Effect of cimetidine on surgery for duodenal ulcer.
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Cimetidine↗
Biomedical subjects
J Alexander-Williams
Publications and source records attributed to J Alexander-Williams.
The prognosis of ileorectal anastomosis in Crohn's disease.
A total of 105 patients have been treated with colectomy and ileorectal anastomosis from 1958 to 1978 in Birmingham, England (48) and in Leiden, Netherlands (57). At the end of 1978 the mean follow-up was 7.6 years (6 months-20 years). Mild or moderate degrees of proctitis were not considered as contraindications for ileorectal anastomosis. The presence or absence of ileal disease or perianal disease at the time of ileorectal anastomosis did not effect the long term prognosis but patients with sigmoidoscopic proctitis appeared to fare less well (69 per cent still functioning) than those with an apparently normal rectum (87 per cent). However, no statistical significance was obtained. The risk of reoperation for recurrence of Crohn's disease after ileorectal anastomosis calculated by actuarial methods shows a 50 per cent cumulative reoperation rate after 16-20 years. This result suggests that ileorectal anastomosis is a safe and useful procedure for most patients with Crohn's colitis who did not have severe proctitis.
Adolescent↗
Reoperation for recurrent peptic ulceration.
Thirty-eight patients undergoing reoperation for recurrent peptic ulceration have been reviewed after at least 3 years. All were considered to be in Visick grade IV before reoperation. There were no operative deaths. Thirty-three of the patients ended with both a vagotomy and antral resection. After reoperation 17 patients (45 per cent) remained in Visick grades III and IV. Eight patients have had further operations and, after 47 procedures in 38 patients, 14 (37 per cent) were still in Visick grades III and IV. Vagotomy and antrectomy has a high non-ulcer mobidity rate and we conclude that other methods of treatment for recurrent ulceration require evaluation.
Aged↗
A randomized trial to compare rubber band ligation with phenol injection for treatment of haemorrhoids.
A prospective randomized trial has compared rubber band ligation with phenol injection in 82 patients with symptomatic haemorrhoids. The symptomatic results in all patients 12 months after treatment were indistinguishable, 64 per cent being improved after rubber band ligation, compared with 70 per cent after injection. Complications of treatment were recorded in 5 patients after rubber band ligation, 3 of whom required hospital admission compared with one minor complication after infection. However, repeated treatment was necessary in 13 patients after phenol injection compared with only 4 following rubber band ligation (P less than 0.05). Additional treatment was necessary in 6 patients from each group. Two-thirds of patients with third-degree piles required additional therapy. It is concluded that rubber band ligation and injection provide similar results, but rubber band ligation is more liable to complications with inexperienced operators.
Female↗
Treatment of anal fissure by lateral subcutaneous sphincterotomy should be under general anaesthesia.
Seventy-one consecutive patients with acute anal fissure were randomly allocated to treatment by lateral subcutaneous sphincterotomy under either local anaesthesia (n = 34) or general anaesthesia (n = 37). Four months after treatment there were 18 patients with a recurrent or persistent anal fissure, 17 had had local anaesthesia (50 per cent) and only one had a recurrent fissure after general anaesthesia (3 per cent). These results indicate that if lateral subcutaneous sphincterotomy is used for treatment of anal fissure the operation should be performed under a general anaesthetic.
Acute Disease↗
Duodenogastric reflux after gastric operations.
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Bile Reflux↗
A study of motility of normal human gastroduodenal region.
A method of recording continuously and simultaneously the intraluminal pressure in the antrum, pylorus, and duodenal bulb has been used to study gastroduodenal motility during intragastric infusion of saline. Twenty-two studies were performed in 15 normal individuals. Two types of contraction were recorded: (1) independent contractions of the individual parts of the gastroduodenal region, and (2) related contractions of the antrum, pylorus, and duodenal bulb, resulting in a concerted contraction of the whole region. The majority of pyloric contractions were part of a concerted contraction of the whole gastroduodenal region during which the pylorus behaved as the terminal part of the antrum. The majority of duodenal contractions were not associated with pyloric contractions, only 21.7% of duodenal contractions coincided with closure of the pylorus. This suggests that under the conditions of this study the pylorus was not acting as a barrier to reflux. An elevated basal pressure was never recorded from within the pylorus; apart from a brief closure during contraction, the pylorus is always open.
Adult↗
Faecal toxin and severity of antibiotic-associated pseudomembranous colitis.
The relationship between faecal toxin titre, histological evidence of pseudomembrane in the rectum, and severity of antibiotic-associated colitis has been analysed from data on 62 patients whose faeces contained Clostridium difficile toxin. There was a significant correlation between a toxin titre of 6400 or more and the presence of pseudomembrane (p less than 005). There was no correlation between toxin titre, duration of diarrhoea, total white cell count, temperature, serum albumin or serum orosomucoid concentrations. There was, however, a significant correlation between the presence of rectal pseudomembrane and duration of diarrhoea (p less than 0.005). Exposure to clindamycin or lincomycin was also associated with a significantly higher toxin titre than that seen in patients who were given other antibiotics. The duration of diarrhoea of diarrhoea was not longer and rectal pseudomembrane did not occur more often in the patients who had received clindamycin or lincomycin.
Anti-Bacterial Agents↗
Pathogenesis of urgency in defaecation in Crohn's disease.
