PubMed Health⌕ Search

Biomedical subjects

M Atkinson

Publications and source records attributed to M Atkinson.

At least 91 records · Page 5Linked to original sources
PubMed1982

Outcome of endoscopy and barium radiography for acute upper gastrointestinal bleeding: controlled trial in 1037 patients.

A study was conducted to find whether the higher diagnostic yield of endoscopy compared with barium radiography improves management or survival in patients with acute upper gastrointestinal bleeding. A total of 1037 patients were entered into a randomised study comparing the outcomes after each investigation. The diagnostic yield in patients who underwent endoscopy was 73% (382 of 526 cases) and in those examined by radiography 55% (280 of 511 cases). A fifth of the patients in the radiology group and a tenth of those in the endoscopy group subsequently underwent the alternative investigation; in most cases, however, no additional diagnostic information was obtained. Operation rates were similar in two groups, though patients in the endoscopy group were generally operated on sooner. Mortality rates were also similar in the two groups, though postoperative mortality was higher in the endoscopy group. Endoscopy may be a more accurate means of diagnosis than radiography, but it offers no short-term benefits in management.

Clinical Trials as Topic↗
PubMed1982

Comparison of surgical and medical management of bleeding peptic ulcers.

During 1975-80, 908 patients admitted to Nottingham hospitals with gastrointestinal bleeding and found to have gastric or duodenal ulcers were analysed retrospectively for short-term outcome of treatment. Overall one-quarter of all patients underwent operation, but when the years 1975-7 were compared with 1978-80 the operation rate fell from one in three to just over one in five. Death rates were much lower in patients treated medically than in those who underwent operation, and the risks of operation were greater for patients with gastric ulcer. Less conventional operations were attended by greater mortality. Almost all patients who died during medical treatment and three-quarters of those who died after operation were over 65. No differences in age or clear variations in haemoglobin concentrations or transfusion requirements were found between the earlier and later periods. Reduction in operation rates had no appreciable effect on mortality, despite the accepted view that early operation is advisable.

Adult↗
PubMed1982

Ethanol-associated selective fetal malnutrition: a contributing factor in the fetal alcohol syndrome.

The pathogenesis of the FAS, particularly the characteristic IUGR, may be due in part to ethanol-related placental injury. Ethanol and/ or acetaldehyde may impair placental transfer of nutrients essential for growth, e.g., amino acids. Such restriction could occur regardless of maternal nutritional status: selective fetal malnutrition. Impairment of placental nutrient transport at critical phases of fetal organogenesis could compound any direct fetotoxic effects of ethanol or acetaldehyde. The effect of ethanol upon human placental hormone synthesis and transport of vitamins, minerals, glucose, and nucleic acid precursors awaits further investigation. Similarly, potential interactions between ethanol and other xenobiotics commonly abused by alcoholics require clarification.

Amino Acids↗
PubMed1982

Ambulatory monitoring of oesophageal pH in reflux oesophagitis using a portable radiotelemetry system.

Gastro-oesophageal reflux has been assessed in 10 symptomatic patients and 10 asymptomatic normal subjects during a study period of 24 hours at work and in the home using a newly developed pH sensitive radiotelemetry capsule and a portable receiving system. Oesophageal pH was continuously monitored by the tethered radiotelemetry capsule and recorded with a portable receiver and a 24-hour cassette recorder, allowing the patient complete freedom of movement so that ambulatory studies could be undertaken during a normal working day. The number and duration of reflux episodes was greater in symptomatic patients than normal subjects during 24-hour studies at home (p less than 0.002). In both groups, reflux occurred more during the day than at night (p less than 0.01). Patients refluxed significantly more at home than when they were in hospital (p less than 0.01). Ambulatory outpatient oesophageal pH monitoring may be useful in the management of patients with atypical symptoms and may demonstrate significant reflux when inpatient investigations and endoscopy findings show minimal abnormality.

Adult↗
PubMed1982

Guaiacol -- a new compound in the treatment of gastro-oesophageal reflux?

The effects on the oesophagus of an aromatic oil, guaiacol, has been examined in a group of 20 patients with reflux oesophagitis and also normal volunteers. This agent produced a rapid and sustained rise in resting lower oesophageal sphincter pressures and the peristaltic pressures induced in response to swallowing liquids. This compound may prove useful in the treatment of patients with reflux oesophagitis and other disorders of oesophageal motility.

Esophagitis, Peptic↗
PubMed1982

Palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy.

Of one hundred and twenty-one patients with neoplastic obstruction of the oesophagus or cardia 118 underwent palliative intubation at fibreoptic endoscopy on a total of 135 occasions. Sixty had adenocarcinoma, 49 had squamous carcinoma, and in nine the oesophagus was involved by a growth arising elsewhere. Satisfactory swallowing ws restored in 112 patients. Thirteen patients died in hospital shortly after the procedure. Five fatal and 10 non-fatal perforations were sustained in 135 intubation procedures. Complications of tube function included food blockage on 26 occasions, tumour overgrowth on seven occasions, displacement on 16 occasions, disappearance of the tube in two patients, and late oesophageal perforation on nine occasions. Fifty-six patients survived for three months, 33 for six months, and 10 for a year after intubation. Comparison with series in the literature of patients who underwent surgical palliative intubation suggests that endoscopic palliation has lower mortality and morbidity, and an increased survival time, and is now the method of choice for palliation of oesophagogastric neoplasms.

Adenocarcinoma↗
PubMed1982

Oesophageal stricture associated with emepronium bromide therapy.

Emepronium bromide, a drug used to control urinary frequency, has been reported as causing oesophageal ulceration but not stricture formation. This paper presents 3 cases in which the use of emepronium bromide preceded development of an oesophageal stricture and suggests that the drug played a causative role.

