Biomedical subjects
R T Diggory
Publications and source records attributed to R T Diggory.
Orocaecal transit time in health and in thyroid disease.
Altered bowel habit commonly occurs in thyroid disease. We measured orocaecal transit in healthy volunteers and in hyperthyroid and hypothyroid patients before and after treatment, using the lactulose hydrogen breath test incorporating a standard liquid meal to obtain a more physiological assessment. Mean transit time in 12 control subjects was 85 (8) minutes (mean (SE)) (mean coefficient of variation between replicate studies, 8.6% (3%)). In eighteen hyperthyroid patients transit was more rapid at 49 (4) minutes (p less than 0.01). Ten hypothyroid patients had a transit time similar to controls at 91 (9) minutes. Transit time returned to normal in thyrotoxic patients after treatment but in eight hypothyroid patients retested, it remained unchanged. Our findings suggest that (a) the inclusion of a liquid meal provides a reproducible method of measuring orocaecal transit using the lactulose hydrogen breath test, (b) rapid small bowel transit in thyrotoxicosis may be one factor in the diarrhoea which is a feature of the disease and (c) if altered gut transit is the cause of sluggish bowel habit in hypothyroidism, delay in the colon, and not small bowel, is likely to be responsible.
Training of surgical registrars: a regional audit.
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R2/3 gastrectomy for gastric carcinoma: an audited experience of a consecutive series.
A consecutive series of 27 patients with gastric neoplasm (24 carcinoma, 3 lymphoma) have been staged at laparotomy using the Japanese criteria for macroscopic staging. In 20 patients the radical R2/3 resection was considered potentially curative as defined by the Japanese Society for Research in Gastric Cancer. The operative mortality in this subgroup was 1/20 (5 per cent) and 3/27 (11 per cent) in the entire series. Locoregional recurrence was not observed in the potentially curative group. Follow-up has varied from 6 months to 7 years. An overall survival of 12/27 (48 per cent) has been observed to date. Death from cancer dissemination is maximal in the first and second year after resection. The R2/3 resection was considered non-curative in seven patients. In this subgroup there were two postoperative deaths and four have died of metastatic disease within 12 months of the resection. The only 5 year survivor in this group had a gastric lymphoma.
The effect of dose and osmolality of lactulose on the oral-caecal transit time determined by the hydrogen breath test and the reproducibility of the test in normal subjects.
The lactulose hydrogen breath test was used to determine the oral-caecal transit time in healthy volunteers. An inverse relationship between the dose of lactulose ingested and the oral-caecal transit time was found. The osmolality of the lactulose solution did not effect the transit time. Results obtained from the test were found to be reproducible in normal subjects. Standardization of the meal and what constitutes a sustained rise in the breath hydrogen excretion following administration of lactulose are essential in the valid interpretation of this test as a measure of oral-caecal transit time.