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R H Bell

Publications and source records attributed to R H Bell.

At least 91 records · Page 5Linked to original sources
PubMed1980

Long-term results of emergency portacaval shunt for bleeding esophageal varices in unselected patients with alcoholic cirrhosis.

A prospective evaluation of emergency protacaval shunt has been conducted in 180 unselected, consecutive patients with cirrhosis and bleeding varices who were operated on between 1963 and 1978. An extensive diagnostic work-up was completed within three to seven hours of admission to the emergency department, and the shunt operation was undertaken within a mean of 7.81 hours. A program of lifelong follow-up was conducted such that the current status of 97% of the patients is known. On each patient, 220 categories of data were collected and entered into a computer program for analysis. On admission, 49% of the patients had jaundice, 53% had ascites, 19% had encephalopathy, 30% had severe muscle wasting and 100% had abnormal BSP retention. Administration of a bolus dose of vasopressin by the systemic intravenous route temporarily controlled the varix hemorrhage in 95% of patients, and emergency shunt permanently controlled the bleeding in 98%. Maximum perfusion pressure in the portal vein prior to shunt did not correlate with survival rate or incidence of encephalopathy after shunt. The operative survival rate was 58%, the five-year actuarial survival rate is 38% and the 12-year actuarial survival rate is 30%. Encephalopathy was observed in 31.5% of the patients, but was severe enough to require chronic dietary protein restriction in only 7%. The portacaval shunt remained patent in 99% of patients. Of the survivors, 48% abstained from alcohol, 60% resumed gainful employment or housekeeping, and two-thirds were judged to be in excellent or good condition after one and five years. Preoperative factors that adversely influenced survival rate were ascites, SGOT >/= 100 units, BSP retention >50%, hypokalemic alkalosis, blood transfusion requirement >/= 5 L, and consumption of alcohol within seven day[unk] of admission. In comparison with our previous prospective studies, emergency portacaval shunt produced a significantly greater long-term survival rate than either emergency medical therapy or emergency varix ligation, followed by elective shunt. During the past four years, 80% of 49 unselected patients have survived emergency shunt, and the four year actuarial survival rate is 69%.

Adult↗
PubMed1980

Prevention by whole pancreas transplantation of glomerular basement membrane thickening in alloxan diabetes.

Serial thickness measurements of the glomerular basement membrane were performed over a 24-month period in four groups of inbred male Lewis rats. Group I consisted of normal animals age-matched to the remaining experimental groups. In groups II, III, and IV, diabetes was induced by intravenous alloxan (42 to 44 mg/kg). Group II was subsequently untreated. One week after induction of diabetes, groups III and IV received vascularized isografts of the pancreas and duodenum or duct-ligated pancreas alone, respectively. Animals in all groups were killed monthly and X 11,000 electron photomicrographs prepared of the kidney. The thickness of the glomerular basement membrane was measured by a quantitative morphometric technique. Untreated diabetic animals developed significant thickening of the basement membrane when compared to normal animals and the differences remained significant throughout life. Animals undergoing pancreas transplantation were completely protected from the diabetic changes in the basement membrane and showed no increase in basement membrane thickness when compared to normal animals. Pancreaticoduodenal and duct-ligated isografts offered equal protection against changes in the basement membrane. All groups showed age-related thickening of the basement membrane; this change was accelerated in the untreated diabetic group and normalized in the transplanted rats.

Animals↗
PubMed1979

The intestinal phase hormone.

The existence of a stimulatory intestinal phase of gastric acid secretion has been suspected, but largely ignored, for many years. Recently, however, it has become clear that the intestinal phase plays an important role in acid production during digestion. The intestinal phase is of additional interest in relation to the profound gastric acid hypersecretion associated with portacaval shunt (PCS). Substantial evidence indicates that PCS-related gastric hypersecretion is due to unmasking of the intestinal phase by hepatic bypass of a humoral stimulant in portal blood that is normally degraded to a considerable extent by the liver. Studies in our laboratory during the past 12 years have provided strong physiologic evidence for humoral mediation of both the intestinal phase of gastric secretion and of PCS-related hypersecretion by a hormone that arises in the small intestine, particularly in the jejunum. Furthermore, our studies have demonstrated that this intestinal phase hormone (IPH) exists in humans as well as in dogs, rats, and pigs. Additionally, recent work by a number of investigators, as well as by our group, has provided convincing evidence that IPH is different from any of the known gastric stimulatory hormones. With these physiologic observations as a background, we have used a classical method for extracting acidic peptides to prepare a hog intestinal mucosa extract (HIME) that has all of the known physiologic properties of an IPH. Specifically, HIME contains a potent stimulant of gastric acid secretion that acts according to a linear dose-response relationship; that is not gastrin in any of its immunoassayable forms; that significantly augments the maximal acid secretory responses to pentagastrin, gastrin, CCK, and histamine; and that is substantially degraded by the liver, in contrast to gastrin and CCK. Efforts at isolating the gastric stimulatory substance in HIME suggest that it is a peptide of low molecular weight. Work directed at isolating IPH in pure form and identifying it is in progress.

Animals↗
PubMed1979

Cyanide toxicity from the thermal degradation of rigid polyurethane foam.

Thermal degradation products (tdp) from a model, rigid polyurethane foam were collected in such a manner as to eliminate carbon monoxide and other gases with low boiling points. The effects in rats resulting from intratracheal intubation (I.T.) of the tdp are discussed. Cyanide was found to be a major factor associated with severe toxic responses of the experimental rats.

