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Biomedical subjects

C M Royston

Publications and source records attributed to C M Royston.

At least 37 records · Page 2Linked to original sources
PubMed1989

Comparison of 40 mg famotidine nightly and 150 mg ranitidine b.d.: ulcer healing and symptom relief in benign gastric ulcer.

Two hundred and eight patients with benign gastric ulcers seen on endoscopy were recruited by 13 hospitals in the United Kingdom and Ireland into this double-blind study. Patients were assigned by pre-randomized schedule to 8 weeks of treatment with either 40 mg famotidine at night or 150 mg ranitidine b.d. Repeat endoscopy confirmed complete ulcer healing in 62 of 77 evaluable patients in the famotidine group (81%) and 58 of 71 in the ranitidine group (82%). The treatments were equally effective in promptly relieving day and night pain. Adverse events were uncommon; dizziness and headaches were the most frequently reported in both groups. In conclusion, night-time famotidine is as effective as twice daily ranitidine in healing benign gastric ulcers and provides similarly rapid symptomatic relief.

Aged↗
PubMed1986

Duodenal diversion with vagotomy and antrectomy for severe or recurrent reflux oesophagitis and stricture: an alternative to operation at the hiatus.

In cases of mild symptomatic gastro-oesophageal reflux, standard antireflux surgery, such as fundoplication or the Angelchik prosthesis, produces satisfactory results. Duodenal diversion is recommended for use only in patients with severe oesophageal damage. This situation commonly arises where the gastro-oesophageal junction cannot be reduced into the abdomen, or where previous surgery has made reoperation at the hiatus difficult and hazardous. Fifty-seven patients with severe reflux oesophagitis have been treated by Roux-en-Y duodenal diversion and antrectomy. Thirty three patients had vagotomy in addition. Median follow-up after operation is 6.1 years. In 35 patients (61%), the technique was used as primary surgical treatment. These included 22 patients in a randomized trial of the method. Thirteen (23%) had previously had unsuccessful antireflux surgery. Nine (16%) had undergone previous operations for peptic ulcer or achalasia. There was no operative mortality. No patient in the series required stricture resection. Good or excellent overall results were achieved in 86% of patients. Eighteen of twenty seven patients with severe strictures required an average of three dilatations after operation before dysphagia was completely relieved. Heartburn was dramatically relieved and oesophagitis settled within an average period of 6 months. Poor or unsatisfactory overall results were observed in 8 (14%) patients. These included one tight fibrous stricture which required endoscopic intubation despite resolution of oesophagitis, and four patients who developed a stomal ulcer. No patients suffered from the dumping syndrome. Malignancy must be carefully excluded by biopsy in all cases of stricture.

Adult↗
PubMed1985

Prospective study of the Angelchik anti-reflux prosthesis.

Fifty patients with medically refractory gastro-oesophageal reflux were treated by the insertion of an Angelchik anti-reflux prosthesis. All patients had a pre-operative upper gastrointestinal endoscopy, 32 were investigated with 15 h overnight oesophageal pH studies combined with oesophageal bile sampling and 20 underwent oesophageal manometric studies. At pre-operative endoscopy 45 patients had evidence of oesophagitis and the 5 who did not had pathological reflux demonstrated on overnight pH testing. Postoperatively the main clinical problem was dysphagia which appeared to settle with time but left one-third of patients with mild dysphagia at the end of 12 months. A further 12 per cent had residual moderate to severe dysphagia which required the removal of the prosthesis in five patients (10 per cent). In only one patient was the dysphagia due to prosthetic migration and this was the first patient in the series. Subsequently, we have had no problems with prosthetic migration, disruption, or erosion into the oesophagus. The overnight pH studies confirmed the efficacy of the prosthesis in preventing reflux which correlated with symptomatic improvement. We conclude that, while the Angelchik anti-reflux prosthesis is an effective device, it has a disturbingly high incidence of postoperative dysphagia though this appears to settle with time, leaving around 10 per cent of patients with severe dysphagia which will necessitate removal of the prosthesis and one-third with mild dysphagia which may settle with the further passage of time.

