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Biomedical subjects

C G Bremner

Publications and source records attributed to C G Bremner.

At least 19 recordsLinked to original sources
PubMed1992

Surgical options in the treatment of reflux oesophagitis.

Medical treatment of reflux oesophagitis requires life-long medication, does not relieve all patients of their symptoms and may not halt the progression of damage. Antireflux surgery is indicated in refluxing infants who fail to thrive, in disease uncontrolled by medical treatment or when laryngeal and pulmonary symptoms are associated with reflux. A full investigation to establish and quantitate the motility defect and severity of the reflux, nature of the refluxate and pattern of gastric emptying is necessary to plan a correct antireflux procedure which can assure a cure of up to 90% for 10 years.

Esophagitis, Peptic↗
PubMed1991

Reflux esophagitis therapy: sucralfate versus ranitidine in a double blind multicenter trial.

Sucralfate (Sc) suspension 6 g/day and ranitidine (Rn) tablets, 150 mg, were compared in 125 patients in a double-blind, multicenter, endoscopically controlled trial in the treatment of reflux esophagitis. Inclusion criteria were symptomatic reflux (number and severity of attacks) and endoscopic evidence of esophagitis (grades 1 to 4). Clinical assessments were performed on entry, and at 4 and at 8 weeks, and endoscopy was repeated at 8 weeks. Sc suspension and Rn placebo or Sc placebo and Rn tablets were taken on waking and immediately before retiring at night. Of the 125 patients, 27 were withdrawn because of default (Rn = 4; Sc = 14), noncompliance (Rn = 1; Sc = 2), or the development of congestive cardiac failure (Rn = 1), diarrhea (Rn = 1; Sc = 1), nausea (Sc = 1), constipation (Sc = 1), and hematemesis (Sc = 1). Analysis was performed on the remaining 98 patients, 43 of whom had been treated with Sc and 55 with Rn. Heartburn, acid regurgitation, epigastric pain, dysphagia, and chest pain were relieved in 34% vs 40%, 67% vs 72%, 71% vs 57%, and 86% vs 63% for Sc and Rn, respectively. There was no significant difference between the two groups. Endoscopic healing occurred in 47% of the Sc- and in 31% of the Rn-treated patients (chi 2 = 2.50), and healing or improvement was noted in 81% of the Sc- and 64% of the Rn-treated patients. This difference approached statistical significance (chi 2 = 3.73). There was no obvious endoscopic benefit in 8 of the 43 and 20 of the 55 patients in the groups treated with Sc and Rn, respectively. Although the findings with sucralfate and ranitidine in patients with reflux esophagitis completing the trial suggest a benefit of these agents, the absence of a placebo control group and the high default rates, particularly for those receiving sucralfate, preclude any firm conclusions as to relative or specific efficacy of these agents in this condition.

Administration, Oral↗
PubMed1990

Barrett's oesophagus--radiological features in 100 cases.

The columnar-lined or Barrett's oesophagus is an acquired condition resulting from long-continued gastro-oesophageal reflux. In the last 20 years 149 patients with Barrett's oesophagus have been studied in the clinics of the Johannesburg Teaching Hospitals. Important radiological predictors of Barrett's oesophagus, as defined from a series of 100 cases, are the presence of a stricture well above the gastro-oesophageal junction (41 cases), a long stricture (13 cases) and ulceration in the body of the oesophagus (16 cases). An early stricture may be so subtle that it is missed or disregarded, and is the usual site of the squamocolumnar junction. Significant strictures may be seen even in the absence of a hiatus hernia. When associated with a hiatus hernia the strictures are usually concentric and are longer than the usual reflux strictures. The varying length of these strictures suggests an upward progression of the disease process, which begins at the gastro-oesophageal junction. This feature, seen in 6 of our patients, has not previously been stressed as a predictor for Barrett's oesophagus. Radiological reflux, although in itself a poor predictor, lends support to the diagnosis of Barrett's oesophagus if one or more of the other predictors is present. A less important predictor is a reticular mucosal pattern seen on double-contrast radiography.

Barrett Esophagus↗
PubMed1989

Esophageal function in patients with reflux-induced strictures and its relevance to surgical treatment.

Esophageal function was evaluated in 53 patients with increasing severity of esophageal injury caused by gastroesophageal reflux disease (study 1), and the findings were applied to the treatment of 28 patients with reflux-induced strictures (study 2). Fifty asymptomatic volunteers served as controls for both studies. In study 1 there were 14 patients without reflux complications, 14 with esophagitis grade I to III, 13 with esophageal stricture, and 12 with Barrett's epithelium (6 of whom had a stricture). The prevalence of a mechanically defective sphincter increased with the progression of the esophageal injury; 50% in the patients without complications to 84% and 92% in those with stricture or Barrett's epithelium, respectively. Similarly, a decrease in amplitude of contractions in the distal esophagus was observed in patients with stricture and patients with Barrett's epithelium. In study 2, these findings were applied in the surgical management of 28 consecutive patients with a reflux-induced stricture. Preoperative motility studies were performed after patients were dilated to 60F. Control of reflux by a Nissen fundoplication gave excellent (86%) to good (14%) results in patients who had relief of dysphagia after dilation or adequate motility, or both. Four patients with both persistent dysphagia after dilation and inadequate motility underwent resection. Transmural presented are helpful in the selection of the optimal surgical procedure for the treatment of dilatable reflux-induced strictures.

Adult↗
PubMed1989

Relationship of a satisfactory outcome to normalization of delayed gastric emptying after Nissen fundoplication.

