Search PubMed⌕ Search

Biomedical subjects

M Hobsley

Publications and source records attributed to M Hobsley.

At least 73 records · Page 4Linked to original sources
PubMed1983

Relationship between insulin- and histamine-stimulated gastric secretion before and after vagotomy.

The relationship of gastric secretion in response to a single injection of insulin and in response to a histamine infusion, in unoperated patients with duodenal ulcer was studied before and after vagotomy. The secretion in response to insulin was significantly less than that in response to histamine. The ratio was about 0.7 before vagotomy, and about 0.4 after vagotomy irrespective of the adequacy of vagotomy. Highly significant correlations were obtained between the responses to the two stimuli, both in the unoperated group and in the whole postoperative group as well as in the inadequate vagotomy group, but not in patients after adequate vagotomy. Thus, the proportional differences between individuals in response to insulin were substantially the same as the proportional differences in response to histamine. The algebraic excess of histamine- over insulin-stimulated secretion before vagotomy did not differ from the value after vagotomy. Histamine-stimulated secretion after adequate vagotomy approximated to, but after inadequate vagotomy was greater than the preoperative algebraic excess of histamine- over insulin-stimulated secretion. These results are consistent with a new model of acetylcholine/histamine-receptor relationships. A certain proportion of the parietal cells are insensitive to the vagus but sensitive to histamine; and those sensitive to the vagus are also sensitive to histamine, but only when their vagal innervation is intact.

Adolescent↗
PubMed1983

Influences on the occurrence of dumping syndrome.

A dumping provocation test using 50% of glucose solution labeled with Indium 115 m, was performed on 146 occasions pre- and postoperatively in 85 patients. Dumping elicited by the test was defined by the symptoms produced by the test and various objective measures of dumping. The influence of various factors other than the type of operation on the occurrence of dumping has been studied in detail. The incidence of dumping symptoms induced by the test has shown no significant correlation with age, sex, weight, height, smoking habits, race, dose of hypertonic glucose, and the time elapsed since surgery. However, a significant relationship has been observed between the duration of ulcer symptoms before operation and the occurrence of dumping symptoms induced by the test. The test not only reproduced the symptoms patients had reported after eating ordinary foods, it also helped in eliminating patients with borderline symptoms as our objective measures collectively differentiated three patients from those with the dumping syndrome.

Adult↗
PubMed1983

Is the undeniably palpable liver ever 'normal'?

A study of whether the lower border of the normal liver, if it extended below the costal margin, could be reliably identified by clinical examination was undertaken in 42 patients in whom there was no clinical, biochemical or scintographic evidence of liver disease. Two clinical observers independently agreed that in 10 of these patients the liver extended infracostally. However, scintiscanning demonstrated that 30 patients had livers extending below the costal margin and that 2 of the 10 livers clinically identified did not in fact lie infracostally. Thus whilst the normal liver commonly extended below the costal margin, recognition of this extension by clinical methods occurred no more frequently than would be expected by chance. It is concluded that the confident clinical finding of a liver projecting below the costal margin should suggest that the organ is abnormal.

Adult↗
PubMed1982

The treatment of pleomorphic adenomas by formal parotidectomy.

We reviewed 100 patients who underwent formal parotidectomy. Seventy-two were new patients in whom a parotid lump proved to be a pleomorphic adenoma. Twenty-eight were patients in whom a tumour had recurred after treatment for pleomorphic adenoma by local excision (with or without irradiation) elsewhere. After a follow-up of 1--15 years (median 4 years), there were no recurrences in the primary group but 5 recurrences among the secondary cases. Permanent facial nerve damage was not seen in the primary group, but 11 patients undergoing secondary parotidectomy were left with some permanent facial weakness. Malignant change occurred in 4 patients in the secondary group.

Adenoma, Pleomorphic↗
PubMed1982

Changes in gastric secretion with time after vagotomy and the relationship to recurrent duodenal ulcer.

We studied 29 patients who had gastric secretion tests after a vagotomy for duodenal ulcer. There were 14 patients who developed a recurrent duodenal ulcer during the follow-up period and 15 patients who remained free from recurrence. Insulin-stimulated gastric secretion increased with time in the recurrent ulcer group, but not in the group with a satisfactory outcome. On the basis of our results, post-vagotomy patients could be divided into three groups. The first group had a high secretion immediately after the operation and it remained high. The risk of recurrent ulcer in that group was about 50%. The second group had an initially low secretion which increased with time, and the risk of recurrent ulcer in that group was the same as for the first group. The third group had an early low secretion which did not increase with time and the risk of recurrence in this group was less than 5%.

Adult↗
PubMed1982

Effect of two doses of pirenzepine on histamine-stimulated gastric acid secretion in man.

The effect of two dose-schedules of Pirenzepine (25 mg b.d. or 50 mg t.d.s. during 2 1/2 days) on histamine-stimulated gastric acid secretion was tested in eleven healthy volunteers. Gastric secretory responses were calculated as acid output values and as VG-values (VG = gastric secretory volume corrected for duodeno-gastric reflux and pyloric loss). Stimulated acid output per two hours was reduced with Pirenzepine 25 mg b.d. by 12.5% (n.s.), with Pirenzepine 50 mg t.d.s. by 21% (p less than 0.01). Stimulated VG per two hours was reduced with Pirenzepine 25 mg b.d. by 15.8% (p less than 0.01) and with Pirenzepine 50 mg t.d.s. by 24% (p less than 0.01). Pirenzepine reduces histamine-stimulated gastric acid output to a similar degree as other anticholinergic drugs. Reduction seems to be due to true inhibition of acid secretion and not to altered gastric motility.

