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Biomedical subjects

M C Allison

Publications and source records attributed to M C Allison.

At least 55 records · Page 3Linked to original sources
PubMed1988

A double-blind crossover comparison of lidamidine, loperamide and placebo for the control of chronic diarrhoea.

Fourteen patients with chronic diarrhoea, but no evidence of active organic disease, completed a double-blind crossover comparison of the anti-diarrhoeal effects of loperamide, placebo and the clonidine analogue, lidamidine. Failure of diarrhoea control led to early withdrawals from seven placebo- and six lidamidine-treatment periods, but there was only one early withdrawal during treatment with loperamide. Loperamide was found to be superior to lidamidine or placebo for the control of stool consistency in patients with chronic diarrhoea.

Adult↗
PubMed1988

Macrophage heterogeneity in normal colonic mucosa and in inflammatory bowel disease.

Immunohistological techniques using monoclonal antibodies were employed to study the morphology and phenotypic expression of macrophage like cells in ulcerative colitis, Crohn's colitis and histologically normal colonic mucosa. The antibody RFD1 identifies interdigitating (antigen presenting) cells whereas RFD7 binds to mature tissue macrophages. In normal colonic mucosa, the majority of cells recognised by these reagents were positive for Class II antigen expression and a median 87% (range 80-95%) were positive for both RFD1 and RFD7, with 6.5% (ranges 1-14%) positive for either antibody alone. There was much greater macrophage heterogeneity in the ulcerative colitis and Crohn's colitis biopsies than in normal mucosa. Clusters of RFD9+ cells (epithelioid cells) were found in Crohn's colitis and, to a lesser extent, in ulcerative colitis. Some Crohn's colitis sections showed replacement of the normal colonic macrophage phenotype with RFD1-RFD7+ cells (classical scavenger macrophages). The degree of this replacement correlated with the histological severity of the disease. By contrast, large numbers of RFD1+ RFD7- cells, with long dendritic processes, were found in intimate association with the lymphoid infiltrates in the lamina propria of the ulcerative colitis sections. Future studies of the factors controlling macrophage differentiation in tissues may help to explain the greater macrophage heterogeneity in inflammatory bowel disease and the differences between ulcerative colitis and Crohn's colitis observed in this study.

Colitis, Ulcerative↗
PubMed1988

A microscopic and immunodiagnostic search for giardiasis in patients with gastrointestinal disorders.

Direct microscopy and an ELISA technique were used to determine the prevalence of Giardia lamblia and its antigen in stool samples from patients with Crohn's disease, ulcerative colitis, acute-onset diarrhoea, or dyspepsia. Cysts of Giardia lamblia were observed by microscopy of faeces from two of the patients with acute-onset diarrhoea and one with dyspepsia. Giardia antigen was detected in the faeces of five patients, including all three in whom cysts had been identified by microscopy. No evidence of giardiasis was found in any patient with Crohn's disease or ulcerative colitis. It is concluded that the ELISA can reliably distinguish giardiasis from a range of other gastrointestinal disorders.

Antibodies, Protozoan↗
PubMed1987

Cyclosporin for Crohn's disease.

Eight patients with active uncomplicated Crohn's disease, who were resistant to or intolerant of conventional treatment, were treated for 6 weeks with oral cyclosporin (mean dose 8.2 mg kg-1 day-1). Seven of the eight patients responded to treatment with cyclosporin by symptomatic improvement, weight gain and a return of serum C-reactive protein concentration towards normal. All patients relapsed on stopping cyclosporin. No serious side-effects were encountered. This favourable early experience justifies further trials using cyclosporin for active Crohn's disease.

Adolescent↗
PubMed1987

Bronchobiliary fistula due to acute cholecystitis in a suprahepatic gall bladder.

We describe a patient presenting with painless jaundice, anorexia and pruritus. The gall bladder was found to be lying above and behind a hypoplastic right lobe of liver. There was no evidence of cholangitis or biliary obstruction. The patient subsequently developed a bronchobiliary fistula with severe wheeze, cough and bile-stained sputum. Emergency percutaneous drainage of the gall bladder led to immediate cessation of bronchospasm and biloptysis, rendering the patient fit for definitive surgery.

Acute Disease↗
PubMed1987

A controlled study of faecal distribution in ulcerative colitis and proctitis.

