Common variable immunodeficiency associated with nodular regenerative hyperplasia of the liver.
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Adult↗
Biomedical subjects
R Heddle
Publications and source records attributed to R Heddle.
Integration of canine proximal gastric, antral, pyloric, and proximal duodenal motility during fasting and after a liquid meal.
The aim was to investigate the integration of proximal gastric, antral, pyloric, and duodenal motility during fasting and after feeding. Using a proximal gastric barostat and a manometric assembly with an array of side holes astride the gastroduodenal junction, the gastrointestinal interdigestive migrating motor complex was detected in five of seven conscious fasting dogs. During phase III of the complex, which lasted a mean +/- SEM of 13 +/- 0.5 min, 9.6 +/- 0.9 volume waves were present in the proximal stomach. The volume waves were coordinated with clusters of antral waves 64 +/- 11% of the time and with inhibition of duodenal waves 91 +/- 3% of the time. A 300-ml calorie-dense liquid meal abolished the complex and promptly increased proximal gastric volume in five of six dogs. Volume waves were nearly completely suppressed, while antral waves decreased from 24 +/- 3.0 waves/10 min to 10 +/- 2.8 waves/10 min (P < 0.05) and isolated pyloric pressure waves increased from 7.2 +/- 2.8 waves/10 min to 22 +/- 3.3 waves/10 min (P < 0.005). In summary, proximal gastric motility was integrated with antral, pyloric, and duodenal motility under both fasting and fed conditions. The integrated patterns likely account for the efficient clearance of indigestible solids during fasting and the controlled emptying of nutrients with feeding.
Animals↗
Duodenal intramural nerves in control of pyloric motility and gastric emptying.
We have investigated the role of ascending duodenal intramural nerves in the control of isolated pyloric pressure waves (IPPW) and liquid gastric emptying. In six pigs, the proximal duodenum was transected to interrupt intramural nerves. A further six pigs had a sham operation. Four weeks after operation, motility of the antrum, pylorus, and duodenum was recorded by side holes and a sleeve sensor. Gastric emptying of a 1,000-ml test meal was significantly more rapid in duodenum-transected animals (P less than 0.0001) during intraduodenal infusion of each of isosmolar dextrose (424 ml emptied), fatty acid (335 ml), and amino acids (396 ml) than in duodenum-intact animals (dextrose: 128 ml; fatty acid: 57 ml; amino acids: 192 ml). Associated with this, in duodenum-transected animals infusion of each of isosmolar dextrose, fatty acid, amino acids, and hyperosmolar saline failed to produce the stimulation of IPPW seen in duodenum-intact animals. In both duodenum-intact and -transected animals, supramaximal stimulation by intraduodenal infusion of 25% dextrose slowed gastric emptying and stimulated IPPW. Ascending duodenal intramural nerves are a major physiological pathway for nutrient- and osmolar-stimulated feedback control of pyloric motility and gastric emptying.
Animals↗
Response of canine ileocolonic sphincter to intraluminal acetic acid and colonic distension.
The aim was to determine the effect of intraluminal acetic acid and proximal colonic distension on canine ileocolonic sphincter pressure, ileal motility, and coloileal reflux. In six conscious dogs with an isolated ileocolonic loop, basal pressure of the ileocolonic sphincter was similar during ileal perfusion with 100 mM acetic acid at 1 ml/min (mean +/- SEM = 18 +/- 0.4 mm Hg) and with saline (18 +/- 0.5 mm Hg; P = 0.81). Discrete clustered ileal contractions were more frequent with acetic acid, however, and when they propagated across the sphincter, sphincter pressure increased from 18 +/- 0.4 mm Hg to 36 +/- 1.3 mm Hg (P = 0.002). Sphincter pressure was also greater during colonic perfusion with acetic acid (32 +/- 0.7 mm Hg) than during ileal perfusion with acetic acid or saline (P less than 0.017). Moreover, sphincter pressure gradually increased as the colon was distended with saline (slope = 0.8 mm Hg/cm H2O, P less than 0.017) or acetic acid (slope = 0.5 mm Hg/cm H2O, P less than 0.017), but the increase did not prevent coloileal reflux. In conclusion, ileal clustered contractions, colonic perfusion of acetic acid, and colonic distension all increased canine ileocolonic sphincter pressure.
Acetates↗
Role of the proximal and distal stomach in mixed solid and liquid meal emptying.