Delayed gastric emptying in patients with gastroesophageal reflux disease may be due to an incompetent distal esophageal sphincter and/or a gastric abnormality. To determine the influence of the Nissen fundoplication on gastric emptying we studied the rate of gastric emptying before and after operation in 25 patients with proved gastroesophageal reflux disease. Nine patients had no gastric pathology, 9 had gastric acid hypersecretion, 5 had gastritis, and 2 had evidence of significant duodenogastric reflux. All were treated by Nissen fundoplication. Those with gastric acid hypersecretion also had a proximal gastric vagotomy (PGV) and the two patients with pathologic duodenogastric reflux were treated by a bile diversion procedure. We found that in gastroesophageal reflux disease with associated gastric pathology there was a higher prevalence of delayed gastric emptying before operation than in patients without gastric pathology. Nissen fundoplication was associated with speeding of gastric emptying in patients with or without gastric pathology. Proximal gastric vagotomy performed in association with Nissen fundoplication augmented the speeding of gastric emptying, which was advantagenous in most cases but detrimental in two. Every patient in whom gastric emptying was not normalized had postoperative symptoms. Only two of 20 patients with normal postoperative gastric emptying had postoperative symptoms. Both patients had preexisting gastric pathology. Based on these findings, the side effects associated with Nissen fundoplication are due to the failure to normalize gastric emptying rather than the operation.

Follow-Up Studies↗
PubMed1989

Current management of benign oesophageal strictures.

Benign reflux strictures most commonly result from gastro-oesophageal reflux but other causes must be excluded. Ambulatory pH monitoring is useful to confirm and quantitate the severity of reflux. Reflux strictures can be managed by dilatation and vigorous continued antireflux treatment but surgery offers a safe and more effective means of correcting the physiological dysfunction of the sphincter. Healthy patients should, therefore, be offered a permanent cure by surgery and conservative measures should be reserved for patients who are elderly, obese or unfit for surgical management. Before starting surgical treatment a full investigation is mandatory. Radiological, endoscopic, histological and cytological studies, pH monitoring, motility evaluation of the motor power of the oesophagus and sphincter and an assessment of gastric emptying are all necessary investigations for a complete evaluation of the dysfunction and effective surgical planning.

Dilatation↗
PubMed1989

Alkaline gastroesophageal reflux: implications in the development of complications in Barrett's columnar-lined lower esophagus.

Barrett's esophagus is a common finding in patients with gastroesophageal reflux and is associated with a high incidence of serious complications (stricture, ulceration, and carcinoma). The reason that only a portion of patients with reflux develop Barrett's esophagus and why some are prone to develop complications is unknown. Twenty-three patients with Barrett's esophagus underwent endoscopy, 24-hour esophageal pH monitoring, and manometry. Nine of these patients with gastritis underwent 24-hour gastric pH monitoring, and three with symptoms of duodenogastric reflux underwent 99mTc-labeled hepato-iminodiacetic acid scanning. Patients with complicated (n = 12) and uncomplicated (n = 11) Barrett's esophagus were compared with each other and with patients with reflux esophagitis (n = 53) and normal volunteers (n = 50). Patients with Barrett's esophagus showed an increased exposure to acid and alkaline gastric juice compared with patients with esophagitis and normal volunteers. In the patients with Barrett's esophagus with and without complications, there was no significant difference in age, incidence of defective lower esophageal sphincter, incidence of defective peristalsis, extent of the Barrett's epithelium, or percent time the esophageal pH was less than 4. In contrast, the percent time the esophageal pH was greater than 7 was significantly greater in patients with complications. This alkaline exposure is likely to be related to duodenogastric reflux. This was supported by positive gastric pH scores for duodenogastric reflux and 99mTc-labeled hepato-iminodiacetic acid scans in patients with Barrett's complications. These findings suggest that the development of complications in Barrett's esophagus is the result of the damaging effect of refluxed duodenal juice.

Alkalies↗
PubMed1988

Transhiatal blunt esophagectomy.

The operation of transhiatal esophagectomy has been revived in recent years, and several series have reported upon some of the advantages of this procedure over esophagectomy by way of a thoracotomy. Because part of the technique involves a "blind" dissection, it is important that the surgeon is completely familiar with the anatomic relations of the esophagus. A careful anatomic review of these relations was undertaken and important anatomic landmarks have been highlighted with the aid of anatomic dissection. Areas of anatomic fixation are found particularly at the tracheal bifurcation, the dome of the right pleura and the arch of the aorta. The right pleura also crosses the midline between the levels corresponding to the fifth and tenth thoracic vertebrae, and at the eighth thoracic vertebra, there is close proximity of pleurae. A better appreciation of these anatomic features will help the surgeon to decrease the morbidity of the transhiatal esophagectomy.

Esophageal Neoplasms↗
PubMed1987

Malignant fibrous histiocytoma of the breast. A case report.

Primary malignant fibrous histiocytoma of the breast was diagnosed in a 45-year-old Indian woman. She presented with a large ulcerated lesion and had lung metastases. Treatment was by radiotherapy, toilet mastectomy and chemotherapy. The patient died of rapid extension of lung metastases 15 months after first being seen. Although this tumour has previously been considered to have a relatively good prognosis, this report emphasises its fully malignant metastatic potential.

Breast Neoplasms↗
PubMed1987

Penetrating cardiac injuries: selective conservatism--favorable or foolish?

In a current review of the literature regarding the management of patients with suspected penetrating cardiac injuries there appears to be no place for conservative management. Nine patients with penetrating cardiac injuries were successfully treated conservatively and are reported. This series aims to emphasize the point that there is a place for conservative management of selected cases.

Adult↗
PubMed1979

Traumatic diaphragmatic hernia presenting pregnancy. A case report.

A right-sided traumatic diaphragmatic hernia was present in a woman who was 24 weeks pregnant, 8 years after a motor vehicle injury. The hernia had not been diagnosed previously. Correction of severe anaemia and surgical repair of the diaphragmatic defect were successful.

Adult↗