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Biomedical subjects

J Powell-Tuck

Publications and source records attributed to J Powell-Tuck.

At least 55 records · Page 3Linked to original sources
PubMed1985

The effect of insulin infusion on whole-body protein metabolism in patients with gastrointestinal disease fed parenterally.

The effect of insulin infusion on whole-body protein metabolism was studied in six non-diabetic patients with gastrointestinal disease receiving constant total parenteral feeding, with each patient as his own control. Insulin added to the parenteral feed significantly raised the plasma insulin concentration and lowered the blood glucose. With insulin infusion there was a significant increase in the rates of urea output and ammonia excretion, but no change in 3-methylhistidine excretion or in the urinary 3-methylhistidine/creatinine ratio. Studies of whole-body protein turnover were performed with a tracer injection of 15N-glycine and both urea and ammonia as end products. Without insulin urea as end product gave an estimate of flux 18 per cent greater than that given by ammonia. With both end products rates of whole-body protein synthesis were significantly greater than rates of breakdown. When insulin was infused the estimate of flux from ammonia increased significantly, resulting in close agreement with the estimate from urea, and there was no longer a significant difference between rates of whole-body protein synthesis and breakdown. Our data, taken with the results of other studies, suggest that insulin infusion is not beneficial as a means of increasing nitrogen retention in non-diabetic parenterally-fed patients.

Adult↗
PubMed1984

Prediction of early death after therapeutic hepatic arterial embolisation.

A consecutive series of 14 patients with hepatic malignant disease treated by palliative hepatic arterial embolisation was reviewed. Twelve patients had hepatic pain from their tumour and two were suffering from the carcinoid syndrome. Six patients died within four weeks of the procedure (group 1) and eight survived for at least 10 weeks (group 2). Factors were sought that might permit prediction of a high risk of early death (group 1). The pre-embolisation angiograms reviewed by a "blind" observer showed no differences in vascularity or tumour size between the groups and no difference in the extent of arterial occlusion after embolisation. The portal vein was patent in all patients. No significant difference was seen between the groups in the pre-embolisation biochemical values, with the exception of lower serum albumin concentrations and higher alkaline phosphatase activities in group 1. All those who died early had serum alkaline phosphatase activities of 45 KAU or above, while six of the eight who survived longer had activities below this value (p less than 0.02). These findings suggest that serum alkaline phosphatase activity of 45 KAU or more (normal range 3-13) might alone be a useful predictor of early death. Stepwise discriminant analysis using a weighted combination of serum alkaline phosphatase activity and albumin concentration predicted the outcome in all but one of the patients studied (p less than 0.002).

Adult↗
PubMed1984

Rates of whole body protein synthesis and breakdown increase with the severity of inflammatory bowel disease.

Rates of whole body protein synthesis and breakdown were estimated in 19 undernourished patients with inflammatory bowel disease from the cumulative nine hour excretion of urinary 15NH3 after intravenous injection of 15N glycine. Thirty six studies were made during constant nutrient input either parenterally by 3 litre bag technique (29 studies), or enterally by nasogastric infusion of protein containing liquid feeds (four studies), or by diet kitchen prepared food eaten at two hourly intervals (three studies). Mean daily intakes were 50.7 kcal and 0.29 g nitrogen/kg body weight. Synthesis and break down rates correlated significantly with disease activity as judged by erythrocyte sedimentation rate and by ranking by an observer unaware of the turnover results. Rates for synthesis and breakdown by this method were about 2.1 and 1.7 g protein/kg/24 h respectively for ESR 10 increasing to 4.0 and 3.3 for ESR 100.

Adolescent↗
PubMed1984

The effect of surgical trauma and insulin on whole-body protein turnover in parenterally-fed undernourished patients.

