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Biomedical subjects

W G Thompson

Publications and source records attributed to W G Thompson.

At least 19 recordsLinked to original sources
PubMed1992

The irritable bowel syndrome: review and a graduated multicomponent treatment approach.

The irritable bowel syndrome is a common chronic disorder having a broad clinical spectrum of severity. Although only a small proportion of those afflicted seek medical help for their symptoms, a subset have severe and intractable symptoms. A positive diagnosis should be established from the history and physical examination; endoscopic and radiologic investigations should be minimized. We suggest that the physician also assess the severity of the illness based on its symptomatic and functional features and the patient's behavioral response. Classifying the disorder in this manner permits a graduated treatment approach that emphasizes education, reassurance, and dietary adjustment for mild symptoms. Moderate symptom severity requires, in addition, identification and modification of factors exacerbating symptoms, psychotherapeutic and behavioral techniques and, if a certain symptom type predominates, pharmacologic agents directed toward the presumed gastrointestinal motor dysfunction. For severe symptoms, physician-based behavior modification and psychopharmacologic agents are helpful. When the disorder is intractable, referral may be needed, for example, to a pain treatment center. In all cases, the skillful physician must ensure continued psychosocial support to enhance coping and continued focus on the palliative aspects of care rather than on cure.

Colonic Diseases, Functional↗
PubMed1992

The potential for using non-physicians to compensate for the reduced availability of residents.

Both the number of residents and the amount of time existing residents have in which to carry out their activities may soon be decreasing. To consider the potential for alternative ways of staffing teaching hospitals, it is necessary to know how residents spend their time. The authors sought to learn this by conducting a time-motion study of eight internal medicine residents at two urban hospitals in New York City in 1988. The residents' activities were observed and coded by premedical students, and the authors independently classified the possible activities into (1) those that had to be done by a physician, (2) those that were educational only, and (3) those that could be done by a non-physician. A total of 1,726 activities of 67 kinds were coded, averaging 7.75 minutes each. The authors analyze and project their data using two models--the traditional model of care in which the physician is the primary medical manager of the patient, and an alternative model in which a midlevel practitioner, such as a nurse practitioner, would perform the day-to-day monitoring of patients. For example, the data indicate that in the traditional model, almost half of a resident's time is spent in activities that must be done by a physician, meaning that another kind of physician would be needed to do those activities if the resident were unavailable; but in the midlevel practitioner model, only around 20% of the activities would require a physician. The authors give detailed breakdowns of their data, estimate the kinds and numbers of non-physician health care professionals necessary to substitute for residents in appropriate activities, and review possible difficulties in implementing such substitutions.

Evaluation Studies as Topic↗
PubMed1992

Drug treatment of the irritable bowel syndrome.

Irritable bowel syndrome (IBS) is defined as a functional bowel disorder in which abdominal pain is associated with defecation or a change in bowel habit, and with features of disordered defecation and distension. The irritable bowel syndrome occurs in 10 to 20% of people worldwide and is very commonly encountered in clinical practice. This has encouraged the pharmaceutical industry to search for effective drug therapy. So far, a universally effective agent has not been found, and since this is a chronic, benign disorder, beginning in youth, long term drug use should be avoided. Nevertheless, if a specific IBS symptom, such as constipation or abdominal pain dominates, a specific drug may be helpful. However, tests and treatment should be minimised or even avoided in order to do no harm. A largely nonpharmaceutical approach to IBS should be taken. This approach employs drugs sparingly and then only targeted at specific and resistant symptoms.

Analgesics↗
PubMed1992

Is rectal biopsy necessary in irritable bowel syndrome?

Many physicians obtain a rectal biopsy from patients with irritable bowel syndrome (IBS) in order to exclude melanosis coli and collagenous or microscopic colitis. To determine the value of routine rectal biopsy in IBS, 89 patients and 59 controls were administered a bowel questionnaire, and a rectal biopsy was obtained at sigmoidoscopy. IBS patients were 82% female and averaged 44 yr. Eighty-nine percent fulfilled three or more Manning criteria, and 84% fulfilled the Rome criteria for IBS. The 59 control subjects were 37% female, and averaged 57 yr. Only 15% fulfilled three or more Manning criteria, and 5% the Rome criteria. The 148 rectal biopsies were examined histologically by a pathologist whose methods were validated by a second pathologist. Although minor changes previously reported with phosphate enemas were observed, not a single subject had melanosis coli or fulfilled criteria for microscopic or collagenous colitis. Thus, patients with an endoscopically normal colon and a diagnosis of IBS made by established criteria are unlikely to have histologic abnormalities in the rectum. Rectal biopsies are costly and unnecessary in the investigation of IBS.

