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Biomedical subjects

J Alexander-Williams

Publications and source records attributed to J Alexander-Williams.

At least 199 records · Page 11Linked to original sources
PubMed1976

A symptomatic discriminant to identify recurrent ulcer in patients with dysperpsia after gastric surgery.

A questionnaire has been completed by 99 patients referred for investigation of symptoms after gastric operations. The replies were analysed in an attempt to distinguish patients with a recurrent peptic ulcer from those with no recurrent ulcer. All cases were investigated by barium meal, endoscopy, and oral cholecystography. All recurrent ulcers were confirmed by reoperation and patients with gastric carcinoma, gallstones, or symptomatic hiatus hernia were excluded. The study was retrospective in 40 patients in whom the diagnosis was already confirmed when the questionnaire was analysed and prospective in 59 in whom the diagnosis was originally unknown. The replies were analysed with (a) a small computer using Bayes' theorem, (b) weighted tables, and (c) a discriminant analysis. The computer prediction of the prospective data was 85% accurate. The results of simpler methods were almost as good as the computer prediction, and questions related only to the severity of pain and vomiting accurately distinguished recurrent ulcer from other causes of dyspepsia in 81% of patients.

Diagnosis, Computer-Assisted↗
PubMed1976

The association of duodenogastric reflux with dumping and gastric retention.

Gastric emptying of solid and liquid meals together with duodenogastric reflux has been measured in a prospective trial of proximal gastric vagotomy and truncal vagotomy and antrectomy. Three abnormalities of motility associated with postoperative symptoms have been defined. If more than one abnormality was present in an individual there was an 80 per cent incidence of associated symptoms. Proximal gastric vagotomy produced significantly fewer abnormalities of gastro-duodenal motility than did truncal vagotomy and antrectomy.

Bilirubin↗
PubMed1976

Multivariate analysis of clinical and operative findings associated with bilary sepsis.

A cluster analysis of 17 preoperative and 10 operative variables has been undertaken from a prospective study of 181 patients undergoing operations on the biliary tract in order to identify those with organisms in the bile who would therefore benefit from prophylactic antibiotic cover. The analysis defined populations of high risk (45 patients) and low risk (136 patients) in which the incidence of infected bile was 67 and 19 per cent respectively (P less than 0-001). Eight variables were more common in the high risk than in the low risk group (P less than 0-001). These "high risk factors" were: jaundice at operation, recent rigoors, emergency operation or one within 4 weeks of an emergency admission, age over 70 years, previous biliary operation, common duct obstruction and stones in the bile duct. In 67 patients where one or more "high risk factors" was present, the bile contained organisms in 37 (53 percent); when 4 "high risk factors" occurred in the same patient (16 cases) biliary organisms were isolated in 14(87 per cent). We conclude that the presence of one or more "high risk factors" indicates a patient in whom prophylactic antibiotics would be advised during an operation on the biliary tract.

Adult↗
PubMed1976

Prophylaxis against anaerobic sepsis in bowel surgery.

Sixty-two patients were admitted to a prospective randomized controlled trial to investigate the influence of a prophylactic antibiotic, lincomycin, on anaerobic sepsis following bowel surgery. The incidence of postoperative sepsis was reduced from 45 to 18 per cent (P less than 0-025). Wound infections were reduced from 38 to 12 percent (P less than 0-05). Intra-abdominal or pelvic abscess occurred in 1 of the treated group compared with 3 controls. Septicaemia occurred after operation in 1 patient receiving lincomycin and in 3 of the controls; in 2 of the latter, pure growths of bacteroides were isolated from the blood cultures and 1 of these patients died. Although lincomycin had no influence on the number of patients who developed aerobic postoperative infections, there was a significant reduction in the incidence of sepsis due to bacteroides, which occurred in 10 of the control group compared with 1 in the lincomycin group (P less than 0-005). No patients developed complications attributable to lincomycin, such as pseudomembranous colitis. These data indicate that the genus Bacteroides are important pathogenic organisms and are responsible for postoperative morbidity. Furthermore, anaerobic sepsis can be reduced by appropriate prophylactic antibiotics.

Aged↗
PubMed1976

Complications of supraduodenal choledochotomy: a comparison of three methods of management.

The complications of elective choledochotomy in a prospective study of 116 patients with suspected intraduct calculi are reported. Management included T tube drainage (n = 59), primary closure of the bile duct (n = 29) and choledochoduodenostomy (n = 28). Septicaemia occurred in 12 patients (10%), with 1 death, and was unrelated to the type of operation. Thirty patients (26%) developed wound infection; this complication was more common after T tube drainage than the other procedures. Intra-abdominal abscess occurred in 3 patients only. Thrombo-embolism was recorded in 10 patients (9%), 7 of whom had an intraduct drain. Postoperative pancreatitis occurred in 5 patients (4%), with 2 deaths; a third of the patients in whom sphincteroplasty had been combined with supraduodenal choledochotomy developed this complication. Reoperation for stones was required in 3 patients with T tube; 3 patients developed a temporary biliary fistula after choledochoduodenostomy. The hospital stay was 9-5 days after primary closure, 14-0 days after choledochoduodenostomy and 16-8 days after T tube drainage. Wound sepsis (32%) and thrombo-embolism (12%) were more common in patients with bacterbilia than in patients where the bile was sterile at operation (13 and 3% respectively). Furthermore, wound sepsis, septicaemia and thrombo-embolism were reduced in patients who were given effective antibiotic cover.

Abscess↗
PubMed1976

The place of ileorectal anastomosis in Crohn's disease.

A study of 41 patients who underwent ileorectal anastomosis for Crohn's disease has shown this operation to be a relatively safe procedure with an immediate mortality of 2.5%. A defunctioning ileostomy may protect the patient against the consequences of anastomotic leakage. Ileorectal anastomosis is associated with a high early recurrence rate and on overall failure rate of up to 50% because of recurrence, intractable diarrhoea and exacerbation of perianal disease. However, half of the patients are able to retain the anastomosis and be restored to long-standing good health. The surgical philosophy in this Centre has largely evolved from treatment of small-bowel Crohn's disease, that is, resection of only the worst areas of involvement with the aim of symptomatic relief, and the results shown by this survey encourage us to pursue this policy by using ileorectal anastomosis for diffuse colonic disease, particularly if the rectum is uninvolved.

Adolescent↗