Search PubMed⌕ Search

Biomedical subjects

D B Skinner

Publications and source records attributed to D B Skinner.

At least 145 records · Page 8Linked to original sources
PubMed1976

Functional evaluation of the interposed colon as an esophageal substitute.

Five Rhesus monkeys and four human adults with colonic reconstruction of the esophagus have been studied by manometric, fluoroscopic and reflux tests. Transit through the graft is mainly under the influence of gravity. Infrequent colon contractions can be propulsive, and sequential haustral contractions give the appearance of peristalsis. The diaphragmatic hiatus and esophagocolic anastomosis are the sites of weak barriers to reflux which are readily overcome by abdominal compression and gastric distension. Esophageal peristalsis is necessary to return refluxed material and cricopharyngeus muscle is the final barrier to regurgitation.

Adult↗
PubMed1976

Long term transhepatic intubation for hilar hepatic duct strictures.

A technique for repairing benign hilar hepatic duct strictures using transhepatic intubation with a large bore silastic stent is described. This procedure has been used in 10 patients. In 9 instances the stricture involved the common hepatic duct, and in one patient the right and left hepatic ducts. Nine of the strictures followed cholecystectomy; one followed the primary repair of a gun shot wound to the hepatic duct. Hepaticojejunostomies were created and the transhepatic silastic stent was left in place for 6 months in one patient, and for 12 months in 8 patients. In one patient the silastic stents are still in place. There have been no treatment failures. All patients are healthy and at full activity from one year, 3 months to 6 years, 6 months from the time of repair (average 3 years, 5 months). In the 9 patients whose stents have been removed, the serum bilirubin levels are normal There have been no episodes of cholangitis following repair. This method of repair using long term transhepatic silastic stents is recommended for all high hilar hepatic duct strictures.

Adult↗
PubMed1976

Patterns of gastroesophageal reflux in health and disease.

Twenty-four pH monitoring the distal esophagus quantitates gastroesophageal reflux in a near physiologic setting by measuring the frequency and duration of acid exposure to the esophageal mucosa. Fifteen asymptomatic volunteers were studies with 24-hour pH and esophageal manometry. The normal cardia was more competent supine than in the upright position. Physiologic reflux was unaffected by age, rarely occurred during slumber, and was the rule after alimentation. One hundred symptomatic pateitns with an abnormal 24-hour pH record (2 S.D. above the mean of controls) could be divided into three patterns of pathological reflux: those who refluxed only in the upright position (9), only in the supine position (37), and in both positions (54). Upright differed from supine refluxers by excessive aerophagia causing reflux episodes by repetitive belching. Compared to controls, they had excessive post-prandial reflux, lower DES pressure, and less DES exposed to the positive pressure of the abdomen. Supine differed from upright refluxers by having a higher incidence of esophagitis and an inability to clear the esophagus of acid after a supine reflux episode. Compared to controls, they had only a lower DES pressure. Combined refluxers had a higher incidence of esophagitis than supine refluxers. Stricture (15%) was seen only in this group. They were similar to supine refluxers in their inability to clear a supine reflux episode. Compared to controls, they had a lower DES pressure and less DES exposed to the positive pressure of the abdomen. Forty of the 100 patients had an antireflux procedure (4 upright, 8 supine, 28 combined). The most severe postoperative flatus and abdominal distention was seen in the upright refluxers. It is concluded that minimal reflux is physiological. Patients with pathological reflux all have lower DES pressure. Patients with upright reflux have less of their DES exposed to the positive pressure environment of the abdomen. Patients with supine reflux have an inability to clear the esophagus of reflux acid and are prone to develop esophagitis. Patients with both upright and supine reflux have the most severe disease and are at risk in developing strictures. In patients with only upright reflux, aerophagia and delayed gastric emptying may be an important etiological factor.

Deglutition Disorders↗
PubMed1976

In situ kidney preservation for transplantation with use of profound hypothermia (5 to 20 degrees C.) with an intact circulation.

