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Biomedical subjects

T V Taylor

Publications and source records attributed to T V Taylor.

At least 73 records · Page 4Linked to original sources
PubMed1984

Surgical experience of deeply jaundiced patients with bile duct obstruction.

One hundred and twenty consecutive deeply jaundiced patients undergoing surgery for bile duct obstruction were analysed. Diagnosis by either ultrasound or percutaneous transhepatic cholangiography was correct in 84 per cent and 86 per cent of patients respectively. Combination of the two procedures resulted in a diagnostic accuracy of 96.5 per cent. Despite pre-operative antibiotics and intravenous fluids, including Mannitol, infective complications and renal failure were common. Gastrointestinal haemorrhage was a major cause of postoperative morbidity and mortality. The operative mortality in this series was 14.2 per cent and was related to the depth of jaundice in patients with benign disease. The same relationship did not appear to occur in those with malignant disease. The median survival after palliative bypass surgery in patients with malignant obstruction was 6.5 months.

Adult↗
PubMed1984

The surgical factors influencing duodenogastric reflux.

The surgical factors influencing duodenogastric reflux have been assessed in dog and man using the biliary radiopharmaceutical 99mTc-EHIDA. Cholecystectomy led to a significant increase in the amount of reflux (P less than 0.01), but the combination of truncal vagotomy and pyloroplasty in addition to cholecystectomy produced a greater amount of reflux (P less than 0.01). In man, cholecystectomy also resulted in a significant increase in the amount of reflux (P less than 0.01). In ten control subjects reflux occurred but the amount was small and was not significantly different from the modified highly selective vagotomy group (n = 20). Symptomatic patients after truncal vagotomy and pyloroplasty (n = 16) showed a significant increase in the amount of reflux (P less than 0.002) but the combination of vagotomy and pyloroplasty in addition to cholecystectomy (n = 15) demonstrated the greatest amount of reflux (P less than 0.002). Similarly the addition of cholecystectomy to highly selective vagotomy (n = 9) showed a significant increase in the amount of reflux (P less than 0.02). Reconstruction of the pylorus (n = 8) was not a satisfactory procedure for the prevention of reflux but antrectomy and Roux-en-Y biliary diversion (n = 8) resulted in a significant reduction in the amount of reflux (P less than 0.001) and this was associated with clinical improvement.

Animals↗
PubMed1984

The effect of cholecystectomy on duodenogastric reflux in dogs and humans.

A prospective study of the effect of cholecystectomy on duodenogastric reflux (DGR) in dogs and humans has been performed and compared with patients presenting with persisting symptoms following cholecystectomy several years earlier. After an intravenous injection of 99mTc EHIDA, assessment of DGR was made by measuring Bilirubin Output and the percentage of 99mTc EHIDA recovered in gastric juice over fifteen minute periods. Cholecystectomy resulted in a significant increase in both amount and frequency of DGR in dogs and patients. Patients with persisting symptoms following cholecystectomy showed the greatest amount and frequency of DGR. We suggest that increased DGR may be an aetiological factor in some patients with persisting symptoms following cholecystectomy.

Animals↗
PubMed1984

The effect of cholecystectomy on duodenogastric reflux in patients with previous peptic ulcer surgery.

Duodenogastric reflux (DGR) has been assessed in healthy volunteers, patients after vagotomy and pyloroplasty, and in patients following vagotomy and pyloroplasty in addition to cholecystectomy. DGR has been assessed using bilirubin output and 99mTc EHIDA recovered in gastric juice. The control group demonstrated reflux but the quantity was small. Symptomatic patients after truncal vagotomy and pyloroplasty (V + P) showed a significant increase in DGR (P less than 0.002) when compared with the control group but the greatest reflux was seen in symptomatic patients following truncal vagotomy + pyloroplasty + cholecystectomy (P less than 0.002). AS with pyloric preservation showed no significant increase in reflux but the addition of cholecystectomy increased both frequency (P less than 0.001) and amount of reflux (P less than 0.001). We suggest that cholecystectomy when combined with a pylorus preserving or destroying procedure increases DGR and that such increased reflux may be an important factor in gastritis following peptic ulcer surgery.

Bilirubin↗
PubMed1983

Operative cholangiography: is there a statistical alternative?

Data from 424 patients who underwent cholecystectomy were analysed on a computer by both univariate and multivariate methods to determine the factors that identify patients with stones in the common bile duct. The presence of common bile duct stones was associated with increased age (p = 0.003), increased numbers of gallbladder stones (p less than 0.0001), a diagnosis of acute cholecystitis (p = 0.06), and a history of jaundice (chi-square = 22.2; p less than 0.001). A dilated common bile duct was the most significant indicator of the presence of stones (chi-square = 155.5; p less than 0.0001), and a dilated cystic duct was second (chi-square = 47; p less than 0.001). Using multivariate analysis, 89.5 percent of patients were correctly classified as having bile duct stones without the use of cholangiographic data (chi-square = 246.5; p less than 0.0001). Common bile duct diameter and the number of gallbladder stones emerged as the most important variables; additional historical factors, including the presence of jaundice and pancreatitis did not add to their predictive value. If multivariate analysis was used without cholangiographic data, bile duct stones would be missed in 3 percent of patients and unnecessary explorations would be carried out in 7.5 percent.

Adolescent↗
PubMed1983

Changes in the biophysical properties and ultrastructure of lungs, and intrapulmonary fibrin deposition in experimental acute pancreatitis.

