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Biomedical subjects

B L Dowling

Publications and source records attributed to B L Dowling.

At least 19 recordsLinked to original sources
PubMed1995

Use of a feeding jejunostomy after oesophagogastric surgery.

Over a 5-year period, 58 patients with oesophageal or gastric malignancy underwent surgical resection with oesophagogastric or oesophagojejunal anastomosis. All were fed temporarily with a catheter feeding jejunostomy placed at the time of surgery. All patients tolerated the feeding well. There were no catheter-related deaths and only one serious complication, formation of an abscess following catheter dislodgement. Experience with this technique suggests that it is safe and cheap method of feeding patients after oesophagogastric surgery. Such patients are particularly suitable for a feeding jejunostomy as they are frequently malnourished, rarely have prolonged postoperative ileus and may develop complications that delay the onset of oral intake.

Aged↗
PubMed1994

An audit of the quality of operation notes in two district general hospitals. Are we following Royal College guidelines?

The quality of medical record keeping is being subjected to increasingly close scrutiny. The 1992 report of the National Confidential Enquiry into Perioperative Deaths (NCEPOD) noted a considerable variation in the quality of operation notes submitted by all contributing surgical specialties. This study has audited the quality of 264 general surgical operation notes written by 10 consultants and 16 trainees in two district general hospitals (DGH). Postoperative instructions were absent in nearly two-thirds of operation notes and serial numbers of prostheses were rarely recorded. On almost every criterion trainees scored higher than consultants and emergency operation notes scored better than elective notes. About 70 per cent of notes written by consultants were illegible or the procedure could not be understood from the description given, by the nurse or junior doctor collecting the data. Until word processor databases become more widespread in operating theatres, it is suggested that a specifically designed proforma be used, with prescribed headings to act as aides-mémoire for the surgeon.

Documentation↗
PubMed1991

Gastric abscess--an unusual presentation. Case report.

Gastric abscess is a rare inflammatory condition of the gastric wall. It is seldom diagnosed preoperatively because of the variety of clinical presentations mimicking the more common conditions. We report a case of a gastric abscess thought preoperatively to be a strangulated epigastric hernia. This prompted early and appropriate surgery.

Abscess↗
PubMed1990

Swallowed button batteries: is there a consensus on management?

The optimum management of ingested button batteries was ascertained by postal questionnaire sent to 608 members of the endoscopic and paediatric sections of the British Society of Gastroenterology. Some 312 returns were suitable for analysis: 36.2% of the respondents were not concerned about ingested button batteries and gave no treatment, 6.4% used medical treatment, 48.4% removed them under certain circumstances, and 9% did not know how to manage the problem. Emetics and H2 antagonists or antacids were often used for batteries in the oesophagus, stomach, and duodenum and laxatives were commonly prescribed for batteries in the small and large bowel. Of the 48.4% who felt batteries should be removed under certain circumstances, 78%, 72%, and 48% extracted them from the oesophagus, stomach, and duodenum respectively within 24 hours of ingestion. The main reason for operative removal from the small and large bowel was failure of the battery to progress. Current management is therefore variable. Heavy metal poisoning may be occurring more frequently than is suggested in the published reports.

Antacids↗
PubMed1989

Brown bowel syndrome: an unusual cause of massive dilatation of the colon.

We report a case of the brown bowel syndrome presenting as major dilatation of the colon which resembled 'toxic dilatation' and necessitated subtotal colectomy. We confirm the reported association between the brown bowel syndrome, malabsorption, and hypovitaminosis E. Furthermore we document failure of the brown pigmentation to resolve after six months in spite of vitamin E supplements and correction of the malabsorption. Finally we suggest that, although the brown bowel syndrome is rare, it should be considered in cases of major colonic dilatation where the patient is or may be suffering from a malabsorption syndrome, and where the sigmoidoscopic appearances do not suggest severe inflammatory bowel disease.

Adult↗
PubMed1986

Duodenal diversion with vagotomy and antrectomy for severe or recurrent reflux oesophagitis and stricture: an alternative to operation at the hiatus.

