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Biomedical subjects

J Alexander-Williams

Publications and source records attributed to J Alexander-Williams.

At least 37 records · Page 2Linked to original sources
PubMed1991

Strictureplasty for ileo-colic anastomotic strictures in Crohn's disease.

We report an audit of outcome on 24 patients (16 females) who had a strictureplasty to treat ileo-colic anastomotic strictures. All except one patient had their original resection for Crohn's disease, and required reoperation because of symptoms of recurrent intestinal obstruction for a mean 9.3 months (range 1-36); the remaining patient was discovered to have ileo-colic anastomotic stricture before he underwent laparotomy for closure of loop ileostomy. At operation, four patients needed additional small bowel strictureplasties, two of whom also underwent small bowel resection for separate areas of phlegmonous disease. There was no post-operative mortality, three patients developed wound infection and one had a pelvic abscess, which settled on antibiotic therapy. Two patients have since died of unrelated disease. Five patients have since needed reoperation for recurrence; only one had a stricture at the site of previous strictureplasty. Over a mean follow-up of 70.8 months (range 18-393) all 22 living patients now have complete relief of symptoms.

Adult↗
PubMed1991

Non-steroidal anti-inflammatory drugs and stercoral perforation of the colon.

Within 6 months, three constipated patients have been seen with stercoral perforation of the colon associated with the ingestion of non-steroidal anti-inflammatory drug medications (NSAIDs). These drugs were taken regularly for painful musculoskeletal disorders 6, 8 and 12 months before admission. Constipation is thought to be the most significant contributory factor in the development of colonic stercoral perforation; however, it is unclear why it develops in so few of the many patients with severe constipation. NSAID medications have been associated with the perforation of colonic diverticula, but there are no reports of an association with stercoral perforations. If our finding of the association is substantiated by other reports there may be a need for greater awareness of lower gastrointestinal problems when prescribing such drugs to constipated patients.

Aged↗
PubMed1990

Sutured posterior abdominal rectopexy with sigmoidectomy compared with Marlex rectopexy for rectal prolapse.

Two treatment policies for rectal prolapse were prospectively assessed between April 1986 and January 1989. Sixteen patients had a Marlex mesh posterior rectopexy alone and 13 underwent a sigmoidectomy combined with a sutured posterior rectopexy. Preoperative and post-operative assessment included manometry, a saline infusion test and video-proctography. Hospital stay, control of prolapse and complications were comparable in both groups. Restoration of continence occurred in nine of the 12 incontinent patients after Marlex rectopexy, compared with six of nine after sutured rectopexy and sigmoidectomy. Constipation persisted in three patients who were constipated before operation and in four of 13 who had previously normal bowel habits became constipated after Marlex rectopexy; constipation persisted in one of five previously constipated patients while none with previously normal bowel habits became constipated after sutured rectopexy and sigmoidectomy. Sigmoidectomy combined with sutured rectopexy was safe and as efficient as Marlex rectopexy in prolapse control and improvement of continence; significantly fewer patients were constipated (one of 13) after sigmoidectomy than following rectopexy alone (seven of 16). A randomized trial now seems justified.

Adolescent↗
PubMed1990

Axonal damage in Crohn's disease is frequent, but non-specific.

We have attempted to confirm the claim by Dvorak and Silen that 'Crohn's disease is accompanied by a severe and extensive necrosis of gut axons...[which] may serve to differentiate Crohn's disease from other inflammatory conditions'. In this electron microscope study the diagnoses were withheld until the assessment of axonal damage was completed. We assessed the axonal damage in ileostomy biopsies in 13 cases of Crohn's disease, four cases of ulcerative colitis, and two 'controls'. In Crohn's disease we found a mean per cent of abnormal axons of 29.85, in ulcerative colitis of 21.25 per cent, and in the two 'controls' of 12.11 and 10.63 per cent, respectively. The difference between the 13 cases of Crohn's disease and the six cases of non-Crohn's disease is not significant. We found considerable numbers of abnormal, very small axons of uncertain nature but probably related to regeneration following surgery. Including or excluding such axons did not significantly alter the incidence of abnormal axons. We conclude that axonal damage is common in chronic inflammatory bowel disease and is not specifically related to Crohn's disease.

Axons↗
PubMed1990

Conservative proctocolectomy with low transection of the anorectum is a poor alternative to conventional proctocolectomy in inflammatory bowel disease.

