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Biomedical subjects

D N Ralphs

Publications and source records attributed to D N Ralphs.

At least 19 recordsLinked to original sources
PubMed1988

An aetiology for fistula in ano.

Four cases of superficial peri-anal fistula occurring in early infancy are described. They were all successfully treated by complete excision of the fistula. Histological examination of the excised fistulae revealed a mixture of columnar, transitional and stratified squamous epithelium lining the tracts in three cases and non-specific connective tissue in the fourth. It is postulated that the presence of these inappropriate types of epithelium (columnar and transitional) along the length of the fistulous tract is evidence of a congenital origin for peri-anal fistulae presenting in the first few months of life.

Humans↗
PubMed1987

Delayed mouth-caecum transit of a lactulose labelled liquid test meal in patients with steatorrhoea caused by partially treated coeliac disease.

Mouth-caecum transit time (M-CTT) of a lactulose labelled liquid test meal has been measured in 27 coeliac patients and 10 healthy controls using the breath hydrogen technique. Although all patients were urged to maintain a gluten free diet, not all did, and there was, therefore, a wide range in the severity of fat malabsorption within the patient group. Gastric emptying of a 113Indium DTPA-labelled liquid test meal was also assessed in separate studies on six healthy controls and 11 of the coeliac patients. Fasting breath hydrogen concentrations and the response to lactulose, as assessed both by the rate of rise, and the peak breath hydrogen concentration reached, showed no difference between coeliacs and controls, regardless of the presence or absence of steatorrhoea. Mouth-caecum transit time in the 16 coeliac patients with steatorrhea (faecal fat greater than 7 g/24 h) was, however, significantly prolonged being 158 +/- 18 minutes (mean +/- SEM), compared with 70 +/- 9 minutes for the controls (p less than 0.02), and 83 +/- 15 minutes for the 11 coeliacs without steatorrhoea (p less than 0.002). Mouth-caecum transit time in the coeliac patients was linearly related to the 24 hour faecal fat excretion, r = 0.55, n = 27, p less than 0.01. Slow mouth-caecum transit in the coeliacs with steatorrhoea was not caused by delayed gastric emptying as the t1/2 for coeliacs with steatorrhoea was within the normal range. Coeliacs with delayed mouth-caecum transit had impaired insulin release but the postprandial profiles of the other peptides measured (cholecystokinin, GIP, secretin, motilin, neurotensin, enteroglucagon, and peptide YY) were all within the normal range in this group of partially treated coeliac patients.

Adult↗
PubMed1986

Changes in gene expression in established human mammary tumor cell lines when compared with normal breast and breast tumor tissue.

RNA complexity analyses of total cellular polyadenylate-containing RNA isolated from lactating human breast tissue, human breast tumor tissue, and a mixture of established cell lines of mammary origin demonstrate extensive homology between the tissue RNA populations but suggest a decrease in the complexity of cell line nuclear RNA populations, with the exception of an early-passage MCF-7 cell line. Cell-free protein synthesis and two-dimensional gel electrophoresis also show quantitative and qualitative differences in gene expression between human mammary tumor tissue and reduction mammoplasty or established mammary cell lines of early and late passage number. The results demonstrate a major role for transcriptional and posttranscriptional mechanisms in the regulation of gene expression in the human mammary gland and show that studies on mammary gland gene expression using established cell lines of mammary origin reflect only in part gene expression in normal lactating human breast or breast tumor tissues.

Breast↗
PubMed1985

Early discharge despite postoperative pyrexia after inguinal herniorrhaphy in unselected patients.

Although shown to be suitable for selected patients with subsequent community medical and social support early discharge from hospital after inguinal hernia repair is apparently not well established. The application of such a policy may also be inhibited by postoperative pyrexia even though the cause of this is not evident. We report a series of 103 unselected patients presenting consecutively to an inner London hospital for hernia repair in whom early discharge was proposed in 95 per cent and achieved in 79 per cent irrespective of clinically unaccountable postoperative pyrexia and without special community health provision. This discharge policy placed no additional burden on the community health services and did not affect adversely patients' welfare, satisfaction or time off work.

Adolescent↗
PubMed1985

The synthesis of 16 alpha-[131I]iodo-oestradiol and evaluation of its use as a radiotracer for oestrogen receptor positive breast tumours.

16 alpha-Iodo-oestradiol binds with high affinity to the oestrogen receptor and has been shown to accumulate in oestrogen sensitive tissues in many test systems. We have prepared the compound labelled with 131I at four specific activities. Using these preparations we have attempted to image human primary and metastatic breast cancer deposits at various times from 15 min to 24 h post injection by external gamma scintigraphy. Clinical studies were conducted on 10 post-menopausal patients. The receptor status was determined in seven cases, four were positive and three negative. The imaging results were very poor, in only two cases were images obtained, these were very faint and only of the primary, never of the metastatic deposits. The oestrogen receptor status was only available in one of these cases, it was positive. Dynamic studies in vivo revealed that the compound is cleared rapidly from the circulation during the first 5 min and thereafter undergoes extensive enterohepatic recycling. Studies of the radiochemical identity of the circulating species revealed that the injected compound was extensively metabolised. Neither an increase in specific activity of injected radiotracer nor imaging at shorter times after injection improved the results.

Breast Neoplasms↗
PubMed1983

Gut hormone profile and gastric emptying in the dumping syndrome. A hypothesis concerning the pathogenesis.

