Showing papers by "Guy J. Maddern published in 1984"

Changes in gastric emptying rates with age.

Abstract: A dual isotope technique which measures simultaneously the emptying of solids and liquids by the stomach was used to study gastric emptying in 35 subjects in the age range 21-84 years, who were all fit, mobile volunteers and were not taking any drugs. Solid and liquid emptying were significantly slower in older subjects, but this finding is unlikely to be of clinical significance because the changes were small and emptying rates were usually within the normal range for younger subjects.

A study of factors responsible for the efficacy of fundoplication in the treatment of gastro-oesophageal reflux.

Abstract: Forty-one patients were followed up for a median 14 months after Nissen fundoplication. Patients were questioned regarding their symptoms and 83% considered the surgery a complete success. Oesophageal manometry was performed before and after surgery. Median pre-operative lower oesophageal sphincter pressure (LOSP) was 5.5 mmHg; following operation median LOSP was 14 mmHg. The ability of the lower oesophageal sphincter (LOS) to relax with swallow was impaired by fundoplication; the median residual lower oesophageal sphincter pressure (RLOSP) was 0 mmHg prior to surgery and 3.5 mmHg following operation. Fundoplication appears to superimpose a zone of constant pressure on the lower oesophageal sphincter and this may be a further factor responsible for the efficacy of surgery.

Twelve years of coronary artery surgery in South Australia.

Abstract: Twelve years' results of coronary artery bypass surgery in South Australia have been reviewed. The preoperative assessment parameters and operative profiles of 4001 patients who underwent isolated coronary artery grafting between 1970 and 1982 have been examined. In addition, all surviving patients received a follow-up questionnaire; only 48 patients have remained untraced. Survival curves for the patient group have been calculated and compared with those for the Australian population. The risk factors which influenced long-term survival have been identified. Surviving patients described their anginal symptoms as diminished in 93% of cases at the time of review. When recurrent angina was described, 58% of patients experienced it within 12 months of the operation. Postoperative activity was improved in 71% of patients; 8% described a deterioration. A second operation was performed in 2.1% of patients. This study provides a comprehensive review of the efficacy of coronary artery bypass surgery both in the short and in the medium term.

Symptomatic and asymptomatic ulcer recurrence following highly selective vagotomy.

Abstract: An assessment of outcome has been made after highly selective vagotomy performed by two surgeons on 174 patients The median time to followup was 36 months (range 3-94) The group comprised 74% males and 26% females (median age 45 years, range 19-75) Assessment was by review of medical history, endoscopy (irrespective of presence or absence of symptoms) and questionnaire Symptomatic ulcer recurrence had already been diagnosed in 16 patients (9%) There were 2 unassociated deaths and 14 patients remained untraced The remaining 142 patients were assessed by questionnaire and asked to undergo an endoscopy One hundred and nineteen agreed to endoscopy and ulcers were found in 11 patients (9%) Five were sited in the duodenum and 6 in the stomach Duodenitis was found in 30% of patients Patients with ulcers in the pyloric region were at significantly greater risk than the general group for developing a recurrence Patients who agreed to endoscopy (119) underwent Visick grading prior to endoscopy A poor correlation was found between ulcer recurrence and Visick score The "asymptomatic" recurrence rate of 9% following highly selective vagotomy should be considered when assessing the outcome of the surgery