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Biomedical subjects

M Atkinson

Publications and source records attributed to M Atkinson.

At least 37 records · Page 2Linked to original sources
PubMed1989

Gastroenterology services: a regional review of changes over a five year period (1981-86).

A survey of all gastroenterologists in the Trent region showed that the number of upper GI endoscopies had doubled to 7.6 per 1000 of the population from 1981 to 1986, equalling the number of barium meals. Colonoscopies had increased from 0.39 to 0.94 per 1000 of the population. There had been a large increase in the proportion of endoscopies done by surgeons. There were 0.37 ERCP examinations per 1000 of the population done in six of the 12 districts, and 0.17 variceal sclerotherapy procedures per 1000 of the population done in five districts. There was widespread dissatisfaction with the provision of facilities and staff for endoscopy. From 1981 to 1986 the number of consultants with an interest in gastroenterology had increased from 20 to 25, but none of these appointments had been anticipated in 1981. All eight senior registrars in gastroenterology in 1981 had achieved consultant status - three in the region, four in the NHS outside the region, and one abroad.

Consumer Behavior↗
PubMed1989

Quantitative assessment of the response to therapy in achalasia of the cardia.

Radionuclide oesophageal transit studies and manometry have been carried out in 15 patients with achalasia of the cardia, before treatment, after a course of nifedipine and after pneumatic bag dilatation. Transit studies were also done in 10 patients after cardiomyotomy and in 10 normal subjects. Images were recorded with the subjects seated in front of a gamma camera while swallowing a 10 ml bolus of 99Tcm-tin colloid and then after a further drink of 50 ml water. There was marked retention of tracer in the oesophagus in patients with achalasia compared with rapid clearance in control subjects. Bag dilatation significantly reduced lower oesophageal sphincter pressure but there was no significant difference in the 50% clearance time or percentage dose retained at 100s before and after the treatments. Oesophageal clearance of tracer after the additional drink of water, was improved by bag dilatation. Oesophageal transit in the patients after cardiomyotomy was similar to that in patients who had undergone bag dilatation. There was considerable retention of the tracer in the oesophagus overnight, but this did not result in pulmonary aspiration. Radionuclide oesophageal transit studies provided a quantitative assessment of therapy in achalasia and the proportion of tracer retained after the additional drink proved to be a sensitive measure of response to treatment. Nifedipine proved ineffective as a treatment for achalasia. Bag dilatation and cardiomyotomy were of similar value.

Administration, Sublingual↗
PubMed1989

Value of DNA image cytometry in the prediction of malignant change in Barrett's oesophagus.

DNA image cytometry was performed on Feulgen stained sections from 91 biopsies obtained during prospective endoscopic surveillance of 55 patients with Barrett's oesophagus. Aneuploid cells were detected in specimens from six of these patients. Four subsequently developed dysplasia and adenocarcinoma but, in the other two, biopsies had been reported as showing specialised epithelium only, with no apparent dysplasia and no evidence of malignancy on clinical follow up to date. In two of the four patients who subsequently developed carcinoma, aneuploid cells were only found in biopsies showing overt dysplasia or carcinoma but in the two other patients aneuploid cells were present in biopsies taken early in the clinical course before any dysplasia had been identified on the original reports. The presence of aneuploid cells on cytometry of these 'benign' biopsies allowed us, on histological review, to identify areas of atypia which were interpreted as mild dysplasia. In this series aneuploidy was always associated with some morphological abnormality varying from mild dysplasia to frank carcinoma. Aneuploid cells were not shown in material from one patient who had an oesophagectomy for dysplasia or in biopsy material from four patients showing 'indefinite dysplasia'. DNA cytometry combines an objective assessment of epithelial atypia with the advantage of detecting rare cellular aneuploidy and the ability to correlate these events with morphology. It should assist in the more accurate diagnosis of dysplasia and prove useful in identifying those patients with Barrett's oesophagus who are at greater risk of subsequently developing malignancy.

Aneuploidy↗
PubMed1989

Treatment of reflux oesophagitis with trimoprostil.

