Biomedical subjects
Publications and source records attributed to M J Stower.
Using an intact concious animal model the effect of various drugs on the rate of canine ureteric peristalsis was studied. The drugs found to reduce consistently the rate of ureteric peristalsis were diazoxide, terbutaline, and ritodrine. Ritodrine was the most consistent, having a prolonged effect and reducing the rate of ureteric peristalsis to 50% of the rates observed in control experiments.
The incidence and pattern of hand fractures occurring in children living in Nottingham has been reviewed. The hand is the second commonest site of fracture in children. The incidence is low in infants, but rises steeply after the age of eight, especially in boys. The most common site is the proximal phalanx. The little finger/fifth metacarpal is the most vulnerable area, especially around the metacarpophalangeal joint. Greenstick fractures are more common in metacarpals, while epiphyseal injuries predominate in the phalanges. Over 45% of fractures occurred either at sport or in a fight. Aetiological factors are discussed in relation to the fracture patterns described.
Twenty-four-hour esophageal pH monitoring was performed in 59 children with symptoms of gastroesophageal reflux using a miniature pH electrode and a portable recording system to establish the diagnosis. Significant reflux was seen in 26 (44%) of the patients and these were treated for six weeks with cimetidine, Gaviscon, and Nestargel. Five children who did not improve either symptomatically or on repeat pH monitoring while on treatment underwent antireflux surgery. The pretreatment reflux index in this group was 26.5 compared with a pretreatment reflux index of 11.2 in the 21 patients who improved on therapy (P less than 0.01). Esophageal pH monitoring has enabled selection of children for surgery and may be used as an early indicator of those who will not benefit from long-term medical therapy. Ambulatory and home monitoring techniques are more convenient and cost-effective and allow studies to be performed in the normal home environment.
Double J stents have been advocated for drainage or splintage of the ureter. One hundred and thirty-eight attempts at stent insertion were made in 100 patients. In 78% of attempts the stent was satisfactorily placed. Their use in retroperitoneal fibrosis, ureteric trauma and acute hydronephrosis of pregnancy has been encouraging. Poor results have been obtained in patients with malignant obstruction or tuberculous stricture.
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The prognostic value of an erect and supine abdominal X-ray was studied prospectively in 97 patients with an acute abdomen. Although 64 (66%) of the radiographs showed an abnormality, the surgical registrar altered his clinical diagnosis on only seven occasions and changed his management on four. A consultant radiologist was the most accurate at reporting the X-rays even without seeing the patient, whilst junior surgical and radiological staff were as accurate as each other. A surgical registrar, however, was more accurate than junior radiologists in making a diagnosis. The investigation was of immediate clinical value in only 4% of the patients, and its use could probably be limited without detriment to patients.
The results of treatment of 1115 patients with colorectal cancer, from one hospital, are presented. The mean age of the patients was 67.24 (+/- 0.35 SEM) years and there were the same number of male and female patients. Forty per cent of patients were admitted as an emergency, and 67% of the tumours were in the rectum or sigmoid colon. 46.7% of the patients were considered to have undergone a 'curative' resection. Six per cent of the tumours were Dukes' Stage A lesions; 37% were Stage B and 57% Stage C. Twenty-six per cent had liver metastases. The overall hospital mortality was 21.5% and the operative mortality 14%. One-third of the patients admitted as an emergency died during their first admission. The overall 5-year survival was 25.8%; those with Dukes' Stage A tumours had a 5-year survival of 82.1%, Stage B 53.6% and Stage C 12.8%. The sex, site of tumour or duration of symptoms had no effect on prognosis.
The effect of glucagon on ureteric peristalsis in man, pig, rabbit and rat has been studied using specially shaped perspex blocks containing silver/silver chloride bipolar electrodes. In all subjects the ureteric electrical activity was recorded during laparotomy. Glucagon was administered as a single intravenous dose of 14 micrograms per kilogram in man and in doses of between 6.25 and 160 micrograms per kilogram in the other species. The mean (+/- S.E.M.) peristaltic rates per minute were: man 4.85 (+/- 0.66), pig 2.04 (+/- 0.36), rabbit 3.78 (+/- 0.23) and rat 5.02 (+/- 0.16). Glucagon was found to have no significant effect on ureteric peristalsis in man, rabbit or rat, whilst in the pig a variable effect was seen.
The emergency surgical admissions to one firm during the year 1979 have been reviewed. Emergency cases constituted half the workload of this and other units in the hospital. Male and female admissions were equal. The under twenty year old was the largest age group admitted. The commonest diagnosis, non specific abdominal pain, was made in 22.9% of all the patients and acute appendicitis accounted for 11.1%, whilst the remainder fell into a large number of diagnostic categories with only a few patients in each. Only 30.2% of all the patients had an operation within 48 of admission. These figures suggest that surgical trainees may no longer gain the experience in managing acute admissions which was once possible and that any future training programmes must ensure wider exposure to surgical emergencies.
Ureteric peristalsis has been studied using extraluminal bipolar electrodes and metal foil strain gauges in both the unanaesthetized and anaesthetized dog. Electrical activity of the ureter was characterized by bipolar action potentials, which always preceded mechanical activity. In the acute studies glucagon 44 micrograms/kg i.v. was given during the unstimulated phase and again during a forced diuresis. Complete inhibition of ureteric activity was seen for 19 . 50 (+/- 3 . 76 s.e.) and 16 . 25 (+/- 1 . 59 s.e.) min respectively. During this period there was no change in the rate of urine flow. In the conscious dog glucagon was given as a bolus of 22 micrograms/kg followed by an infusion for 45 min. An infusion of 88 micrograms/kg h produced complete inhibition for 39 . 2 (+/- 2 . 41 s.e.) min. Propantheline, hyoscine, morphine, pethidine and buprenorphine were given in equivalent therapeutic human doses, but no consistent effect on ureteric peristalsis was seen. Glucagon may have a role to play in the management of ureteric colic.
Seventy-one patients with a clinical diagnosis of painful biliary tract disease have been entered into a double-blind trial of glucagon. Twenty-eight were excluded as gallstones were not proved: of the remainder, 21 patients received glucagon and 22 placebo. Glucagon-treated patients were pain free 14.26 h (+/- 2.77 s.e.m.) after commencing treatment compared to 29.14 h (+/- 6.01 s.e.m.) for the placebo group (P less than 0.05). Tenderness in the right hypochondrium showed a significant improvement when assessed at 12 h (P less than 0.02) and 24 h (P less than 0.1) for those given glucagon. A significant difference in blood glucose levels was seen between the two groups (P less than 0.05). No serious side effects were observed. Glucagon relieves the pain and tenderness associated with painful biliary tract disease more effectively than conventional therapy.
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