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Biomedical subjects

R S Stubbs

Publications and source records attributed to R S Stubbs.

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

Single dose mezlocillin versus three dose cefuroxime plus metronidazole for the prophylaxis of wound infection after large bowel surgery.

A prospective, randomized, controlled trial was conducted in 116 consecutive patients undergoing colorectal surgery to compare single dose prophylaxis with mezlocillin to cefuroxime plus metronidazole in three doses. Patients were randomized to receive either a single dose of iv mezlocillin (5.0 g) or three doses of iv cefuroxime plus metronidazole at 8-hourly intervals. The first dose was given on the operating table. The overall wound infection rate in the mezlocillin treated patients (n = 54) was 30% and in the patients treated with cefuroxime plus metronidazole (n = 56) 25%. This difference is not statistically significant. When trivial wound infections were disregarded the wound infection rates were 11% and 16% respectively, which again was not statistically significant.

Adult↗
PubMed1987

Pressure changes in canine gall-bladder associated with emptying.

1. For decades it has been supposed that emptying of the gall-bladder follows a rise in gall-bladder pressure of some 10-15 mmHg and relaxation of the sphincter of Oddi. 2. This subject has been re-examined in dogs chronically fitted with fistulas, using a model which does not entail interference with either the bile duct or sphincter of Oddi. 3. The pressure in the gall-bladder was recorded continuously under fasting conditions, after feeding and after intravenous infusion of the octapeptide of cholecystokinin (CCK-OP) in six dogs. 4. Gall-bladder pressure showed a modest sustained rise of 2-3 mmHg following ingestion of food and intravenous infusions of CCK-OP (125 ng kg-1 h-1). 5. During half of the experiments a transient rise of 3-10 mmHg lasting 2-3 min was observed after feeding and following infusion of I.V. CCK-OP (125 ng kg-1 h-1). Emptying of the gall-bladder, measured by bilirubin output from the biliary fistula, started shortly before the peak rise in pressure occurred. 6. We conclude that a significant rise in gall-bladder pressure is not a prerequisite for emptying and that the pressure changes occurring physiologically are smaller than have been reported previously. 7. We believe that the larger pressure changes recorded in the past may have been produced because of resistance to bile flow introduced by the models employed. 8. Emptying of the gall-bladder, in the dog, appears to have occurred within 40 min of the ingestion of food, suggesting that the cephalic and gastric phases of this process are quantitatively more important than has been thought previously.

Animals↗
PubMed1987

Faecal carcinoembryonic antigen (CEA) in patients with large bowel cancer.

The possibility that faecal CEA may be a more useful measurement than serum CEA for the detection of large bowel cancer has received very little attention. For this reason faecal CEA was measured before and after tumour resection in colorectal cancer patients and in a variety of control subjects. CEA was extracted from faeces by a new method with 3M KCl and assayed by an EIA technique utilising two monoclonal antibodies. Mean +/- SE faecal CEA in 32 cancer patients was 4.15 +/- 1.17 micrograms/g preoperatively. Values were not related to either stage of disease or serum CEA and they fell to 0.83 +/- 0.34 micrograms/g (n = 20) following tumour resection (P less than 0.05). Mean +/- SE faecal CEA in 34 control patients with no known colorectal disease was 0.94 +/- 0.49 micrograms/g which was significantly lower than in the cancer patients (P less than 0.05). Furthermore faecal CEA in 25 patients with non malignant colorectal disease was 1.44 +/- 0.63 micrograms/g which again was significantly lower than that in the cancer patients. It is concluded that as CEA is present in the faeces of the majority of colorectal cancer patients even at early stages of the disease its measurement here may be more useful for the detection of large bowel cancer than that in serum.

Aged↗
PubMed1986

Faecal carcinoembryonic antigen in colorectal cancer patients.

Carcinoembryonic antigen (CEA) has been measured in the faeces of large bowel cancer patients and control subjects to determine whether this measurement might be a useful aid in the diagnosis of large bowel cancer. The mean faecal CEA in 24 cancer patients fell significantly from 10.43 +/- 2.39 micrograms/g pre-operatively to 3.61 +/- 0.72 micrograms/g postoperatively (p less than 0.05). Pre-operative values were not related to either tumour stage or serum CEA. In 20 patients with no known colorectal disease the mean faecal CEA was 5.43 +/- 1.95 micrograms/g which was significantly lower than the mean pre-operative value in the cancer patients (p less than 0.05). In 14 patients with a variety of benign colonic diseases the mean faecal CEA was 7.12 +/- 1.39 micrograms/g which was not significantly different from the mean pre-operative value in the cancer patients. Considerable overlap of values was observed between individual cancer and control patients making the test, as presently carried out, non-discriminatory. If the potential for making the test more cancer specific can be realised, however, faecal CEA determination may permit discrimination between cancer and non-cancer patients at a relatively early stage of disease.

Aged↗
PubMed1986

Symptom duration and pathologic staging of colorectal cancer.

