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Biomedical subjects

W R Murray

Publications and source records attributed to W R Murray.

At least 37 records · Page 2Linked to original sources
PubMed1990

Late outcome of undersewing alone for gastric ulcer haemorrhage.

Between 1977 and 1988 22 patients requiring urgent surgery for bleeding gastric ulceration were managed by simple undersewing of the ulcer. Long-term follow-up of these patients was undertaken to determine the risk of recurrent gastric ulceration and further gastric ulcer haemorrhage. Two patients died in the immediate perioperative period leaving 20 patients available for long-term follow-up (mean 43.3 months). Three recurrent gastric ulcers were diagnosed, two of these presenting with haemorrhage. No patient presented with further gastric ulceration while on histamine (H2) receptor antagonist therapy. The long-term outcome of undersewing alone, when combined with maintenance H2-receptor antagonist therapy, is satisfactory in terms of low mortality and low risk of ulcer recurrence.

Adult↗
PubMed1990

Prediction of rebleeding in peptic ulcers by visual stigmata and endoscopic Doppler ultrasound criteria.

Following peptic ulcer hemorrhage, the ability to accurately determine those patients at highest risk of rebleeding relies on clinical and endoscopic criteria which are accurate in only a variable proportion of cases. In this study we have assessed prediction of rebleeding in peptic ulcers using a transendoscopic vascular detector (TVD) to compare the presence of a positive Doppler signal in relation to an ulcer base with visual stigmata of recent hemorrhage (SRH). Of 711 patients endoscoped for upper GI hemorrhage over an 18-month period 180 (25%) were found to have a peptic ulcer. One hundred and twenty-four had either minor or no SRH at the time of endoscopy, and none of these patients rebled. Fifty-six patients had a single peptic ulcer with either active hemorrhage, a visible vessel or adherent clot, and 22 were entered into the trial. Overall, 9 patients (41%) in this group rebled. Considering prediction of rebleeding, visible vessels had a sensitivity of 89% and specificity of 92% compared with a positive Doppler signal sensitivity of 87% and specificity of 86%. These results suggest that the TVD can predict rebleeding in peptic ulcers with an accuracy similar to that of endoscopic identification of a visible vessel.

Duodenal Ulcer↗
PubMed1990

The effect of introducing endoscopic therapy on surgery and mortality rates for peptic ulcer hemorrhage. A single center analysis of 1,125 cases.

The introduction of early endoscopic diagnosis has not been associated with a reduction in either surgical intervention or overall mortality for peptic ulcer hemorrhage. Recent studies have suggested that endoscopic therapy can reduce rebleeding rates from peptic ulceration. We report a 2-year experience of the influence of endoscopic heater probe (HP) (Olympus CD 10Z) therapy on the outcome of patients admitted with peptic ulcer hemorrhage. Eight hundred and sixty-two patients admitted with peptic ulcer hemorrhage over a 5-year period (1978/9 and 1983/5) before endoscopic therapy (PRE-HP), and 263 patients admitted with peptic ulcer hemorrhage after introduction of endoscopic therapy (POST-HP: 1986-1988) were assessed. All 1,125 patients were managed by a joint physician/surgeon team. The introduction of HP therapy was associated with a reduction in surgical intervention and overall mortality rates for gastric ulceration from 16% and 8.9% PRE-HP to 7% and 2.6% POST-HP respectively (p less than 0.05). A similar but non-significant trend was noted for duodenal ulceration. The beneficial effects of HP therapy appear to be due to a reduction in the need for surgical hemostasis in patients with an ulcer base visible vessel. Our results suggest that a more widespread use of endoscopic therapy may result in an improved outcome from peptic ulcer hemorrhage.

Endoscopy↗
PubMed1990

Clinical and scintigraphic assessment of the role of endoscopic sphincterotomy in the treatment of sphincter of Oddi dysfunction.