Adolescent↗
PubMed1982

Gastric emptying and dumping after proximal gastric vagotomy.

One hundred dumping provocation tests were performed on patients who had had proximal gastric vagotomy without drainage in the pre- and postoperative period. Other than monitoring the symptoms of dumping on test, various other objective criteria, i.e., plasma volume fall, gastric emptying, and blood sugar changes were also measured simultaneously. Whether dumping was assessed clinically or on test, it seemed to be equally prevalent after proximal gastric vagotomy without drainage compared to vagotomy with drainage or partial gastrectomy. Although the pattern of gastric emptying after proximal gastric vagotomy alone was not significantly different from that before operation in those patients who had dumping symptoms on test, the half-life of the emptying were much faster. The plasma volume fall was also significantly greater and blood sugar was rise steeper in these patients. The objective measurements have not only helped in determining the incidence of dumping after proximal gastric vagotomy but have also proved to be of value in categorizing patients with doubtful symptoms and have given some insight into the etiopathogenesis of this syndrome.

Blood Glucose↗
PubMed1980

How accurately can direct and indirect inguinal hernias be distinguished?

An inguinal hernia was clinically diagnosed as direct or indirect by paired surgeons of 134 occasions. When compared with the findings at operation the hernia was correctly diagnosed in 60 of 78 observations when it was indirect and in 33 of 56 when it was direct. The level of accuracy does not warrant continuing the practice of attempting to distinguish one type of inguinal hernia from another.

Adult↗
PubMed1980

Radiological appearances of parotid duct calculi.

A total of 42 patients presenting with recurrent unilateral parotid gland swelling was studied. Plain radiology of 38 patients with proved calculi showed that the lateral view is valueless. The anteroposterior view was positive in 58 per cent, and when coupled with an intrabuccal view 71 per cent of the calculi were radio-opaque. The overwhelming majority of calculi were visible as filling defects on sialography, while in 4 patients an area of narrowing with dilatation of the parotid duct proximal to it represented the site of the calculus. In the remaining 4 patients with the latter sign, repeat sialography showed normal appearances in 2, suggesting that the calculi had passed.

Humans↗
PubMed1980

Thiocyanate as a marker of saliva in gastric juice?

One source of error in gastric secretion studies is swallowed saliva. The possibility that salivary thiocyanate might be used to measure this contamination has been investigated. Thiocyanate concentration was measured in saliva and gastric juice collected simultaneously in 22 duodenal ulcer patients undergoing routine insulin and histamine secretion studies. On stimulation, despite the increase in the rate of gastric secretion this was not matched by an appropriate fall in the concentration of thiocyanate in gastric juice. Moreover, in one-third of the gastric juice specimens, the thiocyanate concentration was greater than in the simultaneous samples of saliva. Thus, contrary to what has been claimed, thiocyanate is present not only in saliva but also in gastric juice. Therefore it cannot be used as a marker of salivary contamination. An adequate marker of this source of error has not yet been found.

Duodenal Ulcer↗
PubMed1980

Use of a provocation test for objective assessment of dumping syndrome in patients undergoing surgery for duodenal ulcer.

It is difficult to assess the incidence of dumping after various operations for duodenal ulcer on clinical grounds alone. An objective assessment of dumping has been made with the help of a provocation test. The test, using 50% hypertonic glucose solution labeled with radioactive Indium 113m was performed on 39 preoperative patients and 107 times on 72 patients after operation for duodenal ulcer. The dumping status of all the patients prior to surgery was asymptomatic after ordinary food as well as on test. Among the postoperative studies the clinical status was asymptomatic in 69, uncertain in 32 and six had dumping symptoms. On the basis of the symptoms on-test, the status was asymptomatic in 61, uncertain in 14 and 32 had dumping symptoms. The objective indices further defined the status as 70 asymptomatics, none uncertain and 37 confirmed dumpers and thereby completely abolished the uncertain group. All the objective measurements of the dumping provocation test have clearly differentiated those patients with from those without dumping symptoms. Patients with dumping symptoms on-test had a significantly greater fall in plasma volume, more rapid rates of gastric emptying and steeper rise in blood sugar after ingestion of hypertonic glucose than did the patients without dumping symptoms on-test.

Administration, Oral↗
PubMed1979

Dysphagia following selective vagotomy.

Progression of dysphagia after vagotomy to the stage of complete obstruction due to a peri-oesophageal fibrotic collar needing operation is a rare event. Review of the 4 such cases previously described, all needing further operation and all after truncal vagotomy, indicates that the oesophageal mucosa was normal on oesophagoscopy and that bouginage appeared to make the condition worse. This paper describes the first patient in whom (a) the vagotomy was selective and (b) no bouginage was carried out before the condition was relieved by a further surgical operation.

Deglutition Disorders↗