Obstructed defaecation because of adult sacrococcygeal teratoma.
Explore the source record for details and available documents.
Bone Neoplasms↗
Biomedical subjects
C J Stoddard
Publications and source records attributed to C J Stoddard.
Comparison of Nissen total and Lind partial transabdominal fundoplication in the treatment of gastro-oesophageal reflux.
Fifty-two patients with gastro-oesophageal reflux disease refractory to medical treatment were randomized to undergo a Nissen total (360 degrees wrap) or Lind partial (300 degrees wrap) transabdominal fundoplication. Each group was comparable in number (26 patients), mean age (47 and 48 years) and sex distribution (eight women). Preoperative and postoperative assessment involved a modified Visick score, 22-h intraoesophageal pH monitoring, endoscopy and manometry. Follow-up was at 6 weeks and between 3 and 33 (mean 13) months. The prevalence of heartburn and regurgitation and the results of pH monitoring improved significantly after both operations (P less than 0.001). At early assessment eight previously asymptomatic patients (31 per cent) from the Nissen group and six (23 per cent) from the Lind group experienced difficulty swallowing. Ten patients (38 per cent) in each group complained of 'gas bloat'. Both complications had improved at late assessment in the majority of patients. No statistically significant advantage could be demonstrated for either operation.
Adult↗
Limitations of laser treatment for malignant dysphagia.
Explore the source record for details and available documents.
Adult↗
Cutaneous perianal recurrence of cancer after anterior resection using the EEA stapling device.
Explore the source record for details and available documents.
Adenocarcinoma↗
Factors influencing the establishment of tumour-infiltrating lymphocyte cultures from human breast carcinoma and colon carcinoma tissue.
Tumour-infiltrating lymphocytes (TIL) were obtained from breast and colon tumour tissue and cultured in vitro in the presence of recombinant human interleukin-2. Seven of 35 breast tumours and five of 41 colon TIL cultures were established in vitro: proliferation rates of greater than 10(3) were achieved. The cytotoxic capacity of these cells was determined against the cell lines K562 and SW742, and percentage cytotoxicity levels of greater than 97% and 79%, respectively, were seen. An inverse relationship between the ability of TIL to kill and their proliferative capacity was observed in all cultures. The prominent phenotype was CD3 positive, with greater than 55% of TIL expressing this antigen; there was no expression of CD16. The expression of CD56 and CD25 varied, being maximumly expressed on 64% and 38% of TIL, respectively. When greater than 90% of TIL expressed CD3, the ability of the culture to kill the target cell lines was low; only when there was an increase in the proportion of cells expressing CD56 and a decrease in the expression of CD3 was there high cytotoxicity. This study indicates that the TIL which proliferate in vitro in the presence of interleukin-2 are not necessarily the mediators of cytotoxicity.
Adult↗
Loss of monomorphic and polymorphic HLA antigens in metastatic breast and colon carcinoma.
MHC class I antigens are intimately involved in intercellular communication, and recognition by cytotoxic T cells. Thus tumour cells that fail to express them may be at a growth or metastatic advantage. A series of ten colorectal and ten breast carcinomas, and their respective lymph node metastases, were examined immunohistologically using monoclonal antibodies (mAb) against both monomorphic and A2 polymorphic determinants, and beta-2-microglobulin (beta 2m). Four colon polypoid adenomas stained positively throughout, but 6/10 primary tumours had partial or complete loss of expression of monomorphic determinants using mAb W6/32: two node and the liver metastasis showed less, four more expression. Similar results were seen for beta 2m. HLA-A2 expression was absent or reduced in 4/4 colon tumours and all their metastases. Among the breast tumours, W6/32 staining was absent or reduced in 2/10, and node deposits showed two with less reactivity than their primary. Beta 2m staining was reduced or absent in 8/10 primaries and all the node metastases; in every case in which beta 2m was detected in the primary tumour their corresponding lymph node metastasis showed a decreased expression. HLA-A2 expression was absent or reduced in 3/4 primary breast carcinomas, and all their metastases. These results show that individual human colon and breast carcinomas often have a reduced HLA class I antigen expression, which apparently confers a metastatic advantage.
Adenoma↗
Patterns of colonisation of Campylobacter pylori in the oesophagus, stomach and duodenum.
Thirty five subjects underwent upper gastrointestinal endoscopy and multiple biopsy (30 patients, five normal subjects). A total of 11 biopsies per subject from four sites (oesophagus (three), gastric body (two), antrum (three), duodenum (three] were examined for inflammation and the presence of Campylobacter pylori and using standard methods of culture and by light (LM) and electron microscopy (EM). The organism was cultured from oesophageal biopsies in eight of 30 (27%) patients but could not be identified at this site by LM or EM. There was evidence of oesophageal inflammation in 20 patients which was associated with the local finding of C pylori in five (25%) including two of seven (29%) with Barrett's mucosa. Antral C pylori was present in 22 of 23 (96%) patients with chronic active gastritis. The organism was found in the antrum and oesophagus in four of 22 patients (18%), in the antrum and duodenum in four of 22 patients (18%) and in all three sites in a further two of 22 patients (9%). Antral C pylori was found in five of six patients with peptic ulceration. C pylori was cultured from the duodenum in six patients with confirmation by LN and EM in three, but only on areas of gastric metaplasia. The organism was not found in the normal group. This study indicates that C pylori may be irregularly isolated from the oesophagus and duodenum in patients with antral C pylori and chronic active gastritis. The role of C pylori in the oesophagus is most likely that of a