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Biomedical subjects

R G Faber

Publications and source records attributed to R G Faber.

At least 37 records · Page 2Linked to original sources
PubMed1978

Gallstone disease presenting as septicaemic shock.

Three patients are described who were admitted to hospital with septicaemic shock due to gallstones, but in none of whom had the presence of gallstones, been diagnosed previously. All 3 had positive blood cultures, Clostridium welchii being isolated in one patient (in another patient this organism was isolated from the bile). Two patients had renal failure requiring dialysis. All 3 patients survived. The management of this serious presentation of gallstones, hitherto poorly described in British literature, is discussed.

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↗
PubMed1977

The efficacy of graduated compression stockings in the prevention of deep vein thrombosis.

The incidence of deep venous thrombosis (DVT) was studied by the 125I-fibrinogen technique in 70 patients who had had major abdominal operations and who were wearing graduated static compression stockings on one leg, the patient's other leg being used as a control. In the whole group 7 patients developed bilateral DVT, 19 patients developed unilateral DVT in the control leg and only one patient developed unilateral DVT in the stockinged leg. The difference between stockinged and control legs was highly significant (P = 0-0003). In the 19 patients with malignant disease the incidence of DVT in the stockinged leg remained significantly less (P = 0-037). It is concluded that graduated static compression stockings do reduce the incidence of postoperative deep venous thrombosis.

Abdomen↗
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↗
PubMed1975

Hypersecretion and length of history in duodenal ulceration.

Maximal gastric secretion, measured by the histamine-infusion test, was, as expected, significantly greater in a group of 81 patients with duodenal ulcer than in a group of 72 controls. After standardising for the effect of stature on maximal secretion, only 24 of the patients were found to be true hypersecretors. However, maximal secretion in the ulcer group increased with length of history of symptoms, and extrapolation back to zero length of history suggested that there was no significant hypersecretion at that time. These facts support the hypothesis that it is the presence of the ulcer that leads to hypersecretion rather than the converse. Possible mechanisms involved are chronic ingestion of antacids to counter dyspepsia, or gastric distension due to pylorospasm.

Adolescent↗
PubMed1975

The predictive accuracy of the postvagotomy insulin test: A new interpretation.

Insulin-stimulated gastric secretion alone, without reference to basal secretion, has been examined in 45 male patients with duodenal ulcer in whom no gastric operation had been performed and in 124 patients following vagotomy for duodenal ulcer. Gastric juice was examined in terms not only of conventional indices, observed volume, titratable acidity and acid output, but also Vg, the volume corrected for pyloric loss and duodenal reflux. The range of secretion of the unoperated subjects was established in terms of peak and half-totwo-hour values for all indices. By reference to these ranges, secretion of postvagotomy subjects could be divided into two groups: (a) those with secretion within the preperative range, and (b) those with secretion less than the lower limit of the preoperative range. The best discrimination was given by Vg; those within the preoperative range (peak Vg in excess of 140 ml/hour and Vg half to two hours in excess of 105 ml/hour) had a 50% liability to recurrent ulcer, while those below the preoperative range had a zero liability to recurrent ulcer. Of the conventional indices acid output gave the best discrimination, which was almost as good as Vg. Peak acid output of 8 mmol/hour or acid output one half to two hours of 525 mmol/hour discriminated into two groups, with a 50% or zero liability to recurrent ulcer. Titratable acidity (Hollander's index of secretion), being highly susceptible to reflux, was not an adequate discriminant.

Chlorides↗
PubMed1975

Stability of insulin-induced gastric secretion after vagotomy.

Gastric secretory response to insulin-induced hypoglycaemia was stuided in 21 subjects following vagotomy and a drainage procedure for duodenal ulcer. Eighteen subjects had one early test, ie, within one month of operation, and at least one late test, ie, six months or more after operation. Seven subjects had at least two late tests. When the insulin test results were expressed in terms of their Hollander status,there was as much variability with time as expected from previous reports. However, when results were expressed in terms of new criteria, decribed in the previous paper, the insulin status of postvagotomy patients remained constant with time.

Drainage↗
PubMed1974

Duodenal reflux during insulin-stimulated secretion.

Insulin-stimulated secretion has been studied in 67 subjects with intact vagi. The relationship between the changes in the concentrations of hydrogen and sodium ions in individual 10-minute samples showed a highly significant negative correlation. In quantitative terms, this correlation could be explained by the mixing of isotonic gastric juice and duodenal reflux but not by back-diffusion. In 37 subjects duodenal juice was labelled with either bromsulphalein (BSP) or indocyanine green (ICG), both dyes being excreted only in the bile. In aspirated gastric juice there were highly significant positive correlations between the concentration of the dye and the concentration of duodenal reflux calculated from a formula based on the output of sodium ions. The volume of duodenal reflux occurring during insulin-stimulated secretion was estimated from the sodium output in normal controls, in preoperative patients with duodenal ulcer, and in patients following vagotomy with or without a drainage procedure. Reflux following gastrojejunostomy greatly exceeded that occurring in all other groups. Reflux following vagotomy with no drainage procedure was less than that in preoperative patients, and in patients in whom pyloroplasty or gastrojejunostomy had been performed.

Duodenal Diseases↗