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Biomedical subjects

C G Clark

Publications and source records attributed to C G Clark.

At least 91 records · Page 5Linked to original sources
PubMed1986

Gastric secretory responses to modified sham feeding (MSF) and insulin after vagotomy.

Modified sham feeding (MSF) and insulin tests were carried out in 28 patients after vagotomy. Basal and pentagastrin collections were also performed. Using the secretory data from 9 of the patients with endoscopically proven recurrent ulcer as a reference, 20 gastric secretory indices were studied and critical levels were chosen to provide the maximum sensitivity and specificity. The eleven most discriminating indices were then used to evaluate the remaining 19 patients. There was agreement between the responses to MSF and insulin as to the adequacy of vagotomy in 16 of the patients (84 per cent) and contradictory responses in 3 patients (16 per cent). Overall, MSF responses were as discriminating as the responses to insulin. A simplified ward test, based on crude volume measurements in response to MSF is proposed.

Adult↗
PubMed1986

Surgery for peptic ulceration associated with hypergastrinaemia.

Between 1971 and 1983, 31 males and 13 females were found to have peptic ulceration associated with hypergastrinaemia. An antral G-cell lesion was present in 11 (25 per cent) and a gastrinoma in 14 (32 per cent). There were 11 patients with multiple endocrine adenomatosis (MEA) (25 per cent) and 4 (9 per cent) with primary hyperparathyroidism. Four patients (9 per cent) were unclassified. Length of history and level of gastrin did not differentiate between the groups and an average of 2.5 operations was performed per patient, while the overall mortality was 27.3 per cent. The patients with G-cell lesions were significantly younger than all the other groups (P less than 0.01). Partial gastrectomy adequately treated G-cell hyperplasia. Total gastrectomy was required to treat pancreatic gastrinomata but additional pancreatic resection did not improve the outcome. In MEA, parathyroidectomy did not influence the treatment of a gastrinoma. This is the first recorded experience of surgery for hypergastrinaemia in the United Kingdom and the outcome of such a retrospective study may be a guide to the future management of these conditions.

Adenoma, Islet Cell↗
PubMed1986

Proximal gastric vagotomy or truncal vagotomy and drainage for chronic duodenal ulcer?

A comparison has been made between truncal vagotomy and drainage (TVD) and proximal gastric vagotomy (PGV) performed electively for chronic duodenal ulceration from 1968 to 1981 in 209 and 272 patients respectively. The morbidity was 23 per cent after TVD and 19.8 per cent after PGV, with a mortality of 0.5 per cent and 0.4 per cent respectively. Of 163 patients in the former group and 253 patients in the latter group the follow-up was an average of 5.7 and 6.2 years respectively; 128 patients (78.5 per cent) and 198 (78.3 per cent) respectively had a good functional result, graded as Visick I and II, but 35 (21.7 per cent) and 55 (21.7 per cent), respectively, had a poor result owing to recurrent ulceration in 23 (14.1 per cent) after TVD and 44 (17.4 per cent) after PGV. These results were not statistically different. The frequency of diarrhoea was 23 per cent and dumping 6.8 per cent after TVD which was significantly reduced to 2.0 per cent (P less than 0.005) and 1.2 per cent (P less than 0.025), respectively, after PGV. However, only five patients (3.0 per cent) had severe symptoms from diarrhoea and two (1.2 per cent) from dumping after TVD. Both operations seem to carry an equal incidence of unsatisfactory results, though for slightly different reasons it might be concluded that both procedures have an equal degree of acceptability.

Adolescent↗
PubMed1986

Endoscopic treatment of inoperable colorectal cancers with the Nd YAG laser.

Seventeen patients with cancers of the rectum or distal sigmoid and considered inoperable because of old age, severe concomitant disease or advanced stage of malignancy, were treated endoscopically with the Nd YAG laser. Symptoms included rectal bleeding, obstruction, diarrhoea and incontinence. Significant improvement was achieved in 15 (88 per cent) and there were no complications. The procedure was carried out with simple bowel preparation and minimal sedation and, for otherwise fit individuals, the mean total hospital stay was 6.8 days, with day case therapy sometimes possible. Three patients required further therapy for recurrent symptoms 6-8 weeks after treatment. Fourteen patients died 1-39 weeks after therapy (mean survival 15 weeks). Three are alive and free of bowel symptoms after 39-54 weeks. This technique is the only non-surgical therapy that can be used safely for lesions above the peritoneal reflection and provides palliation at least as good as electrocoagulation, cryotherapy and radiotherapy with minimal upset to these seriously ill patients.

Adenocarcinoma↗
PubMed1986

Contractile properties of the adductor pollicis in obese patients on a hypocaloric diet for two weeks.

The muscle function of 21 obese patients on a hypocaloric diet (450 kcal/day) was studied. On days 1, 7, and 12 the maximal isometric force and contractile properties (force:frequency relationship, relaxation rate, and fatigability) of the adductor pollicis were measured. The patients lost a mean of 5.7 kg but there was no significant change in the muscle strength or contractile properties. Twenty normal and three malnourished patients were also studied; the latter demonstrated abnormalities of muscle function. The use of such tests to monitor changes in nutritional status must be treated with caution.

Adult↗
PubMed1986

Conservative surgery in Crohn disease.

As with any disease of unknown etiology, treatment must be based on clinical experience. The principles of conservative surgical treatment outlined offer a compromise between the apparently conflicting interests of symptomatic treatment of a progressive disease and the nutritional consequences thereof. Until more specific etiologic data are available and reliable prognostic indicators characterized, we must base our therapeutic advice on principles that will achieve the maximum symptomatic benefit with the minimum of metabolic and nutritional consequences.

