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Biomedical subjects

J M Watts

Publications and source records attributed to J M Watts.

At least 37 records · Page 2Linked to original sources
PubMed1984

Gastric emptying after gastroplasty for morbid obesity.

Gastric emptying was studied in 11 patients who had undergone gastroplasty for morbid obesity 6 to 8 months previously and in 22 normal controls without gastrointestinal disease. A dual isotope technique for measuring solid and liquid emptying was used. Liquid emptying was slower in patients than controls. The emptying of solid was initially faster, but was followed by a prolonged slow rate of emptying indicating retention of solid food in the proximal partitioned pouch. There was no correlation between the weight loss produced by the operation and rates of solid or liquid emptying. Unlike gastric bypass, the changes in gastric emptying produced by gastroplasty were relatively small and gastric emptying rates in patients overlapped considerably with the range of emptying rates found in control subjects. The success of the procedure may depend on the induction of satiety by the filling of the partitioned pouch.

Adult↗
PubMed1984

Comparison of a monitored dose with a standard dose of chenodeoxycholic acid for gallstone dissolution.

The ability of chenodeoxycholic acid to dissolve gallstones was compared using different dosage regimens in two groups of 21 patients. The groups were closely matched for patient factors and stone characteristics known to influence the outcome of dissolution treatment. The patients in one group received a standard dose of chenodeoxycholic acid (15 mg/kg/day) taken at mealtimes. The patients in the second group received a bedtime dose of chenodeoxycholic acid which was sufficient to result in a proportion of this bile acid of 70% in the bile acid pool. This dose was monitored using serum bile acid profiles and varied within this test group (range 5.1-13.9 mg/kg/day). The number of patients whose stones completely dissolved in 12 months was similar in the standard-dose (7 of 21) and monitored-dose (8 of 21) groups. These results suggest that a bedtime dose of chenodeoxycholic acid, which is monitored to produce a level of 70% chenodeoxycholic acid in the biliary bile acid pool, is lower than the standard dose taken after meals but is of comparable efficacy. Lower dosage has the advantage of reducing costs and side effects from the drug, although serum bile acid profiling increases the cost of treatment.

Adult↗
PubMed1984

The cholesterol saturation of bile and its reduction by chenodeoxycholic acid in massively obese patients.

Massively obese patients are at high risk for developing cholesterol gallstones. The objectives of this study were to determine the influence of massive obesity on the cholesterol saturation of bile, and to examine the effect of massive obesity on the ability of chenodeoxycholic acid to decrease biliary cholesterol saturation. Gallbladder bile collected at surgery from massively obese patients was significantly more saturated with cholesterol than bile from non-obese patients who were matched for age, sex and gallstone status (P less than 0.01). Median biliary cholesterol saturation index values for groups of subjects were: no gallstones-not obese (0.83); no gallstones-obese (1.14); gallstones-not obese (1.08); gallstones-obese (1.37). Furthermore, a 5-week course of chenodeoxycholic acid (6 mg/kg/day) was less effective in reducing biliary cholesterol saturation in massively obese patients. The bile of 4 of 10 obese patients remained supersaturated, compared to only one of 10 non-obese patients. These results indicate that biliary cholesterol saturation is raised in massive obesity and that in this condition, the biliary lipid response to chenodeoxycholic acid is diminished. This may explain why obese patients have a relatively poor response to gallstone dissolution therapy with this bile acid.

Adult↗
PubMed1984

The nutritional knowledge scores of morbidly obese patients selected for gastric bypass surgery.

Repeated attempts at weight-reduction might be expected to coincide with an increase in nutritional knowledge. In this study a 30-item multiple choice test was used to compare the nutritional knowledge of 50 morbidly obese patients, selected for gastric bypass surgery, to that of 50 hospital control subjects prospectively matched for age, sex, educational experience, and socio-economic status. Morbidly obese patients knew less about general nutrition than subjects in the control group (P less than 0.005). In addition there was no significant correlation (rs = 0.10, n = 24) between the amount of weight lost one year after surgery and the nutritional knowledge scores. It seems that whilst morbidly obese patients have a relatively poor level of nutritional knowledge, this finding cannot be related to the extent of weight loss after gastric bypass surgery.

Adult↗
PubMed1983

Patient well-being after gastric bypass surgery for morbid obesity.