The role of the proximal and distal stomach in the emptying of solids and liquids from the stomach remains unclear. We have used a dual isotope technique to quantify proximal and distal stomach emptying of a solid (100 g of 99mTc labelled liver/ground beef) liquid (either 200 ml of normal saline (eight subjects) or 25% dextrose (seven subjects) labelled with 113mIn-diethylenetriaminepenta-acetic acid) mixed meal. A manometric catheter simultaneously measured antral, pyloric, and duodenal motor activity. The liquid component dispersed rapidly throughout the stomach and emptied after a minimal lag period. The emptying of the 25% dextrose was delayed compared with the saline. This delay was associated with increased retention of the liquid in the distal stomach, a significant increase in localised phasic pyloric contractions, and a suppression of antral contractions. The solid component initially resided wholly within a proximal stomach reservoir area. Solids then redistributed from proximal to distal stomach during the emptying of liquid from the stomach. Dextrose delayed gastric emptying of solids compared with saline by increasing the solid lag period and retention in the proximal stomach. There was no significant difference between saline and dextrose meals in the distal stomach retention of solid or in the linear rate of emptying after the lag period. We conclude that, contrary to general opinion, the proximal stomach plays an important role in the control of gastric emptying of solids while the distal stomach is important in the emptying of nutrient liquids.
Adolescent↗
Comparative effects of duodenal and ileal intubation on gastric emptying and postprandial antral, pyloric, and duodenal motility.
The influence of gastric and small-intestinal intubation on fed patterns of antropyloroduodenal motility and gastric emptying of a solid meal has been investigated in normal volunteers. In 10 subjects a manometric assembly was passed as far as the fourth part of the duodenum; in 8 other subjects the terminal ileum was intubated; and a further 8 subjects were not intubated. The manometric assemblies were similar, apart from their length, and both incorporated a sleeve/side hole assembly located across the pylorus. All subjects ingested a meal of 100 g 99mTc-labelled liver/ground beef. There was no significant difference in either the lag phase or the linear emptying phase of gastric emptying between the control and duodenal intubation groups. The emptying phase of the test meal, but not the lag phase, was slower (p less than 0.01) in the ileal intubation group than in the non-intubated and duodenal intubation groups. There were fewer (p less than 0.01) antral pressure waves in the ileal than in the duodenal intubation group. We conclude that ileal but not duodenal intubation has an important inhibitory influence on gastric emptying and antral motility.
Adult↗
Control of belching by the lower oesophageal sphincter.
The mechanism that controls venting of gas from the stomach into the oesophagus was studied manometrically in 14 healthy subjects. The stomach was distended abruptly with one litre of carbon dioxide. Gas reflux was characterised by an abrupt increase in basal oesophageal body pressure to intragastric pressure. Reflux of gas from the stomach into the oesophagus occurred during transient lower oesophageal sphincter relaxations that generally had a pattern distinctly different from swallow-induced lower oesophageal sphincter relaxation. Thus, at the onset of an episode of gas reflux lower oesophageal sphincter pressure had relaxed to 3 mmHg, or less, in 96% of instances. After gas loading of the stomach the prevalence of gas reflux was significantly less when the subjects were supine (1.2/10 min) than when they were sitting (6.8/10 min) (p less than 0.001). The lower oesophageal sphincter relaxations associated with most episodes of gas reflux had a distinctive pattern that resembled those of the lower oesophageal sphincter relaxations associated with acid gastro-oesophageal reflux.
Adult↗
Relationship between fluctuations of pH and pressure in the human stomach and duodenum.
The normal patterns of pressure activity in the antrum, pylorus and duodenum and associated pH changes were monitored in 9 healthy volunteers under fasted conditions and after ingestion of 300 ml of chocolate milk. The manometric assembly incorporated three side holes in the antrum, four side holes in the duodenum, a sleeve sensor positioned across the pylorus, and pH electrodes situated in the terminal antrum and proximal duodenum. The most common motor pattern recorded under fasting conditions consisted of regular co-ordinated contractions, most of which involved the antrum and duodenum, showed evidence of propagation and was associated with transient decreases in duodenal pH and transient increases in antral pH. Ingestion of milk changes the motor pattern to one that was composed of pressure waves which were confined to the pylorus with few or no pressure waves in the terminal antrum or proximal duodenum. Isolated pyloric pressure waves were gradually replaced by propagated antropyloroduodenal contractions which were associated with transient decreases in duodenal pH. Isolated pyloric pressure waves were not associated with episodes of duodenal acidification under fed conditions.
Adult↗
Pyloric motor response to intraduodenal dextrose involves muscarinic mechanisms.
