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Biomedical subjects

R B Smith

Publications and source records attributed to R B Smith.

At least 397 records · Page 22Linked to original sources
PubMed1975

Serum calcium responses to exogenous secretin.

Increasing attention is being focused on the relationship between gastrointestinal hormones and calcium metabolism. While it is apparent that some relationship does exist, the exact nature and significance is as yet undefined. Information regarding the effect of secretin on serum calcium has been both sparse and contradictory. Boot's secretin, 3 units/kg, was given to a group of 44 patients consisting of normal controls and patients with duodenal, gastric, and marginal ulcers; primary hyperparathyroidism; and pernicious anemia. Six serial serum specimens were obtained from each patient at ten-minute intervals for calcium determination by atomic absorption spectrophotometry. Using two-way analysis of variance, no significant changes in postsecretin serum calcium values were observed. It is unlikely that physiologic levels of secretin exert any effect on serum calcium.

Anemia, Pernicious↗
PubMed1975

Percutaneous transtracheal ventilation for anaesthesia and resuscitation: a review and report of complications.

Percutaneous transtracheal ventilation with intermittent jets of oxygen under high pressure has been used for approximately five years. This paper briefly reviews published reports on the use of this technique for resuscitation and during anaesthesia. Complications occurring in the reports reviewed are tabulated. The complications occurring in a series of 80 patients (52 elective prior to anaesthesia and 28 for acute respiratory distress) at the Pittsburgh Eye and Ear Hospital are documented. This includes three detailed case reports. No deaths and few serious complications have so far been reported, particularly with the elective use of transtracheal ventilation. This technique has established itself as an important adjunct in life support. When used in properly selected cases, its continued use appears justified.

Adolescent↗
PubMed1975

Retroperitoneal renal transplantation in young children.

Children with urologic causes of renal failure constitute an increasing percentage of patients requiring transplantation. Two children weighing less than 20 Kg. underwent successful transplantation despite multiple previous intra-abdominal procedures. The retroperitoneal technique employed for these patients is described and its advantages emphasized.

Child↗
PubMed1975

Selective distal splenorenal shunt for bleeding esophageal varices.

The selective distal splenorenal shunt has been shown to be equally as effective as total portal-systemic shunting procedures in the control of variceal hemorrhage and it can now be performed with an equivalent operative mortality. It is superior to other shunts in metabolic aspects and results in a markedly decreased incidence of postoperative hepatic encephalopathy. Massive ascites constitutes a definite contraindication to the selective distal splenorenal anastomosis, but for all other suitable patients this procedure appears to be the optimal method of surgical management at this time.

Angiography↗
PubMed1975

Serial insulin tests over a five-year period after highly selective vagotomy for duodenal ulcer.

Twenty-one patients underwent serial insulin testing, approximately 1 week, 1 year, 3 years, and 5 years after highly selective vagotomy (HSV) for duodenal ulcer (DU). They were thought to be representative of the much larger number of patients who have undergone HSV for DU in Leeds. The results obtained were compared with the responses to insulin of 40 other DU patients who were tested before HSV. Before operation, all tests were positive in the 1st hr after insulin ("early-positive") by Hollander's criteria and the mean peak acid response to insulin after subtraction of basal acid output (PAO1) was 33 mEq per hr. One week after HSV, all 21 tests were negative and mean PAOI was 0.05 mEq per hr. One year after HSV, 62% OF 21 tests were Hollander-positive and PAOI had increased significantly (P less than or equal to 0.001) to a mean of 2.3 mEq per hr. Three years after HSV, 15 of 17 tests (94%) were Hollander-positive and mean PAOI was 3.1 mEq per hr (0.1 greater than or equal to P greater than or equal 0.05, compared with PAOI at 1 year). Five years after HSV, 65% of 20 tests were positive and mean PAOI was 3.5 mEq per hr, a significant increase (P less than or equal 0.05) compared with PAOI at 1 year. Only 2 patients (10%) had consistently negative insulin tests over the 5-year period and neither of them was tested 3 years after operation. Thus, HSV was found to abolish consistently the acid response to insulin soon after operation, but on serial testing 90% of the patients eventually developed positive responses to insulin by Hollander's criteria. Most of the acid responses to insulin after HSV were small and the mean reduction in PAOI 5 years after compared with PAOI before operation is approximately 90%. The positive responses to insulin in the long term after HSV could be due to vagal nerve regeneration or to other causes. After a mean period of follow-up of 5 years (range 3 1/2 to 6 1/2 years), only 1 of the first 100 patients who were treated by HSV for DU in Leeds has so far developed recurrent ulceration. The findings of a positive response to insulin by Hollander's criteria more than 1 year after HSV appears to have no prognostic significance.

Duodenal Ulcer↗
PubMed1975

The significance of elongation and angulation of the carotid artery: a negative view.

Many authors have postulated that angulation of the carotid artery is a cause of stroke and recommend corrective operation. Symptoms attributed to such lesions are often nebulous and unrelieved by the operation, and proof is lacking that unselected patients who have this condition have a risk of stroke exceeding operative risk. A review of 282 cerebral angiograms showed an incidence of elongation and potential angulation of 43 percent in children and 20 percent in adults. Acutal angulation was not found in children, however, and no child was suspected of having cerebral ischemia. Of 47 adults with potential angulation, 17 were suspected of having cerebral ischemia, the remainder having a variety of other lesions, such as tumors, aneurysm, and intracranial hemorrhage. Of the 17 having suspected cerebral ischemia, all had alternative explanations for their symptoms (hypertension, intracranial atherosclerosis), except one whose symptoms were completely inappropriate to the carotid distribution. A single patient had a completed stroke, demonstrable angulation, and only mild hypertension. Elongation and potential angulation of the carotid artery is common but usually coexists with other lesions. If the finding is postulated as the cause for neurologic morbidity the surgeon must be assured that symptoms are clearly neurologic, that no other cause exists, that angulation reduces the carotid lumen significantly and reproduces symptoms, and that the risk of operation is less than the expected risk of stroke in untreated patients.

Adolescent↗