Search PubMed⌕ Search

Biomedical subjects

J N Primrose

Publications and source records attributed to J N Primrose.

At least 73 records · Page 4Linked to original sources
PubMed1989

Intravenous oxypentifylline in critical limb ischaemia.

In an open tolerability study, 36 consecutive patients with critical ischaemia of the lower limbs were treated with intravenous oxypentifylline 1, 200 mg daily for up to three weeks. Patients were assessed objectively using a radioisotope limb blood flow technique and a subjective assessment of the patient's pain was made using linear analogue pain scores and analgesia scores. Treatment was well tolerated in 34 patients but was discontinued in two because of significant side effects. Fifty per cent of the remaining patients avoided surgical reconstruction or amputation and were discharged home on oral oxypentifylline. The results of the radioisotope limb blood flow study showed no change following treatment but the pain scores and analgesia scores decreased significantly in the patients who avoided surgical treatment. Intravenous oxypentifylline is usually well tolerated and may be a useful adjunct to the treatment of critical ischaemia where reconstructive surgery is impossible or undesirable. This type of treatment warrants study in a double-blind, placebo-controlled trial.

Administration, Oral↗
PubMed1988

Highly selective vagotomy and duodenal ulcers that fail to respond to H2 receptor antagonists.

A study was conducted to see whether patients with duodenal ulcers that failed to heal in response to H2 receptor antagonists had a higher incidence of recurrent ulceration after highly selective vagotomy than patients whose ulcers healed with these drugs. Between 1977 and 1983, 157 patients had a highly selective vagotomy for uncomplicated duodenal ulcer; in 57 patients the ulcer had failed to heal despite treatment with H2 receptor antagonists (refractory group), 19 patients had developed recurrent ulceration while receiving maintenance treatment, 67 patients had remained healed while taking H2 receptor antagonists but suffered frequent relapses when treatment was stopped, and 14 patients had not been given these drugs before operation. The overall incidence of recurrent ulceration was 6% after two years and 11% after five years of follow up. In the refractory group, however, the incidence of recurrent ulceration was 18% at two years and 34% after five years, whereas the incidence of recurrence was only 1.5% at two years and 3% after five years in patients whose ulcers had healed with H2 receptor antagonists. Resistance to H2 receptor antagonists was not related to preoperative basal or peak acid output but was related to cigarette smoking. Factors associated with recurrent ulceration after highly selective vagotomy were basal acid outputs before and after operation, cigarette smoking, and the surgeon who performed the operation. Duodenal ulcers that fail to respond to H2 receptor antagonists represent a more severe ulcer diathesis, for which highly selective vagotomy is less effective.

Adolescent↗
PubMed1988

A prospective comparison of the effects of placebo, ranitidine and highly selective vagotomy on 24 h ambulatory intragastric pH in patients with duodenal ulcer.

Twenty-four hour ambulatory intragastric pH (24 h IGpH) recording, a highly reproducible technique, was used to compare the effects of ranitidine and highly selective vagotomy (HSV) in 20 patients who had been referred for surgical treatment of duodenal ulcer. The 24 h IGpH was recorded when they were taking either placebo or ranitidine 300 mg at 10 pm, and again 4 to 13 weeks after elective HSV. Median 24 h IGpH and 24 h hydrogen ion activity (24 h [H+]) were calculated for each patient. Median (quartile) 24 h IGpH was 1.4 (1.3-1.6) with placebo, 2.2 (1.8-2.7) after ranitidine and 2.6 (1.8-3.7) after HSV. IGpH was significantly higher after both ranitidine (P less than 0.0001) and HSV (P less than 0.0001) than after placebo, but IGpH after ranitidine did not differ from IGpH after HSV (0.5 greater than P greater than 0.4). HSV reduced 24 h [H+] by a median 68 per cent (quartiles, 47-82 per cent) whereas ranitidine reduced it by only 50 per cent (34-69 per cent, 0.1 greater than P greater than 0.05). The 24 h pH recording was then analysed as two distinct periods; 'daytime' (8 am to midnight) and 'night-time' (midnight to 8 am). HSV reduced daytime [H+] by a median 77 per cent (59-93 per cent) whereas ranitidine reduced it by only 30 per cent (13-45 per cent, P less than 0.0001). HSV reduced night-time [H+] by a median 57 per cent (40-83 per cent) but ranitidine reduced it by a median 92 per cent (78-98 per cent, P less than 0.01). Thus, HSV inhibits gastric acidity more during the day than at night, whereas ranitidine given at 10 pm effectively suppresses night-time acidity but is much less effective in suppressing daytime acidity. However both HSV and ranitidine will heal more than 90 per cent of duodenal ulcers. Hence, contrary to Dragstedt's teaching, suppression of nocturnal acidity is not of crucial importance for the healing of duodenal ulcers.

