PubMed Health⌕ Search

Biomedical subjects

R M Kirk

Publications and source records attributed to R M Kirk.

At least 19 recordsLinked to original sources
PubMed1990

The effect of nabumetone and its principal active metabolite on in vitro human gastric mucosal prostanoid synthesis and platelet function.

Nabumetone is a novel non-steroidal anti-inflammatory drug (NSAID) which although a weak cyclooxygenase inhibitor is converted by the liver to metabolites which are more potent inhibitors of cyclooxygenase. Nabumetone may thus avoid the occurrence of gastric erosion while maintaining its efficacy as an anti-inflammatory drug. We compared the effects of nabumetone and 6-methoxy-2-naphthylacetic acid (6MNA; the principal metabolite of nabumetone) with naproxen and indomethacin on in vitro synthesis of the gastroprotective prostaglandins I2 and E2 by human gastric mucosa. To study the effects of 6MNA on peripheral target tissues the effects of the above NSAIDs on human platelet aggregation and thromboxane A2 synthesis were also studied. Prostanoid synthesis by the human gastric mucosa was inhibited by indomethacin, naproxen and 6MNA (in this order of potency) whereas nabumetone was completely without effect. Platelet aggregation and thromboxane A2 synthesis were similarly inhibited by the NSAIDS (viz. indomethacin greater than naproxen greater than 6MNA greater than nabumetone). These results support the view that nabumetone does not inhibit gastroprotective prostanoid synthesis, whereas its active metabolite 6MNA is an effective inhibitor of prostanoid synthesis in target tissues.

6-Ketoprostaglandin F1 alpha↗
PubMed1988

Reoperative surgery for early complications following abdominal and abdominothoracic operations.

In-hospital mortality was 9.6% in 3000 abdominal and abdominothoracic operations carried out by me or under my care. Intra-abdominal complications developing during the recovery period required reoperation in 141 patients. The decision to reoperate was a clinical one in 97.8%, although investigations were often helpful in localizing the site of the complicating lesion: the mortality in this group was 42.5%. Technical failure at the first operation could be indicated in 46%. Leaks and bleeding were most frequent and carried a high mortality. Patient selection and preparation, and selection of the simplest effective procedure, are not yet capable of being fully assessed in an individual patient.

Abdomen↗
PubMed1986

Could chronic peptic ulcers be localised areas of acid susceptibility generated by autoimmunity?

It is argued that all chronic gastroduodenal peptic ulcers result from localised increase in mucosal susceptibility to acid attack at the interface between a segment of gastroduodenitis and gastric fundus or duodenal mucosa. The site is predetermined by the background mucosal pattern. Changes can occur in the differentiated gastroduodenal mucosa that closely resemble cell population transformations described in embryology and regeneration biology. A second pathological process, gastroduodenitis, may develop that does not of itself predispose to ulceration, but the combination of factors can produce a zone of increased acid susceptibility. These complex changes could be generated by immunologically activated gastroduodenitis. Destructive or stimulatory immune reactions, analogous to those seen in the thyroid gland, could affect the gastrin-secreting G cells and other paracrine cells. The resulting tropic and inflammatory reactions would provide the background for peptic ulceration.

Autoantibodies↗
PubMed1985

Roux-en-Y.

Explore the source record for details and available documents.

Gastroenterostomy↗
PubMed1985

Disseminated infection associated with corticosteroid therapy after transduodenal sphincteroplasty.

Treatment with oral prednisolone appears to have precipitated an episode of ascending cholangitis in an asymptomatic 55-year-old patient. He had undergone a Pólya partial gastrectomy, a cholecystectomy and a sphincteroplasty 19, 6 and 2 years earlier, respectively. The cholangitis was complicated by septicaemia with six different enteric organisms including aerobes and anaerobes. He developed liver and lung abscesses, and an indolent Pseudomonas aeruginosa septic arthritis of both hip joints. The patient eventually made a complete recovery, but required surgical replacement of both hips.

Ampulla of Vater↗
PubMed1984

Percutaneous transhepatic endoprosthesis for bile duct obstruction. Complications and results.

Sixty-two patients with bile duct obstruction were referred for the percutaneous transhepatic insertion of an endoprosthesis. This procedure was successful in 53 of the 62 patients. Insertion was possible through 28 of 30 periampullary obstructions, but only through 19 of 26 at the hilum. Eighteen patients suffered complications, but in only 3 cases were these serious, including two procedure-related deaths. Bile duct obstruction was relieved completely in 34 of 46 patients with planned long-term drainage, and was partially relieved in 8 patients. The survival of 40 patients with malignant disease was poor, but none of the 6 patients with benign stricture has died. In 7 of 20 long-term survivors, the endoprosthesis eventually became partially or totally blocked. This technique is an alternative method of relieving itching and jaundice in patients with irresectable tumors or poor operative risk. In patients with benign stricture, the early results are encouraging, but longer follow-up is necessary to evaluate this therapeutic approach.

Adult↗