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Biomedical subjects

M Atkinson

Publications and source records attributed to M Atkinson.

At least 55 records · Page 3Linked to original sources
PubMed1987

Achalasia like disorder of the oesophagus in von Recklinghausen's neurofibromatosis.

The association of achalasia like disorder of the oesophagus with von Recklinghausen's neurofibromatosis to our knowledge not previously reported is described in a 56 year old man who also had bladder dysfunction. At necropsy the oesophageal myenteric plexus showed ganglion cell depletion with nerve fibre hyperplasia probably the result of Schwann cell hyperplasia. We suggest that the disturbances of oesophageal and bladder function were a consequence of involvement of the autonomic nervous system by neurofibromatosis.

Autonomic Nervous System Diseases↗
PubMed1987

Twenty four hour oesophageal acidity in achalasia before and after pneumatic dilatation.

Radiotelemetric ambulatory 24 hour oesophageal pH measurement was carried out in 17 patients with symptomatic manometrically proven achalasia before and after pneumatic dilatation. Before dilatation an abnormally high percentage acid exposure time was present but typical episodes of gastro-oesophageal reflux occurred in only one patient. In nine patients who had a oesophageal food residue these values were significantly greater than those found in the remaining patients without retained food. Analysis of oesophageal food residues revealed that the low pH was predominantly caused by lactic acid. These findings indicate that preoperative oesophageal pH studies do not offer a valid means of selection of patients in whom an antireflux procedure should be combined with cardiomyotomy. Repeat studies one week after pneumatic dilatation showed a fall in the acid exposure time in patients with initial food residue presumably resulting from improved oesophageal emptying after treatment. A significant rise in acid exposure time after dilatation was seen in those patients without initial food residue presumably resulting from gastro-oesophageal reflux after therapeutic disruption of the lower oesophageal sphincter. Troublesome symptoms of gastro-oesophageal reflux were, however, uncommon after bag dilatation.

Adolescent↗
PubMed1987

Effect of delta-9-tetrahydrocannabinol on the in vitro uptake of alpha-amino isobutyric acid by term human placental slices.

Tetrahydrocannabinol (THC), the active component in marijuana smoke, crosses the placenta and is a potential fetotoxic agent. In both human and animal studies, the most consistent fetal effect of THC is intrauterine growth retardation. Since fetal somatic growth is dependent on placental transfer of nutrients, including essential amino acids, we studied the effect of THC upon the in vitro uptake of amino acid by term human placental slices. Uptake of alpha-amino isobutyric acid was inhibited in a dose-dependent fashion, correlating with the log of the dose (1-100 microM THC; r = 0.945; p less than 0.01). Compared to control tissue, significant impairment of alpha-amino isobutyric acid uptake began at 20 microM THC. Similar results were found for valine. The time course (30-120 min) for alpha-amino isobutyric acid uptake showed linearity for both control and THC-(50 microM) treated tissue, but there was a marked reduction in the THC slope. Uptake of alpha-amino isobutyric acid was significantly reduced at all times. The sustained effect of THC was slightly, but significantly, reversed by removal of THC from the medium after 90 min of 50 microM THC exposure. Only partial reversal may have been due to the 15- to 20-fold accumulation of THC in the placental tissue. Uptake kinetics showed noncompetitive inhibition with decreased Vmax: control Vmax = 51.66 +/- 6.26 versus 50 microM THC = 26.96 +/- 6.22 (mmol/liter intracellular water per h) (p less than 0.01); and no change in diffusion constant (Km): control Km = 0.78 +/- 0.08 versus 50 microM THC = 0.80 +/- 0.09 (mM).(ABSTRACT TRUNCATED AT 250 WORDS)

Aminoisobutyric Acids↗
PubMed1987

Variations in the prevalence of achalasia in Great Britain and Ireland: an epidemiological study based on hospital admissions.

Six thousand three hundred and six cases of achalasia were admitted to hospital in Britain and Ireland over a 10-year period. The majority (4920) came from England. The disease was significantly more common in Eire than England, Wales, Scotland or Northern Ireland. The prevalence in a 10-year period of 13.4/10(5) in Eire was based on 453 cases. Checks on the accuracy of prevalences collected in this manner showed them to be within 2.5 per cent of the actual figure. Studies of age-specific incidence in Scotland and Oxford showed a close correlation between the regions and between men and women. Achalasia is most common in Eire and its incidence increases with age.

Adolescent↗
PubMed1987

Vagal function in achalasia of the cardia.

