Search PubMed⌕ Search

Biomedical subjects

I McColl

Publications and source records attributed to I McColl.

At least 73 records · Page 4Linked to original sources
PubMed1980

Spontaneous closure of choledochoduodenostomy: diagnosis by endoscopy and ERCP.

Choledochoduodenostomy has been recommended for the management of benign lower common bile duct obstruction, but opinion on this is still divided. Two cases are presented of recurrent cholangitis following choledochoduodenostomy, in which endoscopy and ERCP demonstrated closure of the choledochoduodenal anastomosis, continuing lower biliary obstruction and retained stones or debris. Persistent of recurrent symptoms following this operation may be due to stoma closure without adequate biliary drainage, and in these circumstances endoscopy with ERCP is proving most useful and in difficult cases may be the investigation of choice.

Aged↗
PubMed1979

Effects of several preoperative medications on fat cell lipolysis, and activity of adipose tissue cyclic AMP phosphodiesterase.

Effects were examined of atropine, diazepam, pethidene, promethazine, scopolamine, omnopon and papaverine on basal and noradrenaline-stimulated lipolysis in rat isolated fat cells and on rat adipose tissue cyclic AMP phosphodiesterase activity. Papaverine at high concentration (1 mM) inhibited both basal and hormone-stimulated lipolysis, whereas diazepam enhanced basal lipolysis. At a 'clinical dose', omnopon increased both basal and noradrenaline-stimulated lipolysis. Adipose tissue cAMP phosphodiesterase activity was strongly inhibited by 1 mM diazepam, papaverine, promethazine and omnopon (280 microgram ml-1). Lack of enhancement of lipolysis by the established cAMP phosphodiesterase antagonist papaverine, is compatible with simultaneous inhibition also of adipose adenyl cyclase. Diazepam-stimulated lipolysis is compatible with its phosphodiesterase inhibitory activity. It is proposed that papaverine-containing omnopon may offer some survival advantages during surgical stress by facilitating a caloric supply.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed1979

Studies on human gastric mucosal immunoglobulin A.

Immunoglobulin A (IgA) was found in mucus scraped from the surface of the human antrum. Fresh human gastric mucosa removed at operation was washed free of loosely adhering material and the gelatinous mucus lining the tissue scraped. The scrapings were separated by gel filtration on Sephadex G-200 and on Sepharose 4B into two carbohydrate-containing fractions. One of these fractions was shown by immunodiffusion to contain IgA which differs from human colostral secretory IgA by being devoid of secretory component activity. Moreover, secretory component was not detected in our unfractionated gastric mucosal scrapings. It is concluded that, contrary to the general belief, the predominant immunoglobulin A of human gastric mucus is not associated with the secretory component. Our results do not exclude the possibility that, as in serum, small amounts of secretory IgA and of the secretory component may be present in gastric secretions, however if so, the levels of these compounds would fall below the level of sensitivity of our methods.

Carbohydrates↗
PubMed1979

Medical audit in British hospital practice.

The imposition of a rigid system of medical audit throughout the NHS would be inappropriate at this time; nevertheless, every hospital and general practice could usefully consider what informal methods of audit should be employed. Most hospitals should try weekly death and complication meetings in addition to their other postgraduate activities. Greater attention is required to ensure that the medical records are improved in both hospital and general practice. Metcalf's (1979) suggestion for auditing GP work seems feasible. As medicine becomes more complicated in terms of techniques and team activities there is a greater need for more systematic methods of defining and measuring standards of care and feeding back this information. Much more research is needed to determine whether process or outcome studies are preferable, and structure and patient risks must be taken into account. Whatever system is devised the medical profession will accept it provided it is fair, educational, and shown to benefit the patient.

Feedback↗
PubMed1978

Firm, patient, and process variables associated with length of stay in four diseases.

Factors associated with length of stay in three London teaching hospitals during 1972 and 1975 were examined in patients treated for myocardial infarction, cerebrovascular disease, inguinal hernia without obstruction, and gall stones. Statistical analyses were carried out with multiple regressions on log lengths of stay.Increased length of stay was associated with infection in all four groups and with the seriousness of operative procedures in all but patients with cerebrovascular disease. Although age was a significant variable in patients with hernias and gall stones, it had relatively little practical effect on length of stay. Other significant variables in at least one disease were obesity, number of abnormalities in blood chemistry, administration of parenteral fluids or oxygen, or use of monitoring devices, and whether chest radiography was carried out, blood electrolytes and urea were measured, or anticoagulants were used. Patients with cerebrovascular disease who were not discharged to their own homes stayed on average more than two and a half times longer than other patients.Between a third and a half of the variance was explained by these variables and the variation among firms. The method described is reproducible in other hospital settings, and the study shows that much new information could be available routinely without mounting expensive field trials.

Age Factors↗
PubMed1978

The effect of problem-oriented medical records on clinical management controlled for patient risks.

This study examines the change in clinical management by 28 medical and surgical firms in three London teaching hospitals following the introduction of Problem-Oriented Medical Records (POMR) in one of the hospitals. Comparison is made between firms using and not using POMR. The data are analyzed using a regression model. Analysis is based on the coefficient of change in each firm between the two study years when modified by the physiological and demographic patient variables significantly associated with the management of each disease. Although not conclusive, the results in four of the seven diseases studied encourage the speculation that POMR may have improved the thoroughness of patient management. The significant patient variables in each diagnosis suggest that patient risk on admission can affect management scores. Were this to be found elsewhere, the influences of patient mix might be considered in using explicit criteria to make comparisons between hospitals that serve different kinds of populations.

Adolescent↗