Adult↗
PubMed1985

Anterior resection of the rectum--a simplified stapling technique.

The use of a double stapling technique in anterior resection of the rectum eliminates the necessity for a rectal stump pursestring and removes the problem of tissue pouting on the spindle of the circular EEA stapler when a voluminous rectum is pulled onto it with the pursestring. We have used this technique in 20 patients with tumours in the middle and lower thirds of the rectum without complication. This technique may reduce contamination in the pelvis and certainly shortens operating time. Cost effectiveness of the technique should be evaluated in busy centres where the benefit would appear to be greatest.

Humans↗
PubMed1984

Randomized prospective trial of Roux-en-Y duodenal diversion versus fundoplication for severe reflux oesophagitis.

It is not widely recognized that duodenal contents are implicated in the causation of severe reflux oesophagitis and stricture formation in patients with hiatus hernia. In a randomized prospective trial, including only patients with severe oesophageal changes, standard Nissen fundoplication has been compared with antrectomy and Roux-en-Y reconstruction. Twenty-two patients were randomized to each group. The 42 surviving trial patients have been followed for an average period of over 5 years. Good results (Visick I or II) have been achieved in 91 per cent of 22 patients having antrectomy and Roux-en-Y anastomosis (Group B), compared with 65 per cent of 20 patients surviving after Nissen fundoplication (Group A). Poor results (Visick III or IV) seen in seven patients (35 per cent) in group A were almost all associated with failure of fundoplication to stop reflux. Two of these patients have subsequently had antrectomy and Roux-en-Y reconstruction with excellent results. Antrectomy with Roux-en-Y gastrojejunostomy appears to be superior to a standard anti-reflux procedure as primary surgical treatment in these patients. The technique is recommended: where the patient has a fixed irreducible hiatus hernia; where previous surgery at the hiatus has failed and rendered reoperation hazardous.

Adult↗
PubMed1978

Prospective randomized multicentre trial of proximal gastric vagotomy or truncal vagotomy and antrectomy for chronic duodenal ulcer: interim results.

In three centres, 222 patients (Birmingham 70, London 87 and Rotterdam 65 patients) with chronic duodenal ulcer were treated by proximal gastrict vagotomy (PGV) (116 patients) or truncal vagotomy and antrectomy (TVA) (106 patients) in a prospective randomized trial. After 1 year 5 recurrent duodenal ulcers (4.3 per cent) have been recorded in the PGV group, compared with 1 (1 per cent) in the TVA group. The reoperation rate was high in both groups-6 after PGV, usually for recurrent ulcer, and 7 after TVA, mostly for gastric retention. PGV showed a marked superiority in the number of patients with a good clinical result Visick I or II) at 1 year after operation, i.e. 82 per cent compared with 56 per cent for TVA.

Chronic Disease↗
PubMed1978

G cell population of the gastric antrum, plasma gastrin, and gastric acid secretion in patients with and without duodenal ulcer.

Estimates of the G cell population were made in 24 resected human pyloric antra from counts of cells in multiple samples and from measurements of antral size. Measurements had been made previously in 20 subjects of acid output (basal and after pentagastrin) and in 10 subjects of plasma gastrin (basal and after insulin + bicarbonate). G cells were most dense near the pylorus, but their circumferential distribution was even. The G cell populations ranged from 8 to 15 (mean 10) million in four control patients and from 3 to 43 (mean 18) million in 15 patients with duodenal ulcer. Those with recurrent ulcer after vagotomy had either a low G cell count and incomplete vagotomy, or a high G cell count and apparently complete denervation. Two patients with hypergastrinaemia and duodenal ulcer had moderate (29 X 10(6)) or marked (56 X 10(6)) excesses of G cells. 'G cell hyperplasia' may represent the extreme end of the normal range of G cell numbers in the antrum, and can be assessed by semi-quantitative grading of G cell hyperplasia in antral biopsies. There were significant direct correlations between antral area and G cell density, between peak acid output and G cell population, and between basal plasma gastrin and G cell density (but not population). We suggest that, in patients with duodenal ulcer, acid and gastrin secretion are interrelated and that both are related to the masses of parietal cells and of G cells.