The perineal wound is a frequent source of morbidity following proctocolectomy for inflammatory bowel disease. In 8 patients low transection of the anorectum or conservative proctocolectomy has been performed as an alternative to proctocolectomy in order to avoid a perineal wound. All patients passed copious mucoid discharge per anum post-operatively. Five patients required a proctectomy, 2 remain symptomatic and 1 patient has undergone a restorative proctocolectomy. This small series suggests conservative proctocolectomy does not seem to offer any advantage over conventional proctocolectomy in the surgical management of inflammatory bowel disease.

Adult↗
PubMed1990

Quantitative appraisal of Picolax (sodium picosulfate/magnesium citrate) in the preparation of the large bowel for elective surgery.

The authors have investigated the metabolic sequelae Picolax bowel preparation in a group receiving their preparation either 24 hours (n = 17) or 48 hours (n = 18) before elective colonic resection. No significant changes in any metabolic parameter were found in the 24-hour group. In the 48-hour group, there was a significant decrease in serum sodium (P less than 0.005), serum chloride (P less than 0.005), pH (P less than 0.005), HCO3 (P less than 0.005), and base excess (P less than 0.005). Only 16 of 35 cases (46 percent) had an acceptable bowel preparation: 11 of 17 (65 percent) in the 24-hour group and 5 of 18 (28 percent) in the 48-hour group. Marker studies did not correlate with the quality of bowel preparation. The risk of potentially explosive intraluminal gas was increased if the bowel preparation was poor: 12 of 19 patients (63 percent) with a poor bowel preparation compared with 3 of 16 patients (19 percent) of those with an acceptable preparation (P less than 0.005). Picolax is a poor mechanical bowel preparation and is associated with unacceptable physiologic disturbance if given two days before surgery.

Acid-Base Equilibrium↗
PubMed1990

Relation between flow-pressure-diameter studies in experimental stenosis of rabbit and human small bowel.

Patients with inflammatory and ischaemic bowel diseases seem to tolerate narrowing of the gut lumen to a critical degree of stenosis without obstructive symptoms. To determine the physical factors involved in bowel occlusion, we created an experimental model using New Zealand rabbits in acute experiments under general anaesthesia. At operation a loop of small bowel was isolated and canulated, proximally for perfusion and pressure recording and distally to monitor flow. Having established the physiological pressure and flow conditions in a normal loop of gut, a stenosis was created using circular adjustable rings of determined widths. Pressure and flow were measured constantly and the variables studied were luminal diameter, stenosis length, and perfusate viscosity. This experimental model was reproduced using resected segments of human small bowel. We found a critical point- at 60% of the original diameter-down to which the small bowel is able to maintain normal flow. At a diameter smaller than this, the physiological parameters are rapidly altered up to the point of complete obstruction. In the rabbit model bowel rupture occurs at 30% of the initial size. Increased viscosity of the fluid and length of the stenosis alter this critical point inducing a larger critical diameter. We did not observe any cumulative effect of multiple identical stenoses.

Animals↗
PubMed1990

Surgical aspects of inflammatory bowel disease.

In temperate, developed countries, the principle indications for surgical intervention in inflammatory bowel disease are 1) for the removal of bowel severely damaged by acute or chronic colitis, either Crohn's disease or ulcerative colitis; and 2) for small-bowel Crohn's disease, to overcome the effects of fibrous stenosis and its sequelae, such as abscess or fistula. Unresponsive acute colitis that necessitates emergency surgical intervention involves a total colectomy, end ileostomy, and a mucous fistula of the rectosigmoid above the symphysis pubis. Once the diagnosis is confirmed, a pouch can be considered for patients with ulcerative colitis and an ileorectal anastomosis or proctectomy for those with Crohn's disease. For socially inconvenient colitis (when life with chronic colitis becomes intolerable because of urgency, frequency, or chronic ill health), the patient with ulcerative colitis can be offered proctocolectomy with pouch-to-anus anastomosis as a primary procedure, providing the anal sphincter and pelvic floor function normally. For patients with Crohn's disease, total colectomy and an ileorectal anastomosis can be considered if the rectum is not grossly diseased, and if the anal sphincter has a squeeze pressure of 100 cm and the rectum is capable of holding the balloon distended to 200 ml. It should be noted that better early medical therapy has already led to fewer operations for patients with acute colitis and that safer operations will tend to induce earlier referral for surgery; specifically, safer pouches will induce earlier referrals for patients who have chronic incapacitating diarrhoea. Despite improvement in medical control of the disease, small-bowel Crohn's disease will still tend to be associated with gradual stenosis of the bowel.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1990

Inflammatory bowel disease revisited: surgery today and tomorrow.