Autonomic nervous function in achalasia of the cardia was assessed by measuring the response of the lower oesophageal sphincter to abdominal compression, the gastric secretory response to insulin-induced hypoglycaemia and the pulse rate variability with deep respiration. Twenty-eight patients with symptomatic achalasia and 24 age and sex-matched control subjects were studied. Rise in intra-abdominal pressure normally causes a rise in lower oesophageal pressure through a vagally-mediated mechanism. Before treatment this response was unimpaired in eight of 10 patients with achalasia. A sub-normal response was found in eight of 10 patients who had previously had pneumatic dilatation of the cardia and in three of four who had had a cardiomyotomy. These abnormalities reflected the effect of treatment in disrupting the sphincter rather than impairment of its innervation. The gastric acid secretory response to insulin-induced hypoglycaemia, expressed as a ratio of that to pentagastrin, was normal in each of the nine patients studied. Pulse rate variability with deep respiration, a test of cardiac vagal function, was normal in 22 of 25 patients studied. It is concluded that in achalasia the vagal trunks appear functionally intact and that the myenteric plexus lesion rarely affects the responsiveness of the lower oesophageal sphincter to increase in intra-abdominal pressure.

Adult↗
PubMed1986

[Mid C regional parathyroid hormone in the clinical workup: diagnostic value in extrarenal (primary) and renal (secondary) hyperparathyroidism].

The selective determination of mid-C-regional parathyroid hormone (mid-C-PTH) in combination with other laboratory parameters is a reliable tool for diagnosis and treatment of extra-renal (primary) and renal (secondary) hyperparathyroidism. Early stages, which show either high-to-normal serum calcium and elevated mid-C-PTH or increased serum calcium but normal mid-C-PTH, can be distinguished from overt hyperparathyroidism. Alkaline phosphatase (AP) activity and mid-C-regional PTH provide biochemical confirmation of histologically classified renal osteodystrophy. Since the index AP X PTH signifies osseous changes in dialysis patients at an early stage, therapeutic regimens may be altered without additional invasive procedures. After renal transplantation mid-C-PTH normalizes and serum creatinine decreases. Increased mid-C-PTH in patients with normal renal graft function reflects autonomous PTH secretion, which requires careful monitoring to prevent PTH-induced hypercalciuria.

Chronic Kidney Disease-Mineral and Bone Disorder↗
PubMed1986

The diagnosis and management of perforations of esophagus and pharynx sustained during intubation of neoplastic esophageal strictures.

Twenty-six esophageal and eight pharyngeal perforations sustained during palliative intubation of esophagogastric neoplasms have been reviewed. The majority of the tears were recognized either endoscopically or by the immediate development of subcutaneous emphysema. However, 15 perforations were first identified by radiology, and 10 of these 15 patients were initially asymptomatic. In the years 1976-1979 with conservative management, three patients of eight died from the perforation and none had a pneumothorax. From 1980 a more aggressive nonsurgical approach was used, and of 26 patients who sustained a perforation, there were six deaths before leaving hospital but only four deaths were directly related to the perforation and each of these had sustained a pneumothorax. Pharyngeal tears invariably did well with conservative management. Our experience favors conservative management for instrumental esophageal perforation.

Adenocarcinoma↗
PubMed1986

Parathyroid hormone in coronary artery disease--results of a prospective study.

Parathyroid hormone (PTH) influences the calcium metabolism of many different mammalian cell types; indeed, hypertension due to changes in muscle tone is a frequent symptom of hypercalcemic hyperparathyroidism. In a blind study of 81 patients with various forms of heart disease undergoing coronary angiography, the plasma concentrations of the midcarboxyl regional PTH immunoreactivity were determined. PTH concentrations were elevated in 26 of the 56 patients exhibiting organic coronary artery disease (CAD). The plasma PTH levels were highest in those patients with CAD affecting three vessels and in patients with evidence of myocardial infarction. PTH levels were not influenced by previous drug treatments, and did not correlate to stress hormone levels. We propose that increased PTH levels may be a marker for initiation or potentiation of calcium-dependent changes in vascular smooth muscle behavior inducing coronary functional and anatomic lesions typical of CAD.

Adult↗
PubMed1986

Swallowing problems in patients with motor neuron disease.

A postal questionnaire was sent to 800 members of the Motor Neurone Disease Association about difficulties experienced in eating and swallowing foods and liquids. Replies were received from 310 patients or their relatives. In 45 cases the reply was from the relative of a patient who had died recently. Seventy-three percent of patients had difficulty in chewing or swallowing and this was most marked in patients who had died. Most problems were encountered with solid food rather than liquids. Aspiration was a common problem and may have contributed to some patients' death. Surprisingly, swallowing was often painful.

Adult↗
PubMed1986

Gastro-oesophageal reflux in the irritable bowel syndrome.

Symptomatic assessment and oesophageal investigations were done in 25 consecutive patients with the irritable bowel syndrome attending a gastroenterological clinic. Symptoms of gastro-oesophageal reflux, dysphagia, and a globus sensation were significantly commoner than in a control group of fracture clinic patients. Ambulatory oesophageal pH monitoring showed clearly abnormal reflux in 11 of 22 patients (50%). Nine patients had macroscopic endoscopic changes and a further 11 biopsy changes alone, of oesophagitis which was thus present in 80% overall. Lower oesophageal sphincter pressure was significantly less in irritable bowel patients than in age and sex matched controls, but upper oesophageal sphincter pressure was comparable in the two groups and disordered peristalsis was not found. Oesophageal symptoms in the irritable bowel syndrome are mainly caused by gastro-oesophageal reflux predisposed to by a subnormal lower oesophageal sphincter pressure, rather than by oesophageal spasm.

