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Biomedical subjects

T V Taylor

Publications and source records attributed to T V Taylor.

At least 37 records · Page 2Linked to original sources
PubMed1990

Vomiting after Roux-en-Y biliary diversion: relationship to surgical technique.

Vomiting is a frequent complaint after revisional gastric surgery using a Roux-en-Y biliary diversion. This is believed to be due to gastric stasis or stasis in the jejunal component of the Roux-en-Y. Thirty-three patients, ten with a satisfactory outcome following Roux-en-Y diversion and 23 with an unsatisfactory outcome, were studied using a semisolid, radiolabelled meal and compared with 12 normal subjects. Outcome was assessed by modified Visick grading. Seven patients with an unsatisfactory outcome because of frequent vomiting had gastric stasis and two had delay in emptying of the jejunal component of the Roux-en-Y. Vomiting was more likely in patients with a dependent sump (P less than 0.006) and emptying was significantly prolonged where a sump was present (P = 0.0009). Surgical technique contributed to the dependent sump.

Adult↗
PubMed1990

Outcome of revisional gastric surgery using a Roux-en-Y biliary diversion.

One hundred and seven patients with postoperative reflux gastritis treated by Roux-en-Y biliary diversion were reviewed. Three patients died in the postoperative period, and 16 others have since died; cardiorespiratory disease was the most frequent cause of death. Seventy-nine patients were interviewed at a median of 5.5 years (range 0.5-26 years) following Roux-en-Y diversion. At review, a satisfactory result by modified Visick grading was present in 47 per cent of patients. Bilious vomiting (P less than 0.001), food vomiting (P less than 0.01), the severity of upper abdominal pain (P less than 0.001) and heartburn (P less than 0.025) were significantly improved by Roux-en-Y diversion. Weight, haemoglobin levels and employment status were not significantly altered by the procedure. Outcome was related to the surgery preceding Roux-en-Y diversion with significantly better results after partial gastrectomy compared with truncal vagotomy and drainage (P less than 0.01), cholecystectomy (P less than 0.05), or combinations of these procedures (P less than 0.01). Outcome was not predicted by sex, preoperative symptoms, smoking status, consultant surgeon, length of Roux-en-Y or 99Tc-Sn-2,6-di-ethylacetanilidoiminodiacetate (HIDA) scanning results.

Adult↗
PubMed1990

Anterior lesser curve seromyotomy and posterior truncal vagotomy versus truncal vagotomy and pyloroplasty in the treatment of chronic duodenal ulcer.

In a prospective randomized controlled clinical trial, anterior lesser curve seromyotomy with posterior truncal vagotomy (AMPT, n = 77) has been compared with truncal vagotomy and pyloroplasty (TVP, n = 69) in 146 patients with chronic duodenal ulcer with a mean duration of symptoms of 7 years. The mean follow-up time was 4.5 years with a range of 2-7 years. One elderly patient died from a myocardial infarction in the TVP group. Acid secretory inhibition in response to insulin and pentagastrin stimuli was equal in both groups, indicating a similar degree of vagal denervation. Recurrent ulcers were more common after AMPT (five) than TVP (two) (P = 0.29, n.s.). Dumping and diarrhoea were significantly commoner (P less than 0.001) after TVP, with 31 instances as opposed to eight with AMPT. The mean operating time was increased by 6 min when AMPT was performed rather than TVP. The results of this study have shown that AMPT is associated with a lower incidence of dumping and diarrhoea and achieves better overall Visick grading. However, continued monitoring is required to assess the long-term incidence of recurrent ulceration after this procedure.

Adult↗
PubMed1990

Measurement of gastric emptying rate in humans. Simplified scanning method.

