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Biomedical subjects

A R Baker

Publications and source records attributed to A R Baker.

At least 55 records · Page 3Linked to original sources
PubMed1987

Long term follow-up of patients with side to side choledochoduodenostomy and transduodenal sphincteroplasty.

From a consecutive series of 190 patients with choledochoduodenostomy (CDD) and 56 patients with transduodenal sphincteroplasty (TDS), there were 10 and 3 hospital deaths respectively. A long term follow-up study was performed on the remainder. Late deaths occurred in 35 CDD and 5 TDS patients. Serious long term complications occurred in 3.3% of CDD cases, comprising 5 cases of 'sump syndrome' and a further case of cholangitis in the presence of a clear biliary tree. Cholangitis occurred in 2 of the TDS patients (3.8%). Recurrent common duct stones were found in 3 of the 'sump syndrome' cases (1.6%) and one of the TDS patients with cholangitis (1.9%). Eighty-eight per cent of the CDD patients and 90.2% of the TDS patients, who were reviewed, were subjectively well. Serum alkaline phosphatase was raised in 21.6% of the CDD patients and only 3.4% of the TDS group (P less than 0.05). Radiological studies showed that the CDD stoma admitted air and barium more often than the TDS stoma (P less than 0.001). Neither the biochemical nor the radiological findings correlated with the long term symptomatic results of the two procedures. Dynamic HIDA scans showed a shorter time to peak activity in the common hepatic duct for both CDD (P less than 0.01) and TDS (P less than 0.05) as compared with endoscopic sphincterotomy (ES). These long-term clinical, biochemical and radiological results are similar to those reported following ES.

Adolescent↗
PubMed1987

Hemobilia treated by nasobiliary catheterization.

Hemobilia results in obstructive jaundice because blood clots may obstruct the bile duct. Decompression relieves jaundice, promotes clot lysis, and may encourage cessation of bleeding. We report a case of hemobilia that followed needle biopsy of the liver and was managed nonoperatively with an endoscopically placed nasobiliary catheter.

Adult↗
PubMed1987

Choledochoduodenostomy, transduodenal sphincteroplasty and sphincterotomy for calculi of the common bile duct.

The clinical features, indications and operative results in a consecutive series of 246 patients who underwent choledochoduodenostomy (CDD) and transduodenal sphincterotomy or sphincteroplasty (TDS) over a period of ten years (1972 to 1981) were reviewed. The over-all mortality for CDD was ten of 190 patients (5.3 per cent) and three of 56 patients for TDS (5.4 per cent). The over-all major morbidity rate for these procedures was 11.6 per cent for CDD and 21.4 per cent for TDS. This was not a statistically significant difference, but there were more elderly patients (more than 65 years old) in the CDD group (60.5 per cent) than in the TDS group (21.4 per cent) (p less than 0.001). The major morbidity rate associated with elective operations was 10.7 per cent for CDD and 20.0 per cent for TDS which is significant (p less than 0.05). Long term follow-up study (one to 12 years and mean of four and one-half years) revealed six patients in the CDD group with sump syndrome or cholangitis, or both, (3.3 per cent) and three patients in the TDS group had cholangitis develop (5.7 per cent). Over-all, the results compared favorably with the published results of endoscopic sphincterotomy. We conclude that CDD is the operation of choice when a permanent biliary drainage procedure is indicated and TDS should be reserved for instances of ampullary gallstone impaction.

Adolescent↗
PubMed1986

The effect of adjuvant chemotherapy on relapse-free survival in patients with osteosarcoma of the extremity.