Twenty-seven anesthetized dogs were surface cooled at 4 to 6 degrees C. or 15 to 20 degrees C. Circulation was provided by the mechanical ventricular assist in 23 dogs. After 24 or 48 hours of in situ preservation, the kidneys were transplanted into the necks or iliac fossas of anephric recipients. Renal function was preserved in the cadaver for up to 48 hours at 15 to 20 degrees C. by maintaining a pulsatile circulation. Further cooling to 4 to 6 degrees C. caused progressive deterioration in renal function. The nonperfused kidneys kept in situ at 4 to 6 degrees C. did not produce any urine after transplantation. If the practical problems of total body cooling are solved, in situ preservation of multiple organs in the cadaver would increase the number of available organs for transplantation.

Animals↗
PubMed1976

Gastro-oesophageal reflux and hiatal hernia. A re-evaluation of current data and dogma.

Various methods of investigating and treating patients with gastro-oesophageal disorders are described and the rationale of current concepts is outlined. Emphasis is placed throughout on gastro-oesophageal reflux and its sequelae rather than on sliding hiatal hernias. Symptoms of gastro-oesophageal dysfunction can be misleading, and careful studies are essential in assessing its importance and the results of various modes of therapy.

Animals↗
PubMed1976

Effect of fifty percent small bowel resection on gastric secretory function in rhesus monkeys.

Basal acid output (BAO) and histamine-stimulated acid output (MAO) were studied in 11 fasting rhesus monkeys. Serum gastrin and gastric inhibitory polypeptide (GIP) were assayed in eight. Fifty percent distal small bowel resection was performed and the studies were repeated at 6 weeks and 6 months. Highly significant increases were seen in BAO (0.37 "/- 0.05 to 1.73 +/- 0.37 mEq. per hour; P less than 0.005) and MAO (1.7 +/- 0.22 to 3.21 +/- 0.45 mEq. per hour P less than 0.01) at 6 weeks. These levels persisted at 6 months. The ratio BAO:MAO increased throughout the experiment, the changes being significant at both time intervals. A significant rise was noted in the levels of both fasting serum gastrin (P less than 0.05) and GIP (P less than 0.01) during the early phase. By 6 months the levels of both hormones had fallen and were not significantly different from the control values. It was concluded that 50 percent small bowel resection causes a persistent increase in gastric acid secretion. No corresponding sustained change in serum gastrin or GIP occurs.

Animals↗
PubMed1976

Gallium-67 scanning for carcinoma of the lung.

Gallium-67 citrate scanning was prospectively evaluated in 55 patients who had lung lesions suspected to be primary carcinoma on chest x-ray films and in whom subsequent histologic diagnosis was obtained. Of 47 patients with histologically proved carcinoma of the lung, 44 (94 per cent) had a positive 67Ga scan. No patient with a positive scan had a benign lesion, so that the positive scan accuracy rate was 100 per cent. All 8 patients with a benign lesion and 3 patients with a malignant lesion had negative scans, for a negative scan accurary rate of 72 per cent for benign lesions. These results give statistical validity for the usefulness of the 67Ga scan in diagnosing carcinoma of the lung (p less than 0.001). Tumor cell type had little effect on the sensitivity of 67Ga scan. The 67Ga scan was equally useful in the evaluation of peripheral and central lesions. There was little difference amount T1, T2, and T3 classified lesions in their ability to take up 67Ga. The 67Ga scan was competitive with mediastinoscopy in assessing mediastinal lymph node metastases and provides a noninvasive method of assessing hilar lymph node metastases. There was a good correlation between the clinical staging of patients with lung cancer based on a chest x-ray film and 67Ga scanning and the staging after surgical treatment based on the histology of the resected specimens.

Gallium Radioisotopes↗
PubMed1976

Benign esophageal strictures.