Animals↗
PubMed1976

Hepatic transplantation, 1975.

This report reviews experience with 97 patients given liver transplants. We regard out survival statistics as unsatisfactory, but fell they should encourage further work since 22 patients have survived at least one year with a maximum survival of 5 13 YEARS. The Achilles' heel of liver transplantation os bile duct reconstruction. We presently rely upon Roux-en-Y reconstruction, or alternatively, duct-to-duct anastomosis with a T-tube stent. The prime indication for liver replacement is non-neoplastic liver disease, but a favourable malignancy for treatment may prove to be small intrahepatic duct cell carcinomas.

Adolescent↗
PubMed1976

Past experience and future studies with antilymphocyte globulin in recipients of kidney homografts.

We remain convinced that antilymphocyte globulin (ALG) is a potent immunosuppressive agent in humans. For that reason, we have used it in essentially every case of renal transplantation since May of 1966; now, however, we are about to embark on a controlled clinical trial of ALG in kidney transplantation and await with tremendous interest the results of other such trials from other centres around the world.

Antilymphocyte Serum↗
PubMed1975

Hepatic trisegmentectomy and other liver resections.

Trisegmentectomy, extended right hepatic lobectomy, is the removal of the true right lobe of the liver in continuity with most or all of the medial segment of the left lobe. Some important features of the operation have not been well described previously. To perform trisegmentectomy safely, a fusion of liver tissue covering the umbilical fissure at the level of the falciform ligament must first be split open in many patients. The left branches of the portal triad structures are mobilized from the undersurface of the liver nearly to but not into the umbilical fissure. The blood supply and duct drainage of the medial segment originate within the umbilical fissure and feed back toward the right side buried in liver substance. They are found with blunt dissection just to the right of the falciform ligament, encircled and ligated. Failure to appreciate this switch back anatomic arrangement may lead to injury of the blood supply or biliary drainage of the residual lateral segment. Parenthetically, the mirror image operation of lateral segmentectomy could result in devascularization of the medial segment if dissection and ligation were performed within the umbilical fissure instead of well to the left of this landmark. In most trisegmentectomies, the left portion of the caudate lobe is not removed. This small piece of tissue is interposed between the lateral segment and the inferior vena cave into which it drains by small tributaries. If the left portion of the caudate lobe is to be excised, it is necessary to ligate the last two posteriorly running branches before the main left trunks of the portal triad structures reach the umbilical fissure. Once this step is taken and if the caudate removal is completed, the remaining lateral segment usually has only one remaining outflow, that of the left hepatic vein. The other principles of trisegmentectomy are the same as with less radical subtotal hepatic resection. These include vascular suture closure of the main outflow veins, avoidance of parasegmental planes that leave behind a strip of devitalized tissue, preservation of intersegmental or interlobar veins, omission of techniques that sew shut or otherwise cover the raw surface of the remnant and provision of adequate drainage of dead space. After trisegimentectomy and also after true lobectomy, this last objective is usually met by leaving part of the operative incision open. Using these guidelines, there has been no mortality with 27 hepatic resections carried out since 1963, including 14 trisegmentectomies.

Bile Ducts↗
PubMed1969

Mission to Israel.

Explore the source record for details and available documents.

Schools, Dental↗
PubMedDate not supplied

Proximal clavicle excision: an analysis of results.

Medial clavicle excision has been reported by several authors, but few cases are documented, and long-term follow-up information is lacking. The purpose of this study was to examine the long-term results of medial clavicle excision in regard to function, pain, cosmesis, and complications. Fifteen patients ranging in age from 18 to 64 years (average 43 years) were evaluated an average of 4.6 years (range 1 to 14 years) after proximal clavicle excision. The indications for excision were unstable anterior subluxation/dislocation of the sternoclavicular joint (four cases), unstable posterior dislocation (one case), sternoclavicular osteoarthritis (nine cases), and proximal clavicle osteomyelitis (one case). An average of 2.9 cm of the medial clavicle was excised (range 1 to 4 cm). Fourteen of the 15 patients received significant relief of pain. On a strict grading scale four patients had an excellent result, five a good result, four a fair result, and two a poor result. Regeneration of the clavicle appeared to contribute to a poor result. No operative complications occurred. These findings aid our understanding of surgical options and outcome in the treatment of sternoclavicular joint disease.

Adult↗
PubMedDate not supplied

Cholecystokinin-A receptor messenger RNA expression in human pancreatic cancer.

Cholecystokinin (CCK) is a gut peptide hormone known to stimulate postprandial gallbladder contraction and pancreatic enzyme secretion. It has also been shown to induce the growth of normal pancreas and of malignant and premalignant lesions in rodents. Although CCK has been shown to promote the growth of human adenocarcinoma cell lines, its role in the growth of human pancreatic adenocarcinomas in vivo is less clear. Localization of CCK receptors to neoplastic cells within resected human tissue specimens would be suggestive of its potential action as an in vivo promoter of human pancreatic cancer. Resected tissue specimens of pancreatic adenocarcinomas were therefore studied by both reverse transcriptase-polymerase chain reaction (RT-PCR) and in situ hybridization for the presence of CCK-A receptors. Ninety percent of studied tumors demonstrated CCK-A expression by RT-PCR, and this expression was localized to neoplastic cells by in situ hybridization. An increase in the expression of CCK receptors is a mechanism by which pancreatic malignancies may gain a significant growth stimulus.

Adenocarcinoma↗