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Biomedical subjects

R H Higgs

Publications and source records attributed to R H Higgs.

13 recordsLinked to original sources
PubMed1984

Adolescent patients in an Inner London general practice: their attitudes to illness and health care.

A postal questionnaire was sent to 121 patients aged 16-20 years identified from the age-sex register of an Inner London practice; 87 replied. Information was sought about adolescents' perceptions and experience of illness and health care, and their attitudes to preventive medicine. Few of the girls reported that they were in good health; 59 per cent of girls and 23 per cent of boys had visited their general practitioner in the previous three months. Thirty per cent of girls and 15 per cent of boys felt that there was something wrong with their health and in particular that they were overweight. Smoking and drinking were common. Adequate contraception was being practised by most girls.Detailed interviews with 18 of the respondents identified a number of family problems and difficult relations with staff in hospitals. Most of them considered that good health was not merely a matter of luck.Adolescents are usually described as being a most healthy group, but this study of an inner city practice suggests that adolescents themselves do not share this view.

Adolescent↗
PubMed1977

Lower esophageal sphincter response to oral administration of cimetidine in normal subjects.

Anithistamines that specifically block the gastric and secretory action of histamine have recently been developed. One of these H2-receptor blockers, metiamide, has been found to increase lower esophageal sphincter (LES) pressure in the opossum. Because of reported agranulocytosis with metiamide, another H2-receptor blocking agent, cimetidine, was developed. To determine its effect on LES pressure, 8 normal volunteers received placebo or oral doses of cimetidine (50, 100, 200, and 400 mg) in a random, blinded manner. Indicative of adequate absorption, significant serum levels were achieved with all doses of cimetidine (50 mg = 0.17 mug per ml; 100 mg = 0.33 mug per ml; 200 mg = 0.76 mug per ml; and 400 mg = 1.61 mug per ml). Although these serum levels have been found to produce marked inhibition of gastric acid secretion, no discernible effect was found on LES pressure when compared to placebo. Thus cimetidine does not increase LES pressure. It does not decrease sphincter pressure either and is therefore not contraindicated in patients with reflux esophagitis.

Administration, Oral↗
PubMed1976

Lower esophageal sphincter pressures and serum gastrin levels after cholinergic stimulation.

To define the role of gastrin, if any, in the response of the lower esophageal sphincter (LES) to bethanechol, serum gastrin determinations and LES pressure measurements were made in controls, patients with vagotomy and antrectomy (V&A), and patients with vagotomy and pyloroplasty (V&P). Despite significant differences in mean basal serum gastrin levels no differences were found in mean resting LES pressures among these groups. In controls significant increases in LES pressure occurred after subcutaneous bethanechol, but serum gastrin levels did not change from basal values. Subcutaneous injections of bethanechol produced significantly greater increases in LES pressures in V&P patients than in V&A patients. Serum gastrin levels did not change in either group; however, background serum gastrin concentrations were significantly greater for V&P patients than V&A patients throughout the study. Intravenous infusion of human gastrin I heptadecapeptide in controls significantly increased sphincter responses to bethanechol. Thus, these studies provide evidence to suggest that the LES response to bethanechol is affected by background serum gastrin levels.

Adult↗
PubMed1976

Colonoscopy associated bacteremia.

Fifty-two patients undergoing uneventful diagnostic colonoscopy with or without polypectomy and biopsy were evaluated for evidence of bacteremia during and after the procedure. In only two instances was bacteremia noted. Positive findings were noted in patients with carcinomatosis and severe liver involvement. These data suggest that routine prophylactic antibiotic coverage is unnecessary in uncompromised patients. Further studies are warranted when patients have either severe liver involvement or impairment of normal host defense mechanisms.

Adult↗
PubMed1976

Studies on the mechanism of esophagitis-induced lower esophageal sphincter hypotension in cats.

Perfusion of 0.1 n HC1 5 cm above the lower esophageal sphincter (LES) in cats for 30 min on 4 consecutive days produced biopsy-documented esophagitis and marked decreases in LES pressure. Using this model the effects of experimental esophagitis on the LES response to edrophonium, pentagastrin, and bethanechol were determined. The sphincter response to both edrophonium and pentagastrin after esophagitis was induced was significantly less than preperfusion responses. When the esophagitis had resolved, the pressure response to edrophonium and pentagastrin returned to preperfusion levels. In contrast, the sphincter response to bethanechol during esophagitis was not different from the preperfusion response and remained unchanged after resolution of the esophagitis. Lower esophageal smooth muscle taken from cats with active esophagitis appeared normal by both light and electron microscopy. These studies indicate that besides decreasing resting LES tone, esophageal inflammation causes functional impairment of a cholinergic mechanism regulating LES pressure. In contrast, the smooth muscle appears to be unaffected by inflammation despite the LES hypotension.