For the treatment of esophageal strictures caused by reflux, dilation alone is rarely curative, as a reflux is not prevented. Standard antireflux repairs are the 1st procedures to be used whenever possible. If esophageal damage and shortening is more severe, the Collis gastroplasty operation coupled with an antireflux repair is effective, but the selection of patients is important. The gastroplasty should not be used if the stricture cannot be dilated easily or if several previous operations have been performed at the cardia. If the Thal fundic patch operation is used, a skin graft and full fundoplication should be employed as well. The results from a fundoplication left in the chest are encouraging from initial reports. Further follow-up of all 3 of these approaches is required. For patients with the most difficult strictures, especially following multiple previous failed operations, resection of the stricture and intestinal interposition is the operation of choice.

Colon↗
PubMed1975

Factors influencing local recurrence after abdominoperineal resection for cancer of the rectum and rectosigmoid.

One hundred and fifty-two patients who underwent abdominoperineal resection for cancer of the rectum and rectosigmoid are reviewed. Six physicians were selected to predict which of these patients would have a local recurrence. All information available at the end of the operation was duplicated and submitted to the observers. None of the physicians was able to predict local recurrence significantly better than random. There were 31 local recurrences, i.e. an incidence of 20-4 per cent. Low level of tumour in the rectum, local spread into perirectal fat or serosa, lymph node involvement and age below 60 years at time of operation were the only factors that were statistically related to local recurrence. The strategy for careful follow-up of patients at risk is outlined and a plea is made for a controlled trial of postoperative radiotherapy.

Age Factors↗
PubMed1975

The continuing challenge of gallbladder cancer. Survey of thirty years' experience at the University of Chicago.

The current concepts of the etiologic factors and spread of carcinoma of the gallbladder are discussed. The experience at the university of Chicago with this condition over a period of thirty years is reviewed. Of eighty-two cases diagnosed during this time, 88 per cent of the patients died within one year of diagnosis and the five year survival rate was 5 per cent. The difficulties in diagnosis of cholecystic neoplasms are considered, and the possibility of increasing diagnostic accuracy by the use of celiac axis angiography, immunologic tests for tumor-associated antigens, peptide hormone assays, and cytologic study of duodenal juice is discussed. The place of palliative surgery in the management of cancer of the gallbladder is outlined. Means of improving the current high mortality of this condition are evaluated, and a plea is made for a controlled trial of the various forms of treatment that have been suggested.

Adult↗
PubMed1975

Polypoid sarcomas of the esophagus. A rare but potentially curable neoplasm.

Five patients with polypoid esophageal sarcoma are reported. All had dysphagia similar to that occurring in epithelial carcinoma of the esophagus. The clinical diagnosis of sarcoma was suspected when barium swallow showed a large polypoid lesion. Biopsy was often inconclusive concerning the nature of the lesion except to identify it as a neoplastic process. In spite of their large size, the tumors remained superficial within the esophageal wall. Nodal or distant organ metastasis was absent in 4 of the 5 patients. The histology of these tumors suggests that so-called carcinosarcoma is an epithelial carcinoma of the esophagus with varying amounts of spindle cell features and should be considered separately from sarcoma arising from mesenchymal tissue. Unlike carcinoma, esophageal sarcoma has a favorable prognosis following radical resection, and recent advances in esophageal surgery have decreased the mortality and morbidity of esophagectomy.

Aged↗
PubMed1975

The effects of premedication drugs on the lower oesophageal high pressure zone and reflux status of rhesus monkeys and man.

Thirty-five human volunteers and eight Rhesus monkeys were studied with standard gastrooesophageal manometric techniqes and their reflux status was evaluated witha pH probe placed in the lower oesophagus. morphine sulphate, pethidine hydrochloride, or idazepam was given intravenously until drowsiness was induced. The manometric and pH studies were repeated. All three drugs decreased the lower oesophageal high pressure zone and increased the probability of relux in both monkeys and man. Thes findings are relevant in the preparation of patients for surgery since gastrooesophageal reflux and pulmonary aspiration may be a problen in the pre-and postoperative phases.

Animals↗