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Biomedical subjects

T Gledhill

Publications and source records attributed to T Gledhill.

At least 19 recordsLinked to original sources
PubMed1997

[Pulmonary alveolar proteinosis: ultrastructural study of 4 cases].

Pulmonary Alveolar Proteinosis (PAP) is a rare and diffuse lung disease characterized by the abnormal deposition of PAS positive, lipoproteinaceous material in the alveolar spaces. It has been related, mainly, to alterations in the immune state and to secondary infections. We studied four cases of PAP diagnosed by light microscopy. In two cases we were able to demonstrate disseminated Histoplasmosis related to immunodeficiency states (AIDS and malnutrition), one case with Pneumocystis carinii infection and AIDS, and one case with no related pathology. Granular and electron dense material, concentric myelin figures, and variable-sized osmiophilic bodies were observed by electron microscopy. We found yeast-like structures, trophozoites and cysts in the alveolar spaces, in the Histoplasmosis and Pneumocystic carinii infection cases, respectively. In one of our cases, the circulating neutrophils showed crystalloid inclusions in the nucleus. PAP should be considered in the differential diagnoses of patients with pulmonary infiltrates.

Adult↗
PubMed1988

A prospective comparison of the effects of placebo, ranitidine and highly selective vagotomy on 24 h ambulatory intragastric pH in patients with duodenal ulcer.

Twenty-four hour ambulatory intragastric pH (24 h IGpH) recording, a highly reproducible technique, was used to compare the effects of ranitidine and highly selective vagotomy (HSV) in 20 patients who had been referred for surgical treatment of duodenal ulcer. The 24 h IGpH was recorded when they were taking either placebo or ranitidine 300 mg at 10 pm, and again 4 to 13 weeks after elective HSV. Median 24 h IGpH and 24 h hydrogen ion activity (24 h [H+]) were calculated for each patient. Median (quartile) 24 h IGpH was 1.4 (1.3-1.6) with placebo, 2.2 (1.8-2.7) after ranitidine and 2.6 (1.8-3.7) after HSV. IGpH was significantly higher after both ranitidine (P less than 0.0001) and HSV (P less than 0.0001) than after placebo, but IGpH after ranitidine did not differ from IGpH after HSV (0.5 greater than P greater than 0.4). HSV reduced 24 h [H+] by a median 68 per cent (quartiles, 47-82 per cent) whereas ranitidine reduced it by only 50 per cent (34-69 per cent, 0.1 greater than P greater than 0.05). The 24 h pH recording was then analysed as two distinct periods; 'daytime' (8 am to midnight) and 'night-time' (midnight to 8 am). HSV reduced daytime [H+] by a median 77 per cent (59-93 per cent) whereas ranitidine reduced it by only 30 per cent (13-45 per cent, P less than 0.0001). HSV reduced night-time [H+] by a median 57 per cent (40-83 per cent) but ranitidine reduced it by a median 92 per cent (78-98 per cent, P less than 0.01). Thus, HSV inhibits gastric acidity more during the day than at night, whereas ranitidine given at 10 pm effectively suppresses night-time acidity but is much less effective in suppressing daytime acidity. However both HSV and ranitidine will heal more than 90 per cent of duodenal ulcers. Hence, contrary to Dragstedt's teaching, suppression of nocturnal acidity is not of crucial importance for the healing of duodenal ulcers.

Adult↗
PubMed1986

Controlled trial of transcutaneous electrical nerve stimulation (TENS) for postoperative pain relief following inguinal herniorrhaphy.

We have evaluated the effect of transcutaneous electrical nerve stimulation (TENS) on postoperative pain following inguinal herniorrhaphy in a prospective randomized controlled trial. Forty male patients undergoing unilateral inguinal herniorrhaphy for the first time were randomized to receive either active or inactive TENS. Electrical stimulation was delivered by electrodes placed along either side of the wound following operation. An identical apparatus, which did not deliver an electrical current, was applied to control patients. Pain was assessed over the first 3 postoperative days by visual analogue pain scores, expiratory peak flow rates and analgesic requirements. There was no difference between the two groups for pain scores, peak flow rates or analgesic requirements and we conclude that TENS as used in this trial does not reduce postoperative pain. However, TENS had considerable patient appeal and many patients believed that it was effective.

Adult↗
PubMed1986

Blind total gastrectomy for massive bleeding from the stomach.

The source of massive haemorrhage from the stomach cannot always be identified even with the use of fibreoptic endoscopy and angiography. Six patients with massive, continuing, non-variceal haemorrhage from the stomach are described in whom total gastrectomy was eventually required. Three patients were shown to have bled from submucosal arteriovenous malformations, two from erosive gastritis and one from a vessel in an ulcer at the oesophagogastric junction. One patient died as a result of surgery and another died later of disseminated malignant disease. The functional results in the remaining patients were surprisingly good and rebleeding has not occurred. Total gastrectomy is a satisfactory 'last resort' treatment for life-threatening gastric haemorrhage for which no cause can be found.

