76
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McMahon AJ, Baxter JN, O'Dwyer PJ. Physiological and metabolic responses to open and laparoscopic cholecystectomy. Br J Surg 1993; 80:402. [PMID: 8472169 DOI: 10.1002/bjs.1800800356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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77
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78
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Quin JD, Gray HW, Baxter JN, Thomson JA. Thyroid abscess complicating subacute thyroiditis: a consequence of steroid therapy? Clin Endocrinol (Oxf) 1992; 37:570-1. [PMID: 1286528 DOI: 10.1111/j.1365-2265.1992.tb01490.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A patient with subacute thyroiditis developed a thyroid abscess after drainage of a pilonidal abscess. An infective focus in a patient with subacute thyroiditis on steroids should be treated aggressively with adequate antibiotic cover.
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79
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McMahon AJ, O'Dwyer PJ, Russell IT, Baxter JN. Laparoscopic versus open cholecystectomy and the need for a randomized trial: a survey of surgeons and ethical committees in the British Isles. JOURNAL OF LAPAROENDOSCOPIC SURGERY 1992; 2:277-80. [PMID: 1489991 DOI: 10.1089/lps.1992.2.277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A questionnaire on the necessity and ethics of a randomized trial to compare laparoscopic cholecystectomy and open cholecystectomy was sent to 200 randomly selected surgeons in the British Isles, of whom 117 replied. Of these, 58% thought that a trial was needed to compare laparoscopic cholecystectomy with open cholecystectomy by either minilaparotomy or the conventional approach. Nearly half (45%) expressed interest in participating in such a trial. A hypothetical protocol for a trial was sent to 40 ethical committees; 25 gave approval and only 3 considered that a trial was unethical (12 refused to comment). This survey shows wide support for a trial comparing laparoscopic cholecystectomy with open cholecystectomy.
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80
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Jenkins SA, Shields R, Jaser N, Ellenbogen S, Naylor E, Baxter JN. The management of persistent or recurrent variceal bleeding after injection sclerotherapy by somatostatin. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 1992; 5:221-6; discussion 226-7. [PMID: 1356419 PMCID: PMC2442968 DOI: 10.1155/1992/86987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sixteen patients with persistent (n = 11) or recurrent (n = 5) variceal bleeding after injection
sclerotherapy and balloon tamponade were treated with an intravenous infusion of somatostatin 250μg/
h. Somatostatin infusion successfully controlled the bleeding in 15 of the 16 patients but one rebled after
72 h of treatment. In one patient with poor liver function (Child’s C) bleeding was not controlled by
somatostatin, further injection sclerotherapy or balloon tamponade of the oesophagus. The results of
this study, although uncontrolled and with a small number of patients, suggest that somatostatin is a very
effective treatment for the control of post-injection sclerotherapy variceal bleeding.
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81
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Fenton-Lee D, Baxter JN, Riach ET, Cooke TG, O’Driscoll K, O’Dwyer T, Harkin R, Geraghty JG, Smyth E, Lane B. Audit. Ir J Med Sci 1992. [DOI: 10.1007/bf02943730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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82
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Angerson WJ, Geraghty JG, Baxter JN, Anderson JR, O’Sullivan G, Corbett A, O’Mahony A, Collins JK, Soo KS, Michie CA, Baker SR, Wyllie JH, Beverley PCL, Byrne J, Horgan PG, McKenna N, Headon DR, Given HF, Butterworth RJ, Jasani B, Hughes LE, Maynard N, Smithies M, Bihari D, Mason R, Weir CD, Anderson NH, MacCaigue M, Halliday MI, Rowlands BJ. Research I. Ir J Med Sci 1992. [DOI: 10.1007/bf02943711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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83
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McGinn FP, Uglow M, McMahon AJ, O’Dwyer PJ, Russell IT, Baxter JN, O’Sullivan ST, O’Sullivan GC, Kirwan WO, Majeed AW, Reed MWR, Johnson AG, Kelly SB, Rowlands BJ, Miles WFA, Bradley J, Turnbull L, Allan P, Garden OJ, McEntee G, Vougas V, Rela M, Hadjimarcou A, Mohammed R, Zobolas V, Heaton N, Tan KC. Hepatobiliary. Ir J Med Sci 1992. [DOI: 10.1007/bf02943717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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84
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Paterson IS, Watson RJ, Davies M, England PC, Egleston CV, Woods AE, Gorey TF, McGovern EM, MacDonald A, Baxter JN, Bessent RG, Gray HW, Finlay IG, O’Donoghue JM, Doyle J, Flynn JR, Connolly K, Gallagher M, Butler P, Salman S, Leahy A, Keeling P, Winslet MC, Mohsen Y, Hallissey M, Fielding JWL, Griffith J, Adams I, Sue-Ling H, Finan PJ, McMahon MJ, Johnston D. GAstro-Intestinal. Ir J Med Sci 1992. [DOI: 10.1007/bf02943722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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85
