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Biomedical subjects

M Hobsley

Publications and source records attributed to M Hobsley.

At least 91 records · Page 5Linked to original sources
PubMed1979

Recurrent unilateral swelling of the parotid gland.

The clinical features of 109 patients with recurrent unilateral parotid swelling (24 patients with Sjögren's disease were excluded) have been analysed to explore the best system of management. The cause was definitely a parotid duct calculus in 36 patients, and evidence is presented that the same diagnosis probably applied to another 59 patients. Features suggesting a diagnosis of calculus included age (greater than 29 years); duration of the attacks of pain (less than 24 hours); cessation of salivation on the affected side; and a spurt of saliva heralding the relief of symptoms. Only three patients in the definite calculus group (8.3%) had no physical signs. However, had physical examination not included inspection and palpation of the parotid duct and its orifice from within the mouth 75% of the proven calculi would have been missed. The intraoral and anteroposterior plain radiographs are likely to be helpful, and sialography even more so. A sialographic appearance of a stricture in the main duct with proximal dilatation is usually due to a claculus. It would appear that calculi are the cause of recurrent unilateral parotid swelling (after exclusion of Sjögren's disease) in an overwhelming proportion of patients with this symptom.

Adult↗
PubMed1979

A simple clinical approach to quantifying losses from the extracellular and plasma compartments.

It is possible to estimate the category and volume of lost liquid in patients who have become acutely depleted of body fluids by measuring the haematocrit and plasma protein concentration in venous blood samples. Three recent examples of different categories of loss are presented: plasma loss in pancreatitis, extracellular fluid (saline) loss in paralytic ileus, and mixed plasma and extracellular fluid loss in peritonitis complicating acute appendicitis. Goood clinical results were achieved by infusion of appropriate volumes of either plasma or saline so as to restore the haematocrit and plasma protein concentration to their presumptive basal values.

Aged↗
PubMed1978

Vascular malformations of the parotid region.

Five adult patients with vascular malformations in the parotid region are described. Three of these patients had lumps in the parotid gland clinically indistinguishable from parotid tumours: one had a diffuse swelling of the check, and the fifth had a pulsatile tumour in the deep lobe of the gland. Two patients had a characteristic sign-the lump in the cheek became more obvious, both visually and on palpation, when the masseter muscle was tensed. In 3 of the patients calcified opacities, resembling phleboliths, were demonstrated on plain X-ray examination. This is only the third report of vascular malformations of the parotid region in the British literature; no other report of a pulsating tumour within the parotid gland has been found in a search of the world literature.

Adolescent↗
PubMed1978

The relationship between the rate of gastric emptying and the dumping syndrome.

Following an oral hypertonic glucose challenge, gastric emptying and changes in plasma volume were measured in 15 subjects before and in 36 subjects after a truncal or selective vagotomy with a drainage procedure. The symptoms experienced during the test were noted, and the postoperative patients divided into two groups, (a) 20 patients who experienced dumping symptoms during the test and (b) 16 patients who did not. Gastric emptying was significantly faster and the fall in plasma volume significantly greater in those patients who experienced symptoms after the ingestion of hypertonic glucose than in those who did not, clearly demonstrating that the dumping syndrome is associated with an increased rate of gastric emptying. In addition, there was a significant positive correlation between the rate of gastric emptying and the fall in plasma volume.

Dumping Syndrome↗
PubMed1978

Gastric secretion and basal gastrin concentration in bilharzial hepatic fibrosis.

Gastric secretion and fasting plasma gastrin levels were investigated in 26 patients with bilharzial hepatic fibrosis and 26 controls. The groups did not differ in their basal secretion. When stimulated by intravenous infusion of histamine the maximal acid output in patients with bilharzial hepatic fibrosis was significantly less than in the control group. This was unlikely to be a result of neutralisation by reflux of alkaline duodenal contents as the volumes of reflux were not different from control subjects, but was compatible with a true reduction in gastric secretion as assessed by two-component hypothesis. Neither the lowered gastric acidity nor the liver damage in patients with bilharzial hepatic fibrosis correlated with circulating gastrin. The fasting levels of plasma gastrin in these patients were not different from controls. As in other liver diseases the cause of diminished gastric secretion remains unclear.

Adolescent↗
PubMed1977

Multiseptate hypoplastic gallbladder.

A case is presented of multiseptate hypoplastic gallbladder, which is an extremely rare combination of two congenital anomalies. The patient was diagnosed as having cholecystitis and was relieved of her symptoms following cholecystectomy, even though the specimen did not show evidence of inflammation or calculi. The significance of this is emphasized by reviewing the 5 authenticated cases of multiseptate gallbladder reported in the literature. Awareness of this condition should avoid misinterpretation of cholecystograms.

Adult↗
PubMed1977

Plasma gastrin concentration related to acid secretion during insulin hypoglycaemia.

The release of gastrin by insulin hypoglycaemia was studied in man before and after vagotomy. Completeness of vagotomy was judged by the gastric acid response to the same hypoglycaemia, using several criteria including one that allows for pyloric losses and duodenogastric reflux. A total of 137 tests was performed on 10 subjects. The plasma gastrin concentration was found to rise in the preoperative studies and also in the postoperative studies no matter what type of vagotomy had been performed or what criteria of completeness of vagotomy were used. We concluded that gastrin can be released in response to hypoglycaemia in the absence of the vagus nerve.

Adult↗
PubMed1977

A new interpretation of the insulin test validated and then compared with the Burge test.