Adult↗
PubMed1991

Symptomatic presentations of the irritable bowel syndrome.

Because functional bowel disorders have no reliable markers, they must be defined by their symptoms. The various constellations of symptoms (syndromes) may have different mechanisms, differential diagnoses, and treatments. Therefore, precise classification is important on clinical and scientific grounds. Functional bowel disorders are a subset of functional gastrointestinal disorders attributed to the intestine. By symptoms they may be subclassified as IBS, burbulence, functional constipation and functional diarrhea. "Orphan" symptoms insufficient to qualify as one of these syndromes may be classified as unspecified functional bowel disorder. There may be overlap in symptoms among the disorders. A more careful definition of these symptom complexes will permit a logical approach to their study, investigation, and management.

Colonic Diseases, Functional↗
PubMed1990

An assault on old friends: thiazide diuretics under siege.

The adverse biochemical effects of thiazide use are of uncertain clinical significance. Thiazides raise LDL cholesterol only slightly in long-term studies and do not decrease HDL cholesterol. The evidence linking thiazide-induced hypokalemia with arrhythmias and sudden death is tenuous at best. Thiazide diuretics cause glucose intolerance, but no strong evidence has been advanced to suggest that this is dangerous. Because these effects are probably related to hypokalemia, a randomized trial comparing the effects of thiazides with thiazides plus a potassium-sparing diuretic on LDL cholesterol, ectopy on 48 hour ambulatory cardiac monitoring, fasting glucose and insulin, and post-glucose tolerance glucose and insulin would be of interest. The most compelling reason for continuing to use thiazides is that they have been shown in long-term randomized studies to reduce cardiovascular risk. Beta-blockers are the only other class of anti-hypertensive agent for which this claim can be made. The importance of long-term clinical trials in assessing the efficacy and toxicity of therapeutic agents is illustrated by the study that found clofibrate reduced cholesterol levels and coronary disease but increased total mortality. This finding remained undetected until a large randomized long-term trial was completed. Thiazide diuretics have not reduced the rate of coronary disease to the degree expected from epidemiologic studies, but the short length of the randomized trials may be responsible. It is not clear that other anti-hypertensive agents will be superior. Thiazides are less expensive than other anti-hypertensive agents being touted as metabolically safer; the cost issue is not a trivial matter.(ABSTRACT TRUNCATED AT 250 WORDS)

Benzothiadiazines↗
PubMed1990

Cardiovascular complications of inactivity.

Inactivity has a number of consequences for the cardiovascular system. In particular, inactivity can lead to obesity, which can aggravate arthritis. An examination of the effect of exercise on the cardiovascular system requires the review of epidemiologic or population-based studies, because there are no large randomized trials with an exercise control group. Small randomized trials looking at exercise and the individual risk factors are reviewed.

Adult↗
PubMed1990

[Therapeutic strategy in the irritable bowel syndrome].

The irritable intestine is one of the most frequently encountered complaints in medical practice. Although treatment is generally difficult, a therapeutic strategy which can be used in most cases is proposed. Most patients with these symptoms do not seek medical attention. The motivation for medical consultation can however be of prime importance for adequate treatment. The attending physician must first establish the reality of disease by detailed history-taking, physical examination and sigmoidoscopy. Promoting factors such as dysentery, medications, alimentation, emotions or any other major event in the patient's life must be identified. The physician must reassure and console the patient accordingly. Bran-containing diets are reliable adjuvants for most patients. Follow-up is important to guarantee patient compliance and understanding. The essential risk in the irritable bowel syndrome is the doubtfulness which hovers over the disease entity and can be responsible for patient anxiety, or prompt expensive investigations, undesirable effects of medication or even unnecessary surgery. If the patient's complaints remain unchanged at the second medical visit, other diagnostics should be considered, thus avoiding unjustified investigations. Continued empathy with the patient is important. Medication, either for their placebo or specific symptomatic action (e. g. antidiarrheics) should be considered as well. The physician has to reassure and console the patient who does not improve. The patient can then be directed to a specialized unit, but only on the physician's specific orders.

