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Biomedical subjects

L K Harding

Publications and source records attributed to L K Harding.

At least 91 records · Page 5Linked to original sources
PubMed1984

The incidence of duodenogastric reflux in peptic ulcer disease.

Using 99mTc diethyl HIDA, a gamma camera was used to assess duodenogastric reflux of bile in the supine position in control patients and patients with active duodenal ulceration. Cholecystokinin was injected intravenously during the test to contract the gall bladder. Patients with benign gastric ulcers, and a group of age matched controls, were investigated for duodenogastric bile reflux in the sitting position by a nasogastric aspiration technique after a 10% dextrose meal. Of 60 patients with duodenal ulceration 32 (53%) were reflux positive, and of 13 control patients 6 (46%) were positive. Of 30 patients with gastric ulceration 17 (53%) were reflux positive, and 8 out of 15 (53%) control subjects were positive. The incidence of duodenogastric reflux assessed supine in the fasting state, and seated after a liquid meal, was similar in patients with peptic ulceration and in normal controls.

Cholecystokinin↗
PubMed1984

Bile reflux after duodenal ulcer surgery. A study of 114 asymptomatic and symptomatic patients.

The hypothesis has been examined that the quantity of enteral contents refluxing into the stomach affects the severity of symptoms after peptic ulcer surgery. 99mTc HIDA scintigraphy was used to investigate the incidence and quantity of reflux in 20 normal subjects, in 94 symptomatic or asymptomatic patients after traditional operations for duodenal ulcer, and after revision of surgery for bile reflux gastritis. The percentage of the injected dose of 99mTc HIDA (PID) counted in the stomach area was used as an index of the quantity of refluxed bile. After duodenal ulcer surgery, symptomatic patients had a PID (6.2%) not significantly different (4.5%) from that of asymptomatic patients but higher than (2.1%) that of normals (p less than 0.05). After operations for reflux gastritis, 10 symptom free patients had no reflux, whereas 3 of 8 patients who remained symptomatic and had a short Roux-en-Y gastrojejunostomy, had persistent reflux.

Bile Reflux↗
PubMed1984

Does duodenogastric reflux affect the rate of gastric emptying?

The gastric emptying of a liquid meal (10% dextrose solution) and a semi-solid meal (minced meat, peas, potatoes and milk) was measured in the sitting position; both meals were 400 ml. Duodenogastric reflux was assessed supine after intravenous injection of 75 MBq of 99 mTc HIDA and cholecystokinin. Patients were ajudged reflux positive (R+), or reflux negative (R-) by looking at gamma camera pictures. Thirty-two duodenal ulcer patients (DU), 22 patients after truncal vagotomy and pyloroplasty (TV+P) and 21 after proximal gastric vagotomy (PGV) were studied. In DU sufferers the mean volume of early liquid emptying in R+ patients (74 ml) was similar to R- patients (78 ml). After TV+P early liquid emptying was greatly increased (mean 176 ml) but no difference was found between R+ and R- patients. After PGV excessive early emptying was less common but emptying was significantly greater in R+ patients (R+ mean = 132 ml, SD = 48 n = 8; R- mean = 63 ml, SD = 21, N = 13: t = 4.2 p less than 0.001). There was no difference in solid meal emptying between R+ and R- patients in any group.

Cholecystokinin↗
PubMed1984

The pharmacokinetics of 99mTc HIDA in man and its relationship to intra-gastric bile acids.

We have examined the pharmacokinetics of 99mTc diethyl HIDA in five patients with a T-tube inserted into their common bile duct after choledocotomy. Blood clearance was rapid with 27.5% of the injected dose in the circulation at 2.5 min and 5% at 30 min. The peak bile excretion of 15.4% occurred between 45 and 60 min after injection of the HIDA. By 2 h 69% of the dose was excreted in the bile and 14% in the urine. In a second group of 33 patients a naso-gastric tube was passed after injection of HIDA. The patients drank 400 ml of 10% dextrose and aliquots of the stomach contents were aspirated every 10 min for an hour. In specimens with a pH greater than 4, the amount of HIDA correlated well (p less than 0.01) with the amount of bile acid determined by an enzymatic method.