We conducted a randomized controlled trial to determine whether intensive multi-agent adjuvant chemotherapy improves the chances of relapse-free survival in patients with nonmetastatic high-grade osteosarcoma of the extremity, as compared with concurrent controls. After undergoing definitive surgery, 36 patients were randomly assigned to adjuvant chemotherapy or to observation without adjuvant treatment. At two years the actuarial relapse-free survival was 17 percent in the control group, similar to that found in studies before 1970, and 66 percent in the adjuvant-chemotherapy group (P less than 0.001). Similar results were observed among 77 additional patients who declined to undergo randomization but who elected observation or chemotherapy. We conclude that the natural history of osteosarcoma of the extremity has remained stable over the past two decades, that adjuvant chemotherapy increases the chances of relapse-free survival of patients with high-grade osteosarcoma, and that it should be given to all such patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Haemodynamic assessment of the femoropopliteal segment: comparison of pressure and Doppler methods using ROC curve analysis.

Combined aorto-iliac and femoropopliteal vascular disease remains a problem in vascular surgery. Arteriography does not provide information on the relative contributions of the two lesions to the presenting symptoms. Aorto-iliac haemodynamics may reveal occult aorto-iliac disease but does not show whether combined proximal and distal reconstruction will be required to provide symptomatic relief. Haemodynamic assessment of both segments may help in this respect. A haemodynamic assessment of the femoropopliteal segment of 72 limbs in 38 patients is reported. The segmental pressure drop between a common femoral arterial cannula and a below-knee occlusion cuff is compared with a non-invasive Doppler method combining both transit time and damping factor. Comparison is made using receiver operating characteristic (ROC) curve analysis. The measurement of segmental pressure drop is more accurate than the Doppler method in detection of femoropopliteal stenoses of greater than 50 per cent of the luminal diameter (P less than 0.05).

Aged↗
PubMed1986

Management of acute cholangitis and the impact of endoscopic sphincterotomy.

Ninety-four patients admitted to Leicester Hospitals with acute cholangitis since 1977 were reviewed to coincide with the availability of endoscopic sphincterotomy (ES). Thirty-four were men and sixty were women, their mean age was 69.7 years and the median hospital stay was 20 days. There were 15 deaths (16 per cent) by 30 days in patients with significantly lower initial serum albumin levels (P less than 0.005) and significantly higher serum urea levels (P less than 0.05) than survivors. Eighty-two patients had common bile duct (CBD) calculi of whom 71 underwent early decompression of the biliary tree either surgically (28) or by ES(43). Early surgical decompression was associated with a significantly higher 30 day mortality (6/28) than early ES (2/43) (P less than 0.02) despite the fact that patients undergoing early ES were significantly older (P less than 0.02) and had significantly more medical risk factors (P less than 0.05). Of the 43 patients undergoing early ES 7 had had a previous cholecystectomy, 13 underwent subsequent elective cholecystectomy with no mortality and the remaining 23 had the gallbladder left in situ because of advanced age (mean age 79 years) and frailty. Only 2 of the 23 have since required cholecystectomy. We suggest that patients with acute cholangitis who do not rapidly respond to conservative treatment should undergo early ES with early surgery reserved for those who do not improve following ES. Elective cholecystectomy following successful ES can often be avoided in the elderly and frail.

Acute Disease↗
PubMed1986

Traumatic rupture of the stomach due to a seat belt.

A case of gastric rupture is described in a patient who was wearing a lap and diagonal inertia reel seat belt at the time of a head-on collision. The literature is reviewed and the mechanism of injury is discussed.

Accidents, Traffic↗
PubMed1986

Some failings of pulsatility index and damping factor.

Pulsatility index (PI) is a commonly used method of objective assessment of the Doppler waveform. PI falls with increasing proximal stenosis and is raised by increasing peripheral resistance. Damping factor (DF) for an arterial segment is calculated by dividing the proximal by the distal PI. DF rises with increasing severity of disease of the arterial segment. DF is not, however, sufficiently accurate to be used alone but is usually combined with transit time measurements to provide information of diagnostic use. Both PI and DF have been examined in a canine model of combined segment disease. With increasing stenosis, distal PI falls as expected but so also does proximal PI. Such a stenosis is, in effect, a flow-throttling resistance so that although the characteristics of blood flow are altered by its presence, similar changes are observed both above and below the stenosis. The reduction of PI by a stenosis distal to the insonation site may result in the false interpretation of a low PI as indicating disease proximal to the insonation site. The observed similarity between PI proximal and distal to a stenosis reduces the usefulness of pulsatility index damping factor, particularly in the assessment of the femoro-popliteal segment in combined segment disease.

