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Biomedical subjects

J Alexander-Williams

Publications and source records attributed to J Alexander-Williams.

At least 253 records · Page 14Linked to original sources
PubMed1973

The effect of preserving antral innervation and of a pyloroplasty on gastric emptying after vagotomy in man.

A prospective randomized trial of 40 duodenal ulcer patients is reviewed. The patients had one of four operations (selective vagotomy, proximal gastric vagotomy, selective vagotomy plus pyloroplasty, or proximal gastric vagotomy plus pyloroplasty). The gastric emptying of a hypertonic fluid meal was assessed before and three to four months after operation. Selective vagotomy without a drainage procedure results in gastric retention and should no longer be considered as a method of treatment for duodenal ulcer. Proximal gastric vagotomy without a drainage procedure does not lead to gastric retention. Initial gastric emptying is more rapid after proximal gastric vagotomy but the final emptying time is the same as before operation and this operation alters the pattern of gastric emptying less than the other operations. Pyloroplasty added to either selective or proximal gastric vagotomy results in loss of the normal regulation of gastric emptying, very rapid initial gastric emptying, and a significant increase in the incidence of ;dumping'. It appears from these studies that ;dumping' is due to rapid gastric emptying and mainly due to the drainage procedure.

Coloring Agents↗
PubMed1972

The effect of retaining antral innervation on the reductions of gastric acid and pepsin secretion after vagotomy.

The result of a prospective trial of 40 patients with duodenal ulcer treated either by proximal gastric vagotomy (antrum innervated) or by selective vagotomy (antrum denervated) shows that they are equally effective in reducing gastric acid and pepsin secretion. Preservation of antral innervation by proximal gastric vagotomy reduces gastric secretion as effectively as denervation of the entire stomach.

Duodenal Ulcer↗
PubMed1972

A comparison of results of excision and bypass for ileal Crohn's disease.

One hundred and ten patients presented with Crohn's disease confined to the terminal ileum, and indications for their surgical treatment are reviewed. Treatment was either by ileo-transverse side-to-side bypass (21 patients) or primary excision and end-to-end ileo-colic anastomosis (89 patients). In a long follow up (mean 13.8 years) the date and indications for the second major operative intervention are recorded. The cumulative risk of recurrence recorded each year after the primary operation shows that after bypass compared with excision there is approximately twice the risk of requiring a further major operation. After bypass the indication for the second operation is usually a local complication of the still active disease and after excision it is usually a juxta-anastomotic recurrence with stenosis.

Crohn Disease↗
PubMedDate not supplied

Segmental colonic resection is an appropriate operation for short skip lesions due to Crohn's disease in the colon.

Thirty-six patients have had a segmental colonic resection for Crohn's colitis between 1948 and 1984. There were 2 deaths caused by intraabdominal abscesses present before operation. There were no cases of anastomotic dehiscence in the 29 patients having segmental resection and immediate anastomosis. The reoperation rate at 10 years was 66% (95% confidence interval, 48-84%), the majority of reresections being for recurrent large bowel Crohn's disease. The 10-year reoperation rates were higher than after subtotal colectomy and ileorectal anastomosis (53%; 95% confidence interval, 37-69%) performed in a comparable group of patients with colonic Crohn's disease. The difference did not achieve statistical significance. These findings suggest that when a patient with Crohn's disease has a short segment of diseased large bowel, a segmental resection is feasible and safe.

Adolescent↗
PubMedDate not supplied

An attempt to reduce the side effects of mannitol bowel preparation by intravenous infusion.

The authors compared two groups of patients receiving oral 5% mannitol for bowel preparation to see whether the volume of rectal effluent and quantity of bowel preparation could be maintained by a smaller oral mannitol intake supplemented by an intravenous infusion. Nineteen patients drank 2--3 1 5% mannitol, supplemented by an intravenous infusion of N/saline (intravenous Group) and 19 patients drank 4--5 1 5% mannitol (oral group). The volume of rectal effluent and the quality of bowel preparation was the same in both groups. The loss of sodium in the oral group was corrected by the intravenous infusion, but the infusion resulted in greater water retention. There was no reduction in the incidence of vomiting between the two groups.

Administration, Oral↗
PubMedDate not supplied

A randomized controlled trial to compare anal dilatation with lateral subcutaneous sphincterotomy for anal fissure.

A prospective randomized trial has compared manual dilatation of the anus (MDA)during general anesthesia with lateral subcutaneous spincterotomy (LSS) during local anesthesia for the management of anal fissure in 156 patients. The two groups were similar with respect to age, sex and symptoms. There was no difference in the duration of time off work or early complications of treatment but, four months after operation, 93 per cent claimed to have been improved by MDA compared with 78 per cent after LSS (P less than 0.05). Recurrent fissure was recorded in 13 patients after LSS (29 per cent) compared with four (10 per cent) after MDA (P less than 0.02). There was a significant reduction in anal pressure at four months (P less than 0.02) after MDA, (123 +/- 31 to 97 +/-33) and LSS (127 +/- 36 to 104 +/- 32), but the anal pressure remained unchanged by operation in all patients where pressures were measured with recurrent fissure. These data indicate that MDA gives better results than LSS for treatment of anal fissure and that successful treatment is associated with a reduction in anal pressure.

Adult↗
PubMedDate not supplied

Limitations of biopsy in preoperative assessment of villous papilloma.

Between January 1975 and December 1979, 58 patients were diagnosed as having villous papilloma of the large bowel. A retrospective review was performed and all histologic specimens were re-examined by one gastrointestinal histopathologist (H.T.). On review, 19 (23 per cent) lesions were reclassified as not being villous papilloma. Results of preoperative biopsy examinations were misleading in 13 of the 29 patients who had biopsy procedures reported by any member of the histopathology department. When the assessment of malignancy in the initial biopsy specimens was compared with that of the final histologic diagnosis, there were ten (34 per cent) false-negative and three (10 per cent) false-positive reports. Even when the excised specimens were reviewed for malignancy by a specialist gastrointestinal histopathologist, there were seven (24 per cent) false-negative results.

Biopsy↗
PubMedDate not supplied

The role of strictureplasty in Crohn's disease.

Crohn's disease is a panintestinal disease of unknown aetiology and a tendency to recrudescence throughout the patient's life. It is therefore impossible to cure Crohn's disease by medical therapy or surgical excision. In spite of this, the majority of patients can be managed through their disease and maintained in a good state of health by a combination of medical and surgical treatment. Early attempts at surgical management of Crohn's disease in the 1930's and 1940's involved bypass procedures which were marred with serious complications of sepsis, development of cancer and increased rate of recurrence. By the 1950's resection became the preferred operation but there soon arose a controversy about the amount of bowel that should be removed. There were some who advocated radical excision; removing all diseased bowel with a large margin of apparently normal tissue on each side of the resection. Others found less radical resection safer as it preserved gut and also had no apparent effect on the rate of recurrence of the disease. Although this argument continued, the balance gradually shifted towards less radical surgery. Furthermore, the wave of conservatism led to the evolution of the concept of minimal surgery.

Constriction, Pathologic↗