Adult↗
PubMed1984

Sensitivity and reproducibility of a bile reflux test using 99mTc HIDA.

We have studied the sensitivity and reproducibility of entero-gastric bile reflux measurements using a gamma camera. Aspiration of the stomach at the end of the study in a group of 14 patients showed that less than 1% of the administered HIDA was present in 7 patients who were judged reflux negative. In all 7 patients considered reflux positive, there was more than 1% of the dose in the stomach (median 8.2%, p less than 0.01 Mann-Whitney). The second group of 20 patients was studied twice in the same week with a 48 h interval between the tests. The results were reproduced in 15 patients (75%). Finally, the gamma camera technique was compared with nasogastric aspiration on a separate occasion. There was agreement in 16 patients out of 19(84%). These results suggest that the test is sensitive, and the lack of reproducibility is compatible with day to day variation in entero-gastric reflux.

Bile Reflux↗
PubMed1984

Quantitation and the elimination of errors in bile reflux tests using a gamma camera.

Entero-gastric reflux may be assessed quantitatively using 99mTc HIDA and a gamma camera. We have devised a computer program which applies corrections for several sources of error. The technique was validated using naso-gastric aspiration and phantom experiments. In 23 patient studies, 13 patients considered not to show reflux by visual assessment had a mean percentage injected dose (PID) in the stomach of 1.9% before correction and less than 1% after correction. The 10 patients with reflux showed a fall of PID from 5.8% to 1.7% as a result of the correction. In 14 patients the mean PID in the stomach after computer correction (3%) was not significantly different from that (3.5%) measured by aspiration. Computer correction of bile reflux data is essential when attempting to quantify the amount of entero-gastric reflux using a gamma camera.

Bile Reflux↗
PubMed1984

Does gastric entubation cause entero-gastric reflux?

Using 99mTc diethyl HIDA, we have examined patients with duodenal and gastric ulceration for the effect of naso-gastric intubation on bile reflux. Fourteen patients with duodenal ulceration were studied supine under a gamma camera. Activity from the stomach area showed no significant change before and after naso-gastric intubation (Mann-Whitney U = 0.18). Nineteen patients with gastric ulceration were investigated for bile reflux using two techniques. One method used the gamma camera but without naso-gastric intubation. The other method involved passing a naso-gastric tube and aspirating aliquots of a liquid meal which were analysed for 99mTc HIDA content. The incidence of bile reflux in patients with gastric ulceration was the same when the results of the two methods were compared. We conclude that investigation of groups of patients for duodeno-gastric reflux by naso-gastric aspiration of gastric contents is a valid technique.

Duodenal Ulcer↗
PubMed1984

Quantitative lung scintigrams and lung function in the selection of patients for pneumonectomy.

A method for predicting postoperative respiratory function following lung resection has been used in 11 patients with both histologically proven bronchial carcinoma and chronic obstructive airways disease, in order to assess their fitness for surgical treatment. Quantitative ventilation and perfusion scintigrams were used to measure the amount of functioning tissue in each lung. These data were used in conjunction with spirometric measurements to calculate the likely functional effect of pneumonectomy. There was a high degree of correlation (r) between predicted and measured lung function for both FEV1 (r = 0.75, P less than 0.01) and FVC (r = 0.88, P less than 0.01). The postoperative FEV1 was within 150 ml of the predicted value in 45% of the patients. In the remaining patients the actual volumes were greater than predicted by 210-540 ml. For FVC the results were within 150 ml of predicted in 45% of patients and in the remainder actual volumes were greater by 160-650 ml. Both sets of calculations underestimated lung volumes by an average of 200 ml. The method is shown to be accurate, simple, non-invasive, and readily available and brings a degree of objectivity to an important decision that is often based mainly on clinical assessment.

Aged↗
PubMed1983

Regional distribution of ventilation and perfusion in patients with obstructive pulmonary disease and alpha 1-antitrypsin deficiency.

