Search PubMed⌕ Search

Biomedical subjects

R Dick

Publications and source records attributed to R Dick.

At least 127 records · Page 7Linked to original sources
PubMed1985

Biliary sequelae of endoscopic sphincterotomy.

Twenty five patients were reviewed a mean of 36 months after successful endoscopic sphincterotomy for the removal of bile duct stones. All the patients had improved symptomatically but 20% had episodes of mild abdominal pain and a similar number had elevated serum gamma glutamyltranspeptidase activities (up to 3 times normal). In 12 patients (50%) biliary gas was demonstrated indicating reflux of duodenal contents. Clinical cholangitis did not occur. Aspiration liver biopsy revealed mild portal tract fibrosis and inflammation in patients with biliary reflux. Biliary reflux was significantly associated with mild upper abdominal pain (P less than 0.05). This study has shown that mild abnormalities of biliary function persist after endoscopic sphincterotomy. The long term consequence of these changes is unclear.

Adult↗
PubMed1985

Isotope phallogram: preliminary communication.

The isotope phallogram is an investigation which uses radioisotope-labelled red cells in the imaging of penile arterial blood flow. In a preliminary series of 12 impotent patients undergoing both internal iliac arteriography and isotope phallography, the penogram index described by Fannous et al. (1982) has been modified to derive an accurate indicator of vascular disease.

Arteries↗
PubMed1985

The portal system.

Explore the source record for details and available documents.

Angioplasty, Balloon↗
PubMed1984

Percutaneous transhepatic endoprosthesis for bile duct obstruction. Complications and results.

Sixty-two patients with bile duct obstruction were referred for the percutaneous transhepatic insertion of an endoprosthesis. This procedure was successful in 53 of the 62 patients. Insertion was possible through 28 of 30 periampullary obstructions, but only through 19 of 26 at the hilum. Eighteen patients suffered complications, but in only 3 cases were these serious, including two procedure-related deaths. Bile duct obstruction was relieved completely in 34 of 46 patients with planned long-term drainage, and was partially relieved in 8 patients. The survival of 40 patients with malignant disease was poor, but none of the 6 patients with benign stricture has died. In 7 of 20 long-term survivors, the endoprosthesis eventually became partially or totally blocked. This technique is an alternative method of relieving itching and jaundice in patients with irresectable tumors or poor operative risk. In patients with benign stricture, the early results are encouraging, but longer follow-up is necessary to evaluate this therapeutic approach.

Adult↗
PubMed1983

Controlled trial of propranolol for the prevention of recurrent variceal hemorrhage in patients with cirrhosis.

We conducted a prospective randomized trial of propranolol for the prevention of recurrent variceal bleeding in 48 patients with cirrhosis of the liver. During a follow-up period of up to 21 months, 12 of 26 patients in the propranolol group and 11 of 22 in the control group had rebleeding from esophageal varices. There was no significant difference in rebleeding between the two groups. This contrasts with a previous report of the efficacy of propranolol in preventing recurrent gastrointestinal bleeding in alcoholic cirrhosis. The difference in results may be due to the inclusion in our study of patients with other causes of cirrhosis and more severe liver disease. Propranolol may not be indicated for the prophylaxis of variceal rebleeding in such patients, and we advocate that its use be limited at present to controlled clinical trials.

Adult↗
PubMed1983

The effect of ranitidine on the plasma clearance and hepatic extraction of indocyanine green in patients with chronic liver disease.

Since hepatic clearance of ICG is reduced by H2-receptor antagonists in normal subjects, it has been suggested that they reduce liver blood flow. We have studied the effect of intravenous ranitidine on ICG clearance in twelve patients with chronic liver disease. Wedged and free hepatic venous pressure were measured before and after intravenous ranitidine in nine of the patients, and the hepatic extraction of ICG was determined in six patients. ICG clearance fell by 22 +/- 11% (s.e. mean) 60 min after ranitidine. In patients in whom ICG clearance fell after intravenous ranitidine the hepatic extraction of ICG was also reduced. There was no significant change in the gradient between wedged and free hepatic venous pressure after ranitidine. It is therefore unlikely that ranitidine lowers liver blood flow.

Adolescent↗
PubMed1983

Randomised, controlled study of transhepatic obliteration of varices and oesophageal stapling transection in uncontrolled variceal haemorrhage.

Percutaneous transhepatic obliteration and surgical stapling transection of the oesophagus with the EEA gun were compared prospectively in the treatment of uncontrolled oesophageal variceal haemorrhage unresponsive to conservative measures. Twenty patients with cirrhosis, with a patient portal vein and who were considered suitable for general anaesthesia and surgery, were randomised to two treatment groups (10 patients each). Immediate arrest of haemorrhage was achieved in 17 patients (nine surgery, eight obliteration). In one other patient, stapling transection succeeded where attempted transhepatic obliteration failed, and in another patient obliteration succeeded where attempted transection had failed. One patient continued to bleed and died following attempts at both procedures. Two other patients also died in hospital, without rebleeding following surgery. Variceal rebleeding during the same hospital admission occurred in two patients in the obliteration group and in none after surgery. Oesophageal stapling transection compares very favourably with a non-surgical technique such as transhepatic obliteration of varices in the emergency treatment of uncontrolled variceal haemorrhage in patients with moderate liver failure.

