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R H Diament

Publications and source records attributed to R H Diament.

5 recordsLinked to original sources
PubMed1995

Helicobacter pylori and recurrent ulceration after highly selective vagotomy.

OBJECTIVE: To examine the relationship between Helicobacter pylori and recurrent ulceration after highly selective vagotomy (HSV). SETTING: Academic Department of Surgery at a teaching hospital. PATIENTS: Thirty-eight patients (26 men and 12 women) were studied 2-21 years after HSV. Seven patients had recurrent ulceration. Each patient underwent tests of acid secretion before and 1 week after HSV together with later endoscopic examination of the stomach and duodenum. Four biopsies were taken from the duodenum and gastric antrum. RESULTS: There was no statistical difference in acid output between patients with and those without recurrent ulceration (peak acid output 46.9 versus 55.8 mmol/h, respectively; not significant) before operation. After operation, insulin stimulated acid secretion was significantly higher in patients who later developed recurrent ulceration (0.26 versus 4.1 mmol/h, respectively; P < 0.02). The endoscopic biopsies were tested for H. pylori infection (90 versus 86% for patients without and those with recurrent ulceration, respectively; not significant), gastric metaplasia within the duodenum (23 versus 14% for patients without and those with recurrent ulceration, respectively; not significant), antral gastritis (86 versus 71% for patients without and those with recurrent ulceration, respectively; not significant) and antral intestinal metaplasia (52 versus 43% for those without and those with recurrent ulceration, respectively; not significant). CONCLUSION: H. pylori infection is not influenced by HSV and ulcer recurrence is determined by the completeness of vagotomy rather than by H. pylori status.

Adult↗
PubMed1993

Iatrogenic vascular injury following arterial cannulation: the importance of early surgery.

Prospective data were collected over a 7-year period on patients undergoing repair of iatrogenic vascular injury following arterial cannulation. From 9375 procedures (7790 coronary angiograms, 835 coronary angioplasties, 445 other cardiac catheterizations, 155 femoral angiograms, 150 peripheral angioplasties) surgical repair was required in 26 patients. The overall incidence of significant injury was 0.28% and higher in therapeutic than diagnostic procedures. The mode of presentation included: critical limb ischaemia in 18 cases, false aneurysm in three, haematoma in three and claudication in two. The common femoral artery was the most common site of injury. No patient presenting with false aneurysm or haematoma suffered any deleterious sequelae. However, 50% of those presenting with critical ischaemia suffered permanent disability after operation. The median delay to surgery was significantly longer in this group (24 versus 4 h; P < 0.001) but there was no difference in age or incidence of underlying peripheral vascular disease. The physical, psychological and litigious sequelae of the complications of iatrogenic vascular injury cannot be overstated. It is strongly advocated that immediate surgical consultation be applied when limb ischaemia is suspected.

Adolescent↗
PubMed1993

Management of obstructing lesions of the left colon by resection, on-table lavage, and primary anastomosis.

BACKGROUND: The purpose of this study was to assess the feasibility and safety of single-stage resection, on-table lavage, and primary anastomosis in patients presenting with obstruction of the left colon. METHODS: The outcome of surgery in 73 consecutive patients presenting with obstruction of the left colon during a 5-year period was assessed in terms of perioperative complications and long-term survival. RESULTS: Sixty-three patients (86%) underwent single-stage restorative procedures. In this group there were four clinical anastomotic leaks (6%). However, there were no deaths as a result of leakage. There were four deaths (6%) but these were not due to anastomotic leakage. Long-term survival rates compared favorably, stage for stage, with large published series of elective experience. CONCLUSIONS: We believe that resection, on-table lavage, and primary anastomosis constitute the operation of choice for most patients with acute obstruction of the left colon.

Anastomosis, Surgical↗