Colonic Diseases, Functional↗
PubMed1989

Vitamin B12 and geriatrics: unanswered questions.

Vitamin B12 is an important area in the interface between geriatrics and hematology. B12 deficiency is more common in the elderly and because its neurologic manifestations overlap very common disorders such as dementia, the diagnosis may be more subtle in the elderly. The critical question is whether early treatment of B12 deficiency can prevent some cases of dementia. If prevention is possible, then all elderly patients should be screened for cobalamin deficiency. Research must be ongoing to determine the most cost-effective strategy for evaluating low B12 levels. In our view careful review of the blood smear is still very useful. Although requiring further study, the Herbert/Herzlich model should prove to be very useful to the clinician evaluating patients for possible B12 deficiency. Finally, although the treatment is lifelong, we would argue that when in doubt the patient should be treated. The cost of therapy is small when balanced against the potential consequences.

Aged↗
PubMed1989

Hypersegmented neutrophils and vitamin B12 deficiency. Hypersegmentation in B12 deficiency.

The sensitivities and specificities of the mean cell volume (MCV), the red cell distribution width (RDW), and blood smear hypersegmentation for B12 deficiency were reviewed in 515 patients whose B12 levels were determined. 61 patients had B12 levels less than 200 pg/ml. 43 patients were defined as B12 deficient (n = 13) or non-B12 deficient (n = 30). Hypersegmentation was more sensitive (91%) than MCV greater than 95 fl (62%) or RDW greater than 15% (54%) in detecting B12 deficiency. The MCV and the RDW should not be relied on when screening for B12 deficiency; examination of the blood smear for hypersegmentation is essential.

Anemia↗
PubMed1978

Towards positive diagnosis of the irritable bowel.

A questionnaire to establish the presence of 15 symptoms thought to be typical of the irritable bowel syndrome (IBS) was given to 109 unselected patients referred to gastroenterology or surgery clinics with abdominal pain or a change in bowel habit or both. Review of case records 17--26 months later established a definite diagnosis of IBS in 32 patients and of organic disease in 33. Four symptoms were significantly more common among patients with IBS--namely, distension, relief of pain with bowel movement, and looser and more frequent bowel movements with the onset of pain. Mucus and a sensation of incomplete evacuation were also common in these patients. The more of these symptoms that were present the more likely was it that the patient's pain or altered bowel habit, or both, was due to IBS. We conclude that a careful history can increase diagnostic confidence and reduce the amount of investigation in many patients with chronic abdominal pain.

Abdomen↗
PubMed1978

Villous adenoma with hyponatremia and syncope: report of a case.

A case of villous adenoma of the colon with hyponatremia, hypovolemia, and syncope is presented. The correct diagnosis was delayed because of the prevailing idea that villous adenomas are associated with hypokalemia. The patient recovered fully after surgical removal of one of the largest villous adenomas reported in the literature. Sodium loss may be the dominant feature of this syndrome. Villous adenoma has to be included among the causes of hyponatremia.

Adenoma↗
PubMed1977

Wilson's disease: a common liver disorder?

In two sibships 7 of 24 siblings were homozygous for Wilson's disease. In family A, the largest kindred of this recessively inherited disease thus far reported, the proband presented with chronic active hepatitis, one sibling died of cirrhosis, a second had clinical evidence of chronic liver disease and two others had biochemical and histologic changes in liver biopsy specimens. In family B the proband had cirrhosis and portal hypertension and one sibling had biochemical and histologic evidence of liver disease. All six living patients had low serum concentrations of ceruloplasmin and copper and a high 24-hour urinary excretion of copper, which was greatly increased by administration of D-penicillamine. None showed neurologic abnormalities and only one had Kayser-Fleischer rings (detectable only by slit-lamp examination). Each patient had an erythrocyte sedimentation rate (ESR) of 8 mm/h or less. After 3 and 2 years, respectively, of D-penicillamine therapy the conditions of the two probands had improved. Liver function became normal in three siblings, and no abnormalities developed in the remaining one. Thus, since Wilson's disease may present with chronic active hepatitis or cirrhosis with a normal ESR and without ocular or neurologic signs, it may be a more common cause of liver disease in young people than has been appreciated.

Adolescent↗