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Biomedical subjects

R M Kirk

Publications and source records attributed to R M Kirk.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1985

Roux-en-Y.

Explore the source record for details and available documents.

Gastroenterostomy↗
PubMed1985

Disseminated infection associated with corticosteroid therapy after transduodenal sphincteroplasty.

Treatment with oral prednisolone appears to have precipitated an episode of ascending cholangitis in an asymptomatic 55-year-old patient. He had undergone a Pólya partial gastrectomy, a cholecystectomy and a sphincteroplasty 19, 6 and 2 years earlier, respectively. The cholangitis was complicated by septicaemia with six different enteric organisms including aerobes and anaerobes. He developed liver and lung abscesses, and an indolent Pseudomonas aeruginosa septic arthritis of both hip joints. The patient eventually made a complete recovery, but required surgical replacement of both hips.

Ampulla of Vater↗
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

Prolonged access to the venous system using the Hickman right atrial catheter.

Seventy-one Hickman catheters were inserted into 63 patients for prolonged access to the venous system. The mean catheter life was 98 days, but despite the long life in situ provided by these catheters only 5 (7%) had to be removed for septic complications. The technique of insertion is described and the subsequent management of these catheters discussed. The management of patients receiving parental nutrition, those undergoing bone marrow transplantation for acute leukaemia, and those having cytotoxic chemotherapy was greatly facilitated by the use of the catheter.

Cardiac Catheterization↗
PubMed1981

Release of vasoactive intestinal peptide in the dumping syndrome.

To determine the effect of gastric surgery on the plasma vasoactive intestinal peptide (VIP) concentration, 13 patients with gastrectomy and seven controls were given an oral hypertonic load (200 ml 50% glucose solution). Blood was taken at intervals during the test for measurement of VIP and blood glucose concentrations and packed cell volume. At the same time observations were made on the occurrence of dumping symptoms and a record kept of the pulse rate. VIP values in the patients with gastrectomy were significantly increased by glucose ingestion, while these did not alter in controls (p less than 0.001). There was a highly significant correlation between the rate of rise in plasma VIP concentration and the rates of rise in packed cell volume (r = 0.85; p less than 0.001) and blood glucose concentration (r = 0.76; p less than 0.01) in patients with gastrectomy. Changes in packed cell volume and blood glucose values and the occurrence of dumping symptoms during the test were significantly different when postoperative patients were compared with controls (p less than 0.001, p less than 0.005, and p less than 0.001 respectively). Furthermore, when the patients with gastrectomy were divided into those without symptoms and those with dumping after meals the latter group showed a significantly greater rise of VIP (p less than 0.05). Despite the increased plasma VIP concentrations observed during dumping, VIP cannot be taken as the sole factor in the pathogenesis of the dumping syndrome.

Aged↗
PubMed1981

The influence of an intact pylorus on postprandial enteroglucagon and neurotensin release after upper gastric surgery.

Upper partial gastrectomy for carcinoma of the gastric cardia or fundus is unavoidably accompanied by truncal vagotomy, so it is orthodox practice to carry out pyloroplasty with this procedure. In order to assess the effect of leaving an intact pylorus in this operation, 21 patients were investigated with an oral hypertonic load (200 ml 50 per cent glucose solution), and blood was taken at intervals during the test, for the ileal gut hormones, enteroglucagon and neurotensin, as well as for measurements of haematocrit and blood glucose. Clinical features of dumping during the test were sought. There were 7 patients with upper partial gastrectomy, truncal vagotomy and an intact pylorus, 7 patients without a pylorus (total or near total gastrectomy) and 7 patients not subjected to gastric surgery. No significant difference was found in any of the measurements between gastrectomy patients with an intact pylorus and those draining through an enterostomy. However, both these groups differed significantly from normal controls in having greater rates of rise and higher peak values of enteroglucagon, neurotensin, haematocrit and blood glucose, together with a more frequent occurrence of dumping symptoms during the test. As the above measurements probably reflect transit of glucose into the small intestine, the findings in this study suggest that leaving an intact unstenosed pylorus is unlikely to lead to gastric stasis following upper partial gastrectomy.

Aged↗
PubMed1981

A trial of total gastrectomy, combined with total thoracic oesophagectomy without formal thoracotomy, for carcinoma at or near the cardia of the stomach.

There is a high incidence of residual tumour in the cut ends following orthodox resections for gastric adenocarcinoma and oesophageal squamous carcinoma at or near the cardia. In the hope of preventing the tragic recurrence of malignant dysphagia in patients who have survived a high-risk operation for its relief, the whole stomach and thoracic oesophagus were resected in 6 patients, establishing continuity using jejunum or colon, with anastomosis in the neck. Of 6 patients, 5 survived the operation. Of 2 followed up for more than 1 year, 1 has survived 5.5 years without recurrence, 1 died after 1 year with no post-mortem evidence of recurrence. This radical operation merits and extended trial in suitable patients.

Adenocarcinoma↗
PubMed1981

Are gastric and duodenal ulcers separate diseases or do they form a continuum?

It is argued that separation of chronic peptic ulcers into gastric and duodenal may be artificial and confuse the search for common factors in their etiology. Differences are often exaggerated by contrasting the extremes of a continuous distribution of ulcers from high gastric lesser curve to duodenal bulb and beyond. Genetic and epidemiological factors appearing to favor one or the other type of ulcer may act by determining the background cellular changes on which ulcers develop. The extent of the mucosal changes may influence the site of ulceration and incidentally the level of acid secretion. Thus ulcers could be driven distally or drawn proximally across the arbitrary boundary of the pylorus.

Duodenal Ulcer↗