Animals↗
PubMed1976

Lower esophageal sphincter and gastric acid response to intravenous infusions of synthetic human gastrin I heptadecapeptide.

Human gastrin I heptadecapeptide was administered by constant intravenous infusion to 7 adult male volunteers without gastrointestinal disease, and serum gastrin concentrations and responses of the lower esophageal sphincter (LES) pressure and gastric acid output were measured and compared. Significant responses in LES pressure were found at gastrin infusion rates which produced submaximal gastric acid output. These LES pressure responses were quantitatively smaller than those occurring concomitantly with similar total immunoreactive gastrin levels evoked by administration of a protein meal in the same subjects. These observations suggest that, although increases in serum gastrin concentrations may contribute to increases in LES pressure seen under physiological conditions after feeding, the increase in LES pressure produced by feeding cannot be explained exclusively on the basis of endogenous gastrin release.

Adult↗
PubMed1975

Cholinergic stimulation of the lower esophageal sphincter in patients with vagotomy and antrectomy.

Recently cholinergic stimulation of the lower esophageal sphincter (LES) with bethanechol has been shown to be effective in the treatment of chronic gastroesophageal reflux. Since chronic reflux and esophagitis also occur in patients with vagotomy and antrectomy, we studied the effect of bethanechol on sphincter pressure in 10 patients who had had vagotomy and antrectomy. Both subcutaneous (0.08 mg/kg) and oral (25 mg) administration of bethanechol caused significant increases in LES pressure in these patients. In addition, both subcutaneous and oral administration of bethanechol elevated hypotensive sphincter pressures to normal levels. Orally administered bethanechol produced a sustained increase in LES pressure throughout a 90-min study period. These studies suggest that cholinergic stimulation of the LES with bethanechol may be of therapeutic benefit in vagotomized and antrectomized patients with gastroesophageal reflux.

Administration, Oral↗
PubMed1975

Assessment of simple methods of measuring intestinal transit times in children with gastroenteritis.

Intestinal transit times in children less than 3 years old with gastroenteritis were measured using carmine suspension and radioopaque pellets. Carmine transit times were short as expected in the acute illness, and lengthened on recovery to the values found in children without diarrhoea. Pellet transit times of the sick children were the same as those of controls without bowel disease. Solid markers may thus be misleading in acute diarrhoeal illness of childhood. Possible mechanisms are discussed.

Child, Preschool↗
PubMed1975

Experimental esophagitis in cats impairs lower esophageal sphincter pressure.

We studied the effect of esophageal inflammation on lower esophageal sphincter (LES) pressure in cats by measuring LES pressure and taking mucosal biopsies before and after the development of experimental esophagitis, as well as after a 3 1/2-week recovery period. Perfusion of the esophagus with 0.1 N HCl for either 1 hr or 1/2 hr per day for 4 days produced inflammatory changes by mucosal biopsy and was associated with a marked decline in LES pressure. Upon resolution of the inflammation, LES pressure returned to normal. Biopsies were normal in control groups which underwent either esophageal perfusion with distilled water or intragastric perfusion with acid, 1 hr per day for 4 days, and LES pressures in these groups remained unchanged from pre-perfusion values. These studies indicate that lower esophageal inflammation per se adversely affects LES pressure in cats, and that experimental esophagitis may be a useful model for the study of LES function and its relation to esophageal inflammation.

Animals↗
PubMed1975

Evaluation of the effect of fundoplication on the incompetent lower esophageal sphincter.

The increase in tension of the gastroesophageal high pressure zone after fundoplication and hiatal hernia repair could represent either a mechanical effect or enhanced smooth muscle tone of the lower esophageal sphincter. Determination of the response of this high pressure zone to cholinergic stimulation, a protein meal and deglutition before and after Belsey Mark IV fundoplasty in seven patients with intractable reflux indicates the latter. Fundoplication resulted in a resting tension of the high pressure zone significantly greater than that found preoperatively but similar to that of controls. This normotensive postoperative high pressure zone had properties of a physiologic lower esophageal sphincter, that is, normal relaxation to deglutition, a response to a protein meal and a response to cholinergic stimulation with edrophonium. In response to edrophonium, evidence of a partial improvement in lower esophageal sphincter smooth muscle function was found postoperatively when compared with the response of controls and in patients preoperatively. The response to a protein meal postoperatively remained similar to that noted preoperatively, which was significantly less than the response of controls. Therefore, the increase in tension of the high pressure zone after fundoplication and hiatal hernia repair appears to result from improved function of the lower esophageal sphincteric smooth muscle.

Adult↗