Aged↗
PubMed1980

Vagal function in relation to gastro-oesophageal reflux and associated motility changes.

Vagal function in 28 patients with gastro-oesophageal reflux was examined by determining gastric secretory response to insulin-induced hypoglycaemia and pulse-rate variation with respiration. Gastric secretory studies were also performed on 13 patients with duodenal ulcer who had not undergone operations. In all patients the presence and degree of oesophagitis were determined endoscopically and mucosal biopsy and oesophageal manometry were performed. Seven of the 28 patients with gastro-oesophageal reflux showed evidence of impaired vagal efferent function in the upper alimentary tract. No such impairment was found in those patients who showed manometric evidence of oesophageal spasm secondary to gastro-oesophageal reflux. Low pulse-rate variation with respiration was found in 12 of 27 patients with gastro-oesophageal reflux, suggesting dysfunction of cardiac vagal fibres. Impairment of efferent vagal supply may be a causative factor in some patients with gastr-oesophageal reflux but does not seem to be important in oesophageal spasm secondary to gastro-oesophageal reflux.

Adult↗
PubMed1980

Treatment of a patient with clinical features of both eosinophilic gastroenteritis and polyarteritis nodosa with oral sodium cromoglycate.

A young patient who suffered from allergic respiratory disease presented with an illness characterized by abdominal pain, diarrhea, and weight loss. Investigations revealed radiological and pathological features consistent with a diagnosis of eosinophilic gastroenteritis. Because of extensive gastric ulceration, treatment with corticosteroids was withheld and in its place oral sodium cromoglycate therapy given. The patient's intestinal symptoms rapidly responded to this treatment and remained controlled for a period of five months. The patient subsequently developed a systemic illness with features of polyarteritis nodosa.

Adult↗
PubMed1979

Cimetidine in treatment of reflux oesophagitis with peptic stricture.

Twenty patients with reflux oesophagitis causing a tight peptic oesophageal stricture entered a randomised double-blind crossover trial in which they received cimetidine, 1.6 g daily, and matching placebo each for six months. The gross endoscopic appearances of oesophagitis, though not the grades of histopathological changes, showed significant improvement during treatment with cimetidine. The need for dilatation of the strictures, however, was not reduced.

Aged↗
PubMed1979

Effect of different operation policies on mortality from bleeding peptic ulcer.

The outcome in bleeding gastric and duodenal ulcer has been compared in two hospitals in Nottingham which take their patients randomly from a common source according to a fixed daily admission rota. Bleeding seemed equally severe in the two groups but 66 (32%) of 206 patients were operated upon at hospital A compared with 44 (46%) of 96 at hospital B (P=0.03), where operations also tended to be done earlier. Postoperative mortality-rates were virtually identical at the two hospitals, but at hospital B the overall death-rate from bleeding ulcer was higher, partly because of its higher operation-rate. The value of an aggressive surgical policy in bleeding peptic ulcer is questionable.

Adult↗
PubMed1978

Tube introducer and modified Celestin tube for use in palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy.

A new method for palliative intubation of inoperable neoplasms at or near the cardia is described. A guidewire is passed through the stricture, which is dilated using Eder Puestow metal olive dilators. The tube to be inserted is mounted on an introducer, which grips its distal end from inside, and is slid into position along the wire under radiological control. Twenty-five patients have been intubated with one death directly resulting from the procedure. The method provides a simple and relatively safe means of relieving dysphagia and improving nutrition.

Deglutition Disorders↗
PubMed1978

Circadian rhythm disorders in manic-depressives.

Seven circular manic-depressives were studied through complete of cycles of mania and depression. In five subjects, there was evidence that a circadian rhythm free-ran fast (p less than 0.005 and p less than 0.002 in two of the subjects), and in five subjects, there was evidence that lithium slowed a circadian rhythm. The palliative benefit of lithium may derive from slowing or delaying an overfast circadian clock to prevent desynchronization. Two subjects whose circadian clocks seemed too slow were lithium nonresponders (p less than 0.05). As circadian clock frequency may be transmitted on an X-chromosome gene and may increase with age, a circadian etiology is consistent with the genetics and age distribution of manic-depressive illness. Affective disturbances could be evolutionary remnants of the photo-periodic seasonal responses in animals.

Adult↗
PubMed1977

A prospective, randomised study of endoscopy and radiology in acute upper-gastrointestinal-tract bleeding.

318 patients admitted to hospital with acute upper-gastrointestinal-tract bleeding were entered into a prospective randomised comparison of investigation by either endoscopy or radiology. Although the diagnostic yield was higher in the endoscopy group than the radiology group, there was no difference between the two groups in management or survival, and the accuracy of the findings as judged independently at operation and/or necropsy was also similar in the two groups. These findings case doubt on the need to provide emergency endoscopic facilities for the investigation of patients with acute upper-gastrointestinal-tract bleeding where radiological services are already adequate.

Acute Disease↗
PubMed1977

Dysphagia.

Explore the source record for details and available documents.

Aged↗
PubMed1977

Fibreoptic endoscopic palliative intubation of inoperable oesophagogastric neoplasms.

Palliative intubation for inoperable malignant strictures at the cardia was done on 16 occasions in 13 patients using fiberoptic endoscopy. Preliminary dilatation was performed, and the Celestin tube was mounted on an introducer and passed over a guide wire inserted with a fiberoptic endoscope. Only one death resulted from the procedure and all the 12 patients who left hospital were swallowing satisfactorily on discharge. The method provided a simple and relatively safe means of relieving dysphagia and improving nutrition.

Cardia↗