Animals↗
PubMed1986

Doppler ultrasound assessment of the femoro-popliteal segment: comparison of different methods using ROC curve analysis.

Coexisting aorto-iliac and femoro-popliteal occlusive lesions remain a problem in vascular surgery. Arteriography does not provide information on their relative contributions to the presenting symptoms. The success of proximal reconstruction alone in such cases depends to some extent on the haemodynamic significance of the femoro-popliteal disease which will remain. Several noninvasive Doppler methods have been recommended for haemodynamic assessment of the femoro-popliteal segment. These methods were studied in 72 limbs of 38 patients. The results are compared using receiver operating characteristic curve analysis. The best single test in this group of patients was normalised transit time which was significantly better than pulsatility index damping factor (p less than 0.01). The addition of damping factor to normalised transit time tended to give some improvement but this was not statistically significant in the clinically relevant part of the ROC curve.

Aged↗
PubMed1986

Pseudo-splenomegaly as a result of subphrenic abscess.

A case of left-sided subphrenic abscess, secondary to perforation of a carcinoma of stomach, is described. The patient presented with a palpable spleen which was shown to be normal in size but displaced by the subphrenic collection. The importance of correct interpretation of this physical sign is discussed.

Adenocarcinoma↗
PubMed1985

Sump syndrome following choledochoduodenostomy and its endoscopic treatment.

The clinical features of eight patients with 'sump syndrome' following side-to-side choledochoduodenostomy are reported. The syndrome is defined and its aetiology discussed with special reference to debris in the common bile duct, bacterial overgrowth and the clinical picture of acute cholangitis, which does not appear to be necessary for the diagnosis to be made. Five patients were successfully treated by endoscopic sphincterotomy and a sixth by endoscopic removal of food debris from the sump. The other two patients had further surgery.

Aged↗
PubMed1985

Human kidney kallikrein: cDNA cloning and sequence analysis.

The primary structure of human kidney kallikrein has been elucidated by molecular cloning and cDNA sequence analysis. Structural homology between mammalian glandular kallikreins permitted the isolation of several clones from a human kidney cDNA library where kallikrein sequences represented approximately 0.01% of the cDNA. Identity of the cloned sequence with the published amino-terminal sequence of human urinary kallikrein strongly implicates the kidney as a major source of this protein. The overall structure of the kidney enzyme is 67% homologous to that of the corresponding mouse kidney kallikrein and only 60-62% homologous to the other published mouse kallikrein sequences. Homology to the pancreatic kallikreins of pig and rat is 67% and 61%, respectively. As expected, the amino acids required for catalytic activity are conserved as is the Asp residue required for the kallikrein-type specificity. Southern blot analysis demonstrates the presence of a number of related sequences in human DNA, although these do not appear to be as numerous as those in the mouse genome. Several polymorphisms in the kallikrein genes were observed.

Amino Acid Sequence↗
PubMed1985

Characterisation of aorto-iliac arterial stenoses in terms of pressure and flow.

Aorto-iliac stenoses were characterised in terms of pressure drop and flow velocity in a canine model and in patients with occlusive arterial disease. Pressure above and below the stenosis was measured intra-arterially and flow related measurements were made at rest and during reactive hyperaemia in the dog, and following papaverine administration in patients. The addition of flow velocity information to the pressure drop across a stenosis gave an increased separation of stenoses in the experimental animal and also in man.

Animals↗
PubMed1985

The accuracy of "pull-through" pressure measurements and papaverine testing.

Intra-arterial pressure measurements have been made in a group of vascular patients using two different methods. The pull-through method, without systemic pressure monitoring, is compared with a technique employing simultaneous radial and femoral arterial puncture. In both techniques, pressures are measured at resting flow and during papaverine induced hyperaemia.

Angioplasty, Balloon↗