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Biomedical subjects

H L Duthie

Publications and source records attributed to H L Duthie.

At least 19 recordsLinked to original sources
PubMed1990

Stress in surgeons.

A sample of 1000 members of the Association of Surgeons of Great Britain and Ireland was circulated with a postal questionnaire relating to their occupational stressors, their type A coronary-prone behaviour and their mental health. Six hundred and seventy-two (67 per cent) useable forms were returned anonymously. The major individual stressors were: (1) the interference of the job with personal life, (2) general administration, and (3) the number of patients in clinics. Type A behaviour was similar to that of other professional groups. Surgeons showed mean scores significantly higher than the general population on two subscales of the mental health index (free-floating anxiety and hysterical anxiety). The findings for the few female surgeons (2 per cent) were similar to those in men but they did not exhibit raised free-floating anxiety levels.

Adult↗
PubMed1986

Teaching medical history-taking: a comparison between the use of audio- and videotapes.

The efficacy of audiotape was compared with that of videotape as a way of teaching students the essentials of the medical interview. Two consultants--a general physician and a neurologist--were videotaped as they took histories from two patients. The neurologist described his methods and summarized his findings, but his interview was conducted conventionally without interruptions (continuous interview). In a contrasting style, the general physician frequently explained his methods and findings in steps, interrupting his interview to do this (discontinuous interview). Fifty students starting their main medical term were divided into two groups (A and B). Group A was shown the videotape of the discontinuous interview while group B was played an audiotape of that interview. Groups A and B were then crossed over, but this time group A was allowed only to hear the audiotape of the continuous interview, while the videotape of it was played to group B. After each tape the students were tested on its content. There was no significant difference between the mean scores of Group A and Group B when tested on the discontinuous interview and both groups scored well. For the continuous interview the group who saw the videotape scored significantly better than the group who only heard this tape. Both groups scored significantly better in the test based on the discontinuous interview than they did in the test based on the continuous interview. The results indicate that videotapes are a good medium for teaching history-taking, but also suggest that audiotape recordings of medical history-taking can be effective teaching aids if the interview is explained in stages.

Attitude of Health Personnel↗
PubMed1985

Linked tutorial teaching by teleconference and videocassette.

A system for linked tutorial teaching involving several groups of students at different locations has been introduced successfully into the teaching resources of the University of Wales College of Medicine. It utilizes standard telephone equipment supplemented by specially prepared videocassette material. The results of an evaluation questionnaire given to students indicate that the format as currently used is very acceptable and interesting. Students feel more involved than in larger group teaching sessions and value the discussion periods. This teaching method has the potential to overcome several weaknesses in existing formal teaching programmes, especially when students are based at several sites. In particular, it minimizes travelling, allows more time for clinical experience and makes optimal use of teaching expertise. The system is being developed further to encompass postgraduate centres in Wales.

Education, Medical, Undergraduate↗
PubMed1984

The four to eight year results of the Sheffield trial of elective duodenal ulcer surgery--highly selective or truncal vagotomy?

In a prospective randomized trial between June 1973 and July 1978 highly selective vagotomy (HSV) was compared with truncal vagotomy and pyloroplasty (TVP) in 137 male patients undergoing elective surgery for chronic duodenal ulceration. Ninety per cent of patients were followed up for between 49 and 102 months (mean 77). A good result was obtained in 49 of 59 patients (83 per cent) after HSV compared with 41 of 64 (64 per cent) after TVP (P less than 0.02). The recurrent ulcer rate was 8.8 per cent after HSV and 9.4 per cent after TVP. Dumping and diarrhoea were significantly commoner after TVP (P less than 0.05). We believe that HSV is a better operation than TVP for the treatment of uncomplicated duodenal ulcer.

Adult↗
PubMed1979

Highly selective vagotomy with excision of the ulcer compared with gastrectomy for gastric ulcer in a randomized trial.

Fifty-six patients with benign gastric ulcer of the body of the stomach have been entered into a randomized trial of highly selective vagotomy with excision of the ulcer (HSVE) (26 cases) against standard Billroth I partial gastrectomy (BI) (30 cases). The operations were carried out by all grades of surgical staff. No patient died within 1 month of operation. Postoperative morbidity was greater after gastrectomy than after HSVE. At an average follow-up of about 4 years, functional results according to a modified Visick classification were similar in both groups, with about 75 per cent good results. Two recurrent ulcers occurred after gastrectomy (7 per cent) and 4 after HSVE (15 per cent). Neither operation has a distinct advantage at this stage.

Clinical Trials as Topic↗
PubMed1979

Double-blind comparison of cimetidine and placebo in the maintenance of healing of chronic duodenal ulceration.

