ABSTRACT
Data are presented from manometric and prolonged pH monitoring studies in 11 patients in whom the Angelchik anti-reflux prosthesis was inserted for control of symptomatic gastro-oesophageal reflux. Symptomatic and objective improvement was seen in the majority of our patients, although three suffered major side effects (erosion of prosthesis into the stomach in two, severe dysphagia in one). Impaired lower oesophageal sphincter relaxation noted after operation may explain both the transient dysphagia observed in five patients and the reduction in reflux episodes. Improvement in oesophageal acid clearance may result from fixation of the oesophagus within the abdomen by the device. While continued use of the prosthesis should be viewed with caution, it is effective and may have a place in the management of selected patients.
Subject(s)
Esophagogastric Junction/physiopathology , Gastroesophageal Reflux/surgery , Monitoring, Physiologic , Prostheses and Implants , Adult , Female , Follow-Up Studies , Gastroesophageal Reflux/physiopathology , Humans , Hydrogen-Ion Concentration , Male , Manometry , Middle Aged , Prostheses and Implants/adverse effects , SiliconSubject(s)
Adenoma, Bile Duct/surgery , Bile Duct Neoplasms/surgery , Palliative Care , Pancreatic Neoplasms/surgery , Prostheses and Implants , Adult , Aged , Aged, 80 and over , Cholangiography/methods , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Pancreatic Neoplasms/diagnostic imaging , Postoperative ComplicationsABSTRACT
A case is presented where gastric outlet obstruction was found to be secondary to carcinoma of the distal duodenum in a patient with acute on chronic duodenal ulceration. The fallibility of barium studies in this condition is discussed.
Subject(s)
Adenocarcinoma/complications , Duodenal Neoplasms/complications , Duodenal Obstruction/etiology , Pyloric Stenosis/diagnosis , Chronic Disease , Diagnosis, Differential , Duodenal Obstruction/diagnosis , Humans , Male , Middle AgedABSTRACT
A series of 34 histologically verified cases of pancreatic heterotopia in the records of the Department of Pathology at the University of Edinburgh between 1959 and 1979 has been analysed in order to determine the clinical significance of this unusual condition. In 13 patients (38 per cent) the heterotopic pancreatic tissue was symptomatic (i.e. the symptoms regressed completely on its removal). A correlation has been established between the presence of symptoms, the size of the lesion and the extent of mucosal involvement. Clinically significant lesions are greater than 1.5 cm in maximum diameter and are adjacent to or directly involve the mucosa.
Subject(s)
Choristoma/diagnosis , Gastrointestinal Neoplasms/diagnosis , Pancreas , Adolescent , Adult , Aged , Choristoma/pathology , Female , Gastrointestinal Neoplasms/pathology , Humans , Male , Middle AgedABSTRACT
We have reviewed the clinical and investigative details of 141 patients who underwent laparoscopy in order to determine how best this technique can be used. The clinical history and biochemical investigations usually only indicated some form of hepatobiliary disease, but all patients with spider telangiectasia, splenomegaly, or esophagogastric varices had diffuse parenchymal liver disease, and further investigation was only required to detect its cause. Laparoscopy succeeded in 129 patients (91%), and serious complications occurred in six (4%). The appearance of the liver did not accurately reflect the underlying pathology, indicating the need for biopsy in all cases. Laparoscopy and 99mTc-sulfur colloid liver imaging each failed to detect a few hepatic malignancies, but none were missed by both investigations combined, and similar results were obtained for parenchymal liver disease. Scanning and laparoscopy proved a highly accurate diagnostic combination.
Subject(s)
Laparoscopy , Liver Diseases/diagnosis , Humans , Laparoscopy/adverse effects , Liver/diagnostic imaging , Liver Cirrhosis/diagnosis , Liver Diseases/diagnostic imaging , Liver Neoplasms/diagnosis , Liver Neoplasms/diagnostic imaging , Radionuclide Imaging , Spleen/diagnostic imagingSubject(s)
Vagotomy , Biliary Tract/physiopathology , Deglutition Disorders/etiology , Drainage , Duodenal Ulcer/surgery , Gastric Mucosa/metabolism , Gastrointestinal Motility , Humans , Intestinal Absorption , Intestine, Small/physiopathology , Pancreas/physiopathology , Stomach/physiopathology , Vagotomy/adverse effects , Vagus Nerve/anatomy & histologyABSTRACT
Gastric adaptation was impaired immediately after the performance of complete vagotomy in a series of 20 acute experiments in the dog. Preliminary isolation of the intact vagi in 10 of these animals produced alterations in adaptation similar to those seen after vagal division. It is concluded that alterations in gastric adaptation are not a reliable intraoperative aid to complete vagotomy. These findings may be significant in the interpretation of all intraoperative tests for vagotomy.