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Biomedical subjects

T T Irvin

Publications and source records attributed to T T Irvin.

At least 19 recordsLinked to original sources
PubMed1979

Does obstructive jaundice adversely affect wound healing?

The effect of obstructive jaundice on wound healing has been investigated in an experimental study of abdominal wounds in rats following ligation and division of the common bile duct. Animals were jaundiced for 2 weeks before a second operation at which the abdominal wounds were made. The wounds in jaundiced and control animals showed no significant differences in mechanical strength during a 21-day period of study but there was a significant delay in the accumulation of collagen in the wounds of jaundiced animals. The findings suggest that the biochemical changes in the wounds of jaundiced animals did not interfere with wound repair and cast doubt on the thesis that jaundice has an adverse effect on wound healing.

Abdomen↗
PubMed1978

Abdominal wound healing in jaundiced patients.

Abdominal wound healing was studied in 48 patients undergoing laparotomy for jaundice and 281 anicteric patients undergoing elective operations for cholelithiasis at the Sheffield Royal Infirmary during the period 1967 to 1976. Wound dehiscence or incisional hernia occurred in 27.1 per cent of jaundiced patients and in 4.3 per cent of anicteric patients (P less than 0.001). There was a slightly higher incidence of dehiscence and herniation in deeply icteric patients (plasma bilirubin greater than 170 mu mol/l), but patients who developed these complications did not appear to have a more severe degree of malnutrition or impaired liver function. The results of the study suggest that malignant disease may be an important factor in the pathogenesis of wound complications in jaundiced patients. Wound dehiscence or incisional hernia occurred in 59.1 per cent of patients with obstructive jaundice resulting from malignant disease but patients with jaundice resulting from biliary stones or benign pathology did not develop these complications.

Cholelithiasis↗
PubMed1978

The measurement of resting and stimulated lower esophageal sphincter pressure using the rapid pull-through technique of esophageal manometry.

The value of the rapid pull-through technique of esophageal manometry for the measurement of lower esophageal sphincter pressure (LESP), in the diagnosis of symptomatic gastroesophageal reflux, has been investigated. The technique provides reproducible measurements of LESP in individual subjects during the period of a single recording study. It does not discriminate between normal subjects and patients with symptomatic gastroesophageal reflux in measurements of basal LESP or in measurements of the LESP response to abdominal compression and the cholinergic drugs bethanechol and metoclopramide. The findings of the study suggest that the rapid pull-through technique will not prove helpful in the diagnosis of symptomatic reflux.

Adult↗
PubMed1978

Effects of malnutrition and hyperalimentation on wound healing.

The effects of malnutrition and hyperalimentation on wound healing were studied in rats. Progressive weight loss occurred in rats given a protein-free diet, and there was a significant reduction in the mechanical strength of sutured skin and abdominal wounds in rats starved of protein for seven weeks. There was also a significant, but less pronounced, reduction in the tensile strength of colonic anastomoses in severely malnourished rats. Malnourished rats given oral supplements of amino acids for seven days before and after operation had a consistently positive nitrogen balance, and these rats had a significantly higher daily caloric intake than did untreated and normal rats. Amino acid therapy was associated with a significant improvement in the tensile strength and collagen content of abdominal wounds, but it had no measurable effect on the healing of skin wounds or colonic anastomoses. The results suggest that visceral and parietal tissues do not respond in a uniform manner to malnutrition or hyperalimentation, and further studies are required to determine whether or not hyperalimentation has a useful role in the enhancement of wound healing in malnourished subjects.

Abdomen↗
PubMed1978

Ascorbic acid requirements in postoperative patients.

The postoperative ascorbic acid requirements of 63 surgical patients were assessed by measurements of buffy layer leukocyte ascorbic acid and the ascorbic acid content of leukocytes. There was a significant reduction in ascorbic acid levels following operation. The postoperative changes were unrelated to the extent of surgical trauma or the volume of blood transfused during operation, but there was a significant correlation between postoperative ascorbic acid measurements and white blood counts. It appears that postoperative leukocytosis and release by the bone marrow of leukocytes with a low ascorbic acid content may partly account for the postoperative changes in buffy layer and leukocyte ascorbic acid measurements. However, surgical operations were followed by an authentic increase in ascorbic acid requirements, and there was a 42 per cent reduction in circulating leukocyte ascorbic acid levels on the third postoperative day. The findings of this study create an argument for the use of ascorbic acid supplements in surgical patients, although it is unlikely that postoperative changes in leukocyte ascorbic acid have pathologic significance in wound repair.

Aged↗
PubMed1977

Abdominal wound healing: a prospective clinical study.

The incidence of wound dehiscence and incisional hernia after two methods of abdominal wound closure (layered closure with retention sutures and single-layer "mass closure") was studied in a randomised prospective clinical trial in a consecutive series of 200 patients. Dehiscence occurred in 1% of patients and herniation in 4-7%; the incidence of these complications was similar with both methods of closure. Seven of the 11 cases of dehiscence or herniation occurred in infected wounds, and wound infection was associated with a tenfold increase in the incidence of these complications. The prevention of wound infection would reduce substantially the incidence of dehiscence and herniation in abdominal wounds.

Abdomen↗
PubMed1977

Burst abdomen.

Explore the source record for details and available documents.

Abdominal Muscles↗
PubMed1977

The role of oxygen therapy in the healing of experimental skin wounds and colonic anastomosis.

A number of experimental studies have indicated that wound healing is adversely affected by hypoxia, and it has been suggested that healing can be improved by increasing inspired oxygen tensions. However, this hypothesis is based on observations on simulated wounds or tissue implants in experimental animals, and the clinical relevance of these observations is uncertain. The effects of oxygen therapy on the healing of skin wounds and colonic anastomoses were examined in rats. Sutured skin incisions and normal and ischaemic colonic anastomoses were studied in control animals breathing air and in test animals breathing 50 per cent oxygen. Wound healing was assessed by measurements of wound breaking strength, colonic bursting wall tension and wound collagen after 7 days' treatment with oxygen. There was no significant difference in the measurements in skin wounds or colonic anastomoses in test and control animals, and there was a similar incidence of anastomotic dehiscence in the ischaemic colon of test animals and controls. Oxygen therapy had no apparent effect on wound healing in this study, and it was concluded that further studies are required to determine whether or not there is a rational basis for the clinical use of oxygen therapy to help wound healing.

Animals↗
PubMed1977

The treatment of colonic cancer presenting with intestinal obstruction.

The factors affecting the prognosis of patients presenting with colonic obstruction caused by carcinoma were examined in a retrospective study of 66 patients undergoing emergency surgery for obstruction. The findings in these cases were compared with 176 patients with colonic cancer undergoing elective surgical treatment. Obstructed patients had a significantly higher surgical mortality (37.9 per cent) than elective cases (11.9 per cent). There was a significantly higher incidence of lymph node metastases in obstructed patients and those who survived surgery had a significantly lower 5-year survival rate (22.9 per cent) than elective cases (41.5 per cent). Primary resection of obstructing tumours was followed by a higher 5-year survival rate (31.8 per cent) than staged resections (7.7 per cent), but these operations were used selectively and the 5-year survivors following primary resection all had tumours of the proximal colon. Primary resection and anastomosis of the distal colon was associated with a surgical mortality of 50 per cent. Further progress in the cure of patients with obstructing cancer of the colon may be limited by the aggressive nature of the disease, but the use of primary resection in these cases should be examined in a prospective clinical trial.

Colonic Neoplasms↗
PubMed1977

Effect of cigarette smoking on the lower oesophageal sphincter.

Observations on the effect of smoking on lower oesophageal sphincter pressure (LOSP) are based on station pull-through techniques of eosophageal manometry and recent studies have suggested that these techniques are inaccurate. Reproducible measurements of LOSP may be achieved with a rapid pull-through (RPT) method of manometry. This method was used to determine the effect of cigarette smoking on LOSP in 10 asymptomatic volunteers and in a group of 10 patients with symptoms of gastro-oesophageal reflux. Basal LOSP measurements in the two groups were not significantly different but LOSP was reduced by 19% in asymptomatic subjects (p less than 0-01) and by 21% in symptomatic patients (p less than 0-02) during cigarette smoking. The results suggest that smoking should be avoided in the clinical management of gastro-oesophageal reflux.

Adolescent↗
PubMed1977

Diagnosis of symptomatic gastroesophageal reflux by prolonged monitoring of lower esophageal pH.

Lower esophageal pH was continuously monitored for 15 hours in 10 asymptomatic subjects and 27 patients with symptoms of gastroesophageal reflux, and the pH measurements in symptomatic patients were compared with the results of other esophageal investigations. Symptomatic patients had significantly longer periods of reflux in the pH test than asymptomatic subjects (P less than 0.01), but there was no significant correlation between the pH measurements and the results of esophageal manometry, acid-perfusion, and acid-clearing tests. Ten patients had evidence of esophagitis at esophagoscopy, but there was no correlation between pH measurements and the findings at esophagoscopy. Two patients with esophagitis had no evidence of reflux in the pH monitoring test. The results indicate that the pH-monitoring test has a useful role in the diagnosis of gastroesophageal reflux in patients who do not have endoscopic signs of esophagitis. However, negative pH tests do not exclude the diagnosis of symptomatic reflux, and it appears that the test has no value in assessing the severity of esophageal inflammation.

Adult↗
PubMed1977

Duration of symptoms and prognosis of carcinoma of the colon and rectum.

The symptomatic history in 335 instances of carcinoma of the colon and rectum was compared with the long term survival of the patients. The patients were divided into four groups according to the duration of symptoms recorded on admission to the hospital. There was a significantly higher incidence of resections for cure in those who had symptoms for less than five months' duration, but the long term survival of patients was not significantly related to the duration of symptoms. The pathologic findings suggested that patients presenting early had more virulent or biologically active tumors, and the onset of symptoms in these patients more frequently included complaints of abdominal pain and multiple symptoms. It appears that the prognosis of carcinoma of the colon and rectum is largely determined by the biologic behavior of the primary tumor rather than by the length of the symptomatic illness, and it also appears that the earlier diagnosis of symptomatic patients may result in comparatively small gains in the survival rate.

Colonic Neoplasms↗