Adult↗
PubMed1988

Endoluminal ultrasound and computed tomography in the staging of rectal cancer.

Pre-operative staging of rectal cancer might define patients with disease confined to the rectal wall without lymph node metastases, in whom local excision might be appropriate, or patients with extrarectal spread, who might benefit from pre-operative radiotherapy. With these objectives, 36 consecutive patients with rectal cancer were studied by endoluminal ultrasound: 17 of them also underwent computed tomography (CT) of the pelvis. The results were correlated with the findings at operation and subsequent pathological examination. Endoluminal ultrasound correctly predicted invasion of the tumour through the rectal wall in 86 per cent of patients, with a sensitivity of 96 per cent and specificity of 50 per cent, but correctly identified lymph node metastases in only 61 per cent of patients (sensitivity 57 per cent; specificity 64 per cent). CT correctly predicted invasion through the rectal wall in 94 per cent of cases, with a sensitivity of 100 per cent and specificity of 67 per cent and correctly identified lymph node metastases in 70 per cent of patients (sensitivity 25 per cent; specificity 85 per cent). These findings indicate that both endoluminal ultrasound and CT may be helpful in selecting patients for pre-operative radiotherapy. Neither technique, however, can reliably identify lymph node metastases and therefore cannot be used to select patients who would be suitable for local excision.

Aged↗
PubMed1988

Gastrin-producing ovarian mucinous cystadenomas: a cause of the Zollinger-Ellison syndrome.

An ovarian gastrinoma would appear to be an extremely rare cause of the Zollinger-Ellison syndrome. Nevertheless, two consecutive cases of Zollinger-Ellison syndrome seen at our institution each proved to be caused by a gastrin-producing ovarian mucinous cystadenoma. That the ovarian tumor was the source of gastrin production was established by preoperative and postoperative gastrin and gastric secretory studies and by specific immunocytochemistry of the excised tissue. After oophorectomy, each patient was apparently cured of the disease. Ovarian gastrinomas may not be as uncommon as is generally believed and should be considered as a possible cause of the Zollinger-Ellison syndrome in any female patient in whom a primary gastrointestinal or pancreatic tumor cannot be located.

Adult↗
PubMed1987

Preservation of the entire anal canal in conservative proctocolectomy for ulcerative colitis: a pilot study comparing end-to-end ileo-anal anastomosis without mucosal resection with mucosal proctectomy and endo-anal anastomosis.

