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Biomedical subjects

F R Vicary

Publications and source records attributed to F R Vicary.

At least 19 recordsLinked to original sources
PubMed1997

Drinking before endoscopy: milk or water?

BACKGROUND: The traditional fluid fast prior to endoscopy is unnecessary. We have previously shown that drinking water prior to endoscopy does not affect either the quality of mucosal views or residual gastric fluid volumes when compared to patients undergoing endoscopy after a standard fast. The present study was designed to establish whether milk, which may delay gastric emptying, could also be drunk prior to endoscopy without adverse effect. METHODS: Forty-eight patients (mean age 48 years, range 20 to 79) undergoing routine upper gastrointestinal endoscopy after overnight fast were randomized to drink 200 ml of either still mineral water or full fat milk. Endoscopy was performed 90 minutes later, when all residual gastric fluid was aspirated via the endoscope. Volume and pH of gastric aspirate were measured and the quality of the mucosal view at endoscopy recorded as poor, adequate, or excellent. RESULTS: No difference was shown between water (n = 27) and milk (n = 21) drinkers in residual gastric volume (mean +/- SEM, water vs milk) (16.0 ml +/- 1.5 vs 18.9 ml +/- 2.9) or pH (2.23 +/- 0.14 vs 2.48 +/- 0.14). Of those patients with poor, adequate, or excellent views, 4 of 4, 11 of 12, and 6 of 32 patients, respectively, were milk drinkers (chi-squared test for trend = 21.7, df = 1, p < 0.001), indicating significantly worse mucosal views in the group drinking milk. CONCLUSION: Drinking water up to 90 minutes prior to endoscopy is safe, but milk should be discouraged because of suboptimal mucosal views.

Animals↗
PubMed1996

Assessment of residual gastric volume and thirst in patients who drink before gastroscopy.

BACKGROUND: Before endoscopy patients undergo an uncomfortable fluid fast to reduce the risk of gastric acid aspiration and to ensure good endoscopic views are obtained. However, fluids rapidly leave the stomach and thus a long fluid fast before endoscopy may not be required. AIMS: The object of this study was to establish whether drinking before endoscopy is safe and relieves patients' symptoms of thirst. PATIENTS AND METHODS: 88 patients with American Society of Anaesthesiologists classification of physical status grades I and II were recruited in a controlled randomised single blind trial. The volume and pH of gastric aspirate obtained at gastroscopy was assessed in patients who drank 330 ml of water a minimum 90 minutes before their endoscopy and compared with values in patients who starved overnight. RESULTS: 44 patients who drank ('drinkers') 330 ml of water a mean 117 minutes before their morning gastroscopy had a similar volume and pH of gastric aspirate compared with 44 patients starved overnight ('starvers'); median volume 12.5 ml versus 10 ml, median pH 2.0 versus 2.0; 'drinkers' versus 'starvers' (NS). Before endoscopy patients were asked to score their thirst and hunger ratings as either none, mild, moderate or severe. Ratings for moderate and severe thirst were grouped together for analysis. The percentage of drinkers compared with starvers in each group with no thirst, mild thirst, and moderate severe thirst was 63%, 46%, and 37% respectively (chi 2 test for trend p < 0.05). Hunger ratings were similar in the two groups. CONCLUSIONS: It is safe for elective day cases to drink a significant volume of water two hours before endoscopy and this alleviates symptoms of thirst.

Adult↗
PubMed1991

'Solubile': decision-making in the diagnosis of jaundice.

We have designed a computer program 'Solubile' to aid clinicians in the diagnosis of jaundice. Based on Bayes' theorem, 'Solubile' uses up to 47 items of information about the patient to produce the most probable diagnosis from 22 possible diseases. In a prospective analysis of 50 patients, 74% were correctly diagnosed in first place and 94% within the first three choices. The possibility of using 'Solubile' at differing locations was tested by prospectively diagnosing 100 cases at a second centre having a significantly different patient population. 75% of these patients were correctly diagnosed in first place and 89% within the first three choices. The diagnostic ability of 'Solubile' was compared with that of 20 clinicians of various grades. The clinicians correctly diagnosed 49.5% of cases (Solubile 74%) and placed 68.5% (Solubile 94%) within the first three choices. 'Solubile' will be of use to aid clinicians in aspects of the diagnosis and management of jaundice.

Bayes Theorem↗
PubMed1990

Specialized gastrointestinal units for the management of upper gastrointestinal haemorrhage.

In 1986, 292 patients were admitted to a joint medical-surgical gastrointestinal unit with upper gastrointestinal haemorrhage. Fourteen patients died (4.8%) a mortality considerably lower than recorded in most series. The low mortality may result from the use of a specialized gastrointestinal unit to which all patients with upper gastrointestinal haemorrhage are admitted and managed with strict protocols for resuscitation, transfusion and surgery.

Aged↗
PubMed1985

Is Nd-Yag laser treatment for upper gastrointestinal bleeds of benefit in a district general hospital?