The delivery of dextrose solutions to the duodenum is associated with the stimulation of phasic and tonic pyloric contraction. In this study, the effects of intravenous atropine on the antropyloroduodenal motor responses to intraduodenal infusions of 25% dextrose were assessed in 10 normal volunteers. Antropyloroduodenal pressures were recorded with a manometric assembly incorporating a sleeve sensor spanning the pylorus, and sideholes in the antrum and duodenum. In each experiment, three intraduodenal infusions of 25% dextrose were given at a rate of 4 ml/min, for a median duration of 19 min (range 17-20). During the second dextrose infusion, intravenous atropine was given as a bolus (15 micrograms/kg) followed by an infusion (4 micrograms/kg.min), which was continued until the end of each experiment. Before atropine was given, the pyloric motor response to the second dextrose infusion was not significantly different from the response to the first infusion, but after administration of atropine there was a rapid decrease in the rate of isolated pyloric pressure waves, from 0.8 to 0.1 per minute (p less than 0.05). The isolated pyloric pressure wave response to the third dextrose infusion was completely blocked, and there was a much smaller maximum increase in basal pyloric pressure compared with the first infusion (p less than 0.01). This study indicates that intraduodenal dextrose reproducibly stimulates isolated pyloric pressure waves and increases basal pyloric pressure by mechanisms that involve muscarinic receptors.
Adult↗
Motor activity of the gastric antrum, pylorus, and duodenum under fasted conditions and after a liquid meal.
Because the mechanisms that control the movement of food and digestive juices across the human pylorus are not completely understood, the aim of this study was to document the normal patterns of pressure activity in the antrum, pylorus, and duodenum and the associated pH changes in 9 healthy volunteers. Studies were carried out under fasting conditions and after ingestion of 300 ml of chocolate milk, using a unique 11-channel intraluminal probe that incorporated a sleeve sensor positioned across the pylorus and pH electrodes situated in the terminal antrum and proximal duodenum. The most common motor pattern recorded under fasting conditions consisted of regular coordinated contractions, most of which (a) involved the antrum and duodenum, (b) showed evidence of propagation through two or more adjacent channels, and (c) were associated with transient reductions in duodenal pH and transient elevations in antral pH. Ingestion of milk changed the motor pattern to one that was composed of pressure waves, which were confined to the pylorus with few or no pressure waves in the terminal antrum or proximal duodenum. Isolated pyloric pressure waves were gradually replaced by propagated antroduodenal contractions, which eventually occurred at a regular frequency that was higher than that observed under fasting conditions. After ingestion of milk, only the coordinated contractions were associated with transient reductions in duodenal pH. Isolated pyloric pressure waves were also observed under fasting conditions just before or just after phase III of the migrating motor complex, and 17% of these were accompanied by episodes of duodenal acidification.
Adult↗
Relationship of the motor activity of the antrum, pylorus, and duodenum to gastric emptying of a solid-liquid mixed meal.
The postprandial motor activity of the antrum, pylorus, and duodenum in 15 healthy volunteers was compared with the profiles of emptying of the solid and liquid components of a meal. The liquid component of the meal emptied rapidly in an exponential manner, whereas the solid remained in the fundus of the stomach until approximately 80% of the liquid had emptied and then emptied in a linear manner. The onset of solid emptying was associated with an increase in the rate of occurrence of antral pressure waves (p less than 0.05), and the half-time for solid emptying (t1/2 - lag period) was inversely correlated (p less than 0.05) with the rate of coordinated contractions involving the antrum. The substitution of 25% dextrose in normal saline as the liquid component of the meal increased the half-time for liquid emptying from a median of 8 to 40 min (p less than 0.01), increased the lag period for solid emptying from 40 to 87 min (p less than 0.01), and increased the rate of occurrence of isolated pyloric pressure waves during the solid lag phase from 7 to 58/h (p less than 0.05), but did not affect the slope of solid emptying or the rate of coordinated contractions involving the antrum during the solid emptying period.
Adolescent↗
Wiskott-Aldrich syndrome in identical twins: abnormality of CD4 and CD8 positive lymphocytes.
The rare occurrence of Wiskott-Aldrich syndrome (WAS) in identical twin brothers without a preceding family history of the disease is described. Investigation into the nature of the lymphocyte abnormality in the surviving twin suggests that the frequency of T cell clone forming cells is markedly decreased. Further analysis of the T cell clones showed a deficiency of CD8 positive cytotoxic/suppressor cells. This alteration may be an underlying mechanism in the development of some of the clinical manifestations of WAS.
Antibodies, Monoclonal↗
Stimulation of pyloric motility by intraduodenal dextrose in normal subjects.
