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Biomedical subjects

D A Coventry

Publications and source records attributed to D A Coventry.

6 recordsLinked to original sources
PubMed1981

The distal lienorenal shunt: perioperative experience with 30 patients.

During the past 51/2 years, thirty consecutive and unselected patients who bled from oesophageal varices underwent distal lienorenal shunt surgery. Eight deaths occurred in the immediate postoperative period. Three of nine emergency patients died because of continued bleeding and, of the five elective patients who died, four were largely the result of technical problems encountered at surgery. In the immediate postoperative period variceal bleeding recurred in five of eight emergency patients despite shunt patency. This did not occur in the elective group. Shunt blockage was relatively common compared to that following conventional porta-systemic shunt surgery; being documented in five of the 24 patients in whom patency was assessed. No clinical, biochemical or histological criteria were identified as predictors of outcome. In particular, the presence of preoperative ascites gave no indication of postoperative problems. However, if ascites developed in the immediate postoperative period, it was a major management problem in 50% of patients. In conclusion, the distal lienorenal shunt has a high perioperative mortality, is commonly complicated by shunt thrombosis and, in the emergency situation, often fails to control bleeding. The technical difficulties encountered at surgery appear largely responsible for the early morbidity and mortality.

Adolescent↗
PubMed1979

Treatment of duodenal ulcer with carbenoxolone sodium: a double-masked endoscopic trial.

In a double-masked trial, 43 patients with an endoscopically confirmed, symptomatic duodenal ulcer were allocated at random to treatment with either carbenoxolone sodium or placebo, both provided in identical "positioned-release" capsules. The 40 patients who satisfactorily completed the trial were evenly distributed between the two treatment groups. The groups were well matched with regard to clinical features and initial ulcer size. Endoscopic review of ulcer healing after six weeks' treatment showed that 12 patients (60%) receiving carbenoxolone had healed ulcers, compared with five (25%) receiving placebo (P = 0.05). Symptomatic remission occurred by the fourth week in 17 patients (85%) receiving carbenoxolone, compared with six (30%) receiving placebo (P less than 0.001). The mean (geometric) serum carbenoxolone level in patients with healed ulcers was 31.11 microgram/mL compared with 17.75 microgram/mL in those with unhealed ulcers (P less than 0.005). Side effects of carbenoxolone therapy were observed, but they did not necessitate withdrawal of the drug and were readily controlled in every instance. These results confirm the therapeutic efficacy of carbenoxolone sodium in duodenal ulcer. In addition, a relationship between serum carbenoxolone levels and the occurrence of ulcer healing was observed.

Carbenoxolone↗
PubMed1977

The mesocaval "H" graft: experience with 22 cases.

During the past 32 months, 22 consecutive unselected patients who had bled from oesophageal varices have undergone mesocaval "H" graft operations. There have been nine deaths, three in the early and six in the late postoperative periods. Two deaths were the result of bleeding complicating severe primary fibrinolysis and three were due to disseminated sepsis, one originating from an infected shunt. Continued alcohol intake may have contributed to five of the late deaths. Ten of the 19 patients who left hospital developed some degree of hepatic encephalopathy easily controlled by diet and medical therapy. However, in one case the development of grade IV coma necessitated ligation of the shunt to reverse the coma. Patency of the shunt was demonstrated in all but one patient. Recurrence of bleeding occurred only in this patient and the one in whom the shunt was ligated. Although the operation had a comparatively low operative mortality, the long-term mobidity and mortality were no better than those of the more conventional portacaval anastomosis.

Adolescent↗