Anus Diseases↗
PubMed1985

Truncal vagotomy and drainage: a comparison of elective and emergency operations.

A comparison has been made between truncal vagotomy and drainage (TV + D) performed from 1968 to 1981 in 209 patients electively and in 68 patients as an emergency. The male:female distribution was 167:42 and 59:9 with a significant difference (P less than 0.001) in the mean ages of 49 years and 55 years respectively. Major postoperative complications following emergency TV + D (22 per cent) were significantly more common (P less than 0.001) than following elective TV + D (6.7 per cent) with seven (10.3 per cent) and one (0.5 per cent) deaths respectively. Of 163 patients in the elective and 54 in the emergency group followed up for an average of 5.7 and 5.9 years respectively, 132 patients (81 per cent) and 46 (82.5 per cent) had a good functional result graded as Visick I and II, but 31 (19 per cent) and 8 (14.8 per cent) patients respectively had a poor result due to recurrent ulceration in 23 (14.1 per cent) after elective TV + D and in all 8 (14.8 per cent) after emergency TV + D. These results are not statistically different. Thus emergency TV + D carries a higher mortality and morbidity than elective TV + D, but the long term results are similar. This conclusion substantiates the equivalent effectiveness of emergency and of elective TV + D.

Adolescent↗
PubMed1985

Measurement of blood cortisol and acid output in patients with duodenal ulceration and normal subjects during insulin hypoglycaemia.

The blood cortisol and gastric acid responses to insulin hypoglycaemia were investigated in 18 healthy control subjects and 14 patients with endoscopically proven duodenal ulceration. In both controls and patients, insulin hypoglycaemia caused blood cortisol and acid output to rise and peak simultaneously, the rises being significantly greater in patients with duodenal ulcer than in control subjects. The peak acid output and the base to peak cortisol increments were also found to be significantly greater in patients with duodenal ulcer than in control subjects (P less than 0.001 and P less than 0.005 respectively). We conclude that insulin hypoglycaemia causes stimulation of the sympathetic and parasympathetic nervous systems and of the hypothalamo-pituitary-adrenal axis, resulting in the simultaneous elevation of gastric juice acidity and blood cortisol levels. We have shown that synchronous rises in gastric acid and blood cortisol occur during insulin hypoglycaemia and that these rises are greater in patients with duodenal ulcer.

Adult↗
PubMed1985

Diverticula, neoplasia, or both? Early detection of carcinoma in sigmoid diverticular disease.

In 105 patients with symptomatic sigmoid diverticular disease, colonoscopy revealed an associated frequency of carcinoma of seven (6.6%) (Dukes A in 4, B in 2, and C in 1) and adenomas in 29 (27.6%), with a peak incidence of 60 to 79 years and an equal sex distribution. In 45 (43%) examinations, the barium enema was inaccurate. The presenting complaints of abdominal pain and/or alteration in bowel habit in 36 patients with neoplasms and 69 without were similar, but significantly more patients with neoplasms complained of rectal bleeding (p less than 0.05). Endoscopic examination is therefore recommended in patients with sigmoid diverticular disease, particularly in those aged over 60 years and with rectal bleeding.

Aged↗
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↗
PubMed1985

Endoscopic laser treatment of vascular anomalies of the upper gastrointestinal tract.

Vascular anomalies of the gastrointestinal tract are an important source of both acute and chronic blood loss. They present difficult management problems as they are often multiple, involving more than one part of the gastrointestinal tract, and may give rise to bleeds of increasing frequency and severity over a period of many years. We present the results of endoscopic argon and Nd YAG laser treatment of 18 patients with documented recurrent, severe haemorrhage from vascular lesions of the upper gastrointestinal tract with follow up of up to five years. Four patients with hereditary haemorrhagic telangiectasia, five with single angiodysplasias and three with multiple angiodysplasias have had their transfusion requirements reduced to minimal levels after one or more courses of laser treatment. Two of these have required no blood for over two years despite previous total requirements of 52 and 129 units of blood. Four patients were submitted to surgery (two in whom the laser failed to control haemorrhage and two who did not have immediate access to laser therapy at the time of severe bleed). Two of these, however, bled again soon afterwards. Two patients are still undergoing courses of laser therapy although have already shown reductions in transfusion requirements. Both lasers were effective. The Nd YAG laser appears to produce better long term results as its greater penetration makes it possible to ablate the main areas of vascular ectasia in the submucosa, although it does have a slightly higher risk of causing haemorrhage in the first few days after treatment.

Adult↗
PubMed1985

Quantitative changes in mast cells and microvascular pattern associated with dietary gastric ulceration in rats.

The regional distribution of mast cells and the microvascular pattern in the stomach of Wistar rats fed on an ulcerogenic diet were compared with those of control animals. Mounts of the distended stomach were made and stained for blood vessels and mast cells in the subserosal layer. Measurements made under dark ground illumination in 12 operationally defined regions of the serosa demonstrated that the stomach wall in the region around the oesophagus is more richly vascularised and possesses a greater number of mast cells (60 cells per mm2) than other regions. Changes in the mast cells and microvasculature were observed in rats fed an ulcerogenic diet, notably in the zone around the oesophagus, where more than 30% mast cells were degranulated and the mean vascular diameter increased by 26%. The severity of the vascular changes correlated with the location of the ulcers of which 50% were in the zone surrounding the oesophagus.

Animals↗