Recent studies suggest that the pylorus may play an important role in the regulation of the gastric emptying of nutrient liquids in man. Dextrose solutions in the range 5-25 g/dl have been reported to empty from the human stomach at a constant caloric rate of 2.1 kcal/min. This study examined, in 12 healthy volunteers, the effects of intraduodenal dextrose on pyloric motility. Dextrose solutions, 5, 10, 15, and 25 gde/dl and saline solutions, 0.9 and 2.7 g/dl were infused into the duodenum at 4 ml/min for 10 minutes. Antral, pyloric, and duodenal motility were monitored with sideholes and a sleeve sensor positioned across the pylorus. Significant increases in the rate of isolated pyloric pressure waves and in basal pyloric pressure were seen with 15 and 25 g/dl dextrose (p less than 0.02) and 2.7 g/dl saline (p less than 0.05). The intensity and duration of the phasic and tonic pyloric motor responses to intraduodenal dextrose were dose dependent and correlated directly with the rate of calorie delivery (p less than 0.005 for each parameter). Intraduodenal delivery of dextrose at a rate in excess of 2.1 kcal/min stimulates both phasic and tonic pyloric contraction. These changes in pyloric motility may contribute to the close regulation of the emptying of dextrose from the stomach.
Adolescent↗
Antropyloroduodenal motor responses to intraduodenal lipid infusion in healthy volunteers.
The delivery of lipid to the duodenum has been shown to slow gastric emptying and to increase the resistance to gastric outflow. To investigate mechanisms responsible for these effects, we have recorded antropyloroduodenal motility in nine healthy volunteers during alternate intraduodenal infusions of normal saline and triglyceride emulsion (Intralipid 10%). During the lipid infusions there were reproducible, major changes in the patterns of motility. Pressure waves, apparently isolated to the pylorus, usually started within 10 min of initiation of the lipid infusion. After 20-25 min of lipid infusion these waves occurred at median rates of 2.4 and 2.8/min (1st and 2nd lipid infusions, respectively); these rates were significantly greater (P less than 0.05) than the median rates (all less than or equal to 0.4/min) observed during the equivalent period of the succeeding saline infusions. During 10 of 22 lipid infusions, isolated pyloric pressure waves were associated with sustained pyloric tone. Infusion of lipid into the duodenum suppressed antral pressure waves in all subjects and initiated brief periods of regular duodenal contractions during 11 of 22 infusions. These studies have demonstrated alterations of antropyloroduodenal motor patterns in response to changes in the duodenal luminal content. The effects on antral and pyloric motility are probably of importance in the regulation of transpyloric flow by nutrients in the duodenal lumen.
Adult↗
Topography and measurement of pyloric pressure waves and tone in humans.
The topography of human pyloric pressure is ill defined, and previous studies of pyloric motility in humans have given conflicting results. A detailed profile of pyloric pressure has been recorded in seven healthy volunteers using a manometric assembly with 13 side holes spaced at 3-mm intervals on reverse aspect of a 3.5-cm long sleeve sensor. After a fasting control period of 40 min, recordings were made for 40 min during intraduodenal infusion of a lipid emulsion. Two major patterns of pressure waves were seen during the fasting control period, namely pressure waves confined to a narrow pyloric zone (isolated pyloric pressure waves) and pressure waves that were less localized and involved the antrum and/or duodenum. During lipid infusion the motility pattern was dominated by isolated pyloric pressure waves and localized pyloric tone. Ninety-two percent of the isolated pyloric pressure waves recorded by the sleeve were recorded by only one or two side holes, consistent with a phasically active zone less than 9 mm in length. Pyloric tone was confined to an even narrower zone and was most often recorded by only one side hole. When both tone and isolated pyloric pressure waves occurred together, they were recorded by the same side holes. By comparison with the side holes, the sleeve recorded 89% of isolated pyloric pressure waves and 98% of nonlocalized waves and recorded pyloric tone with a moderate sensitivity but high specificity. The technical challenge of recording localized pyloric contraction is considerable, and much of the conflict between previous studies of the human pylorus is explicable on methodological grounds.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Adrenaline and anaphylaxis.
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Anaphylaxis↗
Small cell lung carcinoma and Bowen's disease 40 years after arsenic ingestion.
A non-smoking woman presented with ectopic ACTH syndrome associated with disseminated small cell carcinoma of lung. The patient had Bowen's disease and had taken oral arsenic for psoriasis 40 years ago. It is postulated that the previous therapeutic arsenic ingestion caused both her arsenical dermatosis and her small cell carcinoma of lung.
ACTH Syndrome, Ectopic↗
Meleney's progressive synergistic bacterial gangrene due to subcutaneous end-ileostomy perforation, with delayed plastic reconstruction.
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Escherichia coli Infections↗