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Biomedical subjects

I B Angorn

Publications and source records attributed to I B Angorn.

At least 55 records · Page 3Linked to original sources
PubMed1977

Tests for completeness of vagotomy.

A battery of tests was applied to 60 patients at periods varying from 2 to 24 months after they had undergone truncal vagotomy (42 with pyloroplasty, 18 with gastro-enterostomy). The major comparison was between those with endoscopic evidence of recurrent duodenal ulcers, and those in whom endoscopy showed no abnormality. Tests which differentiated between the two groups to a statistically significant extent were those for increased acid concentration in the first hour after insulin and serum gastrin, which was lower in this group. Useful, but statistically not significant tests, in patients with no endoscopic evidence of recurrent ulcers, were a postoperative decrease in basal acid output and maximal acid output after pentagastrin or insulin. Symptoms, the combined pentagastrin-insulin test, the volume of acid secreted after insulin, and the acid concentration in the second hour after insulin stimulation were poor indicators for differentiating between patients with recurrent ulcers and those without ulcers. Almost as much information was obtained by the postoperative basal acid output alone as by the pentagastrin and insulin stimulatory tests.

Duodenal Ulcer↗
PubMed1977

Segmental dearterialization in penetrating renal trauma.

Refractory renal haemorrhage following low velocity penetrating trauma has conventionally been treated by nephrectomy or partial nephrectomy. Anatomical studies have demonstrated that the renal artery branches are end-arteries, each branch supplying a renal segment, with no collateral artery supply between segments. Life-threatening haemorrhage is arterial, and usually issues from a single segmental artery easily demonstrable by renal angiography. Fourteen patients had various segmental arteries ligated to control haemorrhage. Associated visceral injuries were present in 4 patients. Preoperative selective renal arteriography was possible in 13 patients and demonstrated the bleeding site in all cases. Segmental dearterialization produced haemostasis in 12 of the 14 patients. One patient required nephrectomy and one patient ligation of a second segmental artery to control bleeding. All the patients survived the operative procedure. Supine renin levels were normal on the fourteenth postoperative day and no patient developed hypertension during the follow-up period of 9-24 months. Segmental renal dearterialization by open operation is a simple and effective technique of controlling refractory renal haemorrhage with maximum preservation of renal parenchyma.

Adolescent↗
PubMed1977

Pulsion intubation for palliation of carcinoma of the oesophagus.

One hundred and eighty-one patients with carcinoma of the upper thoracic oesophagus were intubated perorally using a Procter-Livingstone tube. The mortality was 16-6 per cent but, in the patients who survived, the palliation achieved, as judged by improved swallowing, was considered satisfactory. Factors influencing the success of intubation are also considered.

Adult↗
PubMed1977

The effect of vagotomy on the lower oesophageal sphincter: a manometric study.

The pressure profile of the gastro-oesophageal junctional zone was studied at rest and during abdominal compression in 26 duodenal ulcer patients after subdiaphragmatic truncal vagotomy with a drainage procedure. An 'early' group of 9 patients was investigated 10-14 days after surgery and a 'late' group of 17 patients more than 1 year after operation. Comparisons were made with 25 control subjects. The resting lower oesophageal sphincter pressures after vagotomy in both the early and late groups were similar to the levels of sphincter pressure in the controls. However, the increase in sphincter pressure always observed during absominal compression in normal subjects was significantly decreased by complete vagotomy, and the normal increase in the gastrosphincteric pressure gradient was not produced. All 26 patients were tested for completeness of vagotomy using the insulin/pentagastrin test. In 19 patients the vagotomy was complete and in 7 patients it was judged to be incomplete. A decrease in the gastro-sphincteric pressure gradient on manometric study of the lower oesophageal sphincter was interpreted as indicating complete vagotomy. Accurate correlation between secretory response and compression response was achieved in all patients with complete vagotomy and in 5 of the 7 patients with incomplete vagotomy.

Duodenal Ulcer↗
PubMed1977

A conservative approach to traumatic intrarenal arteriovenous fistulae: experience with 13 cases.

Thirteen patients with traumatic intrarenal arteriovenous fistulae due to blunt, penetrating and iatrogenic injury are reported. The major clinical feature in this series was renal haemorrhage. Conservative treatment resulted in spontaneous closure of the fistula and cessation of bleeding in 6 patients. Nephrectomy was performed in 3 patients for refractory haemorrhage, but a conservative operation would have been preferable. Renal segmental artery ligation was effective in controlling renal haemorrhage and promoting closure of the fistula in 4 patients. No adverse sequelae occurred following segmental artery ligation. The initial management of traumatic intrarenal arteriovenous fistulae should be conservative. Segmental artery ligation is recommended for the relief of persistent pain and control of renal haemorrhage.

Adolescent↗
PubMed1977

Palliation of malignant esophago-respiratory fistulae by permanent indwelling prosthetic tube.

