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Biomedical subjects

A Mannell

Publications and source records attributed to A Mannell.

At least 55 records · Page 3Linked to original sources
PubMed1985

Cancer of the oesophagus in Soweto.

Oesophageal cancer is remarkably common in Transkei, a rural part of South Africa, but has not been thought to affect urban blacks nearly as often. The incidence of oesophageal cancer in Soweto, South Africa's largest urban black community, is assessed. The age-standardized incidence is 125/100 000 in men and 37/100 000 in women. Oesophageal cancer is now a disease as much of urban as of rural blacks, a fact which may be epidemiologically significant. The prognosis for oesophageal cancer in blacks is widely believed to be almost hopeless, regardless of treatment. The results of treatment in 265 patients over 3 years are presented - in 21% the disease was confined to the oesophagus and these patients were treated by oesophagectomy (30% 3-year survival rate); 23% had local spread and were treated by extra-oesophageal bypass (11% 1-year and 2% 2-year survival rate); and 51% had advanced disease (1% 1-year survival rate, no survivors at 2 years). Five per cent of the patients died before any treatment could be given.

Adult↗
PubMed1985

Surgery for the complications of peptic ulceration in urban black patients.

We report on a series of 63 urban black patients who required surgical treatment for duodenal or gastric ulcers. Intractable pain from duodenal ulceration was an uncommon indication for surgery, which was mostly required for the complications of perforation, haemorrhage and stenosis. Perforation was the most common indication for surgery in these patients, while in rural black patients pyloric stenosis is reported to be a common complication. It appears that the complications of duodenal ulcers in the urban black population now resemble those occurring in white patients. Giant duodenal ulcers were present in almost 25% of these patients and those presenting with haemorrhage required aggressive surgery to control the bleeding. Twenty-five per cent of cases of gastric ulceration proved to be malignant. These were mostly prepyloric ulcers, suggesting the need for vigorous investigation of such ulcers to exclude gastric carcinoma and early surgery if a conservative regimen fails to heal them. There was a 100% mortality rate among patients with perforated benign gastric ulcers, largely the result of late presentation.

Adolescent↗
PubMed1984

Dermatofibrosarcoma protuberans in black patients.

Twelve cases of dermatofibrosarcoma protuberans in Black patients admitted to Baragwanath Hospital, Johannesburg, between 1979 and 1983 are reviewed. The cause of this slow-growing, low-grade malignant fibrous histiocytoma is unknown, but there is some evidence that trauma may be a predisposing factor. The clinical and histological features of dermatofibrosarcoma protuberans are described, and treatment by wide tridimensional excision with local reconstruction is recommended.

Adolescent↗
PubMed1984

Gastric bile acid content and concentration in asymptomatic adults.

Overnight gastric aspiration was performed on 15 fasting asymptomatic adults in the erect and supine positions. The pH of the gastric aspirates was not directly related to the bile acid concentration, which ranged from 0 to 1116 mumol/l. The total bile acid content of the 12-hour aspirates varied from 0 to 122 mumol. A change in posture had no significant effect on the duodenogastric reflux of bile when subjects were fasting or when gallbladder contraction was stimulated by intravenous pancreozymin. The clinical relevance of these findings is discussed.

Adult↗
PubMed1984

Gastric emptying of a solid meal.

A simple, non-invasive technique for measuring gastric emptying of a solid meal in clinical practice is described. Cooked chicken liver labelled with a radioisotope is used. To establish the range of normal gastric emptying times 11 asymptomatic adults were studied. The effect of posture on solid emptying was also examined.

Adult↗
PubMed1984

Amyloid goitre. A case report.

A case of primary amyloidosis presenting as a goitre is reported. The clinical features of amyloid goitre are described and the difficulties in making a pre-operative diagnosis are discussed. A plan of management for this rare thyroid condition is suggested.

Amyloidosis↗
PubMed1984

The thoracic stomach: a study of gastric emptying, bile reflux and mucosal change.

The clinical progress, histological state of the gastric mucosa, gastric emptying of a liquid meal and duodenogastric reflux were studied postoperatively in 15 patients with a vagotomized intrathoracic stomach without a drainage procedure. The intact though denervated pylorus did not impede the emptying of liquids. Bile reflux into the thoracic stomach in both the erect and supine positions was significantly greater than that measured in control subjects. While posture did not affect duodenogastric reflux in the normal adult, bile reflux across the denervated pylorus was significantly increased in the supine position. Chronic active gastritis was noted in 12 patients but could not be correlated with the degree of bile reflux. Nine patients had evidence of pulmonary aspiration and gastric food residue was a common finding at endoscopy. The vagotomized intrathoracic stomach may need a drainage procedure to facilitate solid emptying.

Adult↗
PubMed1984

Exclusion of the oesophagus: is this a dangerous manoeuvre?