Ten undernourished patients receiving total parenteral nutrition and undergoing major intestinal surgery were restarted on intravenous feeds identical to their pre-operative regimens within 24 h of their operation. Five, chosen at random, received post-operatively 1-2 units insulin/kg body weight/24 h with their feed, while the other five received the feed only. Pre-operatively, and 2 h after commencing their post-operative feeds, rates of whole-body protein synthesis and breakdown were measured over a 9-h period following intravenous injection of a single tracer dose of 15N-glycine by the ammonia and urea end-product methods. During these 9-h study periods measurements were also made of blood glucose, plasma insulin and glucagon, urinary ammonia, nitrogen, creatinine and 3-methylhistidine. Blood glucose and plasma insulin and glucagon concentrations rose post-operatively whether or not insulin was given, but the increment in insulin concentration was significantly greater when insulin was given. Apparent nitrogen balance was positive pre-operatively and became less so post-operatively whether insulin was given or not. Similarly, post-operative increments in urinary excretion of ammonia, creatinine and 3-methylhistidine were not altered by addition of insulin. Protein turnover, as estimated by the ammonia end-product method, tended to rise post-operatively, but there was no significant difference between the increases observed with or without insulin. The urea end-product method suggested that there was no change in whole-body protein turnover after surgery, whether or not insulin was given. This study does not support the clinical use of insulin as a means of modifying protein metabolic losses after major surgery.

Adolescent↗
PubMed1983

Nocturnal nasogastric tube feeding at home.

Five malnourished patients who consistently failed to maintain or gain weight with other oral diets have been taught to give themselves a nocturnal nasogastric tube feed at home to supplement their dietary intake by day. All patients gained weight at a rate of about 0.5 kg per week. Nasogastric tube feeding at home can be an acceptable, safe, economical and efficient treatment for nutritional depletion, particularly in patients with a short functional length of small intestine for whom simpler dietary manipulation has been unsuccessful.

Adolescent↗
PubMed1982

Correlations between defined sigmoidoscopic appearances and other measures of disease activity in ulcerative colitis.

It has been widely assumed that the activity of ulcerative colitis is related to differences in mucosal appearances seen at sigmoidoscopic examination. We have tested this assumption by making comparisons of the symptoms and clinical signs associated with three reproducible appearances of the rectal mucosa. By cross-tabulating 222 observations of each of 10 symptoms and signs with these sigmoidoscopic appearances it has been shown that the subdivision of hemorrhagic mucosae into those which bleed spontaneously and those which bleed only on light touching or scraping is meaningful clinically. Sigmoidoscopic appearances seemed to correlate better with clinical disease activity than histological assessment, even when quantitative, of mucosal biopsies. On the basis of this study, four variables have been suggested which, in addition to the sigmoidoscopic appearances, could form the basis of regular clinical assessment or scoring.

Biopsy↗
PubMed1981

A controlled trial of alternate day prednisolone as a maintenance treatment for ulcerative colitis in remission.

A double-blind crossover trial compared prednisolone, 40 mg given orally on alternate days, with placebo as a maintenance treatment for ulcerative colitis in remission. In each patient, the study was over two periods of 3 months. Of 24 patients who completed both periods, 11 relapsed while taking placebo but not while taking prednisolone, and 1 relapsed on prednisolone but did not on placebo (p less than 0.01). 1 patient had to stop prednisolone because of hyperglycaemia; other side effects noted were mild. Prednisolone, cautiously used in this way, could be justified for the few patients who relapse frequently despite sulphasalazine.

Administration, Oral↗
PubMed1980

Prednisolone absorption in acute colitis.

Peak plasma levels were reduced after an oral dose of 40 mg prednisolone in six patients with severe acute colitis as compared with six normal subjects, though total absorption appeared to be similar; the findings suggest that prednisolone absorption was delayed in acute colitis. A dilutional fall in plasma albumin was observed in normal subjects and in the patients after 40 mg prednisolone by mouth.

Acute Disease↗
PubMed1979

Intravenous feeding in a gastroenterological unit: a prospective study of infective complications.

