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Biomedical subjects

J Alexander-Williams

Publications and source records attributed to J Alexander-Williams.

At least 217 records · Page 12Linked to original sources
PubMed1975

Preparation of the bowel by whole-gut irrigation.

Experience with whole-gut irrigation as a method of bowel preparation in eightyone patients is described. The mean (+/-S.D.) weight-gain during irrigation was 1-9 +/- 0-8 kg; potassium losses in the effluent after one hour (4-0 +/- 2-5 g) were not significantly altered by adding potassium chloride to the irrigant. Eight irrigations were unsatisfactory, three being due to unrecognised obstructive neoplasms. The method provided excellent preparation for colonoscopy and large-bowel resection with anastomosis and was well tolerated by the patients.

Aged↗
PubMed1975

Long term review of the results of rubber band ligation of haemorrhoids.

A long term assessment (mean 4.8 years) of the value of rubber band ligation treatment for haemorrhoids has been obtained by a questionnaire answered by 125 of 147 patients. Eighty-nine per cent of patients were cured or satisfied with the results of treatment, although complete absence of symptoms was only obtained in 44 per cent. Further conservative treatment (rubber band ligation or manual dilatation) was required in 12 per cent and only 3 (2 per cent) have had a haemorrhoidectomy. Similar results were obtained for patients with the additional symptoms of pain and irritation, the presence of large skin tags and for the majority of third degree piles.

Dilatation↗
PubMed1975

The importance of an innervated and intact antrum and pylorus in preventing postoperative duodenogastric reflux and gastritis.

This study has investigated the relationship between duodenogastric reflux, gastritis and certain symptoms 6-12 months after three operations for uncomplicated duodenal ulcer. The operations studied were proximal gastric vagotomy (PGV, 20 cases), truncal vagotomy and pyloroplasty (TV+P, 22 cases) and truncal vagotomy and antrectomy (TV+A, 21 cases). Duodenogastric reflux was assessed both by a radiological technique and by measuring the concentration of bilirubin in the gastric aspirate before and after operation. Incidence and severity of postoperative gastritis were determined by endoscopic biopsy. Symptoms were assessed by symptomatic score and Visick grading. There was a significant correlation between duodenal reflux and histological evidence of both severe superficial gastritis and glandular atrophy (P less than 0-01). There was also a close association between the degree of reflux and the presence of severe heartburn, epigastric pain and bile vomiting after operation. The amount of reflux did not differ before operation. There was significantly less reflux following PGV than after either TV+P (P less than 0-025) or TV+A (P less than 0-001). The results indicate that an operation which preserves an innervated and intact antrum and pylorus will protect against postoperative duodenogastric reflux, gastritis and symptoms.

Adult↗
PubMed1975

Use and abuse of gastric function tests by British and American gastric surgeons.

The use of gastric function tests by American and British gastroenterologic surgeons in different clinical situations has been studied by questionnaire. Clinical practice on both sides of the Atlantic is generally similar. The major difference in the type of test employed is that pentagastrin cannot be used in clinical practice in the United States. Surgeons in the USA were much more liberal in their indications for gastric secretory tests than were their British counterparts. Significantly more tests were used by American surgeons, if x-ray evidence of duodenal or gastric ulcer existed, and to evaluate a post-gastrectomy patient, whether symptomatic or not. The British surgeonswere much less likely to allow the results of secretory tests to influence their surgical approach. The authors discuss indications for and the clinical value of gastric secretion tests and conclude that in most instances far too many tests are being employed.

Cross-Cultural Comparison↗
PubMed1975

Duodenogastric reflux: a cause of gastric mucosal hyperaemia and symptoms after operations for peptic ulceration.