Mucosal proctectomy with endo-anal pull-through anastomosis (MP + PTA) for ulcerative colitis reduces resting anal pressure and low RAP has been found to correlate with minor leakage of faeces or mucus. Our hypothesis was that conservative proctocolectomy with an end-to-end ileo-anal anastomosis (EEA) would result in higher anal pressure and less leakage. Twelve patients were studied after EEA and 24 after MP + PTA: each was in good health several months after operation. After EEA, maximal RAP decreased from a median 90 cmH2O (60-116 cmH2O) to 70 cmH2O (25-104 cmH2O, P less than 0.01), whereas after MP + PTA maximal RAP decreased from 85 cmH2O (70-125 cmH2O) to 40 cmH2O (22-80 cmH2O, P less than 0.003). RAP after EEA was significantly greater than RAP after MP + PTA (P less than 0.001). The pressure profile of the anal sphincter in the EEA group did not differ significantly from that of the pre-operative group at any point from 6 to 1 cm from the anal verge, and the sphincteric high pressure zone averaged 4 cm in length both before and after operation. After MP + PTA, resting anal pressure at stations 1 to 4 cm from the anal verge was significantly less than pre-operative pressure (P less than 0.001) and the sphincteric high pressure zone was only 3 cm in length compared with 4 cm before operation. Anal squeeze pressures were similar in the two groups of patients. After EEA 11 of 12 patients achieved perfect continence, day and night, whereas after MP + PTA 58 per cent of patients experienced minor faecal leakage (P less than 0.01). These findings suggest that the entire anal canal should be kept intact in the course of conservative proctocolectomy for ulcerative colitis.

Adolescent↗
PubMed1986

Blind total gastrectomy for massive bleeding from the stomach.

The source of massive haemorrhage from the stomach cannot always be identified even with the use of fibreoptic endoscopy and angiography. Six patients with massive, continuing, non-variceal haemorrhage from the stomach are described in whom total gastrectomy was eventually required. Three patients were shown to have bled from submucosal arteriovenous malformations, two from erosive gastritis and one from a vessel in an ulcer at the oesophagogastric junction. One patient died as a result of surgery and another died later of disseminated malignant disease. The functional results in the remaining patients were surprisingly good and rebleeding has not occurred. Total gastrectomy is a satisfactory 'last resort' treatment for life-threatening gastric haemorrhage for which no cause can be found.

Adult↗
PubMed1985

Primary amyloidosis of ureter.

Another case of primary isolated amyloidosis of the ureter is reported; we believe this is the seventeenth such case reported in the world literature. The previous cases are reviewed, and the clinical presentation and treatment are discussed. The importance of distinguishing the condition from transitional cell carcinoma of the ureter is emphasized and a conservative approach to surgical treatment is advocated.

Amyloid↗
PubMed1985

Gastrin and gastric secretion in patients with recurrent peptic ulceration--unexpected correlations.

The role of gastrin in the pathogenesis of recurrent peptic ulceration is not established although it is known that plasma gastrin levels are frequently elevated after vagotomy. This study aims to determine whether there is a relationship between gastrin and gastric secretion in patients with and without recurrent ulceration after surgery for duodenal ulceration (DU). The basal acid output (BAO) in 23 and the peak acid output to pentagastrin (PAOPg) in 10 patients with symptomatic recurrent ulcers after DU surgery were determined along with the BAO and PAOPg in 10 control patients who were asymptomatic following DU surgery. The fasting plasma gastrin was determined in all patients and correlated with the acid output. An inverse correlation was demonstrated between the BAO and plasma gastrin in the asymptomatic patients (p less than 0.05) and the patients with proven recurrent ulcers (p less than 0.01) and there was a direct correlation between the PAOPg and plasma gastrin in the recurrent ulcer group (p less than 0.05) which was not observed in the control group. It is suggested that in a subgroup of recurrent ulcer patients 'G cell hyperfunction' may occur and this may have a role in the aetiology of this condition.

Adolescent↗
PubMed1985

Differences between peptic ulcer and control patients on the basis of the response to secretin.

