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Biomedical subjects

D N Ralphs

Publications and source records attributed to D N Ralphs.

At least 37 records · Page 2Linked to original sources
PubMed1982

Distribution of a liquid meal within the stomach and gastric emptying after vagotomy and drainage operations.

The intragastric distribution of a radionuclide labelled liquid meal was studied in 62 patients with duodenal ulceration by means of a gamma camera imaging system. A total of 85 gastric emptying studies (23 preoperative and 62 postvagotomy tests) revealed three distinct patterns of distribution. The activity distribution in the stomach after vagotomy showed a slower rate of return and a decreased accumulation of the meal in the proximal part of the stomach compared with the pattern in the intact stomach. The return of the liquid meal to the proximal stomach was considered to be a physiological process controlled by vagal reflexes and changed by a vagotomy. These observations made during emptying of a liquid meal seem to give rise to a better differentiation of the motor patterns after various types of gastric operations. With a quantification of the intragastric patterns of distribution it may be possible in a prospective study to give a more graded evaluation of changes induced by vagotomy than is possible with the traditional characterisation of gastric emptying.

Drainage↗
PubMed1982

Gastric emptying and dumping after proximal gastric vagotomy.

One hundred dumping provocation tests were performed on patients who had had proximal gastric vagotomy without drainage in the pre- and postoperative period. Other than monitoring the symptoms of dumping on test, various other objective criteria, i.e., plasma volume fall, gastric emptying, and blood sugar changes were also measured simultaneously. Whether dumping was assessed clinically or on test, it seemed to be equally prevalent after proximal gastric vagotomy without drainage compared to vagotomy with drainage or partial gastrectomy. Although the pattern of gastric emptying after proximal gastric vagotomy alone was not significantly different from that before operation in those patients who had dumping symptoms on test, the half-life of the emptying were much faster. The plasma volume fall was also significantly greater and blood sugar was rise steeper in these patients. The objective measurements have not only helped in determining the incidence of dumping after proximal gastric vagotomy but have also proved to be of value in categorizing patients with doubtful symptoms and have given some insight into the etiopathogenesis of this syndrome.

Blood Glucose↗
PubMed1982

Gastric emptying after peptic ulcer surgery. Some pathophysiological mechanisms of the dumping syndrome.

In 76 patients before or after different operations for peptic ulceration, the gastric emptying and changes in plasma volume and blood glucose were studied after ingestion of a radionuclide-labelled hypertonic glucose meal. The patients were divided into three clinical categories in accordance with their spontaneous symptoms of dumping after ordinary meals: (a) 26 postoperative patients formed a dumping group, (b) 30 postoperative patients formed a non-dumping group, and (c) 20 preoperative patients formed a control group. A precipitous early phase of gastric emptying was the only specific finding in patients with spontaneous symptoms of dumping. This early fraction of precipitous emptying was not present preoperatively or in patients without symptoms. It is concluded that the excessively rapid delivery of the hypertonic solution into the upper intestine is the primary stimulus leading to the changes in plasma volume and blood glucose observed in the dumping syndrome. The response of the jejunum with regard to the blood glucose and haematocrit rises is considered proportionate to the given stimulus.

Blood Glucose↗
PubMed1981

Pectin in the dumping syndrome: reduction of symptoms and plasma volume changes.

Twelve patients with the dumping syndrome took on one occasion oral hypertonic glucose and on another a similar glucose drink to which pectin was added. After glucose alone eleven patients had symptoms; after glucose with pectin, six had no symptoms and in five symptoms were reduced. Plasma volume changes were significantly less after glucose with pectin, and the hypoglycaemia at 120 min after glucose alone did not occur after glucose with pectin in patients in whom symptoms were abolished. Gastric emptying was prolonged, and serum insulin levels were lower, after glucose with pectin. In those patients to whom gastric emptying rate reverted to near normal with pectin, symptoms were abolished, but symptoms were only reduced in number when gastric emptying, although slowed, remained rapid. The findings suggest that pectin and similar substances may be useful in the day-to-day management of patients with dumping symptoms.

Adult↗
PubMed1981

alpha-Lactalbumin is not a marker of human hormone-dependent breast cancer.

It has been proposed that milk protein gene expression in human breast carcinomas may indicate a functional oestrogen receptor mechanism, and may therefore be diagnostic of tumours responsive to endocrine therapy. Unfortunately this has not been proved, largely because of inconsistencies in the immunoassay procedures used to identify milk proteins, in particular alpha-lactalbumin, in tissue extracts or serum. Alternative procedures include the identification of milk protein mRNA by cell-free protein synthesis, and the identification of milk protein RNA transcripts by hybridization to a sequence-specific probe. Here we describe experiments using alpha-lactalbumin cDNA probes, purified using recombinant plasmids, which demonstrate that although polyadenylated and non-polyadenylated alpha-lactalbumin transcripts are present in normal human mammary tissue during pregnancy and lactation, alpha-lactalbumin transcripts are not detectable in the human tumour tissues studied. These experiments do however show that a peptide, which shares antigenic determinants with human alpha-lactalbumin is present in some breast tumour tissues.

Breast Neoplasms↗
PubMed1980

How accurately can direct and indirect inguinal hernias be distinguished?

An inguinal hernia was clinically diagnosed as direct or indirect by paired surgeons of 134 occasions. When compared with the findings at operation the hernia was correctly diagnosed in 60 of 78 observations when it was indirect and in 33 of 56 when it was direct. The level of accuracy does not warrant continuing the practice of attempting to distinguish one type of inguinal hernia from another.

Adult↗
PubMed1980

Elevation of plasma neurotensin in the dumping syndrome.

1. The pathophysiology of the dumping syndrome is poorly understood. Plasma levels of four small intestinal hormones have been measured after an oral glucose provocation test in 19 patients with dumping symptoms and in matched controls. 2. Plasma levels of neurotensin, a newly discovered highly potent, hypotensive ileal peptide, were significantly increased in symptomatic patients compared with those of controls [20 min rise of 43 +/- 6.0 (mean +/- SEM) pmol/l in 19 symptomatic patients, 8.0 +/- 5.5 pmol/l in 20 postoperative symptom-free patients, and 4.1 +/- 3.5 pmol/l in 20 pre-operative patients with duodenal ulcer, P < 0.01]. 3. The rise in enteroglucagon was greater than normal but of similar magnitude to that seen in several other gastrointestinal conditions not associated with dumping symptoms. 4. The release of both gastric inhibitory peptide and motilin did not differ significantly from that of controls.

Blood Glucose↗
PubMed1980

Use of a provocation test for objective assessment of dumping syndrome in patients undergoing surgery for duodenal ulcer.

It is difficult to assess the incidence of dumping after various operations for duodenal ulcer on clinical grounds alone. An objective assessment of dumping has been made with the help of a provocation test. The test, using 50% hypertonic glucose solution labeled with radioactive Indium 113m was performed on 39 preoperative patients and 107 times on 72 patients after operation for duodenal ulcer. The dumping status of all the patients prior to surgery was asymptomatic after ordinary food as well as on test. Among the postoperative studies the clinical status was asymptomatic in 69, uncertain in 32 and six had dumping symptoms. On the basis of the symptoms on-test, the status was asymptomatic in 61, uncertain in 14 and 32 had dumping symptoms. The objective indices further defined the status as 70 asymptomatics, none uncertain and 37 confirmed dumpers and thereby completely abolished the uncertain group. All the objective measurements of the dumping provocation test have clearly differentiated those patients with from those without dumping symptoms. Patients with dumping symptoms on-test had a significantly greater fall in plasma volume, more rapid rates of gastric emptying and steeper rise in blood sugar after ingestion of hypertonic glucose than did the patients without dumping symptoms on-test.

Administration, Oral↗
PubMed1978

The relationship between the rate of gastric emptying and the dumping syndrome.

Following an oral hypertonic glucose challenge, gastric emptying and changes in plasma volume were measured in 15 subjects before and in 36 subjects after a truncal or selective vagotomy with a drainage procedure. The symptoms experienced during the test were noted, and the postoperative patients divided into two groups, (a) 20 patients who experienced dumping symptoms during the test and (b) 16 patients who did not. Gastric emptying was significantly faster and the fall in plasma volume significantly greater in those patients who experienced symptoms after the ingestion of hypertonic glucose than in those who did not, clearly demonstrating that the dumping syndrome is associated with an increased rate of gastric emptying. In addition, there was a significant positive correlation between the rate of gastric emptying and the fall in plasma volume.

Dumping Syndrome↗
PubMed1974

Prolactin concentrations in patients with breast cancer.

Basal prolactin levels were measured before operation in 113 patients undergoing surgery for a lump in the breast. Prolactin concentrations were not significantly higher in those patients with breast cancer than in those with benign lumps. Prolactin concentrations were, however, found to be higher in premenopausal women than in postmenopausal ones, regardless of tumour histology.

Adenofibroma↗