Biomedical subjects
Publications and source records attributed to T V Taylor.
Benign gastric ulceration occurred in a patient with pernicious anemia in association with aspirin therapy. Previous reports of benign gastric ulceration in patients with achlorhydria are reviewed, and the potential role of aspirin in the pathogenesis of benign ulceration in the absence of acid is discussed.
Branches of the nerve of Latarjet run with the serosa of the stomach before penetrating the muscularis. Myotomy of the pylorus and esophagus are safe and well established procedures. Myotomy of the lesser curve of the stomach with preservation of the major vessels should denervate the parietal cell mass; this procedure has been investigated in the dog. Pre- and postoperative secretory stimulation was carried out with pentagastrin (0.375--6 micrograms/kg/hr i.v.) and insulin (0.2 units/kg). After myotomy, in response to pentagastrin, there was a marked shift to the right of the dose response curve of acid secretion and a profound inhibition of pepsin output. The insulin response in terms of acid and pepsin secretion was almost completely abolished. Secretory inhibition after lesser curve myotomy is similar so that produced by proximal gastric vagotomy. These results would appear to give the operation a sound anatomic and physiologic basis for it is not difficult to perform technically and obviates the risk of damage to the nerve of Latarjet of ischemic necrosis of the lesser curvature.
A new experimental model of acute pancreatitis in the rat has been devised. It consists of a closed duodenal loop into which infected bile is injected under pressure; intestinal continuity is maintained by a plastic tube passed through the loop. Histological and biochemical evidence of acute pancreatitis in the rat model is presented. The model has been compared with that of Nevalainen and with control groups of rats undergoing bile duct ligation and sham operation. The model produces a consistently fatal acute pancreatitis, more severe than that produced by Nevalainen's model, with a survival time fo 28+/-12.8 (SD) hours. A combination of the reflux of infected bile under increased pressure into the pancreatic duct, at a known time, produces a model which may be suitable for the investigation of therapeutic agents.
A sample of 500 consecutive women without symptoms of breast disease attending a breast screening clinic were investigated regarding their attitude to breast screening and to the extension of the screening programme to other forms of cancer. Attendance at the screening clinic was found to be reassuring by 94.2%, and 96.4% felt that the screening programme should be extended to include other forms of malignancy. There was a history of either respiratory or alimentary tract symptoms, and of smoking, or a family history of cancer in 41% of these women. The study shows that Edinburgh women are enthusiastic for breast screening and for its extension to include other forms of cancer.
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Forty-four general surgical patients were included in a prospective, randomized double-blind controlled trial of ascorbic acid (500 mg b.d.) or placebo for 7 days before operation. This was to test the hypothesis that vitamin C may reduce the instance of deep venous thrombosis postoperatively. Venous blood samples were taken before entering the trial, just immediately before surgery, on the day of operation and on three further occasions at 3-day intervals postoperatively for leucocyte ascorbic acid concentration (LAC). Venous thrombosis was diagnosed using the 125I-fibrinogen test and the leg scans interpreted by Roberts' criteria. There was no significant difference in the incidence of DVT between the treatment and placebo groups. In those with DVT (n = 23) the mean LAC on the day of operation was not significantly different from that in those without DVT. However, on the sixth and ninth postoperative days LAC levels were significantly lower in the DVT group. These results suggest that the administration of ascorbic acid preoperatively does not reduce the incidence of DVT, but a striking decrease in the LAC levels in the DVT patients is in keeping with the hypothesis that the initial event in the pathogenesis of DVT is adherence of leucocytes to the venous endothelium.
Lesser curve superficial seromyotomy has been investigated in the dog and in man. The anatomical basis for the operation, which produces an easily performed denervation of the parietal cell mass, is discussed. Acid studies in the dog confirmed that the operation was capable of producing secretory inhibition in keeping with vagotomy of the parietal cell area. A consecutive series of 25 patients with chronic duodenal ulcer has been treated by lesser curve myotomy without a drainage procedure. The operation has the advantages of being easily performed and the risk of damage to the nerve of Latarjet or of ischaemic necrosis of the lesser curvature is obviated. In 20 insulin tests performed within the first month postoperatively all patients have been negative within the first 75 min and there were 4 late positive responses. Early clinical results have been encouraging, there has been no dumping or diarrhoea and all patients are well. It is suggested that further investigation of lesser curve myotomy is warranted.
