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Biomedical subjects

M Hobsley

Publications and source records attributed to M Hobsley.

At least 55 records · Page 3Linked to original sources
PubMed1988

Gastric outlet loss and enterogastric reflux after gastrectomy.

The relationship of gastric secretion in response to a single injection of insulin and in response to a histamine infusion, before and after partial gastrectomy, was analysed in 58 patients. The aspirated gastric juice was corrected for gastric outlet loss and enterogastric reflux. Gastrectomy drastically reduced the stimulated gastric secretion by a similar proportion for the two secretagogues, thereby implying that antral gastrin plays no greater part in one than in the other. Gastric outlet losses were also reduced after gastrectomy, but as a fraction of gastric contents, both gastric outlet loss and enterogastric reflux more than doubled; the possible relationship of these findings to the aetiology of gastric ulcer is discussed.

Duodenogastric Reflux↗
PubMed1988

The dumping syndrome after pancreatoduodenectomy.

Some patients have postoperative nutritional problems after a pancreatoduodenectomy. These problems have been attributed without objective evidence to the partial gastrectomy that is performed at the time of the pancreatoduodenectomy. The dumping syndrome has been implicated, and the results of this study determine, for the first time, the role of the dumping syndrome in pancreatic surgical procedures. Sixty-four dumping provocation tests have been performed upon patients with pancreatic disease or after pancreatic surgical treatment. Three patients had the dumping syndrome, and in eight, the result of the test was equivocal. Results of the present study demonstrate an incidence of dumping syndrome after pancreatoduodenectomy of 10 per cent; however, in none of these patients, was the dumping syndrome a significant problem. There was no instance of the dumping syndrome after pylorus-preserving or duodenum-preserving pancreatectomy. It is concluded that, contrary to previous assumptions, the dumping syndrome does not contribute to long term postoperative problems after pancreatic surgical procedures.

Diagnosis, Differential↗
PubMed1987

Maximal gastric secretion and duodenogastric reflux in patients with gastric or duodenal ulcer and in control subjects.

Maximal gastric secretion was studied in 41 unoperated patients with gastric ulcer, 201 patients with duodenal ulcer, and 122 control subjects. The patients with a gastric ulcer were divided into high, body and prepyloric, according to the site of the ulcer. Both high and body gastric ulcers secreted significantly less than the controls, and the duodenal ulcer patients secreted significantly more. However, the patients with gastric ulcer were older and lighter than the controls and, since these factors are known to influence maximal gastric secretion, the controls and patients with duodenal ulcer were standardized to the mean weight (and age, for the controls) of the gastric ulcer group. After this standardization, there was no significant difference in secretion between the patients with body ulcers and normal controls. Pyloric loss was a similar percentage of maximal gastric secretion in all groups, but duodenogastric reflux was higher in the gastric ulcer group compared to the controls. The mean volume of duodenogastric reflux was greatest in the patients with a prepyloric gastric ulcer. It is commonly accepted that hyposecretion in patients with a gastric ulcer is due to gastritis consequent upon increased duodenogastric reflux. However, in this study, no gastric hyposecretion was evident in the body and prepyloric gastric ulcer groups, both of whom had greater than normal levels of duodenogastric reflux.

Duodenal Ulcer↗
PubMed1987

Comparison of maximal gastric secretion in smokers and non-smokers with and without duodenal ulcer.

Maximal gastric secretion was induced in 122 control subjects (without peptic ulcer) and 201 preoperative duodenal ulcer patients by intravenous histamine acid phosphate (130 nmol/kg/h), and measured as Vg (ml/h) and MAO (mmol/h). In both groups, men secreted more than women, and smokers secreted more than non-smokers. Significant correlations were found between maximal gastric secretion on the one hand, and height, age, and chronic smoking on the other. After standardisation for these factors, including standardisation to zero smoking, the subgroups of the controls no longer differed significantly, as was also the case for the duodenal ulcer patients. Thus, differences in height, age, and smoking habit were sufficient to account for the variation in maximal secretion between individuals in either the control or duodenal ulcer groups. Even after standardisation, however, the duodenal ulcer patients still secreted significantly more than the controls, and therefore, although chronic smoking has been shown to affect maximal gastric secretion, it does not appear to be the sole reason for hypersecretion in duodenal ulcer patients.

Age Factors↗
PubMed1986

Influence of local surgery and radiotherapy on the natural history of pleomorphic adenomas.