Regional distribution of pulmonary ventilation and perfusion has been determined of 13 patients with chronic obstructive pulmonary disease (COPD). Eight patients had alpha 1-antitrypsin deficiency (alpha 1 ATD). Ventilation studies were carried out using xenon-133 (133Xe) and krypton-81m (81mKr) gases. Trapping indices were determined from the wash-out part of the xenon ventilation studies. Results obtained from patients were compared with those of normal controls. Ventilation studies with 81mKr showed pulmonary changes more clearly than did 133Xe studies and the trapping of radio-xenon was more extensive in lung bases than in apices whether or not the patients had alpha 1 ATD. The distribution of perfusion followed a pattern similar to that of ventilation, but did not differ statistically from that of the normal controls.

Humans↗
PubMed1982

The efficacy of peritoneal lavage at elective abdominal operations.

Human serum albumin microspheres of 1 micrometer diameter labelled with technetium-99 m were evaluated as a model for bacteria in two animal species. Peritoneal lavage recovered comparable amounts of an inoculum of microspheres and simultaneously instilled Escherichia coli. A prospective study was undertaken of 38 patients undergoing elective abdominal operations. Three lavages, each of 500 ml normal saline, were used. Over 80 per cent of the saline was recovered in 37 of the 38 patients with a median of 93 per cent. Recovery of microspheres was assessed from above the spleen, from Morison's pouch and from the pouch of Douglas. There was no difference in the recovery rates from the three sites of placement but significantly fewer microspheres were recovered via a right subcostal incision (median 59 per cent) compared with an upper midline incision (median 91 per cent).

Abdomen↗
PubMed1982

Bile diversion after total gastrectomy.

A method for studying bile reflux into the oesophagus after total gastrectomy is described using 99Tcm-HIDA and an external imaging system. Two reconstructions were studied: oesophagojejunostomy with a diverting entero-anastomosis (omega reconstruction 6 studies) and Roux-en-Y reconstruction (20 studies). The incidence of reflux on scanning correlated well with the incidence of oesophagitis, and the finding of reflux was almost always associated with severe symptoms. The omega procedure was unsuccessful in diverting bile in 5 patients despite an entero-anastomosis as wide as 12 cm. The Roux-en-Y reconstruction was unsuccessful in diverting bile in 5 patients all of whom had a diverting limb 35 cm in length; none of the 9 patients with a diverting limb longer than 35 cm refluxed (range 40--50 cm).

Bile Reflux↗
PubMed1982

Application of gravitational clustering analysis to liquid gastric emptying.

A gravitational clustering analysis was applied to principal component weighting factors and t1/2 values from 100 liquid gastric emptying studies. Using principal components, groups of patients with clinical features in common were identified, whereas the analysis of the t1/2 values failed to differentiate them.

Duodenal Ulcer↗
PubMed1980

Hypoglycemic coma, jaundice, and pure RBC aplasia following chlorpropamide therapy.

Five weeks following the initiation of chlorpropamide therapy for diabetes mellitus, hypoglycemic coma, cholestatic jaundice, and RBC aplasia developed in a 41-year-old woman. Within 40 days of stopping the drug, she had made a complete recovery. To our knowledge, this is the first case in which these three complications of chlorpropamide have occurred simultaneously.

Adult↗
PubMed1979

Interrelations between serum gastrin levels, gastric emptying and acid output before and after proximal gastric vagotomy and truncal vagotomy and antrectomy.

In a prospective study of proximal gastric vagotomy and truncal vagotomy and antrectomy measurements were made, before and after operation, of acid output, gastrin output and gastric emptying of a solid and a liquid meat extract meal. No relationships were demonstrable between acid output and gastrin output. Truncal vagotomy and antrectomy (TVA) produced rapid early emptying of both meals combined with gross prolongation of the overall emptying of the solid meal. Truncal vagotomy and antrectomy reduced the intergrated gastrin output after either meal. Proximal gastric vagotomy (PGV) produced rapid early emptying of the liquid meal with no alteration in the early emptying of the solid meal; however, overall solid meal emptying was delayed. Proximal gastric vagotomy increased basal, peak and integrated gastrin output. In preoperative patients slow solid meal emptying was associated with higher gastrin output but after PGV the reverse was found, the slowest emptiers having the lowest gastrin output. These findings do not support the contention that a pyloroplasty should be added to PGV to reduce the hypergastrinaemia produced by the operation.

Clinical Trials as Topic↗