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Biomedical subjects

R M Kirk

Publications and source records attributed to R M Kirk.

At least 19 recordsLinked to original sources
PubMed1996

Teaching the craft of operative surgery.

(a) Recent changes in practice and organisation of surgery make it even more important than formerly to focus attention on the acquisition of operative skills. Once the elements of good operative technique are inculcated, the trainees need practice to establish and refine the natural skill patterns that convert competence into mastery. As opportunities to acquire practical operative experience diminish in Britain, we should encourage our future surgeons to spend a period in less affluent countries where there is a heavy workload of predominantly open surgery. At present such periods are too often dismissed as 'experience, not training'. (b) Apprenticeship remains the essential element for acquiring the craft skills. Apprenticeship does not imply merely allowing trainees to watch and assist. They must also perform under supervision while being assisted by the master. (c) Craft workshops are valuable adjuncts for formal instruction and 'hands on' experience as a preliminary to continued practice of the skills. They allow the principles of good surgery to be formally stated and reinforced. (d) We do not yet have objective tests of operative skill and should not judge trainees at an early stage, except in their adherence to accepted precepts and by their results. (e) Those of us who are privileged to train the next generation of surgeons should critically assess the standards of our own technique, not just in relation to our surgical success but also to the standards we are passing on to our successors.

Education, Medical, Graduate↗
PubMed1990

The effect of nabumetone and its principal active metabolite on in vitro human gastric mucosal prostanoid synthesis and platelet function.

Nabumetone is a novel non-steroidal anti-inflammatory drug (NSAID) which although a weak cyclooxygenase inhibitor is converted by the liver to metabolites which are more potent inhibitors of cyclooxygenase. Nabumetone may thus avoid the occurrence of gastric erosion while maintaining its efficacy as an anti-inflammatory drug. We compared the effects of nabumetone and 6-methoxy-2-naphthylacetic acid (6MNA; the principal metabolite of nabumetone) with naproxen and indomethacin on in vitro synthesis of the gastroprotective prostaglandins I2 and E2 by human gastric mucosa. To study the effects of 6MNA on peripheral target tissues the effects of the above NSAIDs on human platelet aggregation and thromboxane A2 synthesis were also studied. Prostanoid synthesis by the human gastric mucosa was inhibited by indomethacin, naproxen and 6MNA (in this order of potency) whereas nabumetone was completely without effect. Platelet aggregation and thromboxane A2 synthesis were similarly inhibited by the NSAIDS (viz. indomethacin greater than naproxen greater than 6MNA greater than nabumetone). These results support the view that nabumetone does not inhibit gastroprotective prostanoid synthesis, whereas its active metabolite 6MNA is an effective inhibitor of prostanoid synthesis in target tissues.

6-Ketoprostaglandin F1 alpha↗
PubMed1988

Reoperative surgery for early complications following abdominal and abdominothoracic operations.

In-hospital mortality was 9.6% in 3000 abdominal and abdominothoracic operations carried out by me or under my care. Intra-abdominal complications developing during the recovery period required reoperation in 141 patients. The decision to reoperate was a clinical one in 97.8%, although investigations were often helpful in localizing the site of the complicating lesion: the mortality in this group was 42.5%. Technical failure at the first operation could be indicated in 46%. Leaks and bleeding were most frequent and carried a high mortality. Patient selection and preparation, and selection of the simplest effective procedure, are not yet capable of being fully assessed in an individual patient.

Abdomen↗
PubMed1986

Could chronic peptic ulcers be localised areas of acid susceptibility generated by autoimmunity?

It is argued that all chronic gastroduodenal peptic ulcers result from localised increase in mucosal susceptibility to acid attack at the interface between a segment of gastroduodenitis and gastric fundus or duodenal mucosa. The site is predetermined by the background mucosal pattern. Changes can occur in the differentiated gastroduodenal mucosa that closely resemble cell population transformations described in embryology and regeneration biology. A second pathological process, gastroduodenitis, may develop that does not of itself predispose to ulceration, but the combination of factors can produce a zone of increased acid susceptibility. These complex changes could be generated by immunologically activated gastroduodenitis. Destructive or stimulatory immune reactions, analogous to those seen in the thyroid gland, could affect the gastrin-secreting G cells and other paracrine cells. The resulting tropic and inflammatory reactions would provide the background for peptic ulceration.

Autoantibodies↗