A prospective study of 40 patients undergoing proximal gastric vagotomy confirmed the validity of a new interpretation of the insulin test in the early postoperative period (Maybury et al., 1977). Of the 30 patients falling into the group expected to be free from recurrent ulceration (low risk group), none had developed symptoms suggestive of this condition, whilst of the 10 in the contrasting high risk group, 6 have already developed proved recurrences (mean follow-up period 26 months). A further group of 24 patients was studied by performing a peroperative Burge test for completeness of vagotomy and comparing these results with a postoperative insulin test. This study showed that the Burge test, properly performed, is a reliable test of the adequacy of vagotomy. The use of this test has led to a better understanding of the operative technique required to achieve the objective of an adequate vagotomy.

Electric Stimulation↗
PubMed1977

Basal gastric secretion: reproducibility and relationship with duodenal ulceration.

Basal gastric secretion was examined in control subjects, patients with duodenal ulcer, and patients after vagotomy with or without a drainage procedure, not only in terms of conventional indices of secretion--volume, titratable aciditiy, and acid output--but also in terms of the volume corrected for pyloric losses and duodenal reflux (Vg). In all groups, secretion was less in the second than in the first half-hour of a one-hour basal collection. Basal secretion was examined on more than one occasion in non-operated subjects and patients after vagotomy with or without a drainage procedure. In both groups extreme variability in secretion was found from one study to the next, and the variability was the same whether secretion was expressed in terms of conventional indices or VG. It is concluded that such variability is physiological rather than due to experimental errors. Basal secretion was found on average to be greater in duodenal ulcer patients than in control subjects, and, after vagotomy, to be greater in patients with recurrent ulcer than in asymptomatic patients. However, despite all the corrections made, the overlap in the results from the different groups was so great that basal secretion could not be ascribed an aetiological role in the majority of patients with duodenal ulcer.

Duodenal Ulcer↗
PubMed1977

Post-vagotomy insulin test: improved predictability of ulcer recurrence after corrections for height and collection errors.

Insulin stimulated gastric secretion was studied in 74 unoperated duodenal ulcer patients (DUs), (20 women and 54 men). Three indices of secretion were studied--observed volume, acid output, and volume of gastric juice corrected for pyloric loss and duodenal reflux (VG). These three measurements were expressed both as peak secretion and as secretion during the 1/2 to two hour period after insulin, and also both before and after standardisation for height, making 12 different indices in all. From the data a significant correlation between insulin-stimulated secretion and height in DUs was found. A method of standardising each patient's secretion for height is described. We confirm a significantly higher insulin-stimulated secretion in men than in women and show that this difference can be explained by their difference in height. For each of the 12 indices of secretion, the range of secretion for the unoperated subjects was obtained. The same indices were measured in 155 postvagotomy patients, including 33 patients with recurrent DUs, and compared with the ranges of secretion established in the unoperated patients. Responses above the lower 95% tolerance limit of the preoperative range were designated positive and those below negative. The Hollander status was determined. It was found that the least satisfactory criterion was Hollander's (7% false negative and 69% false positive). The best was 1/2-2 VG standardised for height (3% false negatives and 43% false positives). The improvement in predictably was significant at the 0-0005 level.

Body Height↗
PubMed1976

Hypo-acidity of gastric juice in chronic gastric ulceration caused by neutralisation.

Samples of gastric juice were aspirated every 15 minutes from 54 normal subjects and 31 patients with chronic gastric ulcers during a maximal histamine infusion test. The known tendency of patients with gastric ulcers to secrete a less acid gastric juice than that of normal subjects was confirmed. However, the hypo-acidity was related to the extent by which the total ionic concentration was less than the isotonic value of 328 mEq/l. On the assumption that such hypo-acidity was produced by the neutralisation of hydrogen ions by bicarbonate ions refluxing into the stomach from the duodenum, the data were corrected and resulted in a normal estimate of the hydrogen ion concentration in the gastric ulcer group. Independent corrections, according to the sodium content of refluxed duodenal juice, yielded similar results for the volume of gastric juice aspirated. It is concluded that while back-diffusion can explain the hypo-acidity of gastric juice in patients with gastric ulcers, duodenal reflux can explain both the hypo-acidity and the hypotonicity, and is therefore more likely to be the correct explanation.

Adult↗
PubMed1976

Defective bicarbonate secretion in response to duodenal acidification in patients with chronic gastric or duodenal ulceration.

Histamine infusion studies were performed in 54 healthy persons, in 58 patients with duodenal ulcers and in 29 patients with gastric ulcers. The acid load entering the duodenum was estimated by measuring the loss of an intragastric marker, phenol red. The volume of duodenal juice that had refluxed into the stomach and which was aspirated with the gastric juice was estimated by the sodium content of the aspirate. The bicarbonate concentration of the refluxed duodenal juice was calculated from the relationship between neutralisation and total electrolyte concentration, since the reaction of one bicarbonate ion removes two ions from the resultant mixture. The mean bicarbonate concentration of the refluxed duodenal juice in the control group was 116,4 (+/- 9) mEq/1, and the individual bicarbonate concentrations showed the expected dependence on the magnitude of the intraduodenal acid load. The mean bicarbonate concentration in patients with duodenal ulcers was 84,6 (+/- 9) mEq/1, which was significantly lower than in healthy persons. In patients with duodenal ulcers and in those with gastric ulcers, the reflux bicarbonate concentrations were independent of acid load. These results confirm previous reports of an impaired pancreatic bicarbonate secretion in response to duodenal acid load in patients with duodenal ulcers, and indicate a similar response in patients with gastric ulcers.

Bicarbonates↗