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McMahon AJ, O'Dwyer PJ, Baxter JN. Laparoscopic cholecystectomy. Ann R Coll Surg Engl 1992; 74:439. [PMID: 1471848 PMCID: PMC2497679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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86
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Shields R, Jenkins SA, Baxter JN, Kingsnorth AN, Ellenbogen S, Makin CA, Gilmore I, Morris AI, Ashby D, West CR. A prospective randomised controlled trial comparing the efficacy of somatostatin with injection sclerotherapy in the control of bleeding oesophageal varices. J Hepatol 1992; 16:128-37. [PMID: 1362432 DOI: 10.1016/s0168-8278(05)80105-9] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Since previous reports have suggested that somatostatin may be of value in the control of acute variceal haemorrhage, we compared its efficacy with that of injection sclerotherapy in a randomised controlled clinical trial. Eighty consecutive patients with endoscopically-proven severe variceal bleeding were randomised to injection sclerotherapy (n = 41) or somatostatin (n = 39) given as a continuous infusion of 250 micrograms/h for 5 days plus daily bolus administration of 250 micrograms. The efficacy of injection sclerotherapy and somatostatin infusion in controlling haemorrhage and preventing rebleeding (censored at 5 days), mortality (censored at 28 days) and complications was compared. The aetiology of the portal hypertension and transfusion requirements was similar between the two groups, but there were more patients with severe liver disease (Child's C) in the somatostatin group. There was no significant difference between the two treatments in the initial (p = 1.0) or overall control of bleeding (p = 0.58). Furthermore, somatostatin was as effective as injection sclerotherapy in controlling bleeding in patients with severe liver disease or in those actively bleeding at the time of their endoscopy. The relative risk of rebleeding whilst receiving somatostatin compared to injection sclerotherapy was 1.39 [95% Confidence Interval (CI) 3.73; 0.52], but this was reduced to 0.98 (95% CI 0.37; 2.67) when readjusted for Child's grading, the only prognostic factor shown to be of significance. Mortality was not significantly different between the two groups of patients (p = 0.31). The relative risk of dying whilst receiving somatostatin compared to injection sclerotherapy was 1.6 (95% CI 3.93; 0.66) but was reduced to 1.03 (95% CI 0.47; 2.47) when adjusted for Child's grading, the only significant prognostic factor. Complications in the somatostatin group were minor and less frequent than after injection sclerotherapy. The results of this study indicate that somatostatin is a safe treatment, which is as effective an endoscopic injection sclerotherapy for acute variceal bleeding.
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87
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Baxter JN, O'Dwyer PJ. Laparoscopic or minilaparotomy cholecystectomy? BMJ (CLINICAL RESEARCH ED.) 1992; 304:559-60. [PMID: 1532758 PMCID: PMC1881423 DOI: 10.1136/bmj.304.6826.559] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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88
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Nott DM, Grime SJ, Yates J, Baxter JN, Cooke TG, Jenkins SA. Changes in hepatic haemodynamics in rats with overt liver tumour. Br J Cancer 1991; 64:1088-92. [PMID: 1764371 PMCID: PMC1977860 DOI: 10.1038/bjc.1991.469] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Overt liver tumour was induced in Fisher rats by intraportal administration of 1.6 x 10(7) Walker carcinosarcoma cells. Control groups of rats received similar volumes of dead cells or saline intraportally. All animals were studied at 3 weeks when overt tumour was present. The Hepatic Perfusion Index (HPI) was significantly raised in rats with overt tumour compared to both groups of control animals. Portal flow and portal venous inflow were significantly reduced in the presence of overt tumour but hepatic arterial flow did not alter. These observations suggest that the alteration in the HPI in the presence of overt tumour results from an alteration in portal venous flow and inflow even though the blood supply to the tumour is principally derived from the hepatic artery. The changes in hepatic haemodynamics in the presence of tumour were accompanied by a reduction in portal pressure, an increase in splanchnic vascular resistance and an increase in the degree of arteriovenous shunting through the liver. Portal vascular resistance was unchanged. These findings indicate that the presence of overt hepatic tumour results in gross derangements of hepatic blood flow. These changes must be taken into consideration when attempting to potentiate the delivery of cytotoxic drugs to hepatic tumour by manipulation of hepatic haemodynamics.