We have assessed the bacteriological safety of a system of intravenous feeding by culturing catheters on removal, swabs taken from the catheter's skin entry sites, and samples of infusion fluid. Among 38 treatment periods using 51 catheters over 1551 patient days, septicaemia due to Staphylococcus aureus was observed in one treatment period and bacteraemias due to Staphylococcus albus and Diphtheroid species in two others. The Staph. aureus and the diphtheroids probably gained access via the skin entry site along the outside of the catheter. The origin of the Staph. albus was uncertain. Parenteral nutrition over extended periods can be a safe procedure if aseptic precautions are taken. The importance of the catheter's skin entry site as a source of contaiminating organisms is emphasised.

Adult↗
PubMed1978

Double-blind withdrawal trial of azathioprine as maintenance treatment for Crohn's disease.

51 patients with Crohn's disease who were in good health while taking azathiprine, 2 mg/kg body-weight/day, for at least six months were allocated either to a group in which azathioprine was continued or to one in which a control tablet was substituted. The trial lasted one year unless relapse recurred earlier. The cumulative probability of relapse was nil at six months and 5% (+/-5 S.D.) at a year among those on azathioprine, compared with 25% (+/-9 S.D.) at six months and 41% (+/-11 S.D.) at a year among those in the control group (P less than 0.01). 1 patient in whom azathioprine was continued died of pancytopenia in the fourth month of the trial. Azathioprine is potentially toxic but appears to reduce the relapse-rate in Crohn's disease.

Adult↗
PubMed1978

Team approach to long-term intravenous feeding in patients with gastrointestinal disorders.

A system has been developed for the prolonged administration of intravenous feeding in general wards. The service is coordinated by a clinician, specialist nurse, and pharmacist. Under local anaesthesia a silicone-rubber catheter is introduced through an infraclavicular incision to create a skin tunnel. By this technique 22 of 27 treatment periods (mean duration 42 days) required the use of only one catheter each. Ward care is simplified by the use of 3 litre bags containing aminoacids, glucose, electrolytes, and trace elements. The bags are prepared under laminar-flow conditions by a pharmacist in a specially designed room. Vitamins are added to the mixture and 'Intralipid" is infused separately as needed. In 38 treatment periods over a total of 1551 days weight-gain and gain in fat-free mass when required were satisfactory; the weight-gain correlated with increase in arm-muscle cross-sectional area (r = 0.72). Patients who have learnt to use the catheter have left the hospital for periods of up to 3 days, and 2 patients have given themselves intravenous supplements regularly at night in their homes.

Amino Acids↗
PubMed1978

Clinical outcome of the first ten years of ulcerative colitis and proctitis.

269 patients with ulcerative colitis and a history of less than 6 months when first seen at St. Mark's Hospital in the decade 1966--75 have been followed for up to 11 years. The outcome has been correlated with the maximum extent of the disease observed within 3 months of presentation. 75 patients required hospital admission, 56 within a year of presentation. Extensive colitis developed in 60 patients. The cumulative probability of the disease being extensive was 21% +/- 3% at 5 years and 29% +/- 4% at 10 years. 25 patients required surgical treatment. The cumulative probability of operation was 8% +/- 2% at 5 years and 15% +/- 4% at 10 years. 19 patients are known to have died. The expected number of deaths was 19.2.

Adolescent↗
PubMed1978

A comparison of oral prednisolone given as single or multiple daily doses for active proctocolitis.

Forty mg has been shown to be the optimal daily dosage of prednisone for outpatients requiring oral steroids for active proctocolitis. Although daily doses of oral steroids are commonly divided, a single dose each morning causes less adrenal suppression and is more convenient to take. A randomized controlled trial has been performed on patients with proctocolitis, in which 23 received 40 mg prednisolone each morning as one dose, and 22 received 10 mg four times a day, over two weeks. Physicians unaware of the dosage schedule scored the disease activity and assessed the steroid side-effects when the patient entered the trial, at day 7 and at day 14. Of those taking the divided dose the disease improved in 17 and failed to improve in five. No side-effects were observed in ten patients. Of those receiving a once daily regimen, 17 improved and six did not. Nine patients had no side-effects. Further assessment showed no difference between the two groups either in response rate or side-effects produced. When oral steroids are indicated for active proctocolitis, 40 mg prednisolone, as a single dose each morning can be recommended.

Administration, Oral↗