The physical and psychosocial consequences of gastric bypass surgery were observed in 30 morbidly obese patients. Twenty-seven of these patients were satisfied with the results of surgery. Satisfaction was associated with improved health, a better self-image, and greater social activity. Dissatisfaction occurred when an appreciable amount of weight was not lost, or when the patient's expectations about the results of surgery were unrealistic.

Adult↗
PubMed1983

Chemical and physical properties of gall stones in South Australia: implications for dissolution treatment.

Of 406 consecutive patients with gall-bladder stones, 387 were treated by cholecystectomy and 19 were treated with chenodeoxycholic acid. The gall stones found in 356 of the 387 patients at operation were analysed chemically for cholesterol and calcium, physically for number, size, and mass, and radiologically before cholecystectomy for stone lucency. Gall stones rich in cholesterol (greater than 80% by weight) were present in 75% of patients, while pigment stones (less than 25% cholesterol) were found in 12% of patients. Out of the 406 gall-stone patients, 77 (19%) had functioning gall bladders which contained radiolucent stones 1.5 cm or less in diameter, thereby fulfilling the criteria which are used by most clinicians in selecting patients for dissolution therapy of cholesterol gall stones. The stones of 61 of these patients were available for chemical analysis and 52 (85%) were rich in cholesterol. Using the more stringent criterion for stone size of 1 cm or less in diameter, only 11% of patients had stones suitable for dissolution treatment. Taking into account other factors such as lack of compliance with treatment, obesity, and calcium salts in gall stones, it appears that no more than 10% of gall-stone patients presenting to a general hospital could be successfully treated with chenodeoxycholic acid.

Adult↗
PubMed1983

Effect of synthetic oestrogens and progestagens in oral contraceptives on bile lipid composition.

The prevalence of cholesterol gall stones in young women has increased since the introduction of oral contraceptives. The synthetic female sex hormones used in these preparations, increase the degree of cholesterol saturation in bile. To determine whether oestrogens, progestagens, or both, are responsible for the change in biliary cholesterol saturation index, a prospective randomised, controlled study was performed. A significant increase in the cholesterol saturation index of bile was observed when either 30 micrograms ethinyloestradiol plus 150 micrograms norgestrel (p = 0.01) or 50 micrograms ethinyloestradiol plus 250 micrograms norgestrel (p less than 0.01) were ingested daily for two months. No change in the cholesterol saturation index was observed when 30 micrograms ethinyloestradiol alone, or 30 micrograms ethinyloestradiol plus 2.5 mg norethisterone were used. The mechanism for the increase in cholesterol saturation index did not appear to involve bile acid metabolism. These results indicate that the progestagen, norgestrel, and not as previously thought the oestrogen, ethinyloestradiol, is responsible for the increase in cholesterol saturation of bile which accompanies the use of oral contraceptives.

Adult↗
PubMed1983

Chenodeoxycholic acid administration monitored by serum bile acid profiles: a dose-response study.

Serum bile acid analysis was used to monitor the bile acid composition of bile in 16 healthy male volunteers before and during the oral administration of different doses of the gallstone-dissolving bile acid, chenodeoxycholic acid. Daily chenodeoxycholic acid ingestion increased the percentage of this bile acid in bile to a new steady-state level after two to three weeks. Doses of 125, 250, 500, and 750 mg/day significantly increased the proportion of chenodeoxycholic acid in bile from 41% to 55, 61, 78, and 79%, respectively, during the fourth week of ingestion. The results indicate that useful information concerning chenodeoxycholic acid-induced changes in the bile acid composition of bile can be obtained solely by serum bile acid analysis, and bile collection by duodenal intubation can be avoided.

Adult↗
PubMed1983

Cholesterol crystal formation and growth in model bile solutions.