The secretin injection test is considered a useful adjunct to the diagnosis of gastrinoma, although it may lack specificity. This study determined whether the release of gastrin in response to secretin was different in duodenal ulcer and control patients. Tests were performed on 10 duodenal ulcer patients, 10 normal control subjects, 20 patients asymptomatic after ulcer surgery, of whom 13 had a vagotomy and drainage, 4 a highly selective vagotomy and 3 a vagotomy and antrectomy. The secretin test was also performed in 49 patients with endoscopically proven recurrent ulcers. The surgery performed in this latter had consisted of a vagotomy and drainage in 36, a highly selective vagotomy in 7 and a vagotomy and antrectomy in 6 patients. The basal plasma gastrin level was similar in normal controls, duodenal ulcer patients and patients with vagotomy and antrectomy, both with and without recurrent ulcers. The level was elevated in all the other groups of patients with vagotomy both with and without recurrent ulcer. The plasma gastrin did not change significantly after secretin injection in the normal control or asymptomatic ulcer surgery patients, but rose in the duodenal ulcer patients and all the groups of patients with recurrent ulcer. Most of these increases were validated statistically as were the differences in response between the ulcer and control patients. These results indicate that there are differences in the plasma gastrin response to intravenous secretin between active duodenal ulcer and control patients. This findings may aid our understanding of the pathophysiology of peptic ulcer disease and explains the lack of specificity of the secretin test.

Adolescent↗
PubMed1984

Hyperparathyroidism and hypergastrinemia revisited.

The prevalence of hypergastrinemia was determined in 38 consecutive patients with proved primary hyperparathyroidism. Uncorrected serum calcium levels ranged from 2.6 to 4.0 mmol/L and parathyroid hormone levels from 260 to 8750 ng/L (normal less than 600 ng/L). Preoperative serum gastrin levels were grossly elevated (1000 to 4000 ng/L) in three patients (normal median 63 ng/L; range 30 to 120 ng/L). Two patients were achlorhydric. After parathyroidectomy (adenomatous hyperplasia) in the third patient, the serum gastrin level decreased from 4000 to 3000 ng/L, with a negative response to both a secretin challenge and a meal test. The latter patient was subsequently shown to have an adrenal ganglioneuroma and islet cell hyperplasia, neither containing gastrin, and at 4-year follow-up she still has no symptoms from the hypergastrinemia. Eight patients had a modest hypergastrinemia. Serum gastrin levels returned to normal in three of the four patients after parathyroidectomy. The fourth patient had rheumatoid arthritis, which can be associated with hypergastrinemia. The mean plasma gastrin level before operation (100.3 +/- 26.1 ng/L) was similar to the postoperative value (67.0 +/- 18.5 ng/L). There was no correlation between parathyroid hormone and gastrin levels nor between serum calcium and gastrin levels. The three patients with duodenal ulcers did not have elevated gastrin levels. Therefore it would appear that routine screening of patients with primary hyperparathyroidism adds little to their clinical management.

Adult↗
PubMed1983

Pain provocation test in peptic duodenitis.

Controversy exists as to whether or not duodenitis alone can cause peptic ulcer symptoms. A modified provocation perfusion test has been performed in 10 symptomatic patients with duodenitis confirmed by endoscopy and histology. The test was conducted without the patient being aware of whether 0.1 N hydrocholoric acid, normal saline, or 8.5% sodium bicarbonate was being perfused directly on the area of duodenitis through the endoscopic irrigation cannula at a fixed rate of 10 ml/min for 10 min. The test was also performed in eight patients with dyspepsia alone and in five patients with chronic duodenal ulceration. Intraduodenal infusion of acid reproduced the epigastric pain in all patients with peptic duodenitis and duodenal ulcer patients, including the feeling of nausea in several which was partially relieved by bicarbonate infusion. In patients with dyspepsia but no peptic duodenitis, the symptoms were not reproduced. It would appear that "peptic duodenitis" can cause symptoms and that this "pain provocation test" may prove useful in its diagnosis.

Bicarbonates↗
PubMed1983

The prevalence of gastrinomas in recurrent peptic ulceration.