We have analysed the interval between first treatment and tumour recurrence in 65 patients with parotid pleomorphic adenomas which had recurred following local excision. Our results indicate that 5 years is an inadequate period of follow-up and that 10-20 years may be more realistic. Radiotherapy given to 17 patients after local excision of their tumours was found to have had no significant advantageous effect in terms of recurrence-free interval either before or following formal parotidectomy or in limiting the ultimate surgery required. Major complications directly attributable to radiotherapy developed in at least 3 of these 17 patients. Malignant transformation of the pleomorphic adenoma has occurred in three patients, two of whom had been subjected to radiotherapy. We advise that caution is exercised in the interpretation of results of local excision and radiotherapy in this disease. In view of the fact that an alternative and apparently superior treatment is available in the form of formal parotidectomy, we urge that this should be universally adopted for the management of both primary and recurrent pleomorphic adenomas.

Adenoma, Pleomorphic↗
PubMed1986

Natural history of patients with recurrent parotitis and punctate sialectasis.

The clinical features of 68 patients (26 children and 42 adults) who suffered recurrent attacks of parotitis and in whom sialography had revealed punctate sialectasis of the affected gland is described. The sex incidence was equal in those patients in whom symptoms commenced during childhood (younger than 15). When symptoms commenced later in life, however, there was a marked preponderance of females (female:male = 7.5:1). Bilateral sialography in 16 patients with unilateral symptoms revealed punctate sialectasis in the asymptomatic gland in 11 (69 per cent) of patients. Neither the presence of the sicca syndrome nor auto-antibodies had a significant predictive value as to the outcome of the disease. Five-year follow-up of 52 patients revealed that 56 per cent of adults and 64 per cent of children had shown spontaneous improvement of symptoms with symptomatic treatment alone. In 40 per cent of adults and 4 per cent of children, however, the persistence or worsening of symptoms necessitated parotidectomy. We believe that these results of conservative management indicate that, at least in the first instance and particularly in children, conservative management is justified and that the use of radiotherapy or steroids (with their attendant morbidity) is unnecessary.

Adolescent↗
PubMed1986

The 15-minute dumping provocation test.

Following gastric surgery, the diagnosis of the dumping syndrome (DS) has never been precise. The importance of diagnosis is not only in deciding management, but also in comparing series of incidences. The mainstay of diagnosis has been the gastric emptying and dumping provocation test (DPT); however it requires expensive equipment and the interpretation of the results is subjective and therefore variable. In 38 DPTs the percentage plasma volume and pulse rate changes, 15 min after the ingestion of 150 ml of hypertonic glucose, were expressed as percentages of the maximum values encountered and summed to form a score. The tests were independently interpreted by the authors and where they disagreed the result was defined as equivocal. The score was used with the symptoms provoked to follow a simple algorithm to divide the patients into those with and those without DS. There were six suffering from DS on our current interpretation; the new method identified all of these. Three tests were positive on the scoring scheme only and on review the interpreters agreed that all of these patients were suffering from the dumping syndrome. An accurate test using only the baseline and 15 min samples is simple, cheap and has definite rules of interpretation; the only laboratory measurement needed is the haematocrit estimation of three blood samples.

Dumping Syndrome↗
PubMed1985

Maximal gastric secretion in smokers and non-smokers with duodenal ulcer.

Sex, stature, age and smoking habits were investigated as possible determinants of maximal gastric secretion in pre-operative patients with duodenal ulcer. Stimulation was by an intravenous infusion of histamine (130 nmol kg-1 h-1) in 201 patients. Men were found to secrete significantly more than women, and smokers secreted significantly more than non-smokers. By multiple regression analysis, height and the total number of cigarettes smoked were found to be significant positive, and age significant negative factors in the magnitude of maximal gastric secretion. Upon standardization for these factors, the differences between the sexes and the smoking groups disappeared. It is suggested that, at least in men, chronic smoking increases maximal gastric secretion, and therefore could have a role in the aetiology of duodenal ulcer.

Age Factors↗
PubMed1985

Effect of cimetidine on gastric secretion and duodenogastric reflux.