A large proportion of patients with colorectal cancer continue to present with relatively advanced and therefore incurable tumours. While delay in diagnosis is often felt to have been a contributing factor, the validity of this has seldom been questioned. Two hundred and eleven consecutive large bowel cancer patients have been prospectively studied with respect to their duration of symptoms and pathologic stage: 7.1% presented with Dukes A tumours and a mean symptom duration of 11.2 months; 38.9% with Dukes B tumours and a mean symptom duration of 4.9 months; 22.3% with Dukes C1 tumours and a mean symptom duration of 5.3 months; 3.8% with Dukes C2 tumours and a mean symptom duration of 3.9 months and 26% with stage D disease and a mean symptom duration of 3.8 months. There was no tendency for a longer symptomatic period in patients with more advanced disease. Indeed the Dukes A patients had a significantly longer duration of symptoms than those with all other stages of disease. It is argued that diagnosis at a more favourable pathologic stage would only be possible by presymptomatic tumour detection.

Colonic Neoplasms↗
PubMed1985

Role of cholecystokinin in pancreatic exocrine response to intraluminal amino acids and fat.

Controversy continues over the relative contributions made by hormonal and neural mechanisms in the exocrine pancreatic response to ingested food. The recent description of the drug proglumide as a specific, competitive cholecystokinin (CCK)/gastrin receptor antagonist has permitted reevaluation of the role of CCK in this process. In chronic pancreatic fistula dogs, dose-response studies were performed to determine the effect of proglumide on the pancreatic responses to octapeptide of CCK (CCK-OP), intravenous bethanechol, intraduodenal amino acids, and intraduodenal fat. Pancreatic volume, protein, and bicarbonate outputs to all doses of CCK-OP were inhibited significantly (P less than 0.05) in a competitive manner, consistent with the proposed mode of action of proglumide. In contrast, proglumide caused only minor and insignificant inhibition of the output responses to intravenous bethanechol. Virtually complete inhibition to all doses of intraduodenal amino acids and fat was observed with proglumide administration. If indeed proglumide is a specific CCK receptor antagonist, these results support the hypothesis that CCK is the major mediator of the intestinal phase of exocrine pancreatic secretion.

Amino Acids↗
PubMed1984

Inhibition of the stimulated exocrine pancreas by absorbed amino acids.

Intravenous infusion of amino acids is known to inhibit the stimulated pancreas and it has been suggested that this may act as a feedback mechanism in pancreatic regulation. To investigate this, chronic pancreatic fistula dogs were studied to determine if postprandial levels of hyperaminoacidemia inhibit the stimulated pancreas. Duplicate dose-response experiments using exogenous cholecystokinin (CCK) and intraduodenal amino acids were performed with and without a simultaneous intravenous infusion of mixed amino acids, which simulated postprandial hyperaminoacidemia. Significant (P less than 0.05), though minor, inhibition of pancreatic responses to both endogenous and exogenous CCK was noted with the simultaneous infusion of amino acids. It was concluded that, while amino acids may exert some inhibitory influence on pancreatic secretion after absorption, this is unlikely to be an important physiological mechanism.

Absorption↗
PubMed1984

Intravenous mixed amino acids and fats do not stimulate exocrine pancreatic secretion.

We compared the responses of the canine exocrine pancreas to intraduodenal versus intravenous administration of mixed amino acids, fat emulsion, and glucose. Graded doses of amino acid mixture and of fat emulsion gave graded responses in volume, protein, and bicarbonate when administered intraduodenally. In contrast, the same doses of the amino acid mixture and fat emulsion administered by central intravenous infusion caused no significant pancreatic secretion of volume, protein, or bicarbonate. Graded doses of glucose caused no statistically significant pancreatic secretion whether they were given intraduodenally or intravenously. We conclude, contrary to a previously published observation, that amino acids and fats given parenterally do not stimulate pancreatic secretion. As a corollary, it is reasonable to assume that the pancreas is not stimulated during total parenteral nutrition with acute pancreatitis or a pancreatic fistula.

Amino Acids↗
PubMed1983

Wound infection after cholecystectomy: a case for routine prophylaxis.

Wound infection after cholecystectomy is a not uncommon problem. A retrospective study of 227 cholecystectomies showed the incidence to be 15% when cholecystectomy alone was performed and 30% when a duct exploration was carried out without prophylactic antibiotics. These incidences were reduced to 3.6% and 3.4% respectively when prophylactic antibiotics were used. Though it has been possible to identify a high-risk group of patients, a truly low-risk group is not readily identifiable. It is concluded that prophylactic antibiotics should be given to all patients undergoing cholecystectomy.

Anti-Bacterial Agents↗
PubMed1982

Peroperative cholangiography: routine or selective?

The detection and removal of common bile duct stones remains a major challenge for the general surgeon. Peroperative cholangiography offers the most reliable method of detection and its routine use is now well accepted. This study of 262 cholecystectomies reassesses the value of this procedure and investigates the recent claim that cholangiography should be performed selectively rather than routinely. With routine cholangiography a positive exploration rate of 66% was achieved and retained stones occurred in 5% of patients with choledocholithiasis. Suggestions are made for ways in which the positive exploration rate could have been greatly improved. Had selective cholangiography been employed 47% of patients would have had the examination, the positive exploration rate would have been 70%, but the retained stone rate might have been 10%. In the light of this there appears little to commend selective cholangiography and we should continue to advise its routine use.

Cholangiography↗
PubMed1979

A case of advanced abdominal pregnancy.

A case of advanced abdominal pregnancy is described, with survival of both the mother and a normal infant. Reasons for the failure to establish the correct preoperative diagnosis are discussed.

Adult↗