摘要:

In liver cirrhosis, an associated defect in urinary acidification is well known but its pathophysiologic nature is not well defined. Recent studies suggest that the urinePco2during maximal alkalinization of the urine is an adequate index of distal hydrogen ion secretion. To evaluate the nature of distal renal tubular acidosis (distal RTA) in cirrhosis, the urine minus bloodPco2gradient [(U – B)Pco2] in alkaline urine was determined in four patients with cirrhosis and distal RTA, and compared with that in four patients without distal RTA (control subjects), as well as with that in one patient with Sjögren's syndrome and distal RTA (subject with impaired distal acidification). As expected, the (U – B)Pco2after sodium bicarbonate loading was low (10.6 mmHg) in the subjects with impaired distal acidification and normal (32.5 mmHg, s.e.m. = 4.8) in control subjects. By contrast, all four patients with cirrhosis and distal RTA were able to achieve a normal (U – B)Pco2gradient (33.8 mmHg, s.e.m. = 4.0) after sodium bicarbonate loading, even in the presence of the defect in urinary acidification under acid loading. These results suggest that the pathophysiology of the urinary acidification defect in liver cirrhosis is distinct from that in ordinary distal RTA; the latter signifies a defect in H+secretion (secretory or voltage‐dependent RTA), whereas, in cirrhosis, an increased permeability for H+may cause the inability to acidify t

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1987.tb00154.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The aim of this study was to determine if theCrithidia luciliaeassay for auto‐antibodies to double‐stranded DNA, often positive in systemic lupus erythematosus, is always negative in auto‐immune chronic active hepatitis (CAH) as has recently been suggested. Twenty‐five patients were identified as having auto‐immune CAH. Mean duration of follow‐up was 10.5 years. Antinuclear antibodies were detected in 92%, smooth muscle antibodies in 76% and antimitochondrial antibodies in 16%. Antibodies to double‐stranded DNA were detected by the Crithidia assay in four patients (16%). Two of these patients had positive tests on only one occasion and no features of systemic lupus erythematosus. In the other two the assay was persistently positive. During follow‐up both developed arthritis and serositis but the liver lesion remained the dominant clinical feature. It was concluded that there is significant serological overlap between auto‐immune CAH and systemic lupus erythematosus making the Crithidia assay unreliable in distinguis

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1987.tb00155.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

A study of the immunological status of hepatitis A and B infections was carried out among the residents of eight social welfare homes in Singapore. The sample population consisted of 440 individuals of whom 55% were Chinese, 21% were Malays and 24% were Indians. The mean age of the study population was 14 years and 4 months. The immunological markers studied included specific IgM antibody and total antibody against hepatitis A virus (anti‐HAV‐IgM and total anti‐HAV respectively); hepatitis B surface antigen (HBsAg), surface antibody (anti‐HBs), core antibody (anti‐HBc) and e antigen (HBeAg), all tested by the enzyme immunoassay (EIA) technique.While none of the subjects had detectable anti‐HAV‐IgM (HAVAB‐M‐EIA), 12% were positive for total anti‐HAV (HAVAB‐EIA) indicating evidence of past infection. HBsAg was detected (Auszyme II) in 4.5% and of these, half had HBeAg (Abbott‐HBe EIA). Anti‐HBs positivity (AUSAB‐EIA) occurred in 11.6% and the majority (88%) of these had anti‐HBc positivity (CORZYME) as well. The positive rate for anti‐HBc alone was 3.6% reflecting the ‘window’ period after the fall of HBsAg and before the rise of anti‐HBs. At least one of the hepatitis B markers was present in 19.1% of the study population.The endemic nature of both hepatitis A and B infections in the local population is evident, with infection occurring