Using an experimental model of acute pancreatitis in the rat, we have studied changes in the biophysical properties of lungs and intrapulmonary fibrin deposition in this condition. Acute pancreatitis is associated with a significant decrease in pulmonary compliance (p less than 0.01) and a significant increase in lung weight (p less than 0.01) compared with a control sham operation group. These changes are associated with a 24% increase in intrapulmonary 125I fibrinogen deposition (p less than 0.01), and an 18% increase in 125I fibrinogen deposition per gram of lung tissue (p less than 0.05) in acute pancreatitis, compared with a control sham operation group. The increased fibrinogen deposition is abolished by treatment with low dose heparin. Using the same animal model changes in pulmonary ultrastructure are shown using scanning electron microscopy. The results indicate that pulmonary abnormalities are associated with intrapulmonary fibrin deposition in experimental acute pancreatitis and these findings may be relevant to the well described respiratory complications of the condition in man.

Acute Disease↗
PubMed1983

Vagotomy by chemoneurolysis: an experimental study in the rat.

In the pylorus ligated rat vagotomy has been attempted by chemoneurolysis with alcohol. Surgical truncal vagotomy reduced the intragastric acid produced in a five-hour period from 310 +/- 17.6 (SD) mumol to 5.4 +/- 2.4 mumol with a marked reduction in the ulcer score. Injection of 30% alcohol in the region of the vagal trunks at the level of the lower oesophagus produced a marked reduction in gastric acid secretion (7.6 +/- 3.7 mumol). Injection of solutions of alcohol in concentrations over 10% along the lesser curvature reduced gastric acid output to less than 10 mumol with a corresponding reduction in the ulcer score. Four months after the injection of 30% alcohol along the lesser curvature the acid output was 23.0 +/- 5.7 mumol and no gastric ulceration occurred.

Animals↗
PubMed1982

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

The value of anterior lesser curve seromyotomy with posterior truncal vagotomy as a simple and safe method of denervating the parietal cell mass without the need for a drainage procedure was assessed in 143 patients with chronic duodenal ulcer at two different centres. There were no early complications directly attributable to the gastric surgery and the operation took less time than truncal vagotomy and pyloroplasty. Postoperative diarrhoea and dumping were not significant difficulties. Basal acid output was reduced by 84.4% and an early positive insulin response within the first three months occurred in 8.75% of patients tested. Satisfactory Visick grades (I and II) were recorded in 93.8% of patients during the early postoperative period.

Adolescent↗
PubMed1982

Pre-incisional intraparietal injection of cephamandole: a new approach to wound infection prophylaxis.

Pre-incisional injection of cephamandole has been studied. Wound tissue levels of cephamandole have been found to be extremely high throughout the operation. Serum levels were compared to those obtained with parenterally administered antibiotic. The use of a pre-incisional injection of antibiotic therefore offers major theoretical advantages over the use of either conventional parenteral or topical antibiotics in the prevention of postoperative sepsis.

Abdomen↗
PubMed1982

Preoperative intraparietal (intra-incisional) cefoxitin in abdominal surgery.

The effect of preoperative intraparietal (intra-incisional) injection of cefoxitin along the site of the intended incision on the incidence of wound infection has been investigated by a randomized prospective study of 181 consecutive patients undergoing abdominal surgery. A significant reduction in wound infection was evident in the cefoxitin-treated group (4.4 per cent) when compared with controls (16.7 per cent) (chi 2 = 6; P = 0.02). Administration of antibiotic by this route did not delay wound healing or produce any undesirable sequelae.

Abdomen↗
PubMed1982

Pancreatic blood flow in experimental acute pancreatitis.

The etiology and pathogenesis of acute necrotizing hemorrhagic pancreatitis remain controversial. Recent work has suggested that an early fall in pancreatic blood flow, causing ischemia, may be the initiating factor. Using an established rat model of hemorrhagic pancreatitis and the fractional indicator distribution technique with 86RbCl, pancreatic blood flow and tissue perfusion have been measured at various times in the condition. Six groups of ten rats were studied: control sham operation and pancreatitis groups were sacrificed at 1, 6, and 24 hr. Pancreatic blood flow (% of cardiac output) and perfusion (blood flow/g tissue) were measured. Blood flow was increased by a maximum of 53% at 1 hr (P less than 0.001) and remained elevated for 24 hr, and perfusion was increased by a maximum of 70% (P less than 0.001) at 1 hr and remained elevated at 6 hr. Pancreatic perfusion declines after 6 hr due to increasing gland edema. The results demonstrate a significant increase in pancreatic blood flow and perfusion in experimentally induced acute pancreatitis, suggesting a primary inflammatory response, and refute the ischemic etiological theory.

Acute Disease↗
PubMed1982

An electrophysiological study of the posterior abdominal vagus nerve in man.

1. The compound action potential was recorded in segments of posterior abdominal vagus removed from patients undergoing elective vagotomy and the conduction velocities of the major components were measured. 2. The conduction velocities ranged from 0.15 m/s to 3.9 m/s. The majority of compound potentials recorded had latencies appropriate to C fibre conduction.

Abdomen↗
PubMed1982

Gastric emptying of solids in man.

The influence of the type and size of solid particles on their emptying from the stomach was studied using isotopically labelled chicken liver and inert particles in normal subjects and in patients who had undergone gastric surgery. In normal subjects, initial emptying of the liver was slower than that of inert particles both for large liver cubes (1 cm) and small cubes (0.3 cm). Liver emptying subsequently accelerated to be faster than emptying of the inert particles. Overall emptying of the liver given as small cubes was faster than large cubes; 50% emptied in 50 minutes and 70 minutes respectively. In the postoperative subjects, emptying of the liver and of the inert particles was identical. The findings are consistent with the hypothesis that solid foods such as liver are ground down and 'liquified' by the action of gastric peristalsis before being discharged to the duodenum. Ingested particle size appears to influence the rapidity of this process, which should be distinguished from the propulsive function of the stomach where small solid particles are concerned.

Adult↗