Postcholecystectomy pain caused by sphincter of Oddi dysfunction remains a difficult condition to treat. Endoscopic sphincterotomy has been recommended for those patients with confirmed sphincter of Oddi motor abnormalities. We have studied sphincter of Oddi dysfunction patients to evaluate the effects of endoscopic sphincterotomy on both clinical symptoms and previously reported scintigraphic parameters to determine the efficacy of this method of treatment. Nine postcholecystectomy patients (seven women: two men, median age 59 years) with clinical and manometric evidence of sphincter of Oddi dysfunction underwent endoscopic sphincterotomy for persisting biliary type pain. Each patient had scintigraphy before and eight weeks after endoscopic sphincterotomy. The patients symptomatic response was assessed independently at three monthly intervals after endoscopic sphincterotomy. Scintigraphic analysis showed that the TMAX (time in minutes to maximum counts) was significantly reduced from 25.0 (20-36) (median [range]) before endoscopic sphincterotomy to 15.0 (13-25) after endoscopic sphincterotomy (p less than 0.01). Seven of nine (78%) sphincter of Oddi dysfunction patients had significant improvement in their symptoms after a mean follow up period of 12 months (range 6-19) although only six of nine were totally pain free. These results suggest that endoscopic sphincterotomy in manometrically confirmed sphincter of Oddi dysfunction improves bile drainage as measured by quantitative cholescintigraphy and is associated with at least short term symptom relief in the majority of patients.

Adult↗
PubMed1990

Acetabular salvage in revision total hip arthroplasty using the bipolar prosthesis.

From June 1978 to December 1987, 106 revision total hip arthroplasties (THA) for acetabular salvage were performed using a bipolar device. Bone grafting was necessary in most of the patients. Five patients were unavailable for follow-up examination, leaving 96 patients (101 hips), who were followed for an average of two years 11 months (range, two months to 8.5 years). Excellent or good results were obtained in 43 patients; fair results were achieved in 20 patients. Of the nine patients with poor results, five demonstrated roentgenographic evidence of subluxation, and four showed no roentgenographic changes that could explain their persistent pain. Twenty-nine of these bipolar revisions failed and required reoperation. Fourteen of these failures were revised using fixed, cementless devices in conjunction with bone grafting. Ten patients developed deep-wound infection. Nine were treated successfully; the tenth patient died of overwhelming sepsis, her case complicated by multiple infected joint arthroplasties. While the results of revision THA in the present series are not as satisfactory as those reported by others who used fixed cemented or fixed cementless acetabular components, they are superior to the results obtained with excisional arthroplasty, the only alternative in many of these cases.

Acetabulum↗
PubMed1989

Controlled trial of heater probe treatment in bleeding peptic ulcers.

A prospective randomized controlled trial of endoscopic heater probe therapy in bleeding peptic ulcers was performed to determine whether probe therapy can reduce rebleeding rates. Of 630 patients endoscoped for suspected upper gastrointestinal haemorrhage over a 16-month period, 166 (26 per cent) were found to have a peptic ulcer. Either minor or no stigmata of recent haemorrhage were found in 115 patients at the time of endoscopy. A single peptic ulcer with either active haemorrhage or a visible vessel was found in 51 patients, 43 of whom were entered into the trial. There were eight exclusions: four were inaccessible, one was a torrential haemorrhage and three were excluded for non-technical reasons. Patients were randomized to receive either heater probe (n = 20) or sham (n = 23) therapy. In actively bleeding ulcers, immediate haemostasis was achieved following probe therapy in 14 of 18 patients (78 per cent) compared with none of 21 having sham treatment (P less than 0.002). No rebleeding occurred in the probe therapy group (n = 20) compared with rebleeding in five of 23 sham treated patients (P = 0.05). Urgent surgery for haemostasis was required in three of the five sham treated patients who rebled. It is concluded that heater probe therapy may be effective in reducing rebleeding rates in peptic ulcers accessible to the endoscope.

Clinical Trials as Topic↗
PubMed1989

Endoscopic sphincterotomy for bile duct stones in patients with intact gallbladders.

