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Biomedical subjects

T R Pilkington

Publications and source records attributed to T R Pilkington.

At least 37 records · Page 2Linked to original sources
PubMed1980

Treatment of bone disease after jejunoileal bypass for obesity with oral 1 alpha-hydroxyvitamin D3.

The effects of oral 1 alpha-hydroxyvitamin D3 have been investigated in 12 patients with bone disease after jejunoileal bypass for obesity. Bone histology became normal or improved greatly after four to 12 months' treatment in eight patients but showed little change or worsened in four. There was a significant rise in plasma calcium and fall in plasma alkaline phosphatase concentration with 1 alpha-hydroxyvitamin D3 therapy in the patients with a good histological response. Administration of metronidazole and cotrimoxazole to two patients who had failed to respond to 1 alpha-hydroxyvitamin D3 resulted in clinical and biochemical improvement; in one of these patients histological improvement was also documented. It is concluded that oral 1 alpha-hydroxyvitamin D3 can be effective in healing post-bypass bone disease; the failure of some patients to respond may be related to bacterial contamination of the small intestine and in those patients antibiotics may also be indicated.

Adult↗
PubMed1979

Hypomagnesaemia in diabetes.

The plasma magnesium (Mg) concentrations of 582 unselected diabetic outpatients and 140 control subjects were measured by atomic absorption spectrophotometry. Mean plasma Mg (+/-S.D.) was significantly lower in the diabetic patients (0.737 +/- 0.071 mmol/l) than in the control subjects (0.810 +/- 0.057 mmol/l), and 146 (25%) diabetics had values below those of all control subjects except one. Plasma Mg correlated best with clinic blood glucose concentration (r = -0.32, p less than 0.001) and other significant associations were observed with glycosuria, age, sex, insulin therapy and biguanide therapy. Although its significance is unclear, hypomagnesaemia could conceivably predispose to ischaemic heart disease in diabetes.

Adolescent↗
PubMed1979

Impaired hypothalamic control of prolactin secretion in massive obesity.

Intravenous insulin tolerance tests and thyrotropin-releasing hormone (T.R.H.) stimulation tests were performed in nine massively obese women and six lean female controls and the prolactin, growth hormone, and cortisol responses were measured. A combined pituitary function test (insulin, T.R.H., and gonadotropin-releasing hormone) was performed in eleven other massively obese women. In the obese women to whom insulin was given separately there was no prolactin release, and growth hormone and cortisol responses were impaired. T.R.H. stimulation produced a prolactin response which was subnormal. These changes were not apparent in the obese women in whom a combined pituitary function test was performed. The results suggest an alteration of hypothalamic function in massive obesity.

Adolescent↗
PubMed1979

Leucocyte and erythrocyte magnesium levels after jejuno-ileal bypass surgery.

Leucocyte magnesium concentration was measured in 25 hypomagnesaemic patients following a jejuno-ilean bypass operation for gross obesity. The mean plasma magnesium concentration in the bypass group was 0.67 mmol/l compared with that of 0.90 mmol/l in a group of 17 healthy volunteers, but the leucocyte magnesium concentration in the two groups was not significantly different. The plasma potassium was found to be significantly lower in the bypass group but there was no significant difference in the leucocyte potassium concentration in the two groups. Simultaneous measurements of erythrocyte magnesium, sodium and potassium were made. There was no evidence of intracellular magnesium depletion on the basis of the tissues studied.

Calcium↗
PubMed1978

Bone disease after jejuno-ileal bypass for obesity.

Bone tissue was examined in 21 patients who had undergone jejuno-ileal bypass for obesity between 1971 and 1974. 10 patients had osteomalacia with evidence of secondary hyperparathyroidism. Clinical symptoms and biochemical and radiological investigations were often unreliable in diagnosing bone disease, although plasma-25-hydroxyvitamin-D and plasma-phosphate concentrations were significantly lower and plasma-parathyroid-hormone concentrations were significantly higher in the patients with bone disease. The presence of osteomalacia was unrelated to age, length of time since bypass, or post-bypass weight-loss, and plasma-25-hydroxyvitamin-D levels did not correlate closely with bone histological changes. It is concluded that osteomalacia is common after jejuno-ileal bypass and that factors other than simple vitamin-D deficiency may contribute to its development.

Adult↗
PubMed1977

Hepatic structure and function after modified jejunoileal bypass surgery for obesity.

The most serious adverse effect of standard intestinal bypass for obesity is the high incidence of hepatic dysfunction and death from hepatic failure. We therefore examined the long-term effects of a modified form of jejunoileal bypass (in which a greater continuous length of ileum is retained), on liver function in 120 patients. Substantial weight loss (119-0+/-SD 23-3 kg to 82-3+/-18-8 kg) occurred during the first nine months after surgery, accompanied by a significant rise in serum concentrations of bilirubin, alanine transferase, and alkaline phosphatase, and a significant reduction in albumin concentrations. Biochemical changes were unrelated to weight loss or halothane anaesthesia. After weight stabilisation liver function reverted to normal, and four years after bypass sulphobromophthalein retention and hepatic histology did not differ from those in obese controls. There were two postoperative deaths. Three other patients died during the period of rapid weight loss with severe hepatic steatosis. While transient mild impairment of liver function is common after modified jejunoileal bypass, clinically significant hepatic dysfunction is a rare and unexplained early complication.

Adult↗
PubMed1976

Explanations for weight loss after ileojejunal bypass in gross obesity.

Twenty grossly obese patients underwent ileojejunal bypass operations. Measurements of calories lost in faeces showed that the malabsorption could not account for the weight loss. Furthermore, the malabsorption was not decreased two years after bypass, when weight was no longer being lost. Dietary restriction is therefore largely responsible for the weight loss and increased food intake for weight maintenance.

Body Weight↗
PubMed1976

Obesity.

Explore the source record for details and available documents.

Diet, Reducing↗
PubMed1974

Treatment of gross obesity by jejunal bypass.

Jejunal bypass operations were performed on 47 grossly obese patients. The results were disappointing in three patients who had a standard "14 in/4 in" Payne and DeWind procedure and therefore a more radical operation was performed, joining four inches (10.2 cm) of proximal jejunum to 10 inches (24.4 cm) of terminal ileum. Two years after the modified operation a mean of 44.2 kg had been lost and the weight tended to stabilize. This weight loss was due mainly to inadequate calorie intake. The appetite became more controlled so that if weight was regained this was small in amount. Metabolic sequelae and their symptoms also settled by two years. The physical, psychological, and social outcome was good. The postoperative period was stormy and required close medical and psychiatric supervision. There were two deaths.

Adult↗