Adult↗
PubMed1986

Alternative medicine consultations and remedies in patients with the irritable bowel syndrome.

The use of alternative medicine was assessed by questionnaire in 96 patients with irritable bowel syndrome, 143 patients with organic upper gastrointestinal disorders and 222 patients with Crohn's disease of comparable age and sex. Significantly more patients with the irritable bowel syndrome (16%) had consulted practitioners of alternative medicine about their condition than had patients in either of the other groups. Similarly, significantly more irritable bowel syndrome patients said they would consult an alternative medicine practitioner (41%) if conventional treatment failed. Current usage of alternative medicine remedies was significantly greater in the irritable bowel syndrome patients (11%) than in patients with Crohn's disease (4%) and tended to be greater than in patients with organic upper gastrointestinal disorders (6%). This study has shown that the use of alternative medicine is common in patients with irritable bowel syndrome and this does not appear to be explicable in terms of the nature, chronicity or refractoriness to treatment of symptoms.

Acupuncture Therapy↗
PubMed1986

Achalasia following gastro-oesophageal reflux.

Five patients initially presenting with symptomatic gastro-oesophageal reflux, proven by radiology or pH monitoring, subsequently developed achalasia, confirmed by radiology and manometry, after an interval of 2-10 years. During this period dysphagia, present as a mild and intermittent symptom accompanying the initial reflux in 3 of the 5, became severe and resulted in oesophageal stasis of food in all. Three of the 5 had a demonstrable hiatal hernia. In none was reflux a troublesome symptom after Rider-Moeller dilatation or cardiomyotomy undertaken for the achalasia. Gastro-oesophageal reflux does not protect against the subsequent development of achalasia. It is suggested that the autonomic damage eventually leading to achalasia may in its initial phases cause gastro-oesophageal reflux.

Adult↗
PubMed1986

Does dimethicone increase the efficacy of antacids in the treatment of reflux oesophagitis?

Dimethicone is a common additive to antacids, although its value in the treatment of reflux oesophagitis is unproven. Its efficacy was assessed by comparing the effect of a dimethicone-containing antacid gel (Asilone Gel) with a simple antacid gel in a double-blind trial in 45 patients with reflux oesophagitis. Thirty-eight patients completed the eight-week course of therapy. Antacid therapy alone resulted in a significant improvement of both symptoms and oesophagitis in gastro-oesophageal reflux. The inclusion of dimethicone in the antacid gel preparation did not confer any benefit in terms of symptomatic assessment but did confer a small advantage with regard to objective markers of oesophageal inflammation, suggesting that a dimethicone-containing antacid is of value in the treatment of symptomatic gastro-oesophageal reflux.

Antacids↗
PubMed1986

Audit of surgical and pneumatic/hydrostatic treatment of achalasia in a defined population.

A retrospective survey was made of all the patients resident in the Nottingham area who presented with achalasia between 1959 and 1983. Initial treatment consisted of pneumatic bag dilatation in 26, hydrostatic bag dilatation in one and surgical cardiomyotomy in 22. Those treated by dilatation were older (mean age 52 years) than those treated by cardiomyotomy (mean age 42 years). Seven patients died without receiving active treatment because of old age and infirmity and in 6 this occurred before the introduction of endoscopic dilatation to the area. Initial treatment by cardiomyotomy was associated with a lower recurrence rate than treatment by bag dilatation but with a longer stay in hospital and a higher incidence of complications including empyema, chest infections and oesophageal stricture.

Aged↗
PubMed1986

Achalasia and other diseases associated with disorders of gastrointestinal motility.

The aetiology of achalasia is unknown, but it has been suggested that it is congenital in origin and associated with such disorders as infantile pyloric stenosis or Hirschsprung's disease. Another reported association has been with Hodgkin's disease. A survey of 126 patients with achalasia, and their first degree relatives was undertaken to record the prevalence of infantile pyloric stenosis, Hirschsprung's disease and Hodgkin's disease. The prevalence of motor neurone disease and diabetes, which can be associated with motility disorders of the oesophagus, were also recorded as a measure of the efficiency of the questionnaire. None of the 126 patients with achalasia suffered from pyloric stenosis, Hirschsprung's disease, Hodgkin's lymphoma or motor neurone disease. There was no increased frequency of these disorders amongst first degree relatives. There appears to be no common aetiology for aganglionic bowel disease, and no obvious association between Hodgkin's disease and achalasia. Diabetes is seen with the expected frequency amongst patients with achalasia and their relatives, indicating the adequacy of the questionnaire.

Adolescent↗