Patients suffering from chronic duodenal ulceration were allocated at random to treatment with either cimetidine (400 mg twice daily) or matching placebo for six months. Before entry to the trial all patients were shown to have healed ulcers on endoscopy. Most of the patients had participated in a one-month trial of cimetidine during which their ulcers healed. The trial showed that four of 29 patients relapsed on maintenance treatment with cimetidine, which therefore did not confer complete immunity from relapse. However, cimetidine treatment was very much better than placebo treatment, on which 18 of 31 patients relapsed. Of the 22 patients who relapsed clinically, 20 were submitted to endoscopy and 19 of these were shown to have ulcerated again. Endoscopy at the end of the trial showed that ulcers had also redeveloped in five of 28 asymptomatic patients. Length of previous dyspeptic history had no bearing on the results of the trial but there was evidence that relapse on placebo was less likely if the ulcer had originally healed on a high dose of cimetidine. Clinical relapse was associated with worsening duodenitis. Symptoms, clinical observation, and laboratory tests showed no important abnormalities in the patients.

Chronic Disease↗
PubMed1979

Colonic myoelectrical activity in man: comparison of recording techniques and methods of analysis.

Both monopolar and bipolar recordings of human colonic myoelectrical activity have been made on 29 occasions from implanted serosal electrodes attached to either the ascending colon or transverse colon. Visual and computer analysis of the signals were made and the incidences of the two electrical rhythms present in the colon were compared for the two recording techniques, recording sites, and methods of analysis. The percentage incidence of both rhythms was similar for the mono and bipolar recording techniques in both parts of the colon. The incidence of the two rhythms in the transverse colon was approximately twice that recorded in the ascending colon, this being true for both recording techniques and methods of analysis, but neither was detected for more than 50% of the time. It is concluded that the methods of data analysis probably account for the differing incidences of electrical activity in the human colon that have been reported previously.

Adult↗
PubMed1978

Highly selective vagotomy or truncal vagotomy and pyloroplasty for chronic duodenal ulceration: a randomized, prospective clinical study.

The results of a randomized, prospective clinical trial of highly selective vagotomy (HSV) versus truncal vagotomy and pyloroplasty (TVP) in 126 male patients undergoing elective surgery for chronic duodenal ulceration are presented. The operations were performed by surgeons of all grades of experience. At a mean follow-up time of just over 3 years a satisfactory result was obtained in 93 per cent of patients following HSV and 78 per cent of patients following TVP, the difference being probably statistically significant (P less than 0.05). The incidence of early and late dumping, bile vomiting, flatulence, post-prandial epigastric discomfort and wound infection was statistically significantly less after HSV than after TVP. Three patients have developed a recurrent duodenal ulcer after each type of operation (5.4 per cent). At this early stage HSV has advantages over TVP; it will be interesting to see if these are maintained with the passage of time.

Adult↗
PubMed1978

Electrical activity of human colonic smooth muscle in vitro.

1. Extracellular and intracellular recordings were made of the electrical activity of isolated strips of human colonic smooth muscle, cut from sixty surgical specimens. 2. Strips of taenia were spontaneously active. The myogenic activity consisted in half the strips of intermittent periods of regular spike activity (frequency 22 +/- 5 (S.D.) c/min) accompanied by tetanic contractions; in the other half of the strips activity was continuous. In half the specimens, slow potentials were recorded between periods of spike activity. Slow potentials were not accompanied by contractions. 3. Spikes in taenia were abolished by verapamil. Spikes disappeared in low Ca and low Na solutions, but in low Na solution spikes could be stimulated by 15 mM-KCl. 4. ACh and physotigmine produced tetanic contractions in taenia. 5. Circular muscle was not spontaneously active within 1 h of incubation in the water bath, possibly due to inhibition by prostaglandins. 6. Circular muscle responded to ACh with irregular bursts of spikes associated with discrete contractions. Similar activity was seen after inhibition of prostaglandin synthesis with indomethacin. After treatment with tetrodotoxin, ACh produced regular spikes and tetanic contractions in circular muscle. 7. The possible relationships of these results to the myoelectrical activity of the human colon in vivo are discussed.

Acetylcholine↗
PubMed1977

Abdominal wound healing: a prospective clinical study.

The incidence of wound dehiscence and incisional hernia after two methods of abdominal wound closure (layered closure with retention sutures and single-layer "mass closure") was studied in a randomised prospective clinical trial in a consecutive series of 200 patients. Dehiscence occurred in 1% of patients and herniation in 4-7%; the incidence of these complications was similar with both methods of closure. Seven of the 11 cases of dehiscence or herniation occurred in infected wounds, and wound infection was associated with a tenfold increase in the incidence of these complications. The prevention of wound infection would reduce substantially the incidence of dehiscence and herniation in abdominal wounds.

Abdomen↗
PubMed1977

Surgery for gastric ulcer.

Despite the initial healing achieved by medical treatment with carbenoxolone, surgery is frequently needed in the management of gastric ulcer. We have studied 150 patients over the past 10 years in an attempt to define the place of conservative surgery compared with the standard partial gastrectomy of the Billroth I type. Functional results have not been significantly different and the individual surgeon's choice will depend on his philosophy with regard to the risk of cancer in the postoperative stomach, and his technical expertise with the newer kinds of vagotomy. To my mind it is perfectly justifiable to use highly selective vagotomy with excision of the ulcer to treat gastric ulcer alone, especially if the patient is one in whom postgastrectomy symptoms could be disabling. Further follow-up is needed to decide whether it should replace partial gastrectomy as the standard procedure.

Denervation↗