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Biomedical subjects

K I Bickerstaff

Publications and source records attributed to K I Bickerstaff.

16 recordsLinked to original sources
PubMed1990

Endoscopic sphincterotomy for the palliation of ampullary carcinoma.

Palliative endoscopic sphincterotomy was performed on 17 patients with adenocarcinoma of the ampulla of Vater. An endoprosthesis was inserted immediately after the sphincterotomy in four of the patients. Fourteen patients made uncomplicated recoveries from the procedure and their jaundice resolved completely. Early complications developed in three patients. One patient died from haemorrhage. Two patients, both of whom had an endoprosthesis, developed cholangitis. The endoprosthesis was removed and another inserted in one patient and the other underwent surgery. Both thereafter made uncomplicated recoveries. Jaundice subsequently recurred in eight patients and further endoscopic treatment was successful in five of these patients. Eleven patients died between 4 days and 23 months after the sphincterotomy with a median survival of 12 months. Four patients remain alive between 3 and 17 months after treatment. The results indicate that reasonable palliation can be achieved safely by endoscopic sphincterotomy.

Adenocarcinoma↗
PubMed1989

Endoscopic sphincterotomy for bile duct stones: an institutional review of 272 patients.

The results of the first 283 endoscopic sphincterotomies (ES) attempted in Oxford for bile duct stones are described. Endoscopic sphincterotomy was achieved in 272 patients (96%) and complete duct clearance was achieved in 88% of these patients; an overall success rate of 85%. Complications occurred in 26 patients (10%), five of whom required an emergency laparotomy. Eight patients died within 30 days of ES but only two deaths were attributed directly to the procedure. Although the sphincterotomies were performed by several endoscopists in varying stages of training, the results are similar to those from other large reports. In the last year of the study (1987), 58 patients were referred from within the Oxfordshire District which suggests an annual demand for ES for bile duct stones of 11 patients per 100,000 of population.

Adult↗
PubMed1988

Doppler ultrasonography in the diagnosis of acute scrotal pain.

Pre-operative Doppler ultrasonography was performed on 41 patients who underwent an emergency scrotal exploration because of the clinical suspicion of a testicular torsion. The final diagnoses were testicular torsion in 18 patients, epididymitis in 15 patients and torsion of a testicular appendage in 8 patients. An unequivocal indication as to the presence or absence of a testicular torsion was obtained in 31 patients (76 per cent), an equivocal result was obtained in 5 patients and in 5 patients the examination was unsatisfactory. The sensitivity and specificity of the investigation for the diagnosis of testicular torsion were 67 per cent and 83 per cent respectively, and the predictive value of either a positive or negative result was 100 per cent. Our results suggest that the use of Doppler ultrasonography could reduce the incidence of unnecessary operations without incurring the risk of reduced testicular salvage.

Adolescent↗
PubMed1988

Changing pattern of scrotal exploration for testicular torsion.

A total of 201 urgent scrotal explorations for unilateral painful testis was performed over a six-year period. Seventy-two (36%) testicular torsions were identified. Fifty-seven (79%) testes were salvaged and fifteen (21%) orchiectomies were done. Although the annual number of scrotal explorations increased over the years of study, no benefit in terms of increased testicular salvage could be identified.

Cryptorchidism↗
PubMed1988

Early postoperative endoscopic sphincterotomy for retained biliary stones.

Endoscopic sphincterotomy was attempted on 18 patients with retained biliary stones. Endoscopy was performed within 2 weeks of the operation in 13 patients and within 3 weeks in 5 patients. A T-tube was present in 14 patients and 6 patients had multiple stones. Sphincterotomy and complete duct clearance was achieved in 17 patients (94%) and a complication (haemorrhage) occurred in one patient (6%).

Adult↗
PubMed1987

Splenectomy for massive splenomegaly.

Splenectomy was performed on 47 patients with massive splenomegaly (spleen weight greater than 1.5 kg). With one exception, all patients had a haematological malignancy. The indications for splenectomy were for the diagnosis of unknown cause (n = 5), for the relief of pain (n = 8), as the initial treatment of hairy cell or prolymphocytic leukaemia (n = 8), and for the correction of a haematological cytopenia (n = 26). Splenectomy was completely successful in relieving pain and in establishing a diagnosis, and provided effective palliation in patients with hairy cell and prolymphocytic leukaemia. An immediate correction of a haematological cytopenia was achieved in 24 patients, and the correction was maintained for over 1 year in 11 patients. There were no postoperative deaths and morbidity was acceptably low. We conclude that patients with massive splenomegaly can derive considerable benefit from splenectomy and that massive splenomegaly should not be regarded as a contra-indication to splenectomy.

Adolescent↗
PubMed1983

Effects of resection or bypass of the distal ileum on the lithogenicity of bile.

Changes in the composition and lithogenicity of gallbladder bile after resection and bypass of the distal ileum were investigated in the prairie dog. In animals fed a trace cholesterol diet, both ileal resection and ileal bypass increased the cholesterol saturation of bile. In animals fed a cholesterol-enriched diet, the cholesterol saturation was increased by ileal resection but not by ileal bypass. In the animals fed the trace cholesterol diet, both ileal resection and ileal bypass induced the formation of bilirubinate gallstones.

Animals↗
PubMed1983

Hormonal control of biliary lipid secretion in dogs.

Five dogs were anesthetized, their cystic ducts were ligated, and their common bile ducts cannulated. The experiments were divided into four 1-hour periods. Taurocholic acid (18 mumol/min) and pipenzolate methylbromide (0.5 mg/kg body weight initially followed by 0.1 mg/kg body weight/20 minutes) were infused during all periods. Somatostatin (800 ng/kg/min) was infused during periods 2, 3, and 4 to suppress the endogenous secretion of peptide hormones. During periods 3 and 4, insulin was infused into a mesenteric vein at rates of 0.2 mU/kg/min and 0.8 mU/kg/min, respectively. These rates have been shown to produce fasting and postprandial portal vein insulin levels. Bile was collected during each period and the volume, bile acid concentration, and biliary lipid content were measured. Another five dogs were studied in a similar way, except that glucagon was infused in place of insulin at rates of 0.6 and 3.0 ng/kg body weight/min to produce fasting and postprandial portal vein levels. The results show that 1) the biliary secretion of cholesterol and phospholipid is increased by pharmacologic doses of somatostatin and 2) physiologic doses of glucagon, but not insulin , suppress the biliary secretion of cholesterol and phospholipid.

Animals↗
PubMed1982

Is glucagon a choleretic hormone at physiologic blood levels?

The mechanism of action and possible physiologic implications of glucagon-induced choleresis were investigated in two groups of dogs. Group I demonstrated, in chronic animal models, that glucagon-induced choleresis was not associated with increased bile acid output and was not blocked by somatostatin or Piptal, suggesting a direct stimulatory effect on bile acid-independent canalicular flow. In acute animal models (group II), glucagon infusion at rates which produced postprandial levels in the portal vein induced significant choleresis, implying that glucagon may have a physiologic role in the regulation of bile secretion. No consistent relation between bile secretion and portal venous blood flow could be demonstrated.

Alkaline Phosphatase↗