Malignant esophago-respiratory fistula is an incurable condition calsing severe distress to those patients suffering from it. Sixty two successive patients with esophago-respiratory fistulae, secondary to squamous cell carcinomas of the esophagus, were intubated for palliation. The first 14 were intubated by a traction technique using the Celestin tube, and the remaining 48 were intubated by the Procter-Livingstone tube inserted by a pulsion method. Celestin intubation had a mortality of 64.3% but 75% of those intubated by the Procter-Livingstone tube were discharged from hospital, swallowing satisfactorily and relieved of their respiratory distress. In our experience the insertion of the Proctor-Livingstone tube by a pulsion technique, can be performed in a few minutes, with little morbidity and allows the patient to be discharged from hospital within 3-4 days of the procedure. It is a successful and acceptable method of treating malignant esophago-respiratory fistulae.

Adult↗
PubMed1977

Oral alimentation following intubation for esophageal carcinoma.

The nutritional status of 15 patients suffering from unresectable carcinoma of the midthoracic esophagus was evaluated before and after palliative pulsion intubation. All patients showed evidence of protein-calorie malnutrition, prior to intubation. Oral alimentation using a formulated hospital ward diet with an elemental dietary supplement reversed the nutritional deficit. A mean daily positive nitrogen balance of seven grams was achieved three weeks following intubation. No episode of tube blockage was observed and the elemental diet supplement was well tolerated.

Adult↗
PubMed1976

Villous tumour of the duodenum.

The occurrence of a villous tumour of the duodenum in an 18-year-old female patient is reported. This is the youngest patient who has been recorded as having this type of tumour. Fibre-optic endoscopy with biopsy of the tumour permitted a pre-operative diagnosis to be made.

Adolescent↗
PubMed1976

Primary hyperparathyroidism in Black South Africans.

Despite the presence of stimuli to parathyroid activity, such as low dietary intake of calcium and low serum calcium levels, primary hyperparathyroidism is extremely uncommon in the indigenous population of Africa south of the Sahara. We report the occurrence of primary hyperparathyroidism in 3 black patients, all of whom presented with gross bone disease, high serum calcium levels, short histories of hyperparathyroidism and large parathyroid tumours. The clinical manifestations of hyperparathyroidism in these patients are probably due to the rapid rate of tumour growth and high level of hormone production.

Adenoma↗
PubMed1976

Acid secretion in Zulu and Indian patients with duodenal ulcers.

Pentagastrin-stimulated maximal acid output (MAO) was measured in 337 male patients with duodenal ulcers, 209 of whom were Indian, and 128 of whom were Zulus. The mean MAO standard deviation (SD) value for Zulu patients with uncomplicated ulcers was 36,2 +/- 10,5 mEq/h. In the patients with complicated ulcers, the maximal acid output was 38,5 +/- 6,3 mEq/h in patients with pyloric stenosis, 31,5 +/- 13,7 mEq/h in patients with haemorrhage and 42,9 +/- 9,2 mEq/h in patients with perforation. A statistically significant difference was obtained only in the group with perforation (Pless than0.05). The mean MAO +/- SD value for Indian patients with uncomplicated ulcers was 29,2 +/- 17,0 mEq/h. In those with complicated ulcers, the MAO value in pyloric stenosis was 30,5 +/- 5,5 mEq/h in those with haemorrhage 22,0 +/- 13,7 mEq/h and for patients with perforation, 27,8 +/- 7,5 mEq/h. A statistically significant difference in values was not obtained in Indian patients. In the Zulu patients, 77,6% had MAO values above the upper limit of normal (mean + 2 SD), while in Indian patients only 17.6% had MAO values above the upper limit of normal. The difference between the 2 percentages is highly significant (Pless than0,0001). The proportion of male patients with stimulated acid secretion measurements above the upper limit of normal in other reported series is 30-50%.

Adult↗
PubMed1975

Typhoid perforation of the ileum: A therapeutic dilemma.

Thirty-eight cases of typhoid perforation of the terminal ileum were encountered during a three-year period. Fourteen cases were treated conservatively, with a mortality of 36%. During the same period, the surgical mortality improved from 50% in 1972 to 11% in 1974. It is recommended that typhoid perforation be treated by operation.

Adolescent↗
PubMed1975

Oesophagogastrostomy without a drainage procedure in oesophageal carcinoma.

Ten patients with carcinoma of the lower third of the oexophagus who had oesophagogastrectomy followed by oesophagogastrostomy without a drainage procedure were investigated 6 months postoperatively. Postoperative symptomatic evaluation and modified Visick grading of the results were carried out by an independent observer. Objective assessment included fibre-optic endoscopy of the oesophagus, stomach and duodenum, gastric acid secretory studies and measurement of gastric emptying times following the ingestion of a barium food mixture. Eight of the 10 patients had an excellent or very good result and the remaining 2 were graded as satisfactory. No evidence of macroscopic oesophagitis or gastritis was detected and pyloric obstruction was never observed. Gastric emptying time was not prolonged. The results obtained support the concept that a drainage procedure is unnecessary after oesophagogastrostomy.

Drainage↗
PubMed1975

Traumatic arteriovenous fistulae.

Twenty-two cases of arteriovenous fistulae are reviewed retrospectively, with particular emphasis on their clinical presentation, physical signs, investigations and management. This review allows us to make certain conclusions for the future diagnosis and management of this condition.

Adolescent↗