Forty-four patients with symptomatic endoscopically proven mild to moderate reflux oesophagitis were enrolled in a single-centre, double-blind, clinical trial comparing trimoprostil 750 micrograms taken 4 times daily with placebo. Patients treated with trimoprostil but not placebo experienced a significant reduction in the frequency (p less than 0.005) and duration (p less than 0.02) of heartburn. Both groups reported a reduction in the severity of heartburn and resulting sleep disturbance during the trial, but differences between them in these respects at the end of the trial did not reach statistical significance. There was a significant reduction in the severity of oesophagitis seen at endoscopy after treatment with trimoprostil (p less than 0.01) but not placebo. Trimoprostil was well tolerated and appears to be more effective than placebo in the treatment of mild to moderate symptomatic reflux oesophagitis. Although this agent's mode of action was not investigated, we speculate that it may be protective to human squamous oesophageal mucosa.

Adult↗
PubMed1988

Lack of necessity for corrections for pyloric losses and duodenogastric reflux in the performance of gastric secretory studies.

Gastric secretory studies are subject to considerable error owing to incomplete collections and to contamination by reflux of alkaline duodenal contents. Corrections for these sources of error have been defined, and they have been extensively applied in a research setting. In order to assess their utility in the performance of routine gastric secretory studies, the value of such corrections was assessed in 56 studies in patients with duodenal ulceration (10), previous surgical vagotomy (8), reflux oesophagitis (30) and primary oesophageal motility disorders (8). The effect of such corrections was small, and there were close correlations between uncorrected and corrected acid outputs in all four groups. The status of the vagal efferent gastric fibres was assessed by comparing the acid output after insulin hypoglycaemia with the maximal acid output after pentagastrin (insulin: pentagastrin ratio). The application of the corrections did not alter the conclusion regarding the assessment of vagal status in 55 of the 56 studies performed. It is concluded that such corrections are not necessary in the routine performance of gastric secretory studies.

Adult↗
PubMed1988

Value of endoscopic surveillance in the detection of neoplastic change in Barrett's oesophagus.

Fifty-six patients with Barrett's oesophagus diagnosed between 1977 and 1986 were prospectively studied by 6-monthly endoscopic surveillance and biopsy. During follow-up to-date, four patients have developed high-grade dysplasia and three have adenocarcinoma of the oesophagus. Two of the adenocarcinomas were preceded by progressively severe dysplastic changes but in the third no dysplasia had been previously detected. The incidence of adenocarcinoma was 1 per 56 patient-years of follow-up. Changes in symptomatology or gross endoscopic appearances were usually absent, even after adenocarcinoma had developed, indicating that biopsy is essential for early diagnosis. The high risk of malignant change makes endoscopic surveillance advisable in all patients with Barrett's oesophagus.

Adenocarcinoma↗
PubMed1988

A double-blind placebo-controlled trial of BRL 24924 on lower oesophageal sphincter pressure and gastro-oesophageal reflux in healthy volunteers.

BRL 24924 is a new gastrointestinal prokinetic agent with properties similar to metoclopramide but with increased potency and devoid of side-effects associated with blockade of dopamine receptors in the central nervous system. A double-blind placebo-controlled trial of the effect of a single oral dose of 2.2 mg BRL 24924 on lower oesophageal sphincter pressure and gastro-oesophageal reflux has been performed in 20 healthy volunteers. BRL 24924 significantly increased mean lower oesophageal sphincter pressure (21.9 cmH2O BRL; 15.9 cmH2O placebo: P less than 0.017) but failed to alter either the frequency or the duration of gastro-oesophageal reflux after provocation following a test meal. BRL 24924 has significant effects on lower oesophageal sphincter pressure but no effect on provoked post-prandial reflux in healthy volunteers. Further studies in patients with gastro-oesophageal reflux and oesophagitis are needed to evaluate the clinical efficacy of this compound.

Adult↗
PubMed1988

Benign oesophageal stricture in Barrett's columnar epithelialised oesophagus and its responsiveness to conservative management.