In cases of mild symptomatic gastro-oesophageal reflux, standard antireflux surgery, such as fundoplication or the Angelchik prosthesis, produces satisfactory results. Duodenal diversion is recommended for use only in patients with severe oesophageal damage. This situation commonly arises where the gastro-oesophageal junction cannot be reduced into the abdomen, or where previous surgery has made reoperation at the hiatus difficult and hazardous. Fifty-seven patients with severe reflux oesophagitis have been treated by Roux-en-Y duodenal diversion and antrectomy. Thirty three patients had vagotomy in addition. Median follow-up after operation is 6.1 years. In 35 patients (61%), the technique was used as primary surgical treatment. These included 22 patients in a randomized trial of the method. Thirteen (23%) had previously had unsuccessful antireflux surgery. Nine (16%) had undergone previous operations for peptic ulcer or achalasia. There was no operative mortality. No patient in the series required stricture resection. Good or excellent overall results were achieved in 86% of patients. Eighteen of twenty seven patients with severe strictures required an average of three dilatations after operation before dysphagia was completely relieved. Heartburn was dramatically relieved and oesophagitis settled within an average period of 6 months. Poor or unsatisfactory overall results were observed in 8 (14%) patients. These included one tight fibrous stricture which required endoscopic intubation despite resolution of oesophagitis, and four patients who developed a stomal ulcer. No patients suffered from the dumping syndrome. Malignancy must be carefully excluded by biopsy in all cases of stricture.

Adult↗
PubMed1984

Randomized prospective trial of Roux-en-Y duodenal diversion versus fundoplication for severe reflux oesophagitis.

It is not widely recognized that duodenal contents are implicated in the causation of severe reflux oesophagitis and stricture formation in patients with hiatus hernia. In a randomized prospective trial, including only patients with severe oesophageal changes, standard Nissen fundoplication has been compared with antrectomy and Roux-en-Y reconstruction. Twenty-two patients were randomized to each group. The 42 surviving trial patients have been followed for an average period of over 5 years. Good results (Visick I or II) have been achieved in 91 per cent of 22 patients having antrectomy and Roux-en-Y anastomosis (Group B), compared with 65 per cent of 20 patients surviving after Nissen fundoplication (Group A). Poor results (Visick III or IV) seen in seven patients (35 per cent) in group A were almost all associated with failure of fundoplication to stop reflux. Two of these patients have subsequently had antrectomy and Roux-en-Y reconstruction with excellent results. Antrectomy with Roux-en-Y gastrojejunostomy appears to be superior to a standard anti-reflux procedure as primary surgical treatment in these patients. The technique is recommended: where the patient has a fixed irreducible hiatus hernia; where previous surgery at the hiatus has failed and rendered reoperation hazardous.

Adult↗
PubMed1984

Randomized prospective trial of the Angelchik anti-reflux prosthesis.

Fifty-two patients with reflux oesophagitis resistant to medical treatment were randomized at operation to receive either the Angelchik prosthesis or a fundoplication. All patients were assessed postoperatively by a physician unaware of the nature of the operation. Forty-two patients have been followed up for 1-2 years; ten patients for 3-9 months. Ninety-six per cent of the Angelchik patients had satisfactory or excellent results compared with 81 per cent with a fundoplication. There were no failures to control reflux with the Angelchik prosthesis whereas 6 patients (23 per cent) of the fundoplication group have persisting reflux. Operating times for insertion of the prosthesis averaged a little over half that recorded for fundoplication. Complication rates were similar. The results of the trial encourage the use of the prosthesis in patients with gastro-oesophageal reflux, where medical treatment has failed. The prosthesis should not be used if the gut is opened during operation either inadvertently or deliberately, as in making a suture line or anastomosis, because of the risk of sepsis.

Clinical Trials as Topic↗
PubMed1976

Esophageal dilatation using the Eder Puestow dilators.

We have performed fifty-one dilatations in twenty-six patients using an end-viewing fiberoptic endoscope and Eder Puestow dilators. All (except two) were performed using intravenous diazepam, the majority on an outpatient basis. The only complication has been a single case of aspiration pneumonia. We have found this method of esophageal dilatation particularly useful in the preoperative dilatation of benign strictures, and in those elderly frail patients who are unsuitable for surgery. Transthoracic resection of the stricture is avoided and thus transabdominal repair of the hiatus hernia may be undertaken.

Aged↗
PubMed1975

Antrectomy with Roux-en-Y anastomosis in the treatment of peptic oesophagitis with stricture.

A series of 8 patients with severe oesophageal strictures secondary to reflux oesophagitis who have been treated by antrectomy with Roux-en-Y anastomosis is described. There was 1 postoperative death. The remaining patients have been completely relieved of heartburn and all have had a dramatic improvement in their dysphagia. This method of treatment is strongly recommended for patients who have had prior surgery to the hiatus which has failed, and for those who are too elderly or frail to withstand a direct attack on their oesophageal stricture.

Aged↗