If oesophagectomy is contra-indicated or dangerous, oesophageal bypass can restore the ability to swallow. It is not known if excluding the bypassed oesophagus by closing both ends will lead to serious complications. In this study we report on 89 patients who underwent bypass surgery for benign and malignant strictures of the oesophagus. The thoracic oesophagus was completely excluded in 51 patients and in 30 cases the bypass procedure was combined with distal oesophageal drainage. Gastro-oesophageal continuity was preserved in eight patients undergoing an extra-oesophageal colon bypass. The operative mortality was similar in the three groups. Neck abscesses, probably due to leakage from the upper end of the bypassed oesophagus, occurred in 17 per cent of patients with oesophageal exclusion and in 9 per cent of the remainder. Changes occurring in the bypassed oesophagus of 38 patients were monitored with computed axial tomography. Segmental, mucus-filled dilatations ( mucocoeles ) of the oesophagus were identified in 20 patients. In 19 patients these mucocoeles remained small and asymptomatic. One patient with achalasia developed an oesophago-airway fistula two years after operation. Provided both ends of the oesophagus are securely closed, oesophageal exclusion is not a dangerous manoeuvre in patients undergoing bypass surgery for locally invasive tumours or corrosive injuries of the oesophagus.

Adolescent↗
PubMed1984

The spread of oesophageal cancer: an evaluation of clinical, barium and computed tomography assessments.

One hundred and three patients with proven oesophageal cancer were evaluated prospectively by clinical examination, upper gastro-intestinal barium studies and computed tomography (CT). The accuracy of each method in assessing the extent of disease was determined by correlation with findings at bronchoscopy (100 patients), thoracotomy (26 patients) and laparotomy (63 patients). The results indicated that CT will accurately demonstrate mass invasion of cancer into mediastinal structures. But the absence of fat-planes on CT is the least reliable indication of spread into peri-oesophageal soft tissues. Early mediastinal infiltration is best assessed by analysis of the oesophageal axis on barium swallow and the patient's symptoms. Computed tomography is not helpful in the diagnosis of mediastinal node metastases. Barium studies of the proximal stomach will accurately identify (and CT reliably exclude) local tumour extension into the stomach. CT can frequently fail to detect malignant abdominal lymphadenopathy in cachexic patients.

Abdominal Neoplasms↗
PubMed1983

Acute emphysematous thyroiditis.

Acute emphysematous thyroiditis is a severe pyogenic infection of the thyroid gland characterized by the production of gas. Although earlier writers of the pre-antibiotic era had referred to 'gangrene of the thyroid with gas formation' (1-3), only 5 cases of gas-forming or emphysematous thyroiditis have been specifically documented. In this report, the sixth case of acute emphysematous thyroiditis is presented and the clinical features of this rare but potentially lethal infection of the thyroid gland are described. The pathogenesis and management of the disease are discussed.

Acute Disease↗
PubMed1983

Oesophageal intubation for advanced oesophageal cancer: the Baragwanath experience 1977-1981.

Oesophageal intubation was performed for 324 patients with advanced squamous cell carcinoma of the oesophagus. Peroral pulsion and traction techniques were used. There were 88 deaths in hospital (mortality rate, 27 per cent). The mortality rate did not appear to be directly related to the general condition of the patient or to the experience of the operator. Adequate palliation of dysphagia was achieved in 61 per cent of intubated patients, but a high rate of late complications impaired the quality of life following intubation. It is concluded that the insertion of an oesophageal tube was neither a safe nor satisfactory method for palliation of malignant dysphagia.

Adult↗
PubMed1983

The management of malignant oesophago-airway fistulae.

Gastric bypass was performed for eight patients with advanced oesophageal cancer complicated by an established oesophago-airway fistula. There was one operative death. Seven patients could be discharged from hospital with complete relief from aspiration and eating a normal solid diet. The preoperative preparation, anesthetic management and operative technique is described. Gastric bypass is compared to other methods of palliation for malignant oesophago-airway fistulae.

Adult↗
PubMed1983

The microflora of the oesophagus.

A study of the oesophageal microflora was undertaken in 51 normal adults and in 50 patients with carcinoma of the oesophagus. Aerobic organisms were present in every case. Anaerobic organisms were cultured from 41 (80%) of normal controls and 48 (96%) of patients with carcinoma. The isolation rate of all species of aerobic and anaerobic bacteria was similar in both groups. The antibiotic sensitivities of the oesophageal microflora were examined to determine appropriate antibacterial therapy for patients undergoing oesophageal surgery and for the treatment of oesophageal perforation.

Adult↗
PubMed1982

The role of surgery in the palliative management of oesophageal cancer.

Cure of oesophageal cancer is unlikely in the majority of patients with this disease, so that the first aim of treatment is the effective palliation of dysphagia. Surgery is the most certain method of restoring normal swallowing, but should not be undertaken unless it is likely to be safe and effective. Appropriate therapy for the individual patient can only be selected after careful pre-operative assessment of the level, length and extent of the tumour and of the patient's general condition. The indications and techniques for oesophagectomy and oesophageal bypass are discussed.

Esophageal Neoplasms↗