This study has investigated the possible association between duodenogastric reflux, gastritis, and symptoms in 35 patients with or without dyspepsia one to 15 years after gastric surgery. Five patients were excluded because of biliary disease, hiatus hernia, or recurrent ulceration. The remaining 30 were assessed by a symptomatic score, measurement, of bilirubin and sodium concentrations in samples of fasting gastric juice, endoscopy, gastric biopsy, and the presence of radiological reflux. In 15 patients with a symptom score of less than the median, gastric bilirubin levels were less than 1 mg/100 ml in 80%; severe endoscopic changes were seen in only one patient and reflux was not observed. In contrast, in patients with a symptom score in excess of the median fluoroscopic and biochemical reflux was seen in 69 and 80% respectively and severe mucosal hyperaemia in half. There was a significant correlation between symptoms, gastric hyperaemia, and duodenal reflus ( P smaller than 0-02).

Adult↗
PubMed1975

Assessment and treatment of recurrent peptic ulceration.

From the experience of treating 91 patients with a proven recurrent ulcer we consider that if a proven ulcer is shown to be present and a gastrin-secreting tumour is excluded an appropriate reoperation will almost always produce a successful result (94 per cent). Before subjecting patients to reoperation all attempts must be made to secure a precise diagnosis. The following investigations should be performed: barium meal, panendoscopy of the upper gastrointestinal tract, determination of maximum acid output (with insulin test and gastrin analysis if appropriate), and cholecystography. Before accepting a diagnosis of recurrent ulcer at least 2 of the first 3 tests should be postive. If the primary operation was a resection we advocate vagotomy alone as the second operation, provided there are no local complications such as stenosis, bleeding, or fistula. If the primary operation was a vagotomy and the recurrence is associated with a positive response to the insulin test we advocate revagotomy and antrectomy. If the insulin test is negative we normally repeat the test; if it is still negative then we use antrectomy alone.

Barium Sulfate↗
PubMed1975

Multifocal colonic carcinoma and Crohn's disease.

Multifocal colonic carcinoma occurred in a 65-year-old man with a 13 year history of colonic Crohn's disease. The relationship between solitary and multiple colonic cancer and Crohn's disease is discussed.

Adenocarcinoma, Papillary↗
PubMed1975

Conservative management of haemorrhoids. Part I: injection, freezing and ligation.

Of 111 consecutive patients treated by partial internal sphincterotomy for a haemorrhoidal disease in the course of a prospective study, 101 could be re-examined between 24 and 36 months after operation. There were no major complications but 11 patients had some significant complaints at some time after operation. There were six recurrences, five of which could be attributed to inadequate sphincterotomy. One patient had an excessive sphincterotomy which led to difficulties with continence of fluid stools. One patient developed a peri-anal abscess two years after partial sphincterotomy and four patients with marked soiling will require surgical correction of the posterior gutter. The gutter is due to secondary epithelialisation after open sphincterotomy in the posterior midline. The recommended technique entails the division of the internal sphincter up to a few millimeters above the dentate line and reconstruction of the anal mucosa with a continuous absorbable suture. 'Landscaping' by partial resections of the prolapsed haemorrhoids is recommended to avoid sclerotic tags. Submucosal sphincterotomy should be considered by the very experienced only and then provided that the anal mucosa shows little scarring.

Aged↗
PubMed1975

Fissure-in-ano and anal stenosis. Part I: conservative management.

Acute superficial fissure-in-ano responds readily to conservative non-surgical treatment. For chronic deep fissures we recommend manual anal dilatation and the post-dilatation regimen but recognise that equally good results follow the simple procedure of subcutaneous lateral internal sphincterotomy. The recurrence rate following these minor procedures is less than 10 per cent and the incidence of poor flatus control and mucus leakage is even lower. It is never necessary to excise fissures nor sentinel piles although it may be desirable to excise large redundant skin tags to facilitate anal hygiene. Painless or atypically sited fissures should suggest the diagnosis of Crohn's disease. Treatment is rarely required for fissure-in-ano in this condition, although severe anal stenosis may need extremely gentle anal dilatation. Postoperative anal stenosis can also be managed successfully by manual dilatation under anaesthesia with a prolonged regimen of self dilatation until healing is complete. Radical or complicated plastic operations are rarely indicated for any patient with fissure-in-ano or stenosis and are strongly contraindicated in Crohn's disease.

Acute Disease↗