ABSTRACT
In a prospective randomized controlled clinical trial, anterior lesser curve seromyotomy with posterior truncal vagotomy (AMPT, n = 77) has been compared with truncal vagotomy and pyloroplasty (TVP, n = 69) in 146 patients with chronic duodenal ulcer with a mean duration of symptoms of 7 years. The mean follow-up time was 4.5 years with a range of 2-7 years. One elderly patient died from a myocardial infarction in the TVP group. Acid secretory inhibition in response to insulin and pentagastrin stimuli was equal in both groups, indicating a similar degree of vagal denervation. Recurrent ulcers were more common after AMPT (five) than TVP (two) (P = 0.29, n.s.). Dumping and diarrhoea were significantly commoner (P less than 0.001) after TVP, with 31 instances as opposed to eight with AMPT. The mean operating time was increased by 6 min when AMPT was performed rather than TVP. The results of this study have shown that AMPT is associated with a lower incidence of dumping and diarrhoea and achieves better overall Visick grading. However, continued monitoring is required to assess the long-term incidence of recurrent ulceration after this procedure.
Subject(s)
Duodenal Ulcer/surgery , Adult , Chronic Disease , Diarrhea/etiology , Dumping Syndrome/etiology , Female , Gastric Acid/metabolism , Gastric Emptying/physiology , Humans , Male , Middle Aged , Myocardial Infarction/etiology , Postoperative Complications/etiology , Prospective Studies , Pylorus/surgery , Recurrence , Vagotomy, TruncalABSTRACT
Vomiting is a frequent complaint after revisional gastric surgery using a Roux-en-Y biliary diversion. This is believed to be due to gastric stasis or stasis in the jejunal component of the Roux-en-Y. Thirty-three patients, ten with a satisfactory outcome following Roux-en-Y diversion and 23 with an unsatisfactory outcome, were studied using a semisolid, radiolabelled meal and compared with 12 normal subjects. Outcome was assessed by modified Visick grading. Seven patients with an unsatisfactory outcome because of frequent vomiting had gastric stasis and two had delay in emptying of the jejunal component of the Roux-en-Y. Vomiting was more likely in patients with a dependent sump (P less than 0.006) and emptying was significantly prolonged where a sump was present (P = 0.0009). Surgical technique contributed to the dependent sump.
Subject(s)
Anastomosis, Roux-en-Y/methods , Postoperative Complications/etiology , Vomiting/etiology , Adult , Aged , Duodenogastric Reflux/complications , Esophagitis, Peptic/surgery , Female , Gastric Emptying , Gastritis/etiology , Gastritis/surgery , Humans , Male , Middle Aged , Vagotomy, TruncalABSTRACT
One hundred and seven patients with postoperative reflux gastritis treated by Roux-en-Y biliary diversion were reviewed. Three patients died in the postoperative period, and 16 others have since died; cardiorespiratory disease was the most frequent cause of death. Seventy-nine patients were interviewed at a median of 5.5 years (range 0.5-26 years) following Roux-en-Y diversion. At review, a satisfactory result by modified Visick grading was present in 47 per cent of patients. Bilious vomiting (P less than 0.001), food vomiting (P less than 0.01), the severity of upper abdominal pain (P less than 0.001) and heartburn (P less than 0.025) were significantly improved by Roux-en-Y diversion. Weight, haemoglobin levels and employment status were not significantly altered by the procedure. Outcome was related to the surgery preceding Roux-en-Y diversion with significantly better results after partial gastrectomy compared with truncal vagotomy and drainage (P less than 0.01), cholecystectomy (P less than 0.05), or combinations of these procedures (P less than 0.01). Outcome was not predicted by sex, preoperative symptoms, smoking status, consultant surgeon, length of Roux-en-Y or 99Tc-Sn-2,6-di-ethylacetanilidoiminodiacetate (HIDA) scanning results.
Subject(s)
Anastomosis, Roux-en-Y , Gastritis/surgery , Postoperative Complications/surgery , Vomiting/surgery , Adult , Aged , Female , Follow-Up Studies , Gastritis/diagnostic imaging , Humans , Imino Acids , Male , Middle Aged , Organotechnetium Compounds , Postoperative Complications/mortality , Radionuclide Imaging , Technetium Tc 99m LidofeninABSTRACT
The subjective response to rectal balloon sensation was assessed with anorectal manometry and pudendal nerve terminal motor latency measurement (PNTML) in three groups of patients. There were 37 healthy subjects, 54 patients with idiopathic fecal incontinence (IFI), and 36 with complete rectal prolapse and incontinence (CRP). There was no significant difference for any parameter of rectal balloon sensation between patients with IFI and normals. Patients with CRP differed only in onset (P = .001). The results show that the appreciation of rectal distention is maintained in IFI.
Subject(s)
Fecal Incontinence/physiopathology , Rectum/physiopathology , Action Potentials , Aged , Anal Canal/physiopathology , Catheterization , Defecation , Electric Stimulation , Electromyography , Female , Humans , Male , Manometry , Middle Aged , Reaction Time , Rectum/innervation , SensationABSTRACT
Are written or standardized nursing care plans (NCP) as effective in enhancing the quality of patient care, and thus patient outcomes, as has been proposed for well over a decade? Data in this study did not validate the superiority of these two types of NCPs over another planning system. If the findings of this study are supported by further research, there will be scientific evidence upon which JCAH can base a reconsideration, and possible elimination, of their requirement for written/printed nursing diagnoses with corresponding nursing orders as part of nursing care planning systems.
