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Biomedical subjects

R V Heatley

Publications and source records attributed to R V Heatley.

At least 127 records · Page 7Linked to original sources

Guaiacol -- a new compound in the treatment of gastro-oesophageal reflux?

The effects on the oesophagus of an aromatic oil, guaiacol, has been examined in a group of 20 patients with reflux oesophagitis and also normal volunteers. This agent produced a rapid and sustained rise in resting lower oesophageal sphincter pressures and the peristaltic pressures induced in response to swallowing liquids. This compound may prove useful in the treatment of patients with reflux oesophagitis and other disorders of oesophageal motility.

Esophagitis, Peptic↗

Nippostrongylus brasiliensis infection in the rat: effects of surgical removal of Peyer's patches, mesenteric lymph nodes and spleen.

The influence of the surgical removal of Peyer's patches, mesenteric lymph nodes and spleen has been examined on the host response to Nippostrongylus brasiliensis infection in the rat. In animals subjected to these procedures, no effects were observed on whole blood or plasma histamine levels, peripheral blood leucocytosis or reaginic antibody levels, intestinal mast cell numbers or histamine content, nor on faecal egg output.

Animals↗

Luminal lymphoid cells in the rabbit intestine.

In normal rabbits, lymphocytes have been identified in large numbers on the luminal epithelial aspects of both Peyer's patches and the appendix by scanning and transmission electron microscopy. Luminal cells shared an intimate relationship with intestinal microorganisms. Irrigation of the appendiceal lumen has proved a useful technique for collecting 8.5 x 10(6) (mean) viable lymphocytes (73%) and macrophages (22%). Functional characteristics (mitogen responsiveness, T-cell numbers and cells with positive cytoplasmic immunoglobulin A fluorescence) were similar to isolated intestinal mucosal cell preparations. In vivo cytokinetic studies indicated that 50% of luminal appendiceal lymphocytes were recently divided (within 5 h). The passage of lymphoid cells into the the appendix lumen was antigen responsive, as was the size of the appendiceal lymphoid mass. This evidence suggests that migration of lymphoid cells into the lumen of the intestine in healthy animals occurs normally probably from the gut-associated lymphoid tissue--a phenomenon similar to that observed in the bronchial tract. Both mucosal surfaces may, therefore, be important sites of lymphocyte and macrophage traffic.

Animals↗

Malnutrition in inflammatory bowel disease: an anthropometric study.

Although malnutrition is common in Crohn's disease, some features are often overlooked. We have examined the value of simple anthropometric measurements in identifying the patients who were likely to have clinical features of malnutrition. Measurements were performed in 106 patients with Crohn's disease, 106 with ulcerative colitis and 106 healthy controls; all measurements were significantly reduced in patients with Crohn's disease (P less than 0.01) compared with controls and colitis patients who had similar measurements. Patients with Crohn's disease most severely affected had diffuse small bowel disease or recurrent disease following surgery. Those who had previous resections but no recurrence were similar to controls. Crohn's patients with colonic and ano-rectal disease were similar to patients with colitis. Anthropometry provides a simple method of documenting the nutritional status of patients with inflammatory bowel disease and helps to identify those with both clinical and biochemical features of malnutrition.

Adult↗

Vagal function in relation to gastro-oesophageal reflux and associated motility changes.

Vagal function in 28 patients with gastro-oesophageal reflux was examined by determining gastric secretory response to insulin-induced hypoglycaemia and pulse-rate variation with respiration. Gastric secretory studies were also performed on 13 patients with duodenal ulcer who had not undergone operations. In all patients the presence and degree of oesophagitis were determined endoscopically and mucosal biopsy and oesophageal manometry were performed. Seven of the 28 patients with gastro-oesophageal reflux showed evidence of impaired vagal efferent function in the upper alimentary tract. No such impairment was found in those patients who showed manometric evidence of oesophageal spasm secondary to gastro-oesophageal reflux. Low pulse-rate variation with respiration was found in 12 of 27 patients with gastro-oesophageal reflux, suggesting dysfunction of cardiac vagal fibres. Impairment of efferent vagal supply may be a causative factor in some patients with gastr-oesophageal reflux but does not seem to be important in oesophageal spasm secondary to gastro-oesophageal reflux.

Adult↗

Treatment of a patient with clinical features of both eosinophilic gastroenteritis and polyarteritis nodosa with oral sodium cromoglycate.

A young patient who suffered from allergic respiratory disease presented with an illness characterized by abdominal pain, diarrhea, and weight loss. Investigations revealed radiological and pathological features consistent with a diagnosis of eosinophilic gastroenteritis. Because of extensive gastric ulceration, treatment with corticosteroids was withheld and in its place oral sodium cromoglycate therapy given. The patient's intestinal symptoms rapidly responded to this treatment and remained controlled for a period of five months. The patient subsequently developed a systemic illness with features of polyarteritis nodosa.

Adult↗

Mesenteric lymphatic obstruction in Crohn's disease.