Endoscopic sphincterotomy was performed in 121 patients (age ranged 34-92 years; median 80 years) with intact gallbladders and bile duct stones. Clearance of the duct by basket or balloon extraction was attempted in 97 patients (80 per cent) and achieved in 93 of these patients (96 per cent). In 24 patients the duct was left to empty spontaneously and this occurred in 22 patients. Immediate complications due to endoscopic sphincterotomy occurred in five patients (two haemorrhage, two perforation, one haemorrhage and perforation). Of the 101 patients reviewed 12-72 months (median 24 months) after endoscopic sphincterotomy, 76 (75 per cent) have remained asymptomatic throughout the follow-up period. Eighteen patients (18 per cent) required cholecystectomy for recurrent gallbladder symptoms 1-24 months after endoscopic sphincterotomy. One of the asymptomatic patients underwent cholecystectomy on the advice of his consultant. A further seven had recurrent biliary colic or cholangitis necessitating enlargement of the sphincterotomy and further stone retrieval in three of these patients. Endoscopic sphincterotomy is an effective treatment for bile duct stones in high risk patients, but subsequent cholecystectomy is required in a significant number of patients owing to continuing gallbladder symptoms.

Adult↗
PubMed1988

Surgical management of bleeding gastric ulceration.

In a nine-year period from 1977 to 1985 sixty-one patients underwent surgery for bleeding gastric ulceration in the Western Infirmary, Glasgow. Nineteen patients were treated by partial gastrectomy, twenty-two had undersewing of the ulcer plus vagotomy and drainage and twenty had undersewing alone. Mortality in the three groups was 26, 45 and 10 per cent respectively. All groups of patients were similar in terms of age, severity of haemorrhage, delay before surgery and grade of surgeon performing the procedure. Out-patient follow-up (mean: 37 months) of patients treated by undersewing alone revealed that 73 per cent were symptom free. Treatment of bleeding gastric ulceration by undersewing alone is effective and should be considered in patients who require surgery.

Drainage↗
PubMed1988

Quantitative 99mTc-DISIDA scanning and endoscopic biliary manometry in sphincter of Oddi dysfunction.

Sphincter of Oddi (SO) dysfunction is a recognised cause of postcholecystectomy pain, but a difficult condition to diagnose, requiring endoscopic biliary manometry (EBM) to confirm sphincter motor abnormalities. We have assessed quantitative cholescintigraphy in 10 postcholecystectomy (PC) patients with clinical and manometric evidence of SO dysfunction, 10 PC patients with non-biliary type abdominal pain and 10 asymptomatic PC volunteers acting as controls to determine its value as a non-invasive screening test. Quantitative 99mTc-DISIDA scans lasted 60 minutes, activity/time curves being created by computer analysis using the entire hepatobiliary system as region-of-interest (ROI). Scintigraphic analysis demonstrated that the time in minutes to maximum counts (Tmax) was significantly increased in the SO dysfunction group compared with the non-biliary pain group and the asymptomatic volunteers (p less than 0.001). The per cent of biliary tracer emptied was also significantly less in the SO dysfunction group than either of the other groups at both 45 minutes (p less than 0.01) and 60 minutes (p less than 0.02). We conclude that quantitative cholescintigraphy may be a valuable non-invasive screening test in clinically suspected SO dysfunction.

Adult↗
PubMed1988

Choledocholithiasis--in vivo stone dissolution using methyl tertiary butyl ether (MTBE).

We report a series of 10 elderly patients with large bile duct calculi refractory to standard endoscopic extraction techniques who were treated by gall stone dissolution using methyl tertiary butyl ether (MTBE) instilled through a nasobiliary catheter. In eight patients complete bile duct clearance was achieved after an average of eight hours MTBE instillation. In two patients gall stone size did not change. Both underwent operative gall stone removal and subsequent stone analysis showed low cholesterol content, which is unlikely to respond to MTBE. Apart from occasional transient nausea and drowsiness, no adverse reactions were noted. Methyl tertiary butyl ether appears to be a powerful in vivo gall stone dissolution agent which, from preliminary studies, is not associated with serious toxicity.

Aged↗
PubMed1988

Maintenance ranitidine treatment after haemorrhage from a duodenal ulcer. A 3-year study.

