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Biomedical subjects

R M Watkins

Publications and source records attributed to R M Watkins.

At least 37 records · Page 2Linked to original sources
PubMed1987

Absorptive and motor function of orthotopically vascularized segmental ileal autografts.

In 24 dogs a 100 cm length of terminal ileum was autografted as an orthotopically vascularized Thiry-Vella segment. In six dogs absorption, motility and histology were studied in detail and in two intestinal myo-electrical activity was recorded. At a second operation 5 weeks after autotransplantation the Thiry-Vella segment was returned to its normal anatomical position in the intestinal stream and 2 months later all the non-transplanted intestine was resected. Eighteen grafts were technically successful. Intestinal myo-electrical activity was normal by the second day after transplantation while intestinal transit and contractile activity recovered within 10 days. Mucosal morphology and intestinal absorption had largely recovered by 10 days after grafting but absorption of oleic acid was impaired for 4 weeks. Ten dogs with severe short, bowel syndrome but intact ileocaecal valve were maintained in good health for more than 7 months by a 100 cm ileal autograft.

Animals↗
PubMed1987

Role of computed tomography in selecting patients for hindquarter amputation.

Nine patients with soft tissue sarcomas close to the pelvic girdle and one patient with a primary malignant bone tumour of the pelvis were referred for consideration of hindquarter amputation. Patients were considered unsuitable for hindquarter amputation on clinical grounds if malignant disease infiltrated into the perineum or across the sacro-iliac joint. If disease in the femoral triangle extended above the inguinal ligament the tumour's operability was seriously questioned. Buttock tumours which had passed through the greater sciatic notch to become palpable on pelvic examination were also considered likely to be inoperable. On computed tomographic (CT) examination, tumours were considered inoperable if the psoas muscle was involved above the inguinal ligament, or if malignant disease involved the sacro-iliac joint, sacrum or perineal structures. Soft tissue tumours of the buttock extending significantly through the greater sciatic notch were also considered likely to be inoperable. Five patients thought suitable for hindquarter amputation on clinical assessment had no excluding features on CT; four undergoing hindquarter amputation were proven on histological examination to have good clearance of their tumours. In another patient, considered suitable for hindquarter amputation on clinical grounds, CT suggested that en bloc wide excision of the tumour was feasible enabling the affected limb to be preserved. Four patients after clinical examination were considered unsuitable for hindquarter amputation and in all cases inoperability was confirmed by CT. CT complements clinical examination and provides an objective and reliable means of selecting patients for hindquarter amputation which should avoid unnecessary surgical exploration.

Adult↗
PubMed1987

Segmental small intestinal allografts in the dog. I. Morphological and functional indices of rejection.

Fourteen dogs received an orthotopically vascularized allograft of a 100-cm length of terminal ileum as a Thiry-Vella segment. Absorption, motility, myoelectrical activity and morphology of the allograft were studied to determine the most reliable indices of rejection. The earliest histological evidence of rejection occurred at a mean of 6.2 +/- 0.9 days and was coincident with significant deterioration in the absorption of water, alanine, lauric acid, sodium, and glucose. Intestinal motility did not decrease until 7-8 days after transplantation, and intestinal myoelectrical activity was unchanged for a further 2-3 days, by which time graft necrosis was imminent. Reduced intestinal motility occurs only after rejection is established, and is therefore of little use as an index of rejection, while recording intestinal myoelectrical activity is valueless and serves only to confirm graft death. Decreased intestinal absorption of water, sodium, glucose, alanine, and lauric acid are present as early as the first changes in mucosal histology and are useful indices of rejection of intestinal allografts.

Animals↗
PubMed1987

Segmental small intestinal allografts. II. Inadequate function with cyclosporine immunosuppression: evidence of a protein-losing enteropathy.

Terminal ileum was autografted (24 dogs) or allografted (18 dogs) as a 100-cm Thiry-Vella segment, and absorption, motility, and histology were studied. Dogs with allografts were given cyclosporine (CsA) 20 mg/kg/day. At a second operation 5 to 6 weeks after transplantation continuity of the nontransplanted intestine with the Thiry-Vella segment was restored. At a third operation 3 months after autografting, all the non-transplanted small intestine was excised. All technically successful autografts survived indefinitely, and the dogs weights were maintained at 88 +/- 0.6% (mean +/- SE) of preoperative weights by absorption from the autografted intestine. Administration of cyclosporine to dogs with intestinal autografts produced a reversible impairment of intestinal absorption. Dogs with allografts survived 63.3 +/- 15.5 days (mean +/- SE). Death within 9 weeks of transplantation was from peritonitis secondary to graft rejection. Death in long survivors was a consequence of inadequate intestinal absorption. In the first 4 weeks after transplantation absorption and motility of allografted Thiry-Vella segments was comparable to the intestinal autografts but allografts showed evidence of a protein losing enteropathy. Large volumes of high protein-content fluid were lost from the allografted Thiry-Vella segments, and dogs with allografts became hypoalbuminemic.