The object of this study was to assess faecal distribution and faecal stasis in patients with ulcerative colitis and healthy control subjects and to relate the findings to the activity and extent of the disease. Each subject ingested 10 radiopaque markers daily for 13 days and attended for a plain abdominal roentgenogram on the 14th day. Patients with active ulcerative proctocolitis retained significantly fewer markers in the whole colon (median values, 11 versus 24 markers) due to a decrease of markers in the left colon (median values, 3 versus 13 markers) compared with the control group (p less than 0.05). Patients with either proctitis or colitis in remission and control subjects retained similar numbers of markers. The results of this study suggest that, as a group, patients with proctocolitis do not have proximal faecal stasis.

Adult↗
PubMed1987

The value of rectal biopsy in distinguishing self-limited colitis from early inflammatory bowel disease.

When a patient presents for the first time with acute diarrhoea, it can be difficult to distinguish acute self-limited colitis from idiopathic inflammatory bowel disease. This study was designed to determine whether detailed interpretation of rectal histology can enable this distinction to be made early in the course of the illness. Seventy-two rectal biopsies, taken at the time of presentation from patients with undiagnosed colitis, were reviewed independently by two observers without access to clinical information. Distorted crypt architecture, crypt atrophy, basal lymphoid aggregates and dense lymphocytic infiltrates each emerged as features with a 76 to 86 per cent probability of predicting idiopathic inflammatory bowel disease, but their discriminant value was limited by inter-observer disagreement (16-29 per cent). Isolated basal giant cells, epithelial surface erosions and epithelioid granulomas were found to be the most reliable histological features in the early diagnosis of idiopathic inflammatory bowel disease, and their interpretation was associated with the lowest inter-observer disagreement (6 per cent).

Biopsy↗
PubMed1986

Biliary lavage with corticosteroids in primary sclerosing cholangitis. A clinical, cholangiographic and bacteriological study.

Bile duct perfusion with corticosteroids is reported to improve the cholangiographic and biochemical abnormalities in some patients with primary sclerosing cholangitis. In a randomised placebo controlled trial, thirteen consecutive patients received continuous bile duct irrigation with either normal saline (1 l/day) or normal saline plus hydrocortisone (100 mg daily) via a nasobiliary tube placed in a hepatic duct at endoscopic retrograde cholangio-pancreatography. Eleven patients completed lavage for 2 weeks but no cholangiographic changes were observed in either group. Liver function tests deteriorated during lavage, but later returned to pre-treatment levels. Although bile was sterile at start of lavage, a wide range of bacteria was isolated from bile in all patients during treatment, and cholangitis with septicaemia occurred in 2 patients. We conclude that nasobiliary lavage is not beneficial in treating primary sclerosing cholangitis.

Adult↗
PubMed1985

Steroid sensitive systemic disease with anaemia in the elderly: a manifestation of giant cell arteritis?

Nine elderly patients presented with features of a multisystem disorder thought to be either a connective tissue disease of undefined type or disseminated malignancy. Associated features were a normochromic anaemia, raised erythrocyte sedimentation rate (ESR) (or plasma viscosity) and raised serum alkaline phosphatase levels. None had symptoms to suggest either giant cell arteritis or polymyalgia rheumatica. Temporal artery biopsy was performed before trial of corticosteroid therapy in four, and two showed giant cell arteritis. All nine responded dramatically to corticosteroids and the anaemias resolved. One died after 6 y, and the rest are well after 1 to 7 y.

Age Factors↗
PubMed1984

Temporal artery biopsy and corticosteroid treatment.

Eighty-four of 132 patients with clinically genuine cranial arteritis had histological evidence of inflammation at temporal artery biopsy. The highest incidence of a positive result (82%) was in patients biopsied before corticosteroid therapy. The figure fell to 60% if corticosteroids had been given for less than a week before biopsy and 10% thereafter.

Giant Cell Arteritis↗
PubMedDate not supplied

Cross cover for physicians: an additional burden.

OBJECTIVE: To examine the extra burden placed on consultant physicians when providing cross cover for colleagues who are absent on annual or study leave. METHODS: A questionnaire was sent to 455 consultant physicians with an interest in gastroenterology, practising in the UK in October 1996. RESULTS: The response rate was 77%, with 350 completed forms returned. Ninety percent of respondents participate in the acute intake; they provide 85% of cross cover for their colleagues. Only 2% of this burden is carried by the appointment of locums. CONCLUSION: Provision of satisfactory cover for inpatients under the care of absent colleagues can place serious demands on consultants at a time when their specialty commitments are also high. Future manpower planning must take these added burdens into consideration.

Absenteeism↗