Insulin, enteroglucagon, neurotensin, gastric inhibitory polypeptide (GIP), and motilin have been measured in plasma during an oral glucose test in 76 patients before or after different upper gastrointestinal operations for peptic ulceration. The patients were divided into three clinical groups in accordance with their spontaneous symptoms of dumping after ordinary meals: 26 postoperative patients into a dumping group, 30 postoperative patients into a non-dumping group, and 20 preoperative patients into a reference group. The fasting values of the five hormones were similar in the operated and non-operated groups. Insulin, enteroglucagon, neurotensin, and GIP rose significantly in all patients. The increment of insulin, enteroglucagon, and neurotensin was greater in the postoperative patients with dumping symptoms than in the postoperative and preoperative patients without dumping symptoms. All the patients had a small decrement of motilin. The resulting hypothesis is that an impaired neural control of the gastric emptying is the essential aetiological factor in the dumping syndrome. The excessively rapid delivery of the meal into the jejunum is the abnormal stimulus to the exaggerated hormone release. The response of the small intestine with regard to the hormone release is considered proportionate to the given stimulus. The abrupt fall in circulating blood volume is suggested to play a role in producing the polymorphic symptoms. Neurotensin and GIP cannot be excluded from being the factors arresting the rapid gastric emptying in patients whose neural control has been impaired after gastric surgery.

Adult↗
PubMed1983

Effect of pectin on gastric emptying and gut hormone release in the dumping syndrome.

The effect of pectin on gastric emptying, gut hormone release, and symptoms was studied in four patients with dumping syndrome and in two healthy volunteers after ingestion of a hypertonic glucose meal with and without addition of pectin. The initial fraction emptied from the stomach was reduced in the patients, whose symptoms of dumping were abolished or alleviated by pectin. This change of the emptying seems to be caused by a prolonged stomach transit, probably due to the viscous nature of the pectin meal. Pectin had no effect on the gastric emptying of the volunteers. The motor activity of the stomach was not altered by pectin in either the patients or volunteers. In the patients insulin, enteroglucagon, neurotensin, and gastric inhibitory polypeptide rose to higher levels after the glucose meal than after the glucose-pectin meal. The individual differences in the hormone release were considered secondary to the altered gastric emptying produced by pectin.

Adult↗
PubMed1983

Effect of intravenous 3-hydroxybutyrate on postoperative nitrogen balance.

Thirty-two patients routinely admitted for cholecystectomy were allocated randomly to receive a post-operative fluid regimen containing either 18 g/d of sodium DL-3-hydroxybutyrate, or isoenergetic glucose, each for 3 d. The difference in the post-operative mean daily urinary nitrogen excretion between the control (median 8.3 g/d) and the 3-OH-butyrate groups (median 8.3 g/d) was not statistically significant, nor was there any difference when allowances were made for patient's surface area or for changes in blood urea during the course of the study.

Adult↗
PubMed1983

Influences on the occurrence of dumping syndrome.

A dumping provocation test using 50% of glucose solution labeled with Indium 115 m, was performed on 146 occasions pre- and postoperatively in 85 patients. Dumping elicited by the test was defined by the symptoms produced by the test and various objective measures of dumping. The influence of various factors other than the type of operation on the occurrence of dumping has been studied in detail. The incidence of dumping symptoms induced by the test has shown no significant correlation with age, sex, weight, height, smoking habits, race, dose of hypertonic glucose, and the time elapsed since surgery. However, a significant relationship has been observed between the duration of ulcer symptoms before operation and the occurrence of dumping symptoms induced by the test. The test not only reproduced the symptoms patients had reported after eating ordinary foods, it also helped in eliminating patients with borderline symptoms as our objective measures collectively differentiated three patients from those with the dumping syndrome.

Adult↗
PubMed1983

Is the undeniably palpable liver ever 'normal'?

A study of whether the lower border of the normal liver, if it extended below the costal margin, could be reliably identified by clinical examination was undertaken in 42 patients in whom there was no clinical, biochemical or scintographic evidence of liver disease. Two clinical observers independently agreed that in 10 of these patients the liver extended infracostally. However, scintiscanning demonstrated that 30 patients had livers extending below the costal margin and that 2 of the 10 livers clinically identified did not in fact lie infracostally. Thus whilst the normal liver commonly extended below the costal margin, recognition of this extension by clinical methods occurred no more frequently than would be expected by chance. It is concluded that the confident clinical finding of a liver projecting below the costal margin should suggest that the organ is abnormal.

Adult↗
PubMed1982

Early discharge following hernia repair in unselected patients.

The feasibility and safety of early discharge from hospital following inguinal hernia repair in selected patients is well established. The following is an account of 104 unselected patients who presented consecutively to an Inner London hospital with inguinal hernias. The intention was to discharge all patients 48 h after operation, but for a variety of reasons a later discharge day was planned preoperatively in 50. Of the 104 patients, 62 (60 per cent) were discharged on the planned day, but only 23 per cent left hospital 48 h after operation. The factors which accounted for this are discussed. It was possible, however, to discharge over 85 per cent within 5 days of operation.

Adult↗
PubMed1982

Skin closure of inguinal herniorrhaphy wounds in short-stay patients.

One hundred and twenty-two inguinal hernias were repaired in a consecutive series of 104 patients. The patients were randomly divided into two groups. In one, 66 wounds were closed by the traditional method of using interrupted non-absorbable skin sutures. In the second group, 56 wounds were closed with subcuticular Dexon sutures. The results of the two methods of skin closure were compared in the immediate postoperative period, at 2 weeks, 3 months and at more than 18 months after surgery. The final appearance of the wounds was similar in the two groups. Dexon has the advantage for short-stay patients of not requiring removal.

Adult↗