Animals↗
PubMed1986

The metabolic consequences of infusing emulsions containing medium chain triglycerides for parenteral nutrition: a comparative study with conventional lipid.

In order to test the hypothesis that medium chain triglycerides (MCT's) are a safe and potentially superior energy source during parenteral nutrition 13 patients were entered into a randomised cross over trial. They received either a long chain triglyceride emulsion (LCT) or a 50% medium chain (MCT)/50% LCT mixture as part of their energy supply. Nitrogen balance was significantly better when MCT/LCT was infused and the greater levels of plasma ketones and lower plasma triglyceride levels suggested that MCT was more readily metabolised in these patients. Routine haematology, biochemistry and liver function tests gave no indication of harmful side effects from MCT.

Adult↗
PubMed1985

The role of greater omentum in reconstructing skin and soft tissue defects of the groin and axilla.

In three patients undergoing extended inguinal (2) or axillary (1) block dissection for recurrent malignant disease use of conventional reconstructive methods was not possible. Transposed greater omentum was used to provide a vascularized base for split-thickness skin grafts in two patients and to protect a vascular prosthesis placed in heavily irradiated tissues in the third. In each case whole limb ablation was avoided and the salvaged limb showed good function. No local recurrence of malignant disease was seen.

Aged↗
PubMed1985

Carcinoid tumour arising in a Meckel's diverticulum.

A patient with a carcinoid tumour arising in a Meckel's diverticulum and presenting with acute small intestinal obstruction is described. Review of previously reported cases indicates that the initial clinical presentation of carcinoid tumours occurring in a Meckel's diverticulum is usually similar to that of appendiceal carcinoids. While most carcinoids in Meckel's diverticula present as incidental findings at post-mortem examination or laparotomy, their metastatic potential and subsequent behaviour resembles that of other small intestinal carcinoid tumours.

Aged↗
PubMed1985

Simple mastectomy under local anaesthesia.

Nine patients with locally advanced carcinoma of the breast underwent simple mastectomy under regional anaesthesia (1% lignocaine and 1:100,000 adrenaline). Preoperative sedation was provided by oral lorazepam. There were no technical problems, evidence of lignocaine toxicity or excessive operative blood loss and no wounds became infected.

Aged↗
PubMed1984

What has happened to perforated peptic ulcer?

The number of elective operations for chronic peptic ulceration has decreased substantially with the widespread use of H2-receptor antagonists. We have reviewed all cases of perforated peptic ulcer in Oxford over the last 18 years (1965-82) to see if a similar change in the incidence of this major complication of peptic ulceration has occurred. Since 1976 there has been a fall in the incidence of perforated peptic ulcer from 8.7 to 6.9 cases per 100 000 population per year. The male to female ratio decreased over the review period from 4.9:1 to 1.9:1 owing to a reduced incidence of perforation in men and an increased incidence in women. The mean age of men with perforated duodenal ulcer increased from 52.3 years in 1965-70 to 59.0 years in 1977-82. One hundred and sixty-six patients treated between 1977 and 1982 have been reviewed in detail. The overall mortality in this 6 year period was 12.7 per cent with an operative mortality rate of 8.9 per cent. The majority of perforations (65 per cent) are now of acute ulcers and therefore are unlikely to be prevented by improved therapy for chronic peptic ulceration.

Aged↗
PubMed1984

Primary tumorous aldosteronism due to a black adrenal adenoma: a light and electron microscopic study.

A case of primary tumorous aldosteronism due to a black adrenal adenoma in a 37-year-old man is reported. Light microscopy showed the tumour to consist predominantly of compact cells containing intracytoplasmic lipofuscin, accompanied by zona fasciculata and intermediate type cells. Electron microscopy identified compact and interface (inner zona fasciculata) type cells, and also demonstrated spironolactone bodies in a compact cell. The morphological appearance of the tumour and adjacent adrenal gland, combined with the clinical and biochemical findings, supports both its secretory function and its classification as a rare variant of the more common non-pigmented aldosteronoma.

Adenoma↗