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1987.tb00156.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The results of a policy of intensive intravenous medical treatment and early colectomy in fulminant ulcerative colitis, over a 22 year period, are described. Forty‐nine patients developed fulminant colitis; 43 received a period of intensive treatment including corticosteroids. Half (51%) of patients showed initial objective improvement. Deterioration was always heralded by a sudden increase in pulse rate, temperature or stool frequency. The mean duration of intensive medical treatment was 7.7 days. Early colectomy was performed in 20 (44%) patients because of the lack of sustained improvement and in 25 (56%) patients because of a major complication. All complications developed within the first 5 days of treatment. Toxic dilatation was present in 11 (22%) patients with only one concurrent perforation and no deaths. The perforation rate was 16% and accounted for 59% of the surgical mortality. The overall mortality in this series was 16.3% and in patients treated with the intensive medical regime 11.6%. Post‐operative complications developed in 19% of patients. No colonic perforations or deaths have occurred in 36 consecutive patients admitted since 1967. Earlier results, supporting the hypothesis that early colectomy in fulminant colitis is life‐saving, have been conf

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1987.tb00157.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Hybridoma cultures were produced by the fusion of SP2 mouse myeloma cells with spleen cells from mice immunized with human pancreatic carcinoma cells. After limiting dilutions, three monoclonal antibodies, YPan1, YPan2, and YPan3, which bound to immunizing cells but not to normal human skin fibroblasts, were further characterized. The three monoclonal antibodies were found to bind to all seven pancreatic carcinoma cell lines but not to other carcinoma cell lines tested except some colon carcinoma cell lines. When human tissue sections were examined using immunohistochemical techniques, the three monoclonal antibodies identified antigens in the pancreatic carcinomas and some normal pancreases, but only YPan1 showed strong positive staining. No cross‐reactivity was seen in sections of other carcinomas tested except some colon carcinomas. The results suggest that these monoclonal antibodies may be usefully applied to the detection of pancreatic carcinoma

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1987.tb00158.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Although symptoms of milk intolerance are common in primary (genetically determined) hypolactasia it is a clinical impression that such symptoms are infrequent in adult patients with hypolactasia secondary to damage of the mucosa of the small intestine. This study was designed to determine whether a lactose (50 g) challenge is better tolerated by patients with coeliac disease and secondary hypolactasia than patients with primary hypolactasia. Based on intestinal histology and disaccharidase levels, three groups of adults were studied: controls (n= 20), patients with primary hypolactasia (n= 20) and patients with hypolactasia secondary to newly diagnosed coeliac disease (n= 15). The response to a challenge with 50 g lactose was assessed by a score of five symptoms and breath hydrogen production. Despite an equivalent level of hypolactasia, symptoms affected fewer patients with coeliac disease (33%) than subjects with primary hypolactasia (90%). Further, a positive lactose breath hydrogen test was noted in all (100%) patients with primary hypolactasia but in only six (40%) of those patients with newly diagnosed coeliac disease. These results suggest the presence of a considerable absorptive reserve for lactose in the distal small bowel of many patients with coeliac disease.

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1987.tb00159.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Several hospital series of peptic ulcer patients have suggested that ulcer prevalence may be different in the different races in Singapore. However, such studies may be biased because different races use hospital services differently and also because hospital catchment populations are difficult to define. In the present study the racial composition of a consecutive series of 1248 peptic ulcer patients seen in two medical units of a general hospital was compared to that of 2023 general medical patients attending the same units. For both sexes, the racial structure of the gastric ulcer as well as the duodenal ulcer patients was significantly different from that of the general medical group. There was an excess of Chinese patients of both sexes with gastric ulcer and duodenal ulcer. In contrast, the numbers of male Malay gastric ulcer, male Malay duodenal ulcer, female Malay duodenal ulcer as well as Indian gastric ulcer patients of both sexes were fewer than expected. These results cannot be accounted for by racial differences in either health‐seeking behaviour or analgesic and tobacco usage. These observations confirm the probable occurrence of racial differences in peptic ulcer frequency in Singapor

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1987.tb00160.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The composition of early morning gas from the bags of 10 ileostomates was determined using gas chromatography. Seven of the 10 had a predominance of gases attributable to bacterial fermentation (H2and CO2, 70 ± 12%). The remaining three contained mainly atmospheric gases, N2and O2, with only small amounts of fermentation gases (7 ± 3%).When a controlled low fibre (0.7 g) dinner was substituted for a high fibre (13.5 g) evening meal, there was a corresponding decrease in the volume of fermentation gas in the ileostomy bag the next morning (P<0.05).Gas production from ileostomy effluent was inhibitedin vitroby 10

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1987.tb00161.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1987.tb00162.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1987.tb00163.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY