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Biomedical subjects

T T Irvin

Publications and source records attributed to T T Irvin.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1976

The effect of methionine on colonic wound healing in malnourished rats.

Recent studies have suggested that the healing of colonic anastomoses is impaired in malnourished subjects. It has been claimed that the healing of skin and abdominal wounds in experimental animals is improved by the administration of the essential amino acid methionine, and in the present study the effects of methionine on colonic wound healing were studied in malnourished rats. Test animals were fed a protein-free diet for 7 weeks before surgery. Methionine-treated animals received the amino acid by subcutaneous injection during the seventh week of protein deprivation and throughout the postoperative period. Anastomoses were made in the left colon, and colonic wound healing was assessed by measurements of the bursting wall tension and collagen content of anastomoses. The results were compared with those of control animals fed a normal rat diet. Protein deprivation for 7 weeks resulted in a 34% reduction in body weight, and a significant reduction in the tensile strength and collagen content of colonic anastomoses was observed. Methionine supplements had no apparent effect on these parameters of wound healing. The concept of single amino acid supplementation in cachetic patients undergoing surgery is an attractive one, but it has yet to be established that methionine supplements alone can alter the course of wound healing in such cases.

Animals↗
PubMed1976

Layer closure of laparotomy wounds with absorbable and non-absorbable suture materials.

Opinions vary regarding the best suture material for abdominal wound closure. Some surgeons favour non-absorbable sutures while others use absorbable materials, but there is little objective clinical information regarding the relative merits of the different suture materials. In a randomized prospective clinical trial the synthetic absorbable polyglactin and polyglycolic acid sutures were compared with the non-absorbable polypropylene suture in the closure of 161 laparotomy wounds. A layered closure technique was used in all cases. The total incidence of wound dehiscence and herniation was 8-1 per cent, and there was no significant difference between polylycolic acid (9-6 per cent), polyglactin (5-8 per cent) and polypropylene (8-8 per cent). Dehiscence and herniation were significantly more common in wounds closed by surgeons in training. It was concluded that none of the suture materials provided satisfactory freedom from wound complications. It is possible that these sutures may prove satisfactory with an alternative technique of abdominal wound closure, but this should be the subject of further clinical studies.

Abdomen↗
PubMed1976

The effects of mechanical preparation and acidification of the colon on the healing of colonic anastomoses.

The results of clinical studies have suggested that inadequate preoperative mechanical preparation of the colon is a significant factor in the pathogenesis of disruption of colonic and colorectal anastomoses. A possible explanation for the adverse effect of poor mechanical preparation is that ammonia released from feces has a cytotoxic effect on the healing anastomosis. It has been suggested that acidification of the colonic lumen prevents the release of fecal ammonia and protects the anastomoses. The effects of mechanical preparation of the colon and colonic acidification were studied in anastomoses in the left colon of rats. Colonic acidification was produced by the oral administration of a synthetic disaccharide lactulose solution. Mechanical preparation resulted in a significant increase in the bursting wall tension in anastomoses on the seventh postoperative day. The oral administration of lactulose resulted in a reduction in the colonic mucosal pH, but this was not accompanied by improved healing of anastomoses, as judged by measurements of colonic bursting pressure, bursting wall tension and total challagen content. Mechanical preparation of the colon is an important factor in the safety of colonic anastomosis. However, the results do not suggest that acidification of the colonic lumen significantly improves the quality of colonic healing.

Administration, Oral↗
PubMed1976

Collagen metabolism in infected colonic anastomoses.

Infection of the peritoneum has an adverse effect on the healing of colonic anastomoses. It has been suggested that infection results in a disturbance of colonic collagen metabolism, but the precise nature of the biochemical disorder is uncertain. Colonic collagen metabolism was studied in infected anastomoses in the left colon of rats. The rats were labeled with radioactive proline from an early stage of growth, and infected anastomoses were compared with anastomoses of the control group of uninfected rats. Infection resulted in significant changes in collagen metabolism during the early phase of colonic healing. There was a significant reduction in the amount of salt soluble collagen in infected anastomoses on the third postoperative day compared with anastomoses of the control group, and reduced amounts of acid soluble collagen and insoluble collagen were found in infected anastomoses on the seventh postoperative day. These observations suggest that the defective healing of infected colonic anastomoses results either from an increased lysis of newly formed--salt soluble--collagen or from a reduction in the intracellular formation of collagen.

