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Biomedical subjects

W Sircus

Publications and source records attributed to W Sircus.

At least 19 recordsLinked to original sources
PubMed1979

Evidential value of the hospital record in clinical decision making.

A simulated retrospective exercise in the diagnosis and management of 53 readmissions to a gastrointestinal unit was undertaken by two consultants. Diagnosis of the illness at readmission was made on evidence sought from a referee, who also supplied, on request, items of relevant evidence from the past medical record. Patient management was agreed from these sources. For each item of evidence the evidential weight, the irrecoverability, and the expected benefit accruing to the patient of its availability was calculated. It was concluded that the evidence worth recording in the event of subsequent hospital admission could be largely specified for each diagnosis and each operation. It would be brief and could be numerically coded.

Decision Making↗
PubMed1979

Pneumatosis coli and sigmoid volvulus: a report of 4 cases.

Pneumatosis coli is an uncommon disease which is frequently misdiagnosed and inappropriately treated. The condition can usually be managed conservatively but complications requiring surgical treatment are occasionally encountered. We describe 4 patients with pneumatosis coli and associated volvulus of the sigmoid colon. Some of the factors that may have contributed to pneumocyst formation in these 4 patients are discussed with reference to recent advances in our understanding of the pathogenesis of pneumatosis coli.

Adult↗
PubMed1979

Breath hydrogen in pneumatosis cystoides intestinalis.

Pneumatosis cystoides intestinalis (PCI) is an uncommon condition of unknown aetiology. Bacterial gas production may be an important aetiological factor, but experimental evidence in humans has been lacking. We have studied breath hydrogen excretion as an index of bacterial gas production in 12 patients with PCI and have shown that four out of five with demonstrable cysts produced unusually high levels of hydrogen while fasting. This abnormality has not been previously reported. One patient showed resolution of PCI after antibiotic treatment. These findings confirm the importance of bacterial gas production in the pathogenesis of PCI.

Adult↗
PubMed1977

Is reduced release of gastrin the mechanism of ulcer healing after gastroenterostomy?

Until recently in this unit gastroenterostomy was the operation of choice for patients with duodenal ulcer whose maximal acid output (MAO) is less than 30 mmol/hr. Ulceration (jejunal) has recurred in only 2.1%. Unlike partial gastrectomy, which has a peak incidence of ulcer recurrence in the first two years, the incidence of ulcer recurrence remains constant throughout the years after gastroenterostomy. In looking for the explanation of this low recurrence rate we have studied the effect of the operation upon serum gastrin responses to standardized test meals 3 weeks and 26 weeks after operation in 9 patients. Nine normal subjects acted as controls. Six months after operation the responses were significantly lowered, a fall in the serum levels of gastrin at 30, 45, 60 and 90 min after means suggesting that gastroenterostomy reduces both the gastric and intestinal phases of acid secretion. The mean integrated gastrin response (IGR) throughout the postprandial 90 min is also significantly lower 6 months after surgery. The overall mean reduction was 31.1%.

Adult↗
PubMed1977

Cholinergic inhibition and release of gastric following insulin injection in duodenal ulcer before operation and after complete and incomplete vagotomy.

In 50 duodenal ulcer patients acid and gastrin secretory responses were determined in the fasting state and after insulin hypoglycemia. Completeness of vagotomy was assessed by multiple criteria. In all three groups of patients studied, i.e., the unoperated, the incomplete and the complete vagotomy groups, and initial gastrin inhibition was observed, the inhibition being minimal, moderate, adn exaggerated, respectively. This inhibitory phase was followed by a significant rise in gastrin the unoperated and the incomplete vagotomy groups, the rise being significantly higher in the latter. This rise was insignificant in those with complete vagotomy. The evidence suggests the presence of both an inhibitory and a releasing mechanism for gastrin release. The ratio of basal serum gastrin to postinsulin gastrin separates complete and incomplete vagotomy without overlap.

Duodenal Ulcer↗
PubMed1976

The relation between functioning parietal cell and gastrin cell masses in two groups of duodenal ulcer patients.

1. Serum gastrin concentrations before and after a standardized meal were determined in twenty-eight patients with duodenal ulcer and in ten normal control subjects. 2. In response to pentagastrin, thirteen of the duodenal ulcer subjects secreted acid within the limits of normal and fifteen secreted in excess. 3. The differences in the basal serum gastrin concentrations between the three groups, normal subjects, acid "normosecretors" and hypersecretors were not statistically significant but that of the hypersecretors was suggestively low. 4. The integrated gastrin response and peak gastrin responses to meals were higher in duodenal ulcer patients with normal acid secretion than in the hyper-secretors but the values for the latter were not different from normal subjects. 5. Stabilization of intragastric pH by infusion into the antrum of sodium bicarbonate during the test meal response period did not alter these differences between the two ulcer patient groups. 6. A significant inverse correlation exists between the maximal acid output and the integrated gastrin response in both normal subjects and hypersecreting duodenal ulcer patients. 7. The evidence (a) supports the existence of an inverse relationship between the functioning parietal cell and gastrin cell masses, (b) shows the gastrin response in normosecreting ulcer subjects to be inappropriately high, and (c) suggests that excessive vagotonia exerts trophic effects upon both parietal cell mass and gastrin cell mass.

Adolescent↗
PubMed1976

A comparison of the acid and gastrin secretory responses to hypoglycaemia and meals in duodenal ulcer with and without acid hypersecretion to pentagastrin.

In 60 uncomplicated duodenal ulcers (DU), maximum acid output (MAO) and acid output following insulin hypoglycaemia (IAO) were measured, and in 30 patients also the serum gastrin responses to insulin and to standard meals, In 7 normal controls, all 4 items were measured. Thirty-six of the DU had MAO within normal limits (normosecretors) and 24 were hypersecretors. Hypoglycaemic vagal response was higher in all DU than in normals and was, in normo-secreting DU associated with an abnormally large functioning G cell mass. This mass is not increased in hypersecreting DU and the greater vagal capacity is related to a supranormal parietal cell mass. An unknown mechanism, perhaps genetic, directs the trophic effects of an increased vagal drive to the gastrin cell mass in one group of DU and to the parietal cell mass in the other.

Adult↗