The lymphatic drainage of diseased and normal bowel was studied in 21 patients undergoing surgery for Crohn's disease. Mesenteric lymphatic obstruction was a consistent feature, identified in areas of small bowel macroscopically affected by Crohn's disease. This finding was also observed in some areas of apparently unaffected small bowel. Subsequent examination of these areas confirmed the presence of early Crohn's disease. This method of study may prove to be of value for determining the extent of operative resection in patients with Crohn's disease. Experimental lymphatic obstruction in animals failed to produce pathological changes of Crohn's disease, suggesting that this feature is an epiphenomenon and is not of primary importance in the pathogenesis of regional enteritis.

Animals↗

Immunogenicity of lipid-conjugated antigens. I. The influence of chain length and degree of conjugation on induction of antibody in mice.

An experiments in mice with a range of human serum albumin (HSA) molecules acylated to various degrees with side-chains of 6--20 carbon atoms, the greatest antibody responses against HSA were induced by highly acylated HSA with side-chains of intermediate length (C10--14). Similar results were obtained in rats but in this species the highest acylations with a particular chain length more often induced a less than optimal response. Mouse sera produced in response to acylated antigens and absorbed with HSA itself did not detectably react with acylated HSA when tested by an ammonium sulphate precipitation method. Acylation of antigen may sometimes reduce immunogenicity as shown in experiments with diphtheria toxoid.

Acylation↗

Insulin to inhibit protein catabolism after injury.

Using patients with varying degrees of trauma as their own controls we compared three isocaloric regimens in three-day crossover studies; 9.4 g of nitrogen as l-amino acids was also given daily. The urea production rate was used as an index of protein breakdown. We found that in catabolic patients, insulin and glucose produced a strikingly greater inhibition of protein breakdown that glucose alone, and that glucose alone was marginally more protein sparing than a regimen containing mainly fat (intralipid and sorbitol). These differences were not seen in noncatabolic patients (urea production rate less than 15 g daily). In the catabolic patients (urea production rate greater than 15 g daily) the protein-sparing effect of insulin was proportional to the initial urea production rate. We therefore concluded that insulin has important protein-sparing effects in severely ill traumatized patients, but little effect when there is no increased catabolic rate.

Blood Glucose↗

Atopic disease in ulcerative colitis and Crohn's disease.

Three hundred patients with ulcerative colitis, 200 with Crohn's disease and matched control subjects completed questionnaires about atopic disease. They were asked whether they had ever suffered from asthma, hay fever, allergic rhinitis or eczema; in ulcerative colitis all of these features occurred with twice the frequency, but in Crohn's disease only eczema was more common than in controls.

Asthma↗

A nitroindanedione mast cell stabiliser in the treatment of ulcerative colitis: a controlled trial.

An orally absorbed mast cell stabiliser (BRL-10833) has been compared with placebo in a double-blind controlled trial in twenty-five patients with ulcerative colitis; patients received each treatment for one month. There was no significant clinical improvement in symptoms or sigmoidoscopic findings with the drug but there was significant improvement in the histological appearance of rectal biopsies during active treatment.

Adult↗

Eosinophils in the rectal mucosa. A simple method of predicting the outcome of ulcerative proctocolitis?

One-hundred-and-thirteen rectal biopsies and 17 total colectomy specimens from 50 patients with ulcerative proctocolitis were examined. These patients had been followed for periods up to 220 months, mean 70 months. The histological changes were compared with the clinical features of the disease. Patients with relatively benign disease which responded to treatment had significantly raised eosinophil counts in the mucosa examined, compared with patients who had aggressive disease which failed to respond to medical treatment (P less than 0.001). Tissue eosinophilia in the rectal mucosa may provide a simple method for predicting the clinical course of patients with ulcerative proctocolitis.

Adult↗

Pre-operative intravenous feeding--a controlled trial.

Seventy-four patients with a pre-operative diagnosis of stomach or oesophageal cancer were entered into a randomized, controlled clinical trial to assess the value of a short course of pre-operative intravenous nutrition. The effectiveness of this treatment was assessed by the clinical course and monitored by means of immune and biochemical profiles. Pre-operative parenteral nutrition given over a 7-10-day period resulted in a significant reduction in the incidence of postoperative wound infections. Clinical benefit was confined to those patients who had a low serum albumin on admission to hospital. It is doubtful whether this limited benefit justifies the routine use of intravenous feeding, with its attendant hazards, in the pre-operative preparation of patients with upper gastrointestinal cancer.

Aged↗

Low dose steroids and clinical relapse in Crohn's disease: a controlled trial.

The long-term effect of prednisone in Crohn's disease has been examined in a double-blind controlled trial. Clinical relapse, recurrence, and extension of the disease were examined in 64 patients followed-up for up to three years. Fourteen patients were withdrawn because of severe symptoms (eight on prednisone and six controls); the withdrawal rate in both groups was 30% at three years. Nine other patients had radiological recurrence or extension of disease (five prednisone and four controls). Prednisone did not improve the relapse rate, nor did it affect recurrence or extension of disease.

Adolescent↗