Showing papers by "Guy J. Maddern published in 1991"
TL;DR: In gastro-oesophageal reflux disease there is a high prevalence of parasympathetic nerve dysfunction which relates to delayed oesophageAL transit and abnormal peristalsis and may therefore be of pathogenic importance.
Abstract: Recent studies suggest that vagal nerve dysfunction may be important in the aetiology of gastro-oesophageal reflux disease. Delayed oesophageal transit and slowed gastric emptying occur frequently and may also be of pathogenic importance. In 48 patients with gastro-oesophageal reflux disease we studied the prevalence of and relations between autonomic nerve dysfunction (as assessed by cardiovascular reflex tests) and oesophageal transit, oesophageal motility, gastric emptying, and endoscopic grade of oesophagitis. Of the 48 patients, 21 (44%) had abnormal autonomic nerve function, which was predominantly parasympathetic. Oesophageal transit was delayed in 28% of the patients and gastric emptying of the solid component of the meal was delayed in 46%. Oesophageal transit was significantly (p less than 0.007) slower in patients with abnormal autonomic nerve function. The percentage of synchronous oesophageal contractions was related to the score for autonomic nerve dysfunction (r = 0.40, p less than 0.05). There was no significant relation of autonomic nerve dysfunction to either delayed gastric emptying or endoscopic grade of oesophagitis. We conclude that in gastro-oesophageal reflux disease there is a high prevalence of parasympathetic nerve dysfunction which relates to delayed oesophageal transit and abnormal peristalsis and may therefore be of pathogenic importance.
130 citations
TL;DR: It is concluded that cisapride significantly accelerates gastric emptying of both solids and liquids in patients with gastro-oesophageal reflux disease and delayed gastric emptied.
Abstract: Some patients with gastro-oesophageal reflux disease have delayed gastric emptying. This study investigates the effect of cisapride on gastric emptying in 34 patients with proved reflux and delayed gastric emptying of solids. They were enrolled in a double blind controlled crossover study. Placebo or cisapride (10 mg) tablets were given three times a day for three days followed by further assessment of gastric emptying. The protocol was repeated with the crossover tablet. Gastric emptying was assessed by a dual radionuclide technique. The percentage of a solid meal remaining in the stomach at 100 minutes (% R100 minutes) and the time taken for 50% of the liquid to empty (T50 minutes) were calculated and analysed by the Wilcoxon matched pairs signed ranks test and expressed as medians (ranges). For gastric emptying of solids the initial % R100 minutes (70 (60-100)%) was not significantly different from placebo (71 (35-100)%). After cisapride treatment a significant acceleration (p less than 0.001) in gastric emptying occurred (% R100 minutes, 50.5 (28-93)%). Similarly with gastric emptying of liquids, the initial T50 minute value was 26.5 (12-82) minutes, after placebo the value was 28 (11-81) minutes, but this was significantly accelerated with cisapride (p less than 0.03) to 22.5 (6-61) minutes. The acceleration in gastric emptying occurred in the proximal portion of the stomach for gastric emptying of both solids and liquids suggesting that this is the principal site of action of cisapride. We conclude that cisapride significantly accelerates gastric emptying of both solids and liquids in patients with gastro-oesophageal reflux disease and delayed gastric emptying.
50 citations
48 citations
TL;DR: It is concluded that proximal vagotomy interferes with reflex pathways that are involved in the acceleration of solid gastric emptying after fundoplication.
Abstract: Fifty-four patients having antireflux surgery (20 fundoplication alone [group 1] and 34 fundoplication with proximal gastric vagotomy [group 2], had their gastric emptying assessed preoperatively and postoperatively. At 3 years after operation, in group 1, the emptying of a solid meal was significantly accelerated. In contrast, no such acceleration in solid emptying was observed in group 2. Liquid emptying was significantly accelerated in both groups of patients postoperatively. No consistent relationship was found between symptomatic outcome and gastric emptying in either group of patients. We conclude that proximal vagotomy interferes with reflex pathways that are involved in the acceleration of solid gastric emptying after fundoplication.
32 citations
TL;DR: A new high velocity water jet dissector is reported which offers significant advances over previously developed ultrasonic and low pressure water jet machines.
Abstract: Increasing experience with major hepatic resections has stimulated the development of improved resectional techniques and tools A new high velocity water jet dissector is reported which offers significant advances over previously developed ultrasonic and low pressure water jet machines It has been successfully used in 8 major hepatic resections with minimal blood loss, excellent visibility and without complications The dissector is also of value in the exposure of intrahepatic bile ducts for biliaryenteric anastomosis
24 citations
TL;DR: Two bleeding superior gluteal artery pseudoaneurysms occurred in a patient with advanced malignant disease following an intramuscular injection and were diagnosed by angiography and successfully managed by superselective embolization.
Abstract: Two bleeding superior gluteal artery pseudoaneurysms occurred in a patient with advanced malignant disease following an intramuscular injection. This was diagnosed by angiography and successfully managed by superselective embolization. This avoided further surgery and no additional complication from the pseudoaneurysm occurred up to the time of the patient's demise.
22 citations
TL;DR: The authors conclude that this method may give reliable results in large and medium-sized varices and may be unaffected by peristalsis or esophageal wall elasticity, however, further assessment in vivo remains necessary.
14 citations
TL;DR: It is concluded that the Angelchik prosthesis is an effective antireflux device, but it interferes with esophageal function in some patients, requiring removal of the prosthesis.
Abstract: • The effects of the Angelchik prosthesis on esophageal and gastric function were investigated in 17 patients (11 men and six women; median age, 57 years; age range, 36 to 88 years) who underwent surgery for treatment of gastroesophageal reflux disease. All patients demonstrated unequivocal reflux, either at endoscopy or 24-hour pH testing. There was a significant increase in lower esophageal sphincter pressure after surgery, and no patient demonstrated abnormal reflux on pH testing. Gastric emptying of liquids and solids was not altered by surgery. Six months after surgery, all symptoms except dysphagia had significantly improved. Thirty-three months after surgery, six patients described symptoms as severe as or worse than those before surgery. Four patients had the prosthesis removed, two because of dysphagia alone, one because of reflux and dysphagia, and one because of flatulence and bloating. The patients who required removal of the prosthesis because of dysphagia had gross delay of esophageal emptying. We conclude that the Angelchik prosthesis is an effective antireflux device, but it interferes with esophageal function in some patients, requiring removal of the prosthesis. We think the rate of removal of the prosthesis is too high for its routine use in the treatment of gastroesophageal reflux disease. ( Arch Surg. 1991;126:1418-1422)
10 citations
TL;DR: CT-guided fine-needle puncture was carried out in 74 patients with pelvic masses and resulted in a correct diagnosis in 36/45 patients (80%) with malignant disease and confirmed the suspected CT diagnosis in all cases by cytology and bacteriology.
Abstract: CT-guided fine-needle puncture (FNP) was carried out in 74 patients with pelvic masses and resulted in a correct diagnosis in 36/45 patients (80%) with malignant disease. FNP was true-positive in 66.7% and false-negative in 20%. In benign and inflammatory pelvic space-occupying lesions, FNP confirmed the suspected CT diagnosis in all cases by cytology and bacteriology. CT-guided puncture should always be used complementary to CT when a mass of unclear etiology is present.
8 citations
Journal Article•
3 citations
Journal Article•
TL;DR: A case of severe pancreatitis in association with a solitary parathyroid adenoma in a patient who did not have gallstones or drink alcohol is reported.
Abstract: We report a case of severe pancreatitis in association with a solitary parathyroid adenoma in a patient who did not have gallstones or drink alcohol.