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89
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Allison MC, Baxter JN, Russell RI. The potential pitfall of attributing iron deficiency anaemia to ulceration in a Barrett's oesophagus. Scott Med J 1991; 36:182-3. [PMID: 1805380 DOI: 10.1177/003693309103600608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We report a 58-year-old man with recurrent ulceration in a Barrett's oesophagus whose iron-deficiency anaemia was in fact due to a caecal carcinoma. Recent reports suggest an association between these two disorders. A Barrett's oesophagus should not be blamed for iron deficiency unless neoplasms of the colon have been excluded.
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90
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91
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Dobbs BR, Hider RN, Baxter JN. Structural and functional changes of the gastric mucosa in rats with portal hypertension. J Gastroenterol Hepatol 1991; 6:350-4. [PMID: 1912442 DOI: 10.1111/j.1440-1746.1991.tb00869.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Structural and functional changes of the gastric mucosa were studied in rats made portal hypertensive by partially ligating the portal vein. Studies were carried out at either 3 or 12 days after ligation or sham operation. At 3 days, structural changes were greater than at 12 days, the major effects being vascular congestion in the lamina propria, muscularis mucosa, submucosa, and submucosal oedema. Transmission electron microscopy showed only a mild hyperplasia in the muscularis mucosa. Gastric blood flow appeared to decrease at 3 days post-ligation compared to sham-operated control rats, but was significantly increased by 12 days after ligation (P less than 0.01). Cardiac output also appeared to increase in the portal hypertensive rats by 12 days post-ligation but this was not statistically significant. Portal venous inflow was significantly increased by 12 days (P less than 0.05) but after correction for collateral circulation liver blood flow had returned to normal values by 12 days post-ligation.
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92
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Jenkins SA, Shields R, Jaser N, Ellenbogen S, Makin C, Naylor E, Newstead M, Baxter JN. The management of gastrointestinal haemorrhage by somatostatin after apparently successful endoscopic injection sclerotherapy for bleeding oesophageal varices. J Hepatol 1991; 12:296-301. [PMID: 1682359 DOI: 10.1016/0168-8278(91)90830-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Twenty-two patients who experienced a severe haemorrhage from either oesophagitis (n = 8) or ulcers (n = 14) following injection sclerotherapy of their oesophageal varices were treated with intravenous administration of somatostatin (250 micrograms/h). Somatostatin was effective in controlling haemorrhage and preventing rebleeding in all eight patients bleeding from oesophagitis and in 12 of the 14 patients bleeding from oesophageal ulcers. In two patients with ulcers, haemorrhage persisted despite two periods of concominant balloon tamponade and somatostatin infusion and bleeding was eventually controlled by repeated hourly bolus injections of the hormone for 24 h superimposed on the continuous infusion. The results of this study suggest that somatostatin is an effective and safe treatment for the control of bleeding from either oesophagitis or ulcers following injection sclerotherapy of oesophageal varices.
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93
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Abstract
During an attempt to measure renal function during operation in six patients undergoing major abdominal surgery involving intestinal resection and blood loss in excess of 300 ml, it became apparent that the conventional recommendation for i.v. crystalloid fluid of 5-10 ml kg-1 h-1 was not sufficient to maintain cardiovascular stability and urine output, but a volume of 15 ml kg-1 h-1, given to a subsequent six patients, was adequate. Administration of low sodium (glucose) solutions also produced biochemical abnormalities of a severity not documented previously. A survey of the published literature on volumes of crystalloid fluids used supports the contention that, during major surgery, crystalloid requirements may be of the order of 10-15 ml kg-1 h-1 rather than 5-10 ml kg-1 h-1.