Simultaneous measurements of the gastric emptying rate of the solid and liquid phase of a dual-isotope-labeled test meal were made using a gamma camera and a simple scintillation detector, similar to that used in a hand-held probe. A simple scanning apparatus, similar to that used in a hand-held scintillation probe, was compared with simultaneous measurements made by a gamma camera in 16 healthy males. A dual-labeled test meal was utilized to measure liquid and solid emptying simultaneously. Anterior and posterior scans were taken at intervals up to 120 min using both a gamma camera and the scintillation probe. Good relative agreement between the methods was obtained both for solid-phase (correlation range 0.92-0.99, mean 0.97) and for liquid-phase data (correlation range 0.93-0.99, mean 0.97). For solid emptying data regression line slopes varied from 0.75 to 1.03 (mean 0.84). Liquid emptying data indicated that slopes ranged from 0.71 to 1.06 (mean 0.87). These results suggested that an estimate of the gamma measurement could be obtained by multiplying the scintillation measurement by a factor of 0.84 for the solid phase and 0.87 for the liquid phase. Correlation between repeat studies was 0.97 and 0.96 for solids and liquids, respectively. The application of a hand-held probe technique provides a noninvasive and inexpensive method for accurately assessing solid- and liquid-phase gastric emptying from the human stomach that correlates well with the use of a gamma camera, within the range of gastric emptying rate in the normal individuals in this study.

Adult↗
PubMed1989

Comparison of weight loss with short term dietary and intragastric balloon treatment.

Treatment of 41 morbidly obese patients with a 3.34 mega joule diet has been compared with the same dietary regime together with an intragastric balloon. After eight weeks of closely supervised dietary regime a free floating silicone intragastric balloon with a capacity of 500 ml was inserted and the patient advised to adhere to the same diet for a further eight weeks. Thirty four patients completed the study. Forty eight per cent lost weight during the period compared with 97% during balloon treatment. The mean weight loss with diet alone was 1.9 (3) kg compared with 7.5 (4.1) kg with the balloon (p less than 0.001). Apart from postinsertion vomiting, which resolved by 72 hours, there were no gastric complications associated with the balloon. This study indicates that, in the short term at least, the intragastric balloon can improve on weight loss achieved by diet alone.

Adolescent↗
PubMed1989

Vertical gastric plication: an operation for gastro-oesophageal reflux.

An operation has been devised to prevent gastro-oesophageal reflux in which a vertical partition is made parallel to the proximal gastric lesser curvature. The technique, which can be simply, safely and rapidly performed, prevents reflux in the following ways: 1. Increasing the effective length of the 'intra-abdominal oesophagus'; 2. Increasing the crural sling and mucosal flap valve effect; 3. Sharpening the angle of entry into the gastric reservoir; 4. Creating a flutter valve and markedly reducing the gastric cross-sectional area along which reflux can occur. The stomach is neither opened nor divided. The efficacy of the operation was investigated in six dogs which had their lower oesophageal sphincter excised by circular myomectomy before vertical gastric plication. Pre- and postoperative manometric and oesophageal pH studies were performed. Vertical gastric plication prevented the oesophagitis produced by circular myomectomy alone. The operation has been performed in 26 patients over a 2-year period. Assessment has been by clinical methods, ambulatory 24 h pH studies and endoscopy. Twenty-one patients were classified in Visick grades I and II and ambulatory pH recordings showed a marked reduction in reflux in 13 of 14 patients. The operation is technically simple, quick and safe to perform, being accurately and scientifically reproducible.

Animals↗
PubMed1988

Prediction of choledocholithiasis using a pocket microcomputer.

A computerized method, using a small pocket computer, has been used to predict the presence of choledocholithiasis in a prospective series of 239 patients undergoing cholecystectomy. From an initial data base of 424 patients 36 factors were evaluated and the most important 2 of these were determined by multivariate analysis for use in the prospective analysis. Satisfactory operative cholangiograms were a prerequisite to evaluation of the statistical method and were obtained in 90.4 per cent of cases. Using the computerized method a common bile duct stone would have been overlooked in only 1 patient but 17 unnecessary explorations would have been carried out. The overall accuracy of the computerized method was 92.5 per cent. When the method was applied to a further study of 97 patients from a separate centre the overall accuracy was 85.6 per cent. If the method was used to aid selective use of operative cholangiography, cholangiograms would be performed in 20 per cent and stones would be overlooked in less than 1 per cent.

