 0.03). Specificity was highest for those less than 60 yr of age and decreased with increasing age (p = 0.05). The positive predictivity increased with age from 1.6% for those under 60 yr to 3.6% for those over 70 yr (p = 0.0004).

Age Factors

Quantitative assessment of luminal stirring in the perfused small intestine of the rat.

We measured the resistance (RL) to CO absorption that resulted from poor luminal stirring in the constantly perfused rat jejunum. RL or calculated unstirred layer thickness was greater for 30-cm than 10-cm long segments, indicating lack of a uniform thickness of unstirred layer. The possibility that laminar flow existed in the gut was first tested by calculating expected CO absorptions from fluid moving with laminar flow. These values agreed closely with observed absorption rates. Laminar flow also was supported by the observation that CO absorption was independent of perfusate viscosity. Lastly, after sudden addition of phenolsulfonphthalein (PSP) to the perfusate, PSP outflow concentration was similar in tygon tubing (which has laminar flow) and a gut segment of comparable dimension. We conclude that flow in the perfused gut is laminar and that this laminar flow has many implications for studies carried out with the constant-perfusion technique.

Animals

Pills in the colon.

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Administration, Oral

Use of carbon monoxide to measure luminal stirring in the rat gut.

We used carbon monoxide (CO) as a probe to quantitatively measure intestinal unstirred water layers in vivo. CO has several features that make it uniquely well suited to measure the unstirred layer in that its tight binding to hemoglobin makes uptake diffusion limited, and its relatively high lipid solubility renders membrane resistance negligible relative to the water barriers of the unstirred layer and epithelial cell. The unique application of CO was the measurement of the absorption rate of CO both from the gas phase as well as a solute dissolved in saline. Several lines of evidence showed that a gut stripped free of saline and then filled with gas contained a negligible unstirred layer. Thus, absorption of CO from the gas phase measured resistance of just the epithelial cell. Subtraction of this value from the resistance of CO absorption from saline provided a direct measure of unstirred layer resistance. Studies in the rat showed for a 3-min absorption period that the conventionally calculated apparent unstirred layer for the jejunum was 411 micron and for the colon was 240 micron. However, this conventionally calculated unstirred layer resistance did not truly depict the situation in the rat gut, since there was a continuing depletion of CO from outer surfaces of luminal contents throughout the experiment period. This produced a continually increasing diffusion barrier with time. Calculation of expected absorption rate from unstirred cylinders with the dimensions of the rat gut indicated that there was virtually no stirring in the small intestine and minimal stirring in the colon. The technique described in this paper appears to be simpler and to require fewer assumptions for validity than other techniques previously used to measure unstirred layers in vivo.

Animals

Gastrointestinal transit in thyroid disease.

Diarrhea and malabsorption are common manifestations of hyperthyroidism, whereas constipation or obstipation frequently occur in hypothyroidism. Abnormalities of gastrointestinal motility have been proposed as the primary cause of these complaints, but documentation has been conflicting and largely limited to observations of the transit time of a barium meal. We studied gastrointestinal transit time in fasting patients with thyroid dysfunction using the pulmonary excretion of H2 after the ingestion of a nonabsorbable carbohydrate, lactulose, as an indicator of the rate of transit to the colon. Mean transit time of 10 hyperthyroid patients (29 +/- 4.0 min) was significantly less than that of 42 healthy controls (72 +/- 3.7 min, p less than 0.001), and of 6 hyperthyroid patients when they became hypothyroid after treatment (80 +/- 11.0 min, p less than 0.05). Transit time decreased significantly when hypothyroid patients were given thyroid replacement (p less than 0.01). These findings support the hypothesis that abnormal gut motility may be the primary cause of the diarrhea and malabsorption of hyperthyroidism, and the constipation and obstipation commonly seen in hypothyroidism.

Adult

Use of a model of small bowel mucosa to predict passive absorption.

The purpose of this study was to determine if the observed rate of passive absorption of inert gases from the canine small bowel could be predicted by the use of an anatomical model of the mucosa and measurements of villus blood flow and the diffusive barrier to absorption. Villus blood flow was measured with microspheres and the diffusive barrier separating bulk luminal contents and blood was estimated from CO absorption. The model predicts initial uptake of the inert gases (H2, He, CH4, and 133Xe) in blood at the villus tip, subsequent countercurrent exchange in the villus, and longitudinal diffusion of the gases down the villus to a subvillus blood flow. Observed absorption rates for each of these four gases were reasonably accurately predicted by the model at both basal villus blood flow and at low villus blood flow induced by hypotension. We suggest that this model can be used to predict passive absorption kinetics over a range of villus blood flows and to predict the influence of a variety of parameters on the rate of passive absorption of diffusible substances.

Animals

Use of microspheres to measure small intestinal villus blood flow in the dog.

The accuracy of using 7- to 10-micron microspheres to measure blood flow to dog small intestinal villi was studied. These spheres appear to pass unimpeded through the afferent arterioles of the villus and lodge at the villus tip because 1) virtually all villus spheres were located at the tip, 2) flow determined by visually counting spheres did not differ significantly from flow determined from radioactivity of the sheared-off villus layer, 3) the size distribution of spheres in the villus and subvillus layers was virtually identical to that administered, indicating no premature impaction of the larger spheres, and 4) spheres lodging in the submucosa during vasoconstriction did not subsequently migrate to the villi during vasodilatation. Studies with 25-micron spheres indicated that 28% of the 7- to 10-micron spheres shunted through vessels greater than 10 micron. Double isotope studies showed that lodges spheres do not migrate and that the injection of 2--4 X 10(6) spheres does not alter villus flow. Thus, 7- to 10-micron microspheres pass to and lodge in villus vessels in proportion to capillary flow and should provide an accurate estimate of villus nutrient blood flow.

Animals

Effect of dietary fiber on intestinal gas production and small bowel transit time in man.

The influence of dietary fiber on intestinal gas production and on small bowel transit time was studied in eight healthy subjects using breath H2 excretion as an indicator of colonic gas production. Hydrogen excretion following ingestion of bran was substantially less than that following ingestion of lactulose, a nonabsorbable fermentable sugar. Likewise, human fecal homogenates produced only about 10% as much H2 and CO2 during incubation with bran as with glucose or lactulose. Thus, the polysaccharides in bran appear to be relatively poor substrate for colonic bacterial gas production, and reported gas-related symptoms after bran ingestion may be due to some other mechanism. The small bowel transit time of bran was greater than that of lactulose; however, addition of bran to lactulose did not slow lactulose transit.

Breath Tests

Influence of high luminal PO2 on the anaerobic bacteria of the rat colon.

The influence of high luminal PO2 on colonic anaerobes was investigated by chronically perfusing the colon of unrestrained rats with O2 or N2. A luminal PO2 of approximately 700 mm Hg did not significantly influence the fecal concentration of total anaerobes recovered on rabbit blood agar or of Bifidobacterium sp. and Bacteroides sp. recovered on selective media. However, the O2 infusion reduced the rat's excretion of CH4 (a metabolic product of anaerobic bacteria) to about 5% of the control value, although the feces of O2-treated rats produced CH4 normally. This study suggests that the production of metabolites by the colonic bacteria may sometimes be more accurately studied in situ rather than in culture. Measurement of volatile bacterial metabolites in breath may provide a simple means of studying the in situ metabolism of a variety of colonic bacteria in man.

Actinomycetales