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Biomedical subjects

D E Tweedle

Publications and source records attributed to D E Tweedle.

At least 55 records · Page 3Linked to original sources
PubMed1982

Intraoperative microscopy of bile--is it useful?

Direct microscopy of the bile was performed during cholecystectomy in 111 patients in an attempt to identify those with a high risk of wound infection. Bacteria were identified in 23 patients, 11 of 83 undergoing cholecystectomy alone and 12 of 28 undergoing exploration of the common bile duct (P less than 0.01). These 23 patients were randomly allocated to an antibiotic group or a control group; there was one wound infection in the antibiotic group and two in the control group. A total of 14 patients developed wound sepsis. Infection was more likely if the common bile duct was explored (6 of 28) rather than cholecystectomy alone (8 of 83). There was a poor correlation between microscopy and culture of the bile for bacteria and there was no increase in sepsis when bacteria were observed on microscopy. We were not able to identify a high risk group of patients by intraoperative microscopy of bile.

Adult↗
PubMed1982

Likelihood of relapse of duodenal ulcer after initial treatment with cimetidine or colloidal bismuth subcitrate.

Colloidal bismuth subcitrate (CBS, DE-NOL) and cimetidine have been compared in a double-blind randomized trial in the management of 75 patients with duodenal ulcer. The drugs had similar potency with respect to ulcer healing. At one month the healing rates were 66% for CBS and 59% for cimetidine. At two months the rates were 89% and 85% respectively. When the drugs were withdrawn patients who had received CBS had significantly lower relapse rates than those who had received cimetidine. Relapse rates for CBS and cimetidine were 13% and 70% at six months and 39% and 85% at one year respectively.

Adolescent↗
PubMed1981

Difference in relapse rates of duodenal ulcer after healing with cimetidine or tripotassium dicitrato bismuthate.

In a double-blind randomised trial in 75 patients with duodenal ulceration diagnosed endoscopically, 38 patients were given tripotassium dicitrato bismuthate and 37 cimetidine. There was no significant difference in the healing rates between the two drugs after 1 and 2 months, although relief of symptoms was marginally quicker with cimetidine. During follow-up for at least a year, relapse was significantly more common in patients whose ulcers had healed during treatment with cimetidine than in those whose ulcers had healed during treatment with tripotassium dicitrato bismuthate. This difference appears to be related to the medication rather than to any other difference between the two groups of patients. These results suggest that drug treatment given for a short period in duodenal-ulcer disease influences the progress of the disease.

Adolescent↗
PubMed1980

Ampullary carcinoma associated with multiple duodenal villous adenomas.

A 39-year old Asian with multiple duodenal villous adenomas and an adenocarcinoma arising from one of these tumors is described. The rarity of villous adenomas at this site is stressed and their tendency to undergo malignant change reviewed. Immunoperoxidase studies using carcinoembryonic antigen (CEA) antiserum were positive in high dilutions (1 in 8,000) in the carcinoma and the largest adenoma. This stain would appear to show functional malignancy before histological evidence of malignancy is found.

Adenocarcinoma↗
PubMed1979

A prospective randomized trial of vagotomy in chronic duodenal ulceration.

In a prospective, randomized trial, 76 patients with duodenal ulceration treated by truncal vagotomy and pyloroplasty were compared with 77 patients who underwent highly selective vagotomy. A total of 149 patients was followed up for from 1 to 4 years, the average follow-up period being 2.6 years. There was no operative mortality and no significant difference in postoperative morbidity between the two groups. The incidence of recurrent ulceration was greater after highly selective vagotomy, but this difference was not statistically significant. The clinical results were comparable in each group, and although the incidence of diarrhoea and dumping was greater after vagotomy and pyloroplasty, this difference was not statistically significant.

Adult↗
PubMed1979

Postoperative hypophosphataemia.