Both topical and systemic medical therapy are helpful in controlling the symptoms in patients with ulcerative colitis. However, no drug therapy is known to influence the natural history of Crohn's disease. Surgical management is often required for the complications of acute colitis unresponsive to medical treatment and for socially incapacitating diarrhoea and urgency due to ulcerative colitis. The gold standard of such surgical treatment is a panproctocolectomy with end ileostomy. In young patients with a good anal sphincter, total colectomy with the formation of an ileal pouch-to-anus anastomosis obliterates the disease and usually results in satisfactory continence. There appears to be no prospect of using gut transplantation in the management of this disease. In the absence of curative medical treatment for Crohn's disease surgical intervention is often needed to control the complications of Crohn's disease. The initial complication that makes the disease symptomatic is stenosis from the healing of asymptomatic ulcers. If strictures can be detected early, they can be treated before secondary complications such as abscess or fistula occur. Some success is being achieved with balloon dilatation of strictures. For the first presentation of ileo-caecal Crohn's disease limited resection offers good long-term cure without the need for continued medical therapy. For recurrent and multiple strictures strictureplasty offers a safe alternative to extensive resection.

Colectomy↗
PubMed1990

[Crohn's disease of the small intestine].

Any symptomatic manifestation of Crohn's disease results not from the disease itself but from some complication. The first complication is stenosis, which precedes and favors the appearance of abscesses, fistulae, perforations and sometimes hemorrhages. The ideal treatment consists in identifying and treating the disease as early as the appearance of stenosis and before the other complications occur. In our series, mortality most often was caused by an infection that was not or poorly managed, even when the primary cause of death was embolism or sometimes a massive hemorrhage. In many patients, the risks of septic complications are all the higher as the subject's immunological defense is weakened by immunodepressive corticosteroid treatments and by malnutrition. All septic foci must therefore be located and drained before any extensive surgical operation. Malnutrition can be improved by parenteral nutrition, and often by enteral feeding as well. After severe surgical complications, the next operation should not be performed until 12 weeks have elapsed, in order to reduce both technical difficulties and risks.

Crohn Disease↗
PubMed1989

Recurrence after strictureplasty or resection for Crohn's disease.

This study attempts to define whether there is an increased need for reoperation in patients with small bowel Crohn's disease treated by strictureplasty compared with those treated by small bowel resection. Previous studies of the rate of reoperation for small bowel Crohn's disease do not distinguish between reoperation performed because of a lesion at the original operation site and that undertaken because of a lesion at a distant site. This study analyses the need for reoperation only at the original site of operation and measures operation-free intervals. The site specific operation-free intervals in 41 patients with small bowel Crohn's disease treated by strictureplasty were not significantly different from the similar intervals in 41 patients treated by a small bowel resection.

Adult↗
PubMed1989

A multicenter trial of the use of the proteolytic enzyme inhibitor aprotinin in colorectal surgery.

Animal studies have demonstrated the value of the proteolytic enzyme inhibitor, aprotinin, in reducing collagen breakdown and improving the healing of experimental colonic anastomoses. A double-blind, multicenter, prospective trial has evaluated the use of aprotinin in the prevention of anastomotic leakage in patients. Two hundred sixteen patients undergoing colonic resection and anastomosis were studied. Patients were randomized to receive either aprotinin or placebo intravenously, peroperatively, and for the first three postoperative days. Anastomotic integrity was assessed clinically and by Hypaque enema on the tenth postoperative day. Although the use of aprotinin was not associated with a significant overall decrease in anastomotic leakage rates, in 95 patients undergoing anterior resection, leakage rates in those receiving aprotinin (clinical 10.8 percent; radiologic 32.4 percent) were lower than in those receiving placebo (17.2 percent and 43.1 percent, respectively). An apparent adverse association was noted, however, in patients undergoing left hemicolectomy or sigmoid colectomy who received aprotinin.

Anastomosis, Surgical↗