Biomedical subjects
Publications and source records attributed to C G Bremner.
A review of malignant breast tumours at Coronation Hospital has highlighted their frequency in younger women and their biologically aggressive nature. Inadequate patient compliance with follow-up makes routine use of conservative treatment modalities hazardous.
Primary malignant fibrous histiocytoma of the breast was diagnosed in a 45-year-old Indian woman. She presented with a large ulcerated lesion and had lung metastases. Treatment was by radiotherapy, toilet mastectomy and chemotherapy. The patient died of rapid extension of lung metastases 15 months after first being seen. Although this tumour has previously been considered to have a relatively good prognosis, this report emphasises its fully malignant metastatic potential.
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In a current review of the literature regarding the management of patients with suspected penetrating cardiac injuries there appears to be no place for conservative management. Nine patients with penetrating cardiac injuries were successfully treated conservatively and are reported. This series aims to emphasize the point that there is a place for conservative management of selected cases.
Thirty-four patients with mid-oesophageal and epiphrenic diverticula were studied radiologically and manometrically. All patients had a motility disorder and gastro-oesophageal reflux was the usual precipitating factor. Most patients can be treated conservatively. In patients who do not respond to medical treatment surgery is necessary. The importance of surgical correction of the physiological abnormality should complement diverticulectomy.
Fifty patients with acute upper gastro-intestinal haemorrhage were given either oral or intravenous ranitidine ( Zantac ; Glaxo), the route of administration being allocated on a random basis. Two patients were excluded from the oral group and 5 were excluded from the intravenous group. The two groups were similar as regards age, sex, number of patients aged over 60 years and severity of bleeding. All the patients were carefully monitored for rebleeding, which occurred in a total of 7 cases (16,3%), 6 in the oral group (26%) and 1 in the intravenous group (5%). Statistically this represented a marked tendency towards a significantly lower incidence of recurrent haemorrhage in the patients treated with intravenous ranitidine (P = 0,07, tested according to Fisher's exact method). No patient in the intravenous group who bled again came to surgery, while 3 of the 23 patients in the oral group (13%) required surgery.
Antacids were given to a group of 18 patients who had acute alcoholic pancreatitis and the results were compared with those in a similar group of 15 patients who did not receive antacid therapy. There was no statistical difference in the course of the illness between the two groups as regards duration of abdominal pain, epigastric tenderness, hospital stay or time taken for the patient to resume a normal diet.
During a course of 10 biofeedback sessions in a single subject, the lower esophageal sphincter pressure measured with an open-tipped perfused catheter assembly showed significant and progressive increase with each session, until it reached normal levels. There was also a decrease in symptomatic reflux episodes, from three times daily to once every 2 weeks. Macroscopic esophagitis was detected by endoscopy before the first session, but was no longer evident in the endoscopic examination after biofeedback training. After the biofeedback training program, the subject was able to control his lower esophageal sphincter without biofeedback.
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In the Coloured population of Johannesburg, the incidence of carcinoma of the colon and rectum estimated over an 11-year period (1970-1980) is 1,33 and 1,08/100 000 respectively per year. This is lower than the incidence reported in Whites and appears to be even lower than that reported in South African and Zimbabwean Blacks. A survey of dietary factors in this population showed a diet which was high in protein, low in fats and high in bulk. The frequency of bowel action was higher than in both Whites and Blacks. These factors support Burkitt's hypothesis which states that races with a high-bulk diet have a lower incidence of large-bowel cancer.
Patients with Marfan's syndrome usually present with a positive family history and/or cardiovascular or ocular abnormalities. A patient with Marfan's syndrome who presented with achalasia of the oesophagus is described.
An inflammatory polyp at the gastroesophageal junction due to gastroesophageal reflux is a rare documented finding and its appearance on x-ray has only recently been described. A recently encountered case whose only symptom was of minor episodes of hematemeses is described and the literature is reviewed.
Domperidone (Motilium), a dopamine receptor blocking agent, increased the resting tone of the lower oesophageal sphincter in 15 dogs and 6 baboons. It is therefore a potentially useful drug in the management of gastrooesophageal reflux due to incompetence of the lower oesophageal sphincter.
A right-sided traumatic diaphragmatic hernia was present in a woman who was 24 weeks pregnant, 8 years after a motor vehicle injury. The hernia had not been diagnosed previously. Correction of severe anaemia and surgical repair of the diaphragmatic defect were successful.
Gastric ulceration following an antireflux fundoplication procedure is the result of bile reflux into the stomach and not a consequence of gas bloat, antral distention or hypergastrinemia. Whether the bile reflux was present prior to the fundoplication or was a result of fundoplication is not known.
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