Cholesterol monohydrate crystal formation was studied in supersaturated model bile solutions, containing unlabeled cholesterol, sodium cholate and soybean phosphatidylcholine, and tracer amounts of [3H]cholesterol. Solutions were either seeded with cholesterol crystals to initiate growth, or not seeded to allow self-nucleation and subsequent crystal growth to occur. Crystal growth at 37 degrees C was measured by two methods. First, radioactive cholesterol crystals were isolated by filtration, and the mass of cholesterol that had precipitated was calculated. In unseeded solutions, there was a long lag period before crystal growth was detected. This lag time was decreased by increases in the cholesterol concentration, temperature, and lipid concentration. In seeded solutions, crystal growth also was dependent on the cholesterol concentration, temperature, and lipid concentration. The second method used to measure crystal growth involved the Coulter Counter. At 37 degrees C, reproducible results were not obtained using unseeded solutions due to blocking of the counter aperture with large crystals. In seeded solutions, crystal growth could be measured as an increase in total particle volume. However, comparison of growth rate estimates from the Coulter Counter with those obtained radiochemically revealed poor agreement between the two methods. It is probable that the Coulter Counter is inaccurate in measuring the volume of cholesterol monohydrate crystals due to their anisometric shape.

Bile↗
PubMed1981

The effect of topical povidone-iodine on the incidence of infection in surgical wounds.

A randomized stratified clinical trial of topical povidone-iodine in 627 patients undergoing abdominal procedures demonstrated a reduction in postoperative wound sepsis in female patients, in patients receiving subcutaneous low dose heparin and during the first quarter of the trial when the infection rate in control subjects was high. Overall, there was no significant reduction in wound sepsis after administration of povidone-iodine due mainly to a high infection rate in povidone-iodine treated male appendix operations where, by chance, there was an increased incidence of contamination with Bacteroides fragilis. Postoperative stay in those developing wound infection was significantly reduced in the povidone-iodine group. This is considered as indirect evidence for a decrease in severity of wound infection.

Adolescent↗
PubMed1981

Use of peroperative cefoxitin to prevent infection after colonic and rectal surgery.

A double-blind, controlled trial was performed to assess the effect of a short intraoperative course of Cefoxitin, a new broad spectrum cephamycin antibiotic, on the incidence of septic complications following elective colonic and rectal surgery. In addition to a two-day preoperative bowel preparation, patients entered in the study received a short course of either Cefoxitin (three 2g intravenous bolus doses at two-hour intervals, the first before skin incision) or a matching placebo. Thirty-two patients received Cefoxitin and 33 patients received the placebo. Postoperative abdominal wound infections developed in one (3%) of the Cefoxitin-treated patients and nine (27%) of the placebo-treated patients. This difference is statistically significant (p = 0.01). Septic complications remote from the abdominal wound, e.g. intra-abdominal abscesses, occurred in both Cefoxitin-treated and placebo-treated patients, but numbers were too small for meaningful analysis. The study shows that even a very short peroperative course of Cefoxitin is highly effective in reducing postoperative abdominal wound infections after elective colorectal surgery.

Adult↗
PubMed1981

Precision and accuracy in the measurement of the cholesterol saturation index of duodenal bile. Lack of variation due to the menstrual cycle.

The reproducibility of measurement of the cholesterol saturation index of duodenal bile has been investigated in 5 healthy male and 10 healthy female volunteers. Two possible causes for variation in the saturation index were examined. First, the precision of the assays for cholesterol, bile acids, and phospholipids was such that after replicate analysis of eight individual bile samples, analytic variation produced cholesterol saturation index values which covered a mean range of 0.09 +/- 0.01 (SEM). Secondly, biologic variation was observed in all volunteers when eight duodenal bile samples were collected on different days over a 1-month period. Biologic plus analytic variation accounted for large fluctuations in the biliary cholesterol saturation index, covering a mean range of 0.32 +/- 0.05 (SEM). The magnitude of both types of variation was the same for men and women and was not related to physiologic changes in sex hormone levels during the menstrual cycle. After allowing for analytic variation, the cholesterol saturation index of duodenal bile accurately reflected that of gallbladder bile when collected at the same time from gallstone patients at operation.

Adult↗
PubMed1980

Treatment of gallstones by chenodeoxycholic acid.

Twenty-three patients with radiolucent gallstones in a functioning gallbladder were treated by orally administered chenodeoxycholic acid (750 mg/day) for periods ranging from six to 24 months. Complete dissolution of gallstones occurred in five patients, and partial dissolution occurred in four patients--an over-all response of 39%. Side effects of the treatment were minimal. Stone size was the major factor which influenced outcome, as seven of 15 patients with stones less than 1 cm in diameter had a reduction in stone size or dissolution of stones. It is recommended that chenodeoxycholic acid treatment should be reserved for the treatment of patients with radiolucent stones which are less than 1.5 cm in diameter.

Adult↗