The possible mechanisms of postoperative hypophosphataemia were studied in women undergoing uncomplicated cholecystectomy. Six patients were allocated to each of three groups. Group I received no intravenous fluids, group II received dextrose/saline solution alone and group III received dextrose/saline solution with phosphorus supplementation. The serum concentration of inorganic phosphorus fell in all three groups, the greatest fall being in the group receiving dextrose/saline solution. However, the lowest level reached (0.82 mmol/l) was within the normal range for our laboratory. Concentrations of red blood cell adenosine triphosphate and 2,3-diphosphoglycerate showed similar changes. The operations were not associated with a large catabolic response nor with an increase in urinary phosphorus excretion. The postoperative reduction in serum concentration of inorganic phosphorus appeared to be due mainly to haemodilution. There is no indication for routine phosphorus supplementation following uncomplicated elective surgery.

Cholecystectomy↗
PubMed1979

Peroperative transduodenal biopsy of the pancreas.

Peroperative transduodenal biopsy of the pancreas was performed in 65 patients with the disposable Trucut needle. The technique described is simple, effective, and may reveal unsuspected malignancy. A histological diagnosis of malignancy is reliable but false negative diagnosis may arise because of failure to obtain representative samples.

Biopsy, Needle↗
PubMed1979

Abnormal liver function during nutritional support in postoperative cancer patients.

Patients who receive total intravenous or nasogastric nutritional support after surgery for head and neck cancer show abnormalities of liver function. Twenty such patients were maintained in positive nitrogen balance. Serum alkaline phosphatase and aspartate aminotransferase values were increased in 15 and 18 cases respectively. Possible causes for the abnormalities are discussed and further investigations proposed.

Aged↗
PubMed1977

Intravenous amino acids as the sole nutritional substrate. Utilization and metabolism in fasting normal human subjects.

The fasting normal human volunteer subject provides an ideal experimental setting for the initial investigation of foodstuffs whose use is proposed for the acutely ill surgical patient. In the normal human subject many variables can be controlled; the achievement of an ideal body fuel economy is quite simple; if a favorable utilization of injected foodstuffs cannot be achieved in this setting, it is unlikely, and remains to be proven, that utilization will be satisfactory under the challenges of acute surgical trauma. In this experimental model, employing four normal human volunteer subjects, nutrition has been provided by the intravenous infusion of isotonic amino acids (FreAmine(R) II) at a 3.4% concentration. No other source of calories or nutrients was provided. In this setting, utilization was very poor; the subjects were in negative nitrogen balance throughout. The nitrogen excretion was significantly greater than the total of infused nitrogen. The changes in protein, fat and carbohydrate intermediates, as well as the alteration in hormone concentrations, suggest the following endocrine governance of fuel economy in this setting: a sharp rise in glucagon with maintenance of insulin concentration; rapid gluconeogenesis at the expense of both injected and endogenous amino acids; a progressive ketosis without any associated improvement in protein economy; fat oxidation to meet caloric need. The changes in plasma amino acid concentrations are of outstanding interest. They demonstrate changes appropriate to the infusion gradient with the exception of three amino acids whose concentrations did not respond to high infusate levels (serine, lysine, and alanine); likewise, by the fact that methionine rose remarkably though present in only low concentrations in the infusion. These data, taken with other information reported in the literature, as well as continuing studies in these laboratories, strongly suggest that the utilization of infused amino acids for protein synthesis is favored by the provision of an additional caloric source such as glucose.

Adult↗
PubMed1973

Effect of a Millipore filter on complications of intravenous infusions: a prospective clinical trial.

The Millipore filter unit has been advocated as a means of reducing the chance of bacteria entering the circulation during intravenous infusion. In a prospective study no significant reduction was obtained in the incidence of thrombophlebitis or in the bacterial contamination of cannulae. The unit was inconvenient to use and in-vitro and in-vivo studies showed reduced flow rates and frequent episodes of filter blockage. Its use was further restricted by the fact that blood and fat emulsions would not pass through it.

Bacteria↗