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Biomedical subjects

J Alexander-Williams

Publications and source records attributed to J Alexander-Williams.

At least 109 records · Page 6Linked to original sources
PubMed1983

Results of Marlex mesh abdominal rectopexy for rectal prolapse in 100 consecutive patients.

One hundred and six consecutive patients were seen between January 1973 and January 1982 with a circumferential full thickness rectal prolapse. One hundred were treated by abdominal rectopexy using a rectangular sling of monofilament knitted polypropylene (Marlex) mesh sutured to the sacrum and to the lateral ligaments of the mobilized rectum. There were only 9 men in the series and 23 per cent of the patients were over the age of 80 years. Sixty-seven of the patients gave a history of faecal incontinence. Previous unsuccessful treatment for rectal prolapse included a Thiersch wire or a Silastic perianal sling in 19, electrical therapy in 12, rectopexy with polyvinyl alcohol sponge (Ivalon) in 5 and pelvic floor repair in 2. There were no operative deaths following Marlex mesh rectopexy. Twelve patients had their operation performed under spinal anaesthesia because they were considered unfit for general anaesthesia. No patient developed a recurrent rectal prolapse, but 24 of the 67 patients who had incontinence experienced persistent incontinence after rectopexy (36 per cent); 10 of these patients subsequently had a postanal repair with good results. Rectopexy had no influence on anal canal pressures. Marlex mesh rectopexy is a safe and effective operation for rectal prolapse. It appears to be superior to other operations in that, so far, there has been no recurrence.

Adult↗
PubMed1983

Prospective randomized multicentre trial of proximal gastric vagotomy or truncal vagotomy and antrectomy for chronic duodenal ulcer: results after 5-7 years.

In a prospective, randomized study 145 patients with duodenal ulcer have been followed 5-7 years after proximal gastric vagotomy (PGV) or truncal vagotomy with antrectomy (TVA). Postoperative complications were significantly higher after TVA (P less than 0.0005). There was one death due to anastomotic leakage after TVA. The recurrence rate was significantly higher after PGV (9.9 per cent). Postoperative symptoms were less after PGV (P less than 0.01). Due to the recurrence rate after PGV there was no overall significant difference in the Visick grading, although perfect results (Visick I) were seen significantly more often (P less than 0.01). It is concluded that better results follow PGV.

Body Weight↗
PubMed1983

Entero-enteric fistula complicating Crohn's disease.

We have reviewed our experience with, and management of, entero-enteric fistula in Crohn's disease between 1970 and 1980 (inclusive). Thirty-three patients (20 of them female) came to our unit with entero-enteric fistulas, representing one-third of all Crohn's fistulas seen during those years. Entero-enteric fistulas gave few symptoms and their precise identification was not important in clinical management. The presence of the fistula itself is not an indication for operation and treatment should be directed towards the active or stenotic disease and not to the entero-enteric fistula. Therefore, radiological examination is important only to identify the extent of underlying disease.

Adolescent↗
PubMed1983

Effects of nutrient liquids on human gastroduodenal motor activity.

The effects of intragastric infusion of 10% Intralipid and 10% dextrose on the intraluminal pressures in the antrum, pylorus and duodenal bulb have been examined. Ten studies with each infusate have been performed in 10 normal subjects and the results compared with those obtained previously in 22 studies during intragastric infusion of isotonic saline. During saline infusion, contractile activity varied. In six studies fasting motor activity persisted; in the remainder, variable activity, without recognisable pattern was recorded. With saline, the gastroduodenal region usually functioned as a unit and the pylorus was the least autonomous part. Neither a sustained rise of basal pressure nor rhythmic, independent contractions were recorded from the pylorus. The contractile activity of the gastroduodenal region with Intralipid and dextrose was more uniform than with saline. Fasting motor activity was always abolished. The gastroduodenal region ceased to contract as a unit and the pylorus acquired autonomous activity. Rhythmic, independent contractions of the pylorus were recorded in nine of 10 studies during Intralipid infusion and six of 10 studies with dextrose. In addition, a sustained rise in pyloric basal pressure was recorded in eight of 10 studies with Intralipid and three of 10 studies with dextrose. Pyloric motility indices were significantly greater with fat than with dextrose. The observed differences in gastroduodenal motility are consistent with a role for the pylorus in the control of emptying of liquid from the stomach.

Duodenum↗
PubMed1983

Management of enterocutaneous fistulae in Crohn's disease.

The outcome among 39 patients with enterocutaneous fistulae complicating Crohn's disease has been reviewed. The patients were considered in two groups: (1) no disease - all were early postoperative fistulae (n = 9); (2) active disease (i) without abscess formation (n = 16), (ii) with abscess formation (n = 14). Postoperative fistulae with no evidence of active Crohn's disease healed spontaneously. Fistulae in the presence of active disease did not heal even with prolonged medical management. The only effective treatment was excision of the diseased segment from which the fistulae arose and any distal obstruction. None of the fistulae closed surgically has recurred.

Abscess↗
PubMed1983

Biliary excretion of piperacillin.

1. The excretion of piperacillin sodium in bile was studied after intravenous injection of 2 g (n = 5) and 4 g (n = 7). All patients had undergone cholecystectomy and exploration of the common bile duct for cholelithiasis. Bile, serum and urine concentrations were measured by a microbiological technique. 2. Peak concentrations of piperacillin were found in bile at 150 minutes after 4 g and at 210 minutes after 2 g. 3. Both the concentration of piperacillin in bile at the end of a 6 1/2 hour study and the calculated mean bile concentration of piperacillin were above the minimum inhibitory concentration (MIC) of this drug for organisms commonly found in acute biliary tract infections. We believe piperacillin may be useful in the management of such conditions.

Adolescent↗
PubMed1982

Enterovaginal fistulas associated with Crohn's disease.

Our experience in the management of 16 enterovaginal fistulas complicating Crohn's disease leads us to believe that such fistulas usually arise from active rectal disease and, despite being evident clinically, are difficult to confirm endoscopically or radiologically. Patients with few symptoms can be managed conservatively. Surgical repair protected by diversion may have a place in management, but most with severe symptoms will require excision of the intestine from which the fistula is arising.

Adult↗
PubMed1982

Complications of rectal anastomoses with end-to-end anastomosis (EEA) stapling instrument. Clinical and radiological leak rates and some practical hints.

The complications and results of rectal anastomoses carried out with the end-to-end anastomosis (EEA) stapling instrument on 50 patients by 5 consultant surgeons are recorded. There was a clinical leakage rate of 6% and a radiological leakage rate of 20% assessed by water-soluble contrast enema. The technique has advantages compared with hand-suture by allowing low anastomoses and preservation of sphincters and is accompanied by an acceptably low leakage rate. Despite the cost of disposable cartridges these advantages make the technique economical because of the avoidance of colostomies and reduction in hospital stay.

Humans↗