Forty patients with a recently healed duodenal ulcer (DU) that presented with haemorrhage were entered into a blind, randomized study of maintenance ranitidine therapy (150 mg at night) versus a placebo preparation, to determine whether prolonged ranitidine therapy could influence the natural history of the ulcer diathesis. Duodenal ulceration or duodenal cap erosions of Lanza grade 3 recurred in 24 of the 40 patients studied during the 2-year trial period but was associated with further bleeding in only 2 cases. Maintenance ranitidine therapy significantly reduced the incidence and symptoms of DU/erosion recurrence at all time intervals beyond 3 months, the maximum protective effect being observed after 12 to 15 months of treatment (incidence, p less than 0.001; symptoms, p less than 0.03). The DU/erosion recurrence rate without treatment after 2 years of successful maintenance ranitidine therapy was significantly less than for patients randomized to the placebo group at entry to the study (p less than 0.03). Two years of maintenance ranitidine therapy appear to be beneficial for patients who have a healed DU that presented with haemorrhage. This treatment, however, cannot be recommended without reservation until the implications of the associated high incidence of asymptomatic duodenal ulceration have been fully evaluated.

Adult↗
PubMed1987

Carcinoma of the head of the pancreas: bypass surgery in unresectable disease.

One hundred patients who underwent bypass surgery for unresectable, histologically proven carcinoma of the head of the pancreas were studied to determine: the incidence of a second operation for duodenal obstruction in survivors who had a biliary diversion only; whether the addition of a prophylactic gastroenterostomy is associated with increased mortality. Eighty-six patients (Group A) had a biliary diversion alone while fourteen (Group B) had a biliary diversion and a prophylactic gastroenterostomy. Both groups were comparable regarding sex, age, symptomatology and clinical findings. The postoperative mortality was similar for both groups (Group A, 27.9 per cent; Group B, 14.3 per cent). The mean surgically related hospital stay was 22 +/- 6.5 days (Group A) and 20 +/- 7 days (Group B). Of the 62 patients in Group A who left hospital, 8 (13 per cent) required a second operation for duodenal obstruction (mean interval 5.4 +/- 2.7 months). The in-hospital stay for the second operation was 14.4 +/- 7.7 days. The overall survival for both groups was identical at 6 months (35.5 versus 33.3 per cent) and 12 months (19.3 versus 16.7 per cent). This study suggests that prophylactic gastroenterostomy adds no risk to patients requiring biliary diversion for carcinoma of the head of the pancreas. Its routine use is therefore justified since 13 per cent of the patients who survived the biliary diversion required further surgery for duodenal obstruction before death.

Aged↗
PubMed1987

Diffuse villous adenoma of the pancreatic duct.

A case of diffuse villous adenoma affecting the pancreatic duct in a 31-year-old woman is described. The diagnosis was made by endoscopic retrograde cholangiopancreatography and the patient treated by proximal pancreatectomy. One year later the patient is alive and well. Papillary tumors affecting the pancreatic duct have rarely been described. All previous cases have occurred in middle-aged or elderly patients. None of the previously described benign tumors was as extensive as the one reported here. The possible pre-malignant potential of such tumors is discussed.

Adenoma↗
PubMed1987

Soft tissue sarcoma associated with aluminum oxide ceramic total hip arthroplasty. A case report.

Malignant tumors around fracture fixation implants have been reported sporadically for many years. Recently, however, reports of sarcomatous degeneration around a standard cemented hip arthroplasty and around cobalt-chromium-bearing hip arthroplasties raise new questions of the malignant potential of metallic ends prostheses. Sarcomatous changes around aluminum oxide ceramics seem not to have been reported in the literature. The present report may be the first documented case of an aggressive soft tissue sarcoma detected 15 months after the patient had an uncemented ceramic total hip arthroplasty. If a causal relationship exists, the incidence of this phenomenon in the United States is 250 times greater than would be expected from statistics on soft tissue sarcoma at the hip. Because of the similarity on plane roentgenograms of this tumor to lesions known to be caused by wear debris, tumors should be included in the differential diagnosis of cases of total hip loosening.

Adult↗
PubMed1987

In-vivo chemical choledocholitholysis using MTBE.

Following endoscopic sphincterotomy, it is possible to clear a large proportion of stones from the bile ducts. In a few cases, however, the stones are too large to retrieve. Mechanical lithotripsy is unpredictable and carries a substantial risk of impaction. We report a patient who had multiple large stones in the bile ducts which were successfully dissolved using MTBE. No adverse effects were noted.

Aged↗