Typical liver cell inclusions of alpha-1-antitrypsin deficiency were found in a patient with the Pi S phenotype and acute alcoholic hepatitis. It is suggested that the inclusions resulted from the combined effects of the S phenotype and alcohol and, on the basis of the known chemistry of the variant antitrypsins, that the lowered serum concentration of antitrypsin associated with the S allele may be due to hepatic holdup.
The use of technetium-99m in the noninvasive investigation of the upper gastrointestinal tract is discussed with particular reference to the evolution of a method of assessing gastric function or gastric acid secretion non-invasively and to the applications of this method in the investigation of surgical patients with disease of the upper gastrointestinal tract. The assessment of maximal acid output and the insulin response is described and the use of the test in the diagnosis of pernicious anaemia, hypo- and hyperchlorhydric states, gastric cancer, hiatus hernia and Barrett's oesophagus, coeliac disease, Meckel's diverticulum, and abdominal aortic aneursym outlined. The use of chemicals labelled with this tracer in hepatobiliary scanning is briefly described.
A single scan technique using 99mTc has been developed for the measurement of gastric acid output. After an overnight fast, pentagastrin (6 microgram/kg S.C.) was given 15 min before 99mTc (1 mCi i.v.), and a scan of the abdomen was performed 15 min later using a double-headed scanner. Accumulation of isotope within the stomach was then calculated from the scan and expressed as a percentage of the injected dose. Pentagastrin-stimulated intragastric activity correlated with acid output measured conventionally on a separate occasion (r = 0.87, P less than 0.0001). The test is rapidly performed with minimal inconvenience and discomfort to the patient, and the dose of irradiation used is small. The advantages of the method compared with intubation and gastric aspiration are discussed.
Cholecystectomy increases the incidence of post-vagotomy diarrhoea. The effect of agents which either bind bile acids or prevent their action on the colonic mucosa has been studied in 31 patients with post-vagotomy diarrhoea--15 had had vagotomy and pyloroplasty alone and 16 vagotomy and pyloroplasty and cholecystectomy. Cholestyramine was particularly useful after the combined operation. Aluminium hydroxide in large doses has a similar mechanism of action to cholestyramine and is cheaper and more palatable, but propranolol was of no value. This study suggests that the excretion and chemical composition of bile and the handling of bile acids by the small intestine is of fundamental importance in the pathogenesis of post-vagotomy diarrhoea.
Duodenal ulcers and gallstones, two of the commonest surgical conditions, affect respectively 10% of men and up to 20% of the population. Although many detailed studies of the treatment of these conditions have been conducted, there is no report of the results of surgery when the conditions coexist. 60 patients who had undergone vagotomy, pyloroplasty, and cholecystectomy were compared with age and sex matched controls who had undergone vagotomy and pyloroplasty alone or cholecystectomy alone. In the early postoperative period after the combined procedure there was a very high incidence of post-vagotomy diarrhoea (48.3%, P equal to 0.00013) and bile-reflux gastritis. The findings implicate bile-acids--their excretion and handling by the small intestine--in the aetiology of post-vagotomy diarrhoea. Where the conditions coexist truncal vagotomy and pyloroplasty should be avoided in the treatment of the duodenal ulcer because of the risk of post-vagotomy diarrhoea and bile-reflux gastritis.
Gastric mucosal blood flow in the rat was determined by the indicator fractionation technique of Sapirstein using Rb86Cl. Antral and corpus flow rates were determined in response to increasing doses of pentagastrin and histamine and the effect of vagotomy was determined. With progressive stimulation the antral:corpus flow ratio increased with both stimulants; however, vagotomy and noradrenaline reduced blood flow in both areas of mucosa. It is concluded that the antrum, as well as the corpus, actively responds to secretory stimulants by an increase in mucosal blood flow and support is provided for the theory that the antrum plays an active role in the control of parietal cell blood flow and secretion.