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Biomedical subjects

R G Keith

Publications and source records attributed to R G Keith.

At least 19 recordsLinked to original sources
PubMed2002

Acid suppression in healthy subjects following lansoprazole or pantoprazole.

AIM: To compare the effect of lansoprazole, 30 mg once daily, with that of pantoprazole, 40 mg once daily, for the inhibition of gastric acid secretion. METHODS: Two randomized, single-blind, two-way, crossover studies were conducted in 74 healthy male volunteers. Lansoprazole, 30 mg, or pantoprazole, 40 mg, was administered once daily for five consecutive days with at least a 2-week washout period between regimens. Ambulatory 24-h intragastric pH was recorded at baseline and on days 1 and 5 of each crossover treatment period. RESULTS: On day 1 in both studies, lansoprazole, 30 mg, produced significantly higher mean 24-h intragastric pH values when compared to pantoprazole, 40 mg (3.78 vs. 3.08, P < 0.001, and 3.97 vs. 3.20, P < 0.001, in the first and second studies, respectively). In both studies, lansoprazole, 30 mg, produced significantly greater proportions of time that the intragastric pH was above 3, 4 and 5 when compared with pantoprazole, 40 mg (P < 0.005 in all comparisons). By treatment day 5 in the first study, lansoprazole, 30 mg, continued to produce a higher mean 24-h intragastric pH (4.15 vs. 3.91, P=0.014) and a significantly greater percentage of time that the intragastric pH was above 4 (63% vs. 56%, P=0.017) and 5 (41% vs. 30%, P < 0.001) when compared with pantoprazole, 40 mg. In the second study, the effects on intragastric pH were comparable between the two treatment groups. Headache was the most commonly reported adverse experience (nine lansoprazole-treated subjects, seven in the first study and two in the second study; six pantoprazole-treated subjects, five in the first study and one in the second study). CONCLUSIONS: Lansoprazole, 30 mg once daily, produces a faster onset and greater degree of acid inhibition than pantoprazole, 40 mg once daily. The implications for these differences on symptom relief and healing of erosive oesophagitis should be explored.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1999

Advocacy--answering old mail. Canadian Association of General Surgeons.

Since its inception in 1977, the Canadian Association of General Surgeons (CAGS) has struggled with its responsibility to represent general surgeons in practices across this country. The CAGS has tended to be mute in the presentation of many of its accomplishments, which have improved the role of specialists in community practice, training programs and the subspecialties of general surgery. With the forthcoming changes in direction for the Royal College of Physicians and Surgeons of Canada, based on a recent external survey, the CAGS has a golden opportunity to advocate for a clear identity, autonomous from the Royal College for the purposes of scientific meetings, continuing professional development, scientific and practice affiliation with other surgical specialty societies, and new developments with corporate sector support for advancements in science technology and education. Advocacy for general surgery must be stressed as the priority for the CAGS into the future.

Budgets↗
PubMed1998

Traumatic pseudoaneurysm of the hepatic artery after percutaneous liver biopsy and laparoscopic cholecystectomy in a patient with biliary cirrhosis: a case report.

Hemobilia is a rare but recognizable complication of percutaneous transhepatic diagnostic or therapeutic procedures. The diagnosis is sometimes difficult because of the time lag between the procedure and the first symptoms, which can be intermittent. A 35-year-old woman had hemobilia after percutaneous Trucut biopsy of the liver followed by laparoscopic cholecystectomy. The diagnosis of hemobilia was made on clinical grounds, and a pseudoaneurysm of the right hepatic artery was detected on selective angiography. The patient was successfully treated with arterial embolization during angiography.

Adult↗
PubMed1997

Sporadic ampullary hamartoma simulating cancer.

Ampullary tumours are uncommon. They may occur with familial polyposis syndromes or neurofibromatosis. It can be difficult to distinguish them from their periampullary counterparts on clinical, radiologic or histologic grounds. Because most ampullary and periampullary tumours are malignant, they tend to be treated by radical surgery. A 67-year-old man was seen with a sporadic ampullary hamartoma that simulated cancer. It was successfully treated by local excision through a transverse duodenotomy.

Aged↗
PubMed1995

Surgery for pancreas divisum.

Recurrent acute pancreatitis has a documented association with pancreas divisum. The intermittent inflammation of the gland is caused by episodic obstruction of pancreatic secretions at the minute dorsal duct orifice. Selection of appropriate patients for operative treatment is paramount if long-term success is to be achieved. Dorsal duct sphincterotomy alone, performed by a transduodenal approach, requires precise surgical technique. Long-term freedom from recurrent attacks of pancreatitis can be achieved by operative treatment.