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94
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Baxter JN. Undergraduate medical education; the case for a student loan scheme. THE NEW ZEALAND MEDICAL JOURNAL 1990; 103:405-7. [PMID: 2385422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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95
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96
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Baxter JN, Nott D, Jenkins SA, Grime S, Yates J, Cooke TG. ABSTRACTS FROM THE ANNUAL MEETING OF THE SURGICAL RESEARCH SOCIETY OF AUSTRALASIA, HELD IN WESTMEAD, SYDNEY, NSW, 15–17 SEPTEMBER 1988. ANZ J Surg 1989. [DOI: 10.1111/j.1445-2197.1989.tb01513.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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97
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Coulter GN, Baxter JN. Cystadenoma of the common bile-duct with malignant transformation. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1989; 59:291-4. [PMID: 2930383 DOI: 10.1111/j.1445-2197.1989.tb01566.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A case of cystadenoma of the common bile-duct with areas of carcinoma in situ in a 61 year old woman is presented. Pre-operative investigations may confuse this rare tumour with the more common choledochal cyst although this case raises the possibility that this neoplasm may have arisen within a longstanding choledochal cyst. Due to the risk of malignant transformation, complete excision of any cystic lesion of the bile-duct is recommended.
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98
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Baxter JN, Jenkins SA, Ellenbogen S, Shields R. ABSTRACTS FROM THE ANNUAL MEETING OF THE SURGICAL RESEARCH SOCIETY OF AUSTRALASIA, HELD IN WESTMEAD, SYDNEY, NSW, 15–17 SEPTEMBER 1988. ANZ J Surg 1989. [DOI: 10.1111/j.1445-2197.1989.tb01514.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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99
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Nott DM, Grime SJ, Yates J, Day DW, Baxter JN, Jenkins SA, Cooke TG. Changes in the hepatic perfusion index during the development of experimental hepatic tumours. Br J Surg 1989; 76:259-63. [PMID: 2720322 DOI: 10.1002/bjs.1800760315] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A model of microscopic liver tumour has been developed in the Fisher rat by intraportal injection of 1.6 x 10(7) Walker 256 carcinosarcoma cells. Rats were studied at 2, 4 and 6 days after the inoculation of live Walker cells. A control group received dead Walker cells. No tumour was visible in control groups at 2, 4 and 6 days after inoculation. Similarly in rats injected with live cells no tumour was visible at 2 days after inoculation but at 4 and 6 days the percentage hepatic replacement was (mean +/- s.d.) 7.0 +/- 2.3 and 27.9 +/- 6.80 respectively. The hepatic perfusion index was significantly raised at 4 and 6 days after inoculation of live cells compared with control animals and those receiving viable cells after 2 days inoculation. Portal flow and portal venous inflow were significantly reduced when the hepatic perfusion index increased but hepatic arterial flow did not alter. Changes in the hepatic haemodynamics were accompanied by increases in the portal and splanchnic vascular resistance and an increase in the amount of arteriovenous shunting through the liver. These findings confirm studies that the hepatic perfusion index is useful in the detection of occult liver metastases but that the change is not a consequence of an increase in the hepatic arterial flow.
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100
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Ellenbogen S, Jenkins SA, Grime JS, Critchley M, Mackie CR, Baxter JN. Preduodenal mechanisms in initiating gallbladder emptying in man. Br J Surg 1988; 75:940-5. [PMID: 3219539 DOI: 10.1002/bjs.1800751003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The existence of preduodenal phases of gallbladder emptying in normal volunteers was investigated by evaluating the effect of sham feeding a sandwich (chew and spit) (n = 15), the sight and smell of food followed by sham feeding a cooked meal (n = 15), and gastric distension (intragastric balloon tube) (n = 9) on gallbladder emptying and comparing these responses with those after ingestion of a standard meal (n = 14). A control group given no intestinal stimuli were studied to determine the frequency of spontaneous emptying during fasting (n = 18). 99mTc-EHIDA (2,6 diethylphenylcarbamoylmethyliminodiacetic acid) was used as the biliary tracer. The frequency of gallbladder emptying during fasting was 0.0045/min. Thus, in any 20 min period emptying occurred spontaneously in only about 1 in 11 volunteers. Significant emptying (greater than 5 per cent over 20 min) occurred in 8 out of 15 volunteers after sham feeding a sandwich (P less than 0.001 versus control), in 8 out of 15 volunteers after sham feeding a cooked meal (P = 1.0 versus sandwich sham feed, n.s.), in 6 out of 9 volunteers after gastric distension (P less than 0.001 versus control) and in 14 out of 14 volunteers after meal ingestion. The rate of emptying was significantly greater in the gastric distension and meal ingestion groups compared with other groups (P less than 0.05). However, the emptying rate after sham feeding was not significantly different from spontaneous gallbladder emptying (P greater than 0.05, n.s.). There was no significant difference in time to onset of emptying between the four stimulus groups (P greater than 0.05, n.s.). These results suggest that pre-duodenal stimuli can evoke gallbladder emptying in man, although the precise physiological significance of this phenomenon remains to be established.
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