Adult↗
PubMed1983

Nephrotoxicity of ionic and non-ionic contrast material in digital vascular imaging and selective renal arteriography.

We assessed the nephrotoxicity of ionic and non-ionic radiocontrast material (CM) in two groups of patients in a prospective study. One group of 25 potential live kidney donors was studied following conventional renal angiography, carried out as part of the routine pre-operative assessment. The other group of 49 renal transplant patients with varying degrees of renal impairment was studied following digital vascular imaging carried out for investigation of hypertension. Plasma creatine, urinary N-acetyl-D-glucosaminidase (NAG), urinary microglobulin (B2M) and urinary protein excretion were measured before and after the imaging procedure. There were no significant changes in these parameters following digital vascular imaging, but there were increases in plasma creatinine (p less than 0.005) and urinary NAG creatinine ratio (p less than 0.002) in the conventional angiography group following the procedure. Substantial proteinuria developed in 35% of patients following conventional angiography. The differences in nephrotoxicity of radiocontrast agents during the two procedures could not be accounted for by the dose of material used, but probably reflect the effect of differences in the route of administration on the maximal concentration of the material reaching the kidney. Non-ionic radiocontrast material proved less toxic than ionic and may be preferable in conventional angiography.

Acetylglucosaminidase↗
PubMed1983

[10 cases of retrosternal colonic esophagoplasty for caustic stenosis of the esophagus in children].

This study is the authors' account of their experience of oesophagoplasty with the colon carried out among children in an african population. From 1978 to 1982, they performed 10 substernal intrathoracic transplantation of the colon to replace accidentally strictured oesophagus. The stricture in all cases is one to swallowing of corrosive substance, basic products (potassium lye and locally made bases) in half of the cases and battery acid in the other half. Follow-up has been between 9 months and 5 years. The results are as follows: In the immediate postoperative period there were: -- 1 death after surgery due to anesthetic error, -- 6 complications : -- 4 upper (cervical) anastomotic leakage, -- 1 incomplete stricture of the cervical anastomosis, -- 1 temporary dumping syndrome, -- 1 purulent pleurisy and parietal abscess; -- 3 cases without any complications. Before discharging the patients from the hospital, the functional results were evaluated on clinical features (quality of the deglutition, weight increase) and radiographically by a barium swallow (permeability of the colon transplant); these results were satisfactory. Long term follow-up was possible in 4 children (one monthly for the first 6 months, then once every 3 months for 6 months). Follow-up was less regular for the remaining 5 children. Except for a case of recurrent stricture of the cervical anastomosis which required reoperative surgery, normal deglutition was restored in all the patients, as was confirmed by a barium meal and a satisfactory weight gain.

Adolescent↗
PubMed1982

Radiological patterns of cortical bone modelling in women with chronic liver disease.

The pattern of cortical bone modelling in healthy and diseased populations can be derived from simple measurements taken from radiographs of tubular bones. To determine the pattern of bone modelling in women with chronic cholestatic and parenchymal liver diseases, these parameters have been measured in 83 women with primary biliary cirrhosis (PBC), 34 with steroid-treated chronic active hepatitis (CAH) and 27 with parenchymal liver disease (PLD) not treated with corticosteroids. Bone modelling profiles have been compared in these groups with expected pattern in healthy females. Abnormal bone modelling occurs in all three groups. In PBC, cortical thinning is progressive from the fourth decade onwards. In steroid-treated CAH, an initial increase in cortical thickness is observed in the third and fourth decades, after which cortical thinning occurs. In the PLD group, progressive loss of bone cortex is present from the fourth decade onwards. In all forms of liver disease, cortical thinning results from widening of the medullary cavity rather than resorption of the cortical surface.

Bone Diseases↗
PubMed1982

Vitamin D, hydroxyapatite, and calcium gluconate in treatment of cortical bone thinning in postmenopausal women with primary biliary cirrhosis.

Women with primary biliary cirrhosis malabsorb calcium, phosphate and vitamin D, and develop accelerated cortical bone thinning. We have assessed the value of parenteral vitamin D, oral hydroxyapatite (HA), and calcium gluconate (CG) in the treatment of cortical bone thinning in primary biliary cirrhosis. Sixty-four postmenopausal women with primary biliary cirrhosis were assigned randomly into three groups: one group receiving no mineral supplements (control), one group receiving HA, and one group receiving CG. All patients received parenteral vitamin D2 (100,000 IU monthly). Eleven patients withdrew from the study and 10 withdrew due to poor compliance (six HA, four CG). Over a 14-month follow-up period, none of the groups showed a significant change in serum calcium or inorganic phosphate levels. Pre- and posttreatment hand radiographs were used to assess changes in metacarpal cortical thickness using the technique of caliper radiogrammetry. Cortical bone loss occurred in the control group (p less than 0.01). The HA group showed a significant gain in cortical bone thickness (p less than 0.01), while no significant change occurred in the CG group. This study indicated that vitamin D2 does not halt metacarpal cortical bone thinning in primary biliary cirrhosis. The addition of CG prevents bone thinning, and HA promotes positive cortical bone balance.

Bone Diseases, Metabolic↗