The prevalence of gastrinomas and the Zollinger-Ellison syndrome is unknown. In order to examine a high risk group of patients, basal and secretin-provoked plasma gastrin levels were determined in 50 consecutive patients, predominantly from the west of Scotland. All had endoscopically proven recurrent peptic ulceration following duodenal ulcer surgery. This resulted in three cases strongly suspected of having a gastrinoma. Further investigations including exploratory laparotomy were unable to demonstrate a gastrinoma in two, but the evidence suggested an occult tumour in one. In this remaining unoperated patient, the serum gastrin returned to normal. The reference range for both basal and secretin stimulated gastrin response and percentage change has been determined in normal control subjects (n = 10) and in primary ulcer patients (n = 20). It is concluded that in this study, gastrinomas had a less than 2 per cent prevalence in patients presenting with recurrent peptic ulceration. As the diagnosis of a gastrinoma changes the surgical approach, conducting screening tests still seems warranted.

Adolescent↗
PubMed1981

A prospective study evaluating preoperative gastric secretion and choice of an operation for duodenal ulcer.

This study tests the hypothesis that vagotomy and antrectomy are better operations than proximal gastric vagotomy in patients with duodenal ulcer who have a hypersecretion of acid. On the basis of gastric secretion tests preoperatively and the peak acid output, patients with duodenal ulcer were prospectively randomized into an ignore acid or tailor to acid group. Those in the ignore acid group had a proximal gastric vagotomy, while those in the tailored group had a proximal gastric vagotomy if the peak acid output was less than 40 milliequivalents per hour and a vagotomy and antrectomy if the peak acid output was greater than 40 milliequivalents per hour. At follow-up study, a mean of 2.1 years, the recurrence rate in the ignore acid group was 13.6 per cent compared with 9.5 per cent in the tailored group. However, in the ignore acid group, the recurrence rate was 30 per cent if the peak acid output was greater than 40 milliequivalents per hour and zero per cent if less than 40 milliequivalents per hour. In the tailored group, the vagotomy plus antrectomy recurrence rate was 12.5 per cent and the proximal gastric vagotomy rate, 7.7 per cent. Proximal gastric vagotomy has an unacceptably high recurrence rate in patients with a hypersecretion of acid, and selective duodenal ulcer operations based upon acid studies preoperatively may be of value.

Duodenal Ulcer↗
PubMed1980

Assessment of the secretin provocation test in the diagnosis of gastrinoma.

The effect of intravenous secretin on plasma immunoreactive gastrin is presumed to improve diagnostic accuracy in patients with a gastrinoma. To investigate this further, the secretin provocation test was performed in control patients (n = 10), patients with a primary duodenal ulcer (n = 10), patients who had previously had surgery for a duodenal ulcer (n = 20), patients with symptomatic recurrent peptic ulceration (n = 50) and 2 patients with a histologically proved gastrinoma. It was found that the secretin test gave a false positive result in 3 out of 10 symptomatic duodenal ulcer patients, 2 out of 20 patients who had had previous duodenal ulcer surgery and were now asymptomatic and 15 out of 50 patients with recurrent peptic ulceration. Both gastrinoma patients had positive secretin tests but there were no obvious criteria that separated the gastrin response of a gastrinoma patient from those with primary or recurrent peptic ulceration. It is concluded that the secretin test is probably of little value in both the screening and the diagnosis of a gastrinoma.

Adenoma, Islet Cell↗
PubMed1979

Aspiration cytology and outpatient excision of breast lumps.

Fine-needle aspiration biopsy was performed in 30 consecutive women with clinically non-malignant breast lumps. All aspirates were shown to be benign on cytology and the lumps were excised under local anaesthetic at the outpatient department. Frozen section and paraffin section histology of the excised lump confirmed the diagnosis. Follow-up at the outpatient department and a postal questionnaire revealed the following wound complications: redness (70%), bruising (55%), and discharge (35%). Outpatient excision of solid breast lumps is a safe, rapid, and economical method of treating non-malignant breast lumps, if it is preceded by an accurate cytological interpretation of a technically satisfactory aspirate.

Adolescent↗