Adult↗
PubMed1986

Nocturnal gastric acid secretion: its importance in the pathophysiology and rational therapy of duodenal ulcer.

The importance of nocturnal acid secretion has long been acknowledged. The aim of therapy at present is to control acid secretion throughout the entire 24-h period. However, the fact that in DU patients a 400-mg nighttime dose of cimetidine is more effective than a 200-mg one, along with the observation that poorly responsive patients also show little decrease in H+ activity, suggests that a larger single nocturnal dose is an effective primary treatment for DU patients. In studies investigating the effects of different regimens of H2 antagonists on 24-h H+ activity and nocturnal acid secretion in DU patients and healthy volunteers, 400 mg cimetidine twice daily was compared with 800 mg cimetidine at night, 150 mg ranitidine twice daily, 300 mg ranitidine at night, and placebo. In 12 DU patients no significant difference was observed between twice daily or nighttime cimetidine and twice daily or nighttime ranitidine in the reduction of 24-h H+ activity. Cimetidine at night was significantly more effective than the twice daily regimen in reducing nocturnal acid output. Ranitidine, 300 mg at night, decreased nighttime H+ activity more than 800 mg cimetidine at night, although no significant differences in overnight acid output were observed. In another study of four DU patients and four volunteers, 400 mg cimetidine twice daily was compared with 800 or 1200 mg cimetidine at night, 150 mg ranitidine at night, and placebo. All treatments were equally effective at night but had no effect during the day. Hence, early reports seem to confirm that daytime administration of H2 antagonists is unnecessary.

Administration, Oral↗
PubMed1985

Epidemic hypochlorhydria.

During a study of gastric secretion four out of six previously healthy subjects developed hypochlorhydria after a transient illness with nausea, vomiting, and abdominal pain. Mean basal and peak acid outputs were 0 and 2.3 mmol (84 mg)/h one month after the onset of illness and 1.5 and 27.0 mmol/h (55 and 984 mg/h) at eight months' follow up. Two of the subjects were followed up at 18 months, when mean basal and peak acid outputs were 3.9 and 33.5 mmol/h (142 and 1221 mg/h). No endoscopic abnormality was seen at one and eight months, but biopsies showed active superficial gastritis, which resolved in one subject and became chronic in two. Schilling tests performed in three subjects at eight months showed diminished retention of vitamin B12. During hypochlorhydria a 24 hour intragastric analysis was performed for total and nitrate reducing bacteria, pH, and concentrations of nitrite and total and stable N-nitroso compounds. Of the 48 samples of gastric juice examined, 47 had bacterial growth of more than 10(6) organisms/ml and 46 had growth of nitrate reducing bacteria of more than 10(5) organisms/ml. Mean intragastric nitrite concentrations were 10 times higher than in a group of eight healthy controls. Both mean total and mean stable N-nitroso compound concentrations, however, were not appreciably different from those in controls. Although community transmission was a possibility, serological screening and electron microscopy of gastric biopsy specimens failed to show an infective cause. Transmission of an unidentified enteric pathogen via a contaminated pH electrode was therefore suspected. Thus gastric juice should not be returned to the stomach after contact with a contaminated glass electrode as this is a possible cause of atrophic gastritis.

Achlorhydria↗
PubMed1985

The educational value of being a house surgeon.

A time and motion study has been performed with four house surgeons. The results suggest that modern pre-registration housemen spend over 75% of their time in a hospital service role. There is only a small amount of supervised teaching in what is regarded as an educational post.

Education, Medical, Graduate↗
PubMed1984

Effect of no treatment, cimetidine 1 g/day, cimetidine 2 g/day and cimetidine combined with atropine on nocturnal gastric secretion in cimetidine non-responders.

We have studied nocturnal acid secretion in patients with duodenal ulcer who met predetermined criteria of poor clinical response to cimetidine. Different groups of patients were investigated receiving either no treatment, cimetidine 1 g/day, cimetidine 2 g/day or cimetidine 1 g/day combined with atropine 4.8 mg/day. The results were compared with those obtained from other patients with duodenal ulcer who were studied in our department but who were not classified as according to their clinical response to cimetidine. The results show that despite adequate absorption, cimetidine has a decreased effect at controlling acid secretion in the poor responders and that increasing the dose of drug does not improve response. Control of acid output was, however, dramatically improved when cimetidine was combined with atropine which suggests that patients who do not respond to H2-receptor blockade should be treated by a combination of cimetidine with an anticholinergic agent.

Atropine↗
PubMed1984

Postanal repair to restore fecal continence after failed sphincteroplasty.

The traditional procedure of delayed repair of the sphincters and perineorrhaphy failed to restore continence to a 31-year-old woman who had fecal incontinence following obstetric trauma. Successful control was achieved by postanal surgical repair. This case report shows that good results are possible by reconstruction of the anorectal angle even after failed sphincteroplasty.

Adult↗