The response to treatment of peptic oesophageal stricture associated with columnar lined (Barretts) oesophagus (CLO) has been compared with that in peptic stricture without CLO. Benign oesophageal stricture was present in 23 (41%) of 56 patients consecutive with CLO. In 18 the stricture lay at the squamocolumnar mucosal junction and was associated with reflux oesophagitis, in five it was situated in the columnar lined segment and in four of these it was known to have been preceded by a chronic ulcer at the site of the stricture. Controls were an age and sex matched group of patients with benign stricture related to reflux oesophagitis unassociated with columnar epithelialisation. CLO associated strictures involving squamous mucosa were situated significantly (p less than 0.01) higher in the oesophagus than non-CLO strictures. The response to endoscopic dilatation and active medical treatment was significantly better, as judged by the need for subsequent dilatation (p less than 0.01) in the CLO than in the non-CLO group. It is concluded that associated columnar epithelialisation of the oesophagus is not in itself an indication for antireflux surgery in the management of benign stricture and these usually respond well to dilatation and medical treatment.

Adult↗
PubMed1988

Choice of therapy for achalasia in relation to age.

Over an 11-year period 132 patients with achalasia underwent a total of 253 pneumatic bag dilatations of the cardia as the initial treatment. Adequate symptomatic relief was obtained in the majority, but 16 needed cardiomyotomy after pneumatic dilatation had failed to give lasting symptomatic relief. Older patients, aged 60 years or more, showed longer-lasting improvement with pneumatic dilatation than did younger ones and only 1 patient over 50 required cardiomyotomy. Benefit from pneumatic dilatation showed a closer relationship to age than to oesophageal diameter. Of 50 patients followed for more than 5 years, 48% required no further treatment, 40% needed at least one further dilatation to achieve symptomatic relief and 12% came to cardiomyotomy. This study suggests that pneumatic dilatation is safe, effective and particularly useful in the management of the elderly achalasic patient.

Adolescent↗
PubMed1988

The relationship between schizophrenic patients' perceptions of their parents and the course of their illness.

Sixty-two schizophrenic patients completed the Parental Bonding Instrument (PBI), a measure of perceived parental characteristics, rating their parents on care and protection. PBI ratings were related to a one-year course of illness. Patients who perceived their parents positively tended to experience a milder course of illness if they were in frequent contact with them, and a more severe course if they were not; the reverse was true for patients who perceived their parents negatively. PBI ratings were unrelated to the age at onset of illness. This suggests that patients' perceptions of parental attitudes influence the course of schizophrenia by a current stress effect. The PBI, used alone or in conjunction with other predictors, distinguished good- and poor-outcome cases and appears to be a potentially clinically valuable tool.

Adult↗
PubMed1988

Inherited susceptibility to insulin-dependent diabetes is associated with HLA-DR1, while DR5 is protective.

Of the HLA allelic associations with insulin-dependent diabetes (IDD) reported to date. DR3 and DR4 have been the most positive and DR2 the most negative. In 952 Caucasian proband patients reported here, only 57 or 6% had no DR3 or DR4 alleles. When these 57 patients were compared to 249 Caucasian controls similarly lacking DR3 and DR4 antigens, there were excesses of DR1 (P = 0.13) and DRW8 (P = 0.01) and deficiencies of DR2 (P = 0.03) and DR5 (P = 0.03) in the patient group. The most common phenotype in this group of patients was DR1/DR7 (12.3%). Only four DR-homozygous patients involving alleles other than DR3 and DR4 were found by genotyping, and all were DR1 homozygotes. Among 506 patients wuth DR3/DRX or DR4/DRX phenotypes, DR1 was more frequent (P = 0.001; Bonferronni P = 0.006), and DR2 (P = 0.001) and DR5 (P = 0.001) less frequent than 243 HLA-matched controls. Of 187 patients with a single DR3 and no DR4, DR1 was more frequent (P = 0.02), with DR2 (P = 0.001) and DR5 (P = 0.02) less frequent than 94 HLA DR-compatible controls. Among 319 patients with a single DR4 but no DR3, DR1 was again more frequent (P = 0.01) and DR2 (P = 0.001) and DR5 (P = 0.001) less frequent than 149 HLA-matched controls. We conclude that DR1 is an additional risk DR allele for IDD to that of DR3 and DR4, and DR5 an additional protective DR allele to that of DR2.

