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Biomedical subjects

J Alexander-Williams

Publications and source records attributed to J Alexander-Williams.

At least 73 records · Page 4Linked to original sources
PubMed1986

Fistula-in-ano is usually simple to manage surgically.

Our experience in the surgical management of 115 patients with fistula-in-ano treated over 14 years was reviewed retrospectively. The incidence of previous anorectal infection was 69%. After treatment eight patients (7%) developed a recurrence of the fistula and five (4%) experienced some complication directly resulting from surgical treatment. One patient died of pulmonary embolism following an operation for recurrence. Most of the patients (75%) had a successful outcome of a minor surgical procedure.

Adolescent↗
PubMed1986

The therapeutic dilatation of enteric strictures due to Crohn's disease.

The use of dilatation as a treatment of strictures due to Crohn's disease has hitherto received little attention. We report dilatation of small and large bowel strictures in twelve patients with Crohn's disease. The technique appears to be safe when carried out either endoscopically or as part of a laparotomy. Short term follow-up suggests that the technique may have a part to play in the treatment of suitable strictures that can be reached endoscopically but early restenosis limits its value at laparotomy when strictureplasty may provide a more lasting relief of the stenosis.

Adolescent↗
PubMed1985

A randomized trial of photocoagulation or injection sclerotherapy for the treatment of first- and second-degree hemorrhoids.

One hundred thirty-five patients with a diagnosis of hemorrhoids were randomized to receive either photocoagulation (P) (N = 73) or injection sclerotherapy with phenol (I) (N = 62). Each patient was assessed at one, four, and 12-month intervals after treatment. At one, four, and 12 months, there was no clinical difference between the groups; at 12 months, however, the proportion of patients who were symptomatically improved or asymptomatic was 59 percent after photocoagulation compared with 50 percent of those treated by injection (P = 73 percent; I = 50 percent). Seven patients treated by photocoagulation required repeated therapy compared with only one after injection (P less than 0.02). Additional therapy was used in eight patients after photocoagulation, as compared with three after injection. The operation rate for each group, however, was similar. There were no complications of therapy. Photocoagulation is an easy, non-invasive, safe method of treatment, giving results that are comparable to treatment by injection sclerotherapy.

Adult↗
PubMed1985

Recurrent small bowel Crohn's disease is more frequent after subtotal colectomy and ileorectal anastomosis than proctocolectomy.

The cumulative probability of reoperation for recurrent ileal Crohn's disease at five years was: 17 percent following ileocecal resection, 19 percent following proctocolectomy, and 28 percent after ileorectal anastomosis. At ten years, the rate of ileal recurrence was significantly less after proctocolectomy; 24 percent as compared with 43 percent for ileorectal anastomosis (P less than 0.01), whereas ileocecal resection assumed an intermediary position with 35 percent.

Colectomy↗
PubMed1985

Pitfalls in the diagnosis of recurrent ulceration after surgery for peptic ulcer disease.

We have studied the accuracy of diagnostic methods in achieving a diagnosis in 75 patients with 81 proven episodes of recurrent ulceration. When the endoscopic findings did not permit an accurate diagnosis, radiology usually provided no additional information. The sensitivity of a combined diagnostic approach was not different from that of endoscopy alone, and so the routine use of upper GI radiographs in addition to endoscopy should, therefore, be abandoned. We also assessed observer variation among endoscopists prospectively in 38 patients investigated for dyspepsia after operation for peptic ulcer. Major observer variation in diagnosing suspected recurrent ulceration occurred in 11% of patients, with a sensitivity and specificity higher than 77 and 94%, respectively. As not all the postoperative gastroduodenojejunal mucosal breaches are peptic, we suggest that acid output and enterogastric reflux assessments are useful diagnostic adjuncts to endoscopy.

Deglutition Disorders↗
PubMed1985

Widespread cutaneous Crohn's disease presenting in childhood.

Cutaneous lesions containing Crohn's granulomata are rare and tend to occur in submammary or abdominal wall skin folds when they are to be found (1). Crohn's disease of the skin in nonflexural locations has been reported (2,3) although not in children. We report a 5-year-old girl with extensive colonic Crohn's disease, who at presentation was noted to have a generalised erythematous papular rash which histologically showed typical noncaseating granulomata.

Cecum↗
PubMed1985

Crohn's disease in the elderly.

The natural history of Crohn's disease in 47 patients, 60 years of age or older at the time of diagnosis has been defined, and their clinical management and long term prognosis reviewed. Distal colonic involvement is common in this group while extensive colonic and diffuse small bowel disease is rare. Distal colonic involvement usually carries a good prognosis except for those few patients who present with perforation which accounts for most of the disease related mortality. The pattern of distal ileal disease is similar to that observed in the younger patients except for the acute nature of symptoms at first presentation, and the low recurrence rates after initial surgical resection.

Aged↗
PubMed1985

The surgical treatment of gastroduodenal Crohn's disease.

Crohn's disease can affect any part of the gastrointestinal tract. Gastroduodenal involvement is uncommon and was not recognised until 1949 (1). Since then approximately 200 cases have been described in several series in the world literature. This paper describes the clinical presentation and surgical management of ten patients treated in the Birmingham General Hospital between 1970 and 1984.

Adolescent↗