Animals↗
PubMed1975

Injury to the ureter during laparoscopic tubal sterilization.

As the use of laparoscopy and laparoscopic tubal sterilization has increased, a number of serious complications have been reported. A case is described in which the ureter was damaged during laparoscopic sterilization. The majority of serious complications associated with laparoscopic sterilization have been burn injuries resulting from the use of cautery instruments. Thermal injuries are likely to occur when the operator is inexperienced, and when cautery instruments of the high-energy type are used. Meticulous technique is required in the performance of laparoscopic sterilization and low-energy "cold cautery" units should be used in this procedure.

Adult↗
PubMed1975

A controlled clinical trial of three different methods of perineal wound management following excision of the rectum.

Three methods of perineal wound closure were studied in a randomized prospective clinical trial in 106 patients undergoing excision of the rectum for inflammatory or malignant disease. In method 2 the perineal wound was managed by open drainage. In both methods 2 and 3 the perineal wound was closed by primary suture, suprapubic suction drains being left down to the presacral space, but in method 2 the pelvic peritoneal floor was reconstituted, whilst in method 3 it was left unsutured. Topical and systemic antibiotics were administered to all patients submitted to primary closure of the perineal wound but not routinely to those whose perineal wound was left open. The overall operative mortality was 8-5 per cent but no deaths could be definitely attributed to perineal wound complications. The incidence of primary wound healing after methods 2 and 3 was 45-2 and 42-9 per cent respectively. Operative contamination of the perineal wound had an adverse effect on perineal wound healing. The incidence of persistent wound sinuses and unhealed wounds at 3 and 6 months after primary wound closure was rather less than that encountered after open drainage. It was concluded that primary closure of the perineal wound is the treatment of choice following excision of the rectum, except in cases in which contamination of the perineal wound has occurred during operation or the final state of haemostasis in the pelvis with diathermy and suture at the conclusion of the dissection was deemed to be unsatisfactory.

Ampicillin↗
PubMed1975

A controlled clinical trial of three methods of closure of laparotomy wounds.

A controlled clinical trial was conducted of three methods of closing elective paramedian laparotomy wounds--catgut layer suture alone, catgut layer suture with tension sutures and wire sutures alone. Three hundred and twenty-four patients were entered in the trial. The combined incidence of wound dehiscence and subsequent incisional herniation in patients who did not manifest overt dehiscence in the immediate postoperative period was significantly higher after catgut layer suture alone (14 per cent) than after catgut layer suture with tension stitches (4-8 per cent) or wire sutures alone (0-9 per cent). There seemed to be more wound sespis and sinus formation associated with catgut layer suture and tension sutures than with either of the other methods of closure. In 4 patients a wire suture had to be extracted, because of sinus formation in 2 and on account of pain in 2.

Abdomen↗
PubMed1974

Effect of malnutrition on colonic healing.

It has been suggested that colonic healing is impaired in malnourished subjects, but there have been no biochemical studies of the effect of malnutrition on colonic healing. The effects of malnutrition on the colon and the healing of colonic anastomoses were studied in rats fed a protein-free diet. Test animals were compared with control animals of similar age, and control animals of similar weight. There was a significant reduction in the body weight, total serum proteins and serum albumin of animals starved of protein. Malnutrition resulted in a reduction in the weight of the uninjured colon, and an increase in the colonic collagen concentration. There was a significant reduction in the collagen content of the colon in animals starved of protein for seven weeks, and the collagen content of anastomoses in these animals was significantly lower than the value in control animals. Anastomotic edema occurred during colon healing in animals starved for seven weeks. Measurements of colonic bursting pressure were an inaccurate guide to colonic healing. It is concluded that severe malnutrition resulting in 34% loss of body weight had an adverse effect on colonic healing.

Animals↗