Cholangiography↗
PubMed1987

Migration of gall stones.

The factors influencing the migration of gall stones are ill understood. Altogether 331 patients undergoing cholecystectomy were studied prospectively. The diameters of the cystic and common bile ducts and of stones in the gall bladder and bile ducts were measured. Increasing pressure was applied to the freshly excised gall bladder in an attempt to evacuate stones through the cystic duct. Stones passed in 33 (60.0%) of patients with choledocholithiasis, 45 (67.2%) of patients with pancreatitis, and 7 (3.2%) of patients without either pancreatitis or choledocholithiasis. Stones migrated in 6 (3.0%) who had a normal cystic duct diameter (less than or equal to 4 mm) and in 46 (32.5%) with a duct over 4 mm diameter. Common bile duct stones were often larger than the diameter of the cystic duct and when reintroduced into the gall bladder would not migrate. The passage of debris (less than or equal to 1 mm) through the cystic duct bore no relation to the presence or absence of choledocholithiasis or a dilated cystic duct. Small stones (1-4 mm diameter) must migrate to initiate and facilitate further migration; some must increase in size in the common bile duct. Increased biliary pressure consequently dilates the duct system retrogradely, allowing larger stones to follow. Patients at risk of stone migration and thereby pancreatitis and jaundice have large ducts that can be detected by ultrasound assessment.

Cholecystectomy↗
PubMed1987

Ionic flux and mucosal ultrastructure in the rat bile-pancreatic duct. Effect of bile salt perfusion on duct integrity.

The property of the pancreatic ductal system that restricts free ionic diffusion has been termed the "pancreatic duct mucosal barrier," damage to which may be important in the pathogenesis of acute gallstone pancreatitis. The bile-pancreatic duct of the rat (BPD) was perfused in situ with a standard ionic solution. The normal duct was permeable to both chloride and bicarbonate ions, and flux (JCl-, JHCO3-) appeared to occur by passive ionic diffusion. Measurement of absolute ionic flux and transductal potential difference (PD) gave control values of JCl-, +0.92 +/- 0.15 mumol/cm/hr; JHCO3-, -1.71 +/- 0.12 mumol/cm/hr; PD -2.3 +/- 0.20 mV. The preparation was stable over the experimental period, and the results obtained were reproducible between animals. Glycodeoxycholate compromised the integrity of the BPD with an increase in ionic flux and a reduction in PD with corresponding alterations in mucosal ultrastructure. Increasing concentrations of bile salt produced more severe damage to the BPD. The BPD of the rat is therefore analogous to the pancreatic duct of the cat in possessing a mucosal barrier, and the barrier is damaged by bile salts. This preparation may be useful for studying pancreatic duct integrity, a concept of importance in the pathogenesis of acute gallstone pancreatitis.

Animals↗
PubMed1987

Combined supraduodenal and transduodenal exploration of the common bile duct with sphincterotomy.

From a consecutive series of 2,221 cholecystectomies, 177 patients underwent combined supraduodenal and transduodenal exploration of the common bile duct and 390 were treated by supraduodenal exploration alone. The mortality rate after both exploration procedures was the same (2.8 per cent). However, two patients died of septic complications associated with duodenal fistulas in the combined exploration group. Five patients had retained stones in the common bile duct which subsequently flushed out with a saline solution irrigation administered through the T tube in three patients and the stone passed spontaneously in one patient. Clinically significant and biochemically documented acute pancreatitis occurred in five patients, one of whom died. Four patients had postoperative cholangitis develop which responded to antibiotic therapy. We are not aware of any patient who had common bile duct stones, chronic pancreatitis or ampullary stenosis after the combined procedure at follow-up study of between six months and 13 years.

Aged↗