In 19 subjects (four controls, one gastric ulcer and 14 duodenal ulcer) maximal gastric secretion was evoked with histamine 0.13 mumol/kg/h (0.04 mg/kg/h) for two to two and a half hours. A slow intravenous bolus dose of 200 mg cimetidine was given at the beginning of the last hour. Gastric secretion was measured before and after cimetidine administration and expressed both as mean acid output (mmol H+/h) and 'pyloric loss and duodenogastric reflux corrected' volume (Vg, ml/h). Mean reduction by acid output was 86%; mean reduction by corrected volume (Vg) was only 64%. The discrepancy, which is significant (p less than 0.01), is caused by a marked increase in duodenogastric reflux after cimetidine.

Adult↗
PubMed1984

Insulin- and histamine-stimulated secretion in relation to recurrence of duodenal ulceration after vagotomy.

Gastric secretion after vagotomy for duodenal ulcer in response to a single injection of insulin and in response to a histamine infusion has been compared in 25 patients with and 56 patients without recurrent duodenal ulceration proven by endoscopy. The lower 95 per cent tolerance limits of the pre-operative ranges of secretion to either insulin or histamine stimulation measured in 81 unoperated patients provided thresholds that separated postvagotomy patients with recurrent ulceration and those without. Neither the ratios, nor the regression line, between secretion in response to each secretagogue provided similar discrimination. In a group of 43 patients who had gastric secretion studies before and after vagotomy the reductions in secretion to below the established 95 per cent tolerance limits of secretion were respectively 60 and 80 per cent of their pre-operative insulin- and histamine-stimulated secretion. The percentage reductions however failed to differentiate asymptomatic patients from patients with recurrent ulceration. It appears therefore that, irrespective of the pre-operative level or of the magnitude of the reduction of secretion, a vagotomy to be adequate must achieve a reduction of secretion to below a threshold level.

Duodenal Ulcer↗
PubMed1984

Surgical excision of first cleft branchial fistulae.

Three patients were studied who had fistulae in the neck derived from the first branchial cleft. Evidence is presented to show that although these fistulae usually pass superficial to the facial nerve they may also pass deep to one or both main divisions of the nerve. We conclude that a formal superficial conservative parotidectomy with full exposure of the facial nerve is the safest operative course when excising these fistulae.

Branchial Region↗
PubMed1984

Lymphomas presenting as lumps in the parotid region.

The clinical and pathological features of 17 patients who had lymphomas of the parotid region are discussed. Although it is in general impossible on clinical grounds to make a pathological diagnosis on clinical examination of a lump in the parotid region, features which are not typically seen in the majority of patients with parotid lumps, but which were present in 11 (65 per cent) of those patients, are emphasized. Multiple ipsilateral and bilateral lumps were seen in 30 per cent of our patients with lymphomas of the parotid region. However, these are statistically more likely to indicate the benign adenolymphoma. Palpable lymph nodes were seen in association with the parotid mass in 53 per cent of our patients. Whereas a clinical diagnosis cannot be established simply by the presence of an enlarged lymph node in association with the parotid lump, we suggest that the probability of the lump being a lymphoma is sufficient to justify biopsy of the lymph node as a first line of treatment. Biopsy of associated palpable lymph nodes enabled the diagnosis to be made in seven out of eight patients subjected to biopsy, and avoided the necessity for parotidectomy in these patients.

Adult↗
PubMed1983

The value of parotid sialography.

One hundred consecutive parotid sialograms were reviewed to assess the clinical usefulness of the technique. In 54 per cent of patients significant information was provided by the sialogram, and in 22 per cent the diagnosis was made on sialographic appearances alone or the findings altered subsequent management. The highest proportion of useful investigations was found in those presenting with bilateral parotid swelling. No significant information was obtained in patients with an isolated lump in the parotid region.

Dilatation, Pathologic↗
PubMed1983

Radical surgery following radiotherapy for advanced parotid carcinoma.

We have reviewed the surgical treatment of 12 consecutive patients with advanced carcinoma of the parotid gland at this hospital. Ten patients received immediate preoperative radiotherapy to a mean total dose (TD) of 4000 cGy (rad), range 2600-6500 cGy. Two patients with recurrent carcinoma had previously been treated with local radiotherapy (TD 6500 cGy) at 1 year and 2 years respectively prior to referral. A radical parotidectomy with block dissection of the neck was performed on all 12 patients. After a follow-up period ranging from 6 months to 8 years, 6 patients have remained disease free including 3 patients who have died from unrelated causes within this period. Three patients have developed local recurrent disease (interval 9 months-3 years), 3 further patients with residual microscopic disease have been observed postoperatively (follow-up interval 6 months-2 years) without developing overt local recurrence.

Adult↗