Adolescent↗
PubMed1988

The efficacy and safety of sulindac (400 mg vs 600 mg daily) in rheumatoid arthritis. A Canadian Multicentre Study.

Sulindac, an indene derivative of indomethacin, was compared at 2 dosages (400 mg and 600 mg daily) in patients with rheumatoid arthritis. One hundred sixty-two patients from 19 centers completed the study--85 in the low dose group and 77 in the high dose. No difference in efficacy was found between these 2 regimens. Overall adverse reactions were more frequent with the high dose group especially with respect to blood chemistry and gastrointestinal reactions.

Adolescent↗
PubMed1988

An international study of mortality from achalasia.

Mortality associated with achalasia was studied in 28 populations from 26 countries. 829 deaths were reported in a total population of 754 million over periods ranging from 1 to 8 years. Standardised mortality rates (SMR) were calculated in comparison with the USA white population (SMR = 100; 95% confidence limits = 89-112). The highest mortalities were recorded in New Zealand (SMR = 259; 95% confidence limits 131-420) and the lowest in Spanish speaking countries such as Panama (SMR = 0; confidence interval 0-210) and Spain (SMR = 22; confidence interval 3-79).

Cause of Death↗
PubMed1987

Abnormal vagal function in irritable bowel syndrome.

Alimentary and cardiac autonomic nervous function was assessed in 25 patients with the irritable bowel syndrome. The vagally mediated increase in lower oesophageal sphincter pressure induced by abdominal compression was below that of 25 controls in 13 patients. Efferent vagal function, assessed by the ratio of peak acid output after insulin-induced hypoglycaemia to maximal acid output after pentagastrin, was subnormal in 7 of 23 patients. Pulse rate variability with deep respiration was subnormal in 6 of 23 patients. Abnormality in these tests did not correlate closely with the presence of oesophagitis at endoscopy or with that of gastro-oesophageal reflux on pH monitoring. Thus abnormalities in autonomic nervous reflexes might account for the frequent occurrence of gastro-oesophageal reflux and may be involved in the production of disordered gastrointestinal motility in irritable bowel syndrome.

Adult↗
PubMed1987

Low dose aminophylline accelerates recovery from diazepam premedication for digestive endoscopy.

The value of intravenous aminophylline in accelerating recovery from premedication with diazepam was assessed against placebo in a randomized, double-blind trial. One hundred ten patients undergoing routine diagnostic upper gastrointestinal endoscopy received diazepam intravenously in a dosage sufficient to achieve adequate sedation. On completion of the endoscopy, patients received either aminophylline (1.5 mg/kg) or placebo. Recovery from sedation was assessed on clinical grounds by a nurse, objectively using a serial reaction time test, and by the patient on a visual analogue scale. The number of patients judged to be fully alert at 30 and 60 min after the procedure was significantly greater in the aminophylline group than in the placebo group. Compared with values obtained before sedation, the placebo group had significantly prolonged reaction times 30 min after completion of the endoscopy, whereas patients who received aminophylline did not. However, according to their self-assessments, patients in both groups felt more uncoordinated following sedation. Aminophylline appears to hasten recovery from sedation with diazepam, and its use may permit earlier mobilization of patients after endoscopy.

Adult↗
PubMed1987

Achalasia and pregnancy.

Forty-one women with achalasia diagnosed between the ages of 18 and 45 years were interviewed and 37 of them who had been married at some time were asked to provide details of their fertility and reproductive histories. Thirty-six agreed to do so and were compared with 36 healthy age-matched women. The mean age at the time of study was 44 and the women had been married, on average, for 21 years. The disease developed at a mean age of 27 years and was diagnosed and treated at a mean age of 32 years. For a mean period of 5 years the disease was untreated. There were no significant differences in the number of conceptions or live births before or after the onset of symptoms or during the period when the disease was untreated. In only three of the 20 women who became pregnant after the onset of disease did symptoms become worse. Achalasia during pregnancy is probably best managed by endoscopic dilatation and there is no reason to consider termination.

Adolescent↗