Abdominal Pain↗
PubMed1989

Treatment of chronic alcoholic pancreatitis by pancreatic resection.

Forty-one patients with chronic pancreatitis caused by alcoholism were selected for resective surgery on the basis of clinical criteria and findings on pancreatography. Five patients had Whipple resections, 32 had 80 percent resections, and 7 had total pancreatectomies (3 previously had subtotal pancreatectomies). One perioperative and three late deaths accounted for the overall mortality of 10 percent. Complete freedom from pain on long-term follow-up was achieved in all of the patients who had total pancreatectomy, in half of the patients who had 80 percent resection, and in only one of five patients who had Whipple resection. Diabetes occurred in only one patient after Whipple resection, in nearly half of the patients after 80 percent pancreatectomy, in a gradually accelerating manner, up to 5 years, and in all patients after total resection, where it was frequently complicated by recurrent alcoholism. Jaundice was a rare complication of disease progression in the overall treatment group; none of these patients presented with cholestasis preoperatively. Recurrent alcoholism was reported in 32 percent of the patients and contributed to two deaths.

Alcoholism↗
PubMed1989

Lymphoma pancreatitis: a real entity.

Pancreatitis induced by malignant disease is uncommon. A case of lymphoma presenting as acute pancreatitis and subsequent pancreatic abscess is reported; this led to the patient's death, 6 weeks after the initial attack of pancreatitis. Five other reports are reviewed. The pancreatitis always preceded the diagnosis of lymphoma and the preoperative diagnosis was always difficult. Lymphoma pancreatitis should, therefore, be considered in the etiology of acute pancreatitis, especially if the more likely causes have been ruled out.

Abdominal Neoplasms↗
PubMed1989

Dorsal duct sphincterotomy is effective long-term treatment of acute pancreatitis associated with pancreas divisum.

Nonbiliary, nonalcoholic pancreatic inflammatory disease was investigated by biochemical investigation, ultrasonography, endoscopic retrograde cholangiopancreatography, and secretin tests. Twenty-five consecutive cases were followed up for 12 months to 10 years after treatment of disease associated with pancreas divisum, diagnosed by endoscopic retrograde cholangiopancreatography. Thirteen patients had no recurrence of acute pancreatitis after dorsal duct sphincterotomy alone, during long-term follow-up (mean, 54 months); one patient had recurrent pancreatitis during 33 months after failed sphincterotomy. Eight patients had variable results 12 months to 8 years (mean, 49 months) after dorsal duct sphincterotomy for pancreatic pain syndrome (without amylase elevation), three were pain free, and one had recurrent pancreatitis. For 10 years after dorsal duct sphincterotomy for chronic pancreatitis, one patient had no pain relief; after subtotal pancreatectomy and pancreaticojejunostomy of the dorsal duct, both for chronic pancreatitis, one patient each was pain free and normoglycemic after 54 and 12 months, respectively. Dorsal duct sphincterotomy alone is successful in achieving long-term freedom from recurrence of acute pancreatitis associated with pancreas divisum. Pancreatic pain syndrome is not consistently improved by dorsal duct sphincterotomy. Chronic pancreatitis associated with pancreas divisum should be treated by resection or drainage procedures, not by dorsal duct sphincterotomy.

Acute Disease↗
PubMed1985

Neuropathology of chronic pancreatitis in humans.

To investigate the pathogenesis of pain in chronic pancreatitis, tissue resected from 50 patients with this condition was examined by light microscopy. An examiner, blinded to clinical and pathological data, graded perineural fibrosis, inflammation and the composition of inflammatory infiltrate in 2132 separate perineural fields. Correlation of perineural fibrosis and inflammation grading with alcohol ingestion and pain severity was insignificant. Pain severity did correlate with the timing of alcohol consumption. Although calcification significantly affected pain severity, the status of duct dilatation was not significant. Eosinophils were observed in disproportionate numbers in the perineural infiltrate. The correlation of percentage eosinophilic infiltrate and pain severity was highly significant. Timing of alcohol consumption also correlated significantly with the percentage eosinophilic infiltration. As eosinophils are known to be cytotoxic and injurious to tissue by liberation of enzymes through degranulation, the findings of this study suggest that the pain of chronic pancreatitis may be mediated by perineural eosinophils, through a chemotactic mechanism involving alcohol.

Alcohol Drinking↗