Cell Count↗
PubMed1976

Esophageal dilatation using the Eder Puestow dilators.

We have performed fifty-one dilatations in twenty-six patients using an end-viewing fiberoptic endoscope and Eder Puestow dilators. All (except two) were performed using intravenous diazepam, the majority on an outpatient basis. The only complication has been a single case of aspiration pneumonia. We have found this method of esophageal dilatation particularly useful in the preoperative dilatation of benign strictures, and in those elderly frail patients who are unsuitable for surgery. Transthoracic resection of the stricture is avoided and thus transabdominal repair of the hiatus hernia may be undertaken.

Aged↗
PubMed1975

Antrectomy with Roux-en-Y anastomosis in the treatment of peptic oesophagitis with stricture.

A series of 8 patients with severe oesophageal strictures secondary to reflux oesophagitis who have been treated by antrectomy with Roux-en-Y anastomosis is described. There was 1 postoperative death. The remaining patients have been completely relieved of heartburn and all have had a dramatic improvement in their dysphagia. This method of treatment is strongly recommended for patients who have had prior surgery to the hiatus which has failed, and for those who are too elderly or frail to withstand a direct attack on their oesophageal stricture.

Aged↗
PubMed1975

The effect of the size of the gastric outlet on gastric emptying after vagotomy for duodenal ulcer.

Gastric emptying of isotopically labelled solid meals was studied in normal human subjects and in 30 patients who had had an operation for chronic duodenal ulcer. Each patient had a vagotomy of the whole stomach combined with either a Finney pyloroplasty to produce a large gastric outlet or a Heineke-Mikulicz pyloroplasty to produce a relatively small outlet. At 10-22 days after operation gastric emptying was equally and significantly slowed in both groups when compared with the normal controls. This delay occurred regardless of whether the vagotomy was complete or incomplete. At 4-6 months after operation emptying had returned to normal in the patients who had had a Finney pyloroplasty but remained significantly slowed after Heineke-Mikulicz pyloroplasty. Mild symptoms of gastric stasis frequently occurred in both groups in the early postoperative period, but were rare 4-6 months after operation. There was no correlation between the incidence of these early symptoms of stasis and the size of the gastric outlet constructed.

Adult↗
PubMed1975

Alcohol tolerance after proximal gastric vagotomy.

Alcohol tolerance has been studied in 10 patients after proximal gastric vagotomy and six patients after truncal vagotomy and antrectomy. No difference in alcohol tolerance was found before and after proximal gastric vagotomy, while an increased rate of absorption with higher blood levels of alcohol were found after truncal vagotomy and antrectomy.

Adult↗
PubMed1974

Duodenal reflux during insulin-stimulated secretion.

Insulin-stimulated secretion has been studied in 67 subjects with intact vagi. The relationship between the changes in the concentrations of hydrogen and sodium ions in individual 10-minute samples showed a highly significant negative correlation. In quantitative terms, this correlation could be explained by the mixing of isotonic gastric juice and duodenal reflux but not by back-diffusion. In 37 subjects duodenal juice was labelled with either bromsulphalein (BSP) or indocyanine green (ICG), both dyes being excreted only in the bile. In aspirated gastric juice there were highly significant positive correlations between the concentration of the dye and the concentration of duodenal reflux calculated from a formula based on the output of sodium ions. The volume of duodenal reflux occurring during insulin-stimulated secretion was estimated from the sodium output in normal controls, in preoperative patients with duodenal ulcer, and in patients following vagotomy with or without a drainage procedure. Reflux following gastrojejunostomy greatly exceeded that occurring in all other groups. Reflux following vagotomy with no drainage procedure was less than that in preoperative patients, and in patients in whom pyloroplasty or gastrojejunostomy had been performed.

Duodenal Diseases↗