104 consecutive patients with upper gastrointestinal bleeding admitted to a district general hospital over a period of 20 months were considered for laser photocoagulation. 58 patients were found to have peptic ulcers, of which 42 had stigmata of recent haemorrhage accessible to laser photocoagulation. 17 were treated with a Nd-YAG laser and 25 were managed conservatively. There was no significant difference in the number of patients who re-bled and required surgery, mortality rate, length of stay in hospital or the amount of blood transfusion required in either group. We suggest that the routine use of a laser for bleeding peptic ulcers in a district general hospital is not justified.

Aged↗
PubMed1984

Carcinoma of the colon, sclerosing cholangitis, pericholangitis, and bronchiectasis in a patient with chronic ulcerative colitis.

We report a patient with long-standing ulcerative colitis who developed carcinoma of the colon, sclerosing cholangitis, pericholangitis, and bronchiectasis over the course of 10-15 years. Occurrence of these rare conditions in the same patient supports their reported association and reemphasizes that there may be multisystem involvement in ulcerative colitis.

Bronchiectasis↗
PubMed1983

Coexisting retroperitoneal and mediastinal fibrosis.

A rare case of coexisting retroperitoneal and mediastinal fibrosis is reported. Increasing awareness of this association may lead to earlier recognition of significant symptoms and more effective therapy.

Humans↗
PubMed1981

Iron release from isolated hepatocytes.

The isolated hepatocyte suspension was evaluated as an experimental procedure for investigating liver iron metabolism. Following prelabelling in vivo with transferrin-59Fe, isolated hepatocytes released radioactive iron in vitro by a temperature dependent process, without change in cell viability. Iron mobilization was increased by serum, apotransferrin and a range of iron chelators, of which the most effective were citrate, desferrioxamine and the ionophore A 23187. The rate of iron release was inversely related to oxygen levels, indicating that a ferric-ferrous reduction was involved in iron mobilization. The uncoupler TTFB, DTPA, and hypercapnia caused a reduction in iron release, but the metabolites cysteine, NADH and ascorbic acid had no effect. It was concluded that isolated hepatocytes are a useful experimental model for studying iron metabolism and for further evaluation of iron chelators.

Animals↗
PubMed1979

Double-blind trial of the use of transfer factor in the treatment of Crohn's disease.

We have undertaken a double-blind controlled trial of the use of transfer factor in Crohn's disease. Thirty-three patients with known Crohn's disease completed the trial in which half the patients had three injections of transfer factor and the other half were given saline. After six months there was no significant difference in the clinical condition of either of the two groups compared with before receiving treatment. There was also no difference in their in vitro lymphocyte function, although a number of patients exhibited altered responsiveness to skin testing with tuberculin or streptokinase/streptodornase. A signficant fall on Crohn's disease activity index score occurred over the initial 'acclimatising period' before the trial was started, probably related to overcoming initial introspection and the placebo effect of being part of a trial.

Adult↗
PubMed1978

Ultrasound and hepatic metastases.

Recent advances in ultrasonic technology have permitted differentiation of tissue within an organ. Fifty-nine patients in whom satisfactory follow-up could be obtained underwent grey-scale ultrasonic examination of their livers. Fifty-three patients were scanned successfully and of these a correct diagnosis as to whether metastases were present or not was given in 46. Ultrasound is a safe non-invasive way of detecting hepatic metastases.

Adult↗
PubMed1977

Ultrasonography in the management of haemophilia.

Ultrasonography was used to demonstrate retroperitioneal haemorrhages and intramuscular haematoma in three patients with antibodies to factor VIII and one with von Willebrand's disease in whom major bleeding episodes occurred. Scans were useful in demonstrating the presence, location, size and regression of haemorrhages.

Adult↗
PubMed1977

Ultrasound and amoebic liver abscess.

Eight of 12 patients referred to an ultrasound clinic were eventually found to have a liver abscess. All 8 abscesses were confirmed positively by ultrasonic examination. Using ultrasound, an amoebic abscess can be accurately located within the liver and the optimal site for needling suggested to the clinician. Ultrasound is an accurate, non-invasive, diagnostic aid in this condition.

Drainage↗
PubMed1977

Ultrasound and abdominal hydatid disease.

Twenty-two hydatid cysts have been accurately located in the abdomens of seven patients by ultrasound B-scanning. Lapartomy has confirmed the presence of 19 of these cysts. Grey-scale techniques do not appear to add appreciably to the ease of diagnosis in this condition. Ultrasound can give the clinician a good idea of the extent of the disease process and has the advantage of being completely non-invasive.

Adolescent↗
PubMed1977

Ultrasound and jaundice.

We have examined 26 consecutive jaundiced patients referred to the ultrasound clinic. A differentiation between extrahepatic and other causes of jaundice was possible in 23 of the 24 patients satisfactorily examined. The use of ultrasonic techniques in the jaundiced patient offers a high degree of accuracy to the clinician, and little or no discomfort to the patient.

Cholestasis↗