In 39 patients with Crohn's disease with 20 suffering from urgency in defaecation, the degree of proctitis, anal basal and squeeze pressures and anal sphincter responses to passive rapid or slow rectal filling were not correlated to the presence or absence of urgency or its severity. However, there was a positive correlation between urgency and both defaecation frequency and looseness of stools as well as extent of disease, with invariable involvement of the small intestine in urgency patients. Disease confined to the colon was found only in non-urgency cases. It was proposed that extensive disease involving both the small and large intestine could elicit abnormal bowel motility, and lead to unusually rapid rectal filling, inevitably followed by rapid reflex relaxation of the anal sphincter, manifesting itself as urgency. This hypothesis would be consistent with the observation that operative removal of diseased bowel with ileorectal anastomosis may abolish urgency.
Adolescent↗
Prophylactic trials in colon surgery with special regard to bowel preparation.
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Anti-Bacterial Agents↗
Long saphenous vein stripping under local anaesthesia.
Stripping of the long saphenous vein under femoral nerve block has been preformed on 21 patients (27 limbs). There has been no complication from the nerve block and this form of anaesthesia was found acceptable to all patients in a subsequent questionnaire.
Ambulatory Surgical Procedures↗
Clinical and manometric evaluation of rectal prolapse and incontinence.
The clinical presentation and manometric findings in 46 patients with rectal prolapse and/or incontinence are reported. Basal and maximal squeeze pressures in the anal canal of patients with prolapse alone did not differ from the pressures in age and sex-matched controls whereas anal pressures in both groups of patients with incontinence were significantly lower than in controls. Physiotherapy and faradism had no therapeutic value in rectal prolapse but gave improvement in 30 per cent of patients with incontinence. Rectopexy gave satisfactory results in all the patients with prolapse and improved incontinence in 70 per cent. Post-anal repair cured 87 per cent of patients with idiopathic anorectal incontinence or with persistent incontinence after rectopexy. No form of treatment was associated with any significant elevation of anal pressures.
Adolescent↗
Modification of the physiological disturbances produced by whole gut irrigation by preliminary mannitol administration.
In a prospective non-randomized study of 42 patients it was found that the oral administration of 50 g of mannitol 2 h before whole bowel irrigation (WBI) improved the success rate of the bowel preparation and reduced the time required for the WBI. Mannitol is an osmotic cathartic, and it reduced fluid absorption from a mean value of 2.7 l in patients who had WBI alone to a mean of 1.2 l in those who received mannitol beforehand. Sodium absorption was also significantly reduced.
Administration, Oral↗
Perineal wound healing after proctectomy for carcinoma and inflammatory disease.
The rate of wound healing after proctectomy was assessed in a series of 105 patients. Early healing was dependent principally on the primary diagnosis, to a lesser extent on faecal contamination and was not related to steroid administration. Early healing (with 3 months) occurred in 72 per cent of patients undergoing operation for cancer and 45 per cent of these operated on for ulcerative or Crohn's colitis.
Adult↗
The effect of skin preparation and care on the incidence of superficial thrombophlebitis.
Fifty patients having a variety of intra-abdominal operations necessitating postoperative infusion were randomly allocated to receive antiseptic skin preparation and daily care of the cannula site or no skin preparation either before or after cannula insertion. The study shows that without skin preparation superficial thrombophlebitis is inevitable after about 3 days. However, simple skin preparation and daily care of peripheral infusion sites significantly reduces the incidence of superficial thrombophlebitis.
Abdomen↗
Perianal Crohn's disease.
Perianal disease is a frequent manifestation of Crohn's disease and occasionally is the presenting symptom. However, most lesions are or become asymptomatic and remain so for many years. A series of 109 patients with perianal fissures and fistulas has baeen followed for 10 years. Fourteen have died, 7 from unrelated disorders. Ten have had an excision of the rectum but only 5 for perianal disease. Of the remaininga 85 patients, 24 asymptomatic patients were not re-examined, and 61 were investigated extensively by sigmoidoscopy biopsy or manometry. Many fissures and most fistulas had healed, but some had progressed to some degree of anal stenosis, usually asymptomatic. A very conservative policy is proposed.
Abscess↗
Prophylactic saline peritoneal lavage in elective colorectal operations.
The influence of a single peroperative five-liter saline peritoneal lavage has been assessed in 21 consecutive patients undergoing elective operation for colorectal cancer. The aim of the study was to investigate whether reduction in bacterial counts by saline lavage would reduce the incidence of infection and thereby avoid the need for prophylactic antimicrobials. Saline lavage was shown to reduce significantly counts in peritoneal fluid of aerobic bacteria from 2 x 10(4) to 5 x 10(1) (P less than 0.001) and to reduce the counts of anaerobes in peritoneal fluid from 8 x 10(4) to 1 x 10(2) (P less than 0.001). Despite the profound reduction in peritoneal bacterial counts the rate of postoperative sepsis was extremely high; wound infection 47 per cent, intraabdominal abscess 26 per cent and septicemia 13 per cent. These results indicate that saline peritoneal lavage alone is no substitute for short-term antimicrobial prophylaxis.
Ascitic Fluid↗
Sepsis following operation for inflammatory intestinal disease.
The incidence and pathogenesis of sepsis following 107 elective operations in 87 patients with inflammatory bowel disease has been studied. Eighteen per cent developed wound sepsis and 13 per cent developed intra-abdominal abscess postoperatively. The prophylactic antimicrobial regimens used did not reduce the overall postoperative sepsis rates. The risk of developing postoperative sepsis was increased in patients with preoperative enterocutaneous or entero-enteric fistulas, pre-existing abscess and those with evidence of active disease (serum albumin less than 3.0 g/dl and serum seromucoids greater than 400 mg/gl). The incidence of postoperative sepsis was not affected by corticosteroid therapy at the time of surgery.
Abscess↗