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Biomedical subjects

D C Carter

Publications and source records attributed to D C Carter.

At least 163 records · Page 9Linked to original sources
PubMed1983

Neodymium yttrium aluminium garnet laser photocoagulation for major haemorrhage from peptic ulcers and single vessels: a single blind controlled study.

A prospective single blind controlled trial was performed to assess the efficacy of the neodymium yttrium aluminium garnet laser in the management of patients bleeding from peptic ulcers and single vessels. Over 20 months 184 patients were found at endoscopy to be bleeding from peptic ulcers and single vessels; 130 of these failed to meet the criteria for entry into the study, but their bleeding stopped with conservative management. Forty-five patients entered the study: in all 25 who were bleeding from ulcers with spots the bleeding stopped irrespective of the treatment allocated. Twenty patients were bleeding from arteries. Eight were allocated to placebo treatment, and all later underwent emergency surgery for further haemorrhage. Twelve were allocated to receive laser treatment, and only one of eight who actually received it required surgery (p less than 0.002). It is concluded that laser treatment reduces the incidence of further haemorrhage and the need for emergency surgery, but the technique is difficult and not always applicable.

Adult↗
PubMed1983

The effect of isotonic amino acid infusions on serum proteins and muscle breakdown following surgery.

Twenty patients undergoing major surgical procedures received constant infusion (21/day) of either 3.5 per cent amino acid (AA) or 5 per cent dextrose (D5W) solutions in addition to other fluid requirements for 4 postoperative days. Ketosis was evident in AA patients as a mean daily beta-hydroxy butyrate excretion of 2.16 +/- 1.39 mmol and respiratory quotient of 0.708 +/- 0.013 compared with 0.28 +/- 0.45 mmol/day and 0.754 +/- 0.015 respectively in the D5W group. The serum total protein and albumin concentrations (but not those of transferrin and prealbumin) were significantly higher in the AA than the D5W group on day 4. However, the mean fluid balance for days 3 and 4 was significantly less positive in AA patients. The mean daily nitrogen balance of -6.6 +/- 7.7 gN/day in AA patients and -9.5 +/- 5.8 gN/day in D5W patients was not significantly different. Mean daily 3-methyl histidine excretion (38.2 +/- 12.3 mumol/mmol creatinine) in AA patients was significantly higher than in D5W patients (31.2 +/- 10.8 mumol/mmol creatinine). With no improvement in nitrogen balance, an increase in muscle protein breakdown and the possibility that decreased fluid retention explains the higher serum total protein and albumin levels, this study fails to demonstrate improved protein sparing by isotonic amino acid infusions following surgery.

Adult↗
PubMed1983

Prediction of risk in biliary surgery.

To identify individual risk factors and to establish an index of risk in biliary tract surgery, data on 16 potential predictive factors were compiled from a series of 186 biliary tract operations excluding simple cholecystectomy. Eight factors had a significant association with postoperative mortality. Linear discriminant analysis showed that serum creatinine, serum albumin and serum bilirubin levels in the week before surgery had independent significance in predicting postoperative mortality. The discriminant function derived identified a high risk group of patients and the predictive value was confirmed in an independent series of 54 biliary tract operations carried out in another surgical unit. The discriminant function derived for patients jaundiced before surgery also defined a high and low risk group and was similarly validated. Identification of high risk patients undergoing surgery for obstructive jaundice may be useful in defining a group of patients to be considered for trials of preliminary biliary drainage.

Biliary Tract Diseases↗
PubMed1983

Effect of bile salt perfusion and intraduct pressure on ionic flux and mucosal ultrastructure in the pancreatic duct of the cat.

Net ionic flux and mucosal ultrastructure were examined following perfusion of the cat pancreatic duct with bicarbonate or sodium taurocholate solutions (5-40 mM). Taurocholate perfusion increased net Cl- gain, net HCO3- loss and net K+ gain and was associated with significant widening of lateral intercellular spaces and increased complexity of intercellular labyrinths. Increased perfusion pressure (30 mm Hg) did not affect flux or ultrastructure during perfusion with bicarbonate but increased net ion flux significantly during perfusion with 40 mM sodium taurocholate. Ultrastructural changes during perfusion of 40 mM taurocholate at increased pressure were not consistent but focal epithelial disruption and cell shedding were seen occasionally. The hypothesis is advanced that taurocholate perfusion triggers physiological transport mechanisms and may make the duct mucosa more vulnerable to other potentially harmful agents. The significance of these changes in the pathogenesis of acute pancreatitis in man remains uncertain and care must be exercised before extrapolating from observed net ion flux data in this animal model.

Animals↗
PubMed1983

The effect of environmental temperature on resting metabolic rate and respiratory quotient following elective surgery.

Twenty male patients undergoing routine elective abdominal surgery of moderate severity nursed at either 20 or 28 degrees C had indirect calorimetry carried out on a control day pre-operatively and for the first four post-operative days. The mean resting metabolic rate over the four post-operative days was significantly elevated by 9% above control value. This increase was maximal on post-operative day 1 (13%). Respiratory quotient fell over four days of the post-operative period indicating that a greater proportion of energy was being derived from body fat stores. Nursing at different environmental temperatures did not affect these responses.

Journal Article↗
PubMed1983

The early identification of patients with gallstone associated pancreatitis using clinical and biochemical factors only.

Early differentiation of gallstone from nongallstone associated acute pancreatitis by imaging methods is often difficult. Timing of surgery in gallstone pancreatitis is controversial, but early surgery requires early demonstration of gallstones. This study assesses the value of easily available clinical and laboratory data in establishing gallstones as the etiology of pancreatitis. In 405 consecutive episodes of acute pancreatitis, data were collected prospectively on 14 clinical and laboratory variables. Gallstones caused 177 episodes and alcohol 135, 93 were due to other or unknown causes. Age, sex, and within 48 hours of admission, serum alkaline phosphatase, aminotransferases, amylase, and bilirubin were all significantly different (all p less than 0.001, chi square) in gallstone and alcohol groups. Multivariate analysis based on five of these variables enabled correct prediction of the presence or absence of gallstones in 50 of a further 56 episodes. This method may help in planning early interventional treatment of gallstone associated acute pancreatitis.

Acute Disease↗
PubMed1983

The management of acute variceal haemorrhage.

Sixty-two patients presented on 81 occasions with acute-oesophageal variceal haemorrhage. Bleeding required tamponade on or during that admission on 87 occasions and was successful in arresting haemorrhage in 93%. Employing a policy of management in which injection sclerotherapy was the main therapeutic option, control of haemorrhage was achieved on 89% of admissions with an admission mortality of 30%. These results are compared with other reported series.

Acute Disease↗
PubMed1983

Bile salt-induced gastric mucosal damage and histamine receptor antagonists.

The effects of both an H1 receptor antagonist and an H2 receptor antagonist on changes in monovalent ion flux induced by topical sodium taurocholate were studied in antrectomised dogs fashioned with a denervated fundic pouch. The magnitude of taurocholate-induced ion flux was unaffected by topical administration of H1 or H2 receptor antagonists Parenteral administration of H1 or H2 receptor antagonist given singly or in combination produced an increase in net luminal Na+ gain before taurocholate administration but failed to reduce the magnitude of taurocholate-induced ion flux. It is concluded that histamine receptors are unlikely to have a role in the induction of mucosal injury by bile salts.

Aminopyridines↗
PubMed1983

Second laparotomy following 'curative' resection for colorectal cancer.

Second laparotomy was undertaken in 63 patients with suspected local recurrence following 'curative' resection for colorectal cancer. Nine patients proved to have benign disease and 4 a new cancer. Local tumour recurrence was confirmed in 50 patients. Of these, 19 underwent further resection of the tumour, 19 had palliative colostomy or bypass, and laparotomy only was performed in 12. Five of 15 patients undergoing secondary 'curative' resection survived 1 year and 3 survived 18 months. In contrast only 6 of the remaining 35 patients survived 1 year and none survived 18 months. Second laparotomy may be of benefit in a small number of patients with local recurrence following apparently curative resection for colorectal cancer.

Colonic Neoplasms↗
PubMed1982

Prediction and selective prophylaxis of venous thrombosis in elective gastrointestinal surgery.

Clinical features were noted and routine and non-routine laboratory variables were measured before elective major gastrointestinal surgery in 63 patients aged 40 years or more. Deep-vein thrombosis (DVT), detected by routine 125I-fibrinogen leg scanning, developed in 21 patients. Five clinical variables but no laboratory variables were significantly associated with DVT: age; percent mean weight for age, sex, and height (%MW); presence of varicose veins; cigarette-smoking; and sex. The most useful discriminant index of these variables was age in years plus 1.3 x %MW. The index was validated prospectively in a further 41 patients, in 18 of whom DVT developed. The value of the index in selective prophylaxis was then assessed in a further 40 patients, of whom 24 (60%) with high-risk index received low-dose heparin (5000 units twice daily). DVT developed in 4 of the 40 patients, an incidence of 10% compared with the incidence of 37.5% (39 of 104) in the earlier studies with no prophylaxis.

Adult↗
PubMed1981

Biliary surgery in the same admission for gallstone-associated acute pancreatitis.

The clinical course of 47 patients with gallstone-associated acute pancreatitis who had surgery during the same admission has been reviewed. In 37 patients, when the signs and symptoms of pancreatitis settled on conservative management, biliary tract surgery was safely performed during that admission without mortality. The 10 patients whose clinical condition failed to settle prior to surgery had a complicated hospital stay and a 50 per cent mortality. A revised prognostic factor grading system has been outlined in which the age factor is removed and serum transaminase levels are considered of prognostic significance only if greater than 200 u/l within 48 h of admission. This revised system gives a more accurate assessment of the severity of individual attacks of gallstone-associated acute pancreatitis.

Acute Disease↗
PubMed1980

An evaluation of 99Tcm-labelled HIDA in hepatobiliary scanning.

99Tcm-labelled HIDA administered intravenously is promptly taken up by the liver and excreted into the bile duct and gallbladder. In this study the use of this agent in hepatoscintigraphy was evaluated. Thirty patients with a variety of hepatobiliary pathology were studied. After an overnight fast 2 mCi of 99Tcm HIDA were given intravenously and the patient was scanned continuously for 1 h. A rapid outline of the liver and biliary tract was usually obtained and the T 1/2 of the tracer in the blood stream was 20 min. In total obstructive jaundice, isotope was excreted through the renal tract without visualization of the liver. Hepatoscintigraphy was compared with conventional radiographs and ultrasonography in 19 patients presenting an emergencies with suspected hepatobiliary disease and was found to be comparable to the latter modes of investigation. In the jaundiced patients hepatoscintigraphy was inferior to percutaneous transhepatic cholangiography and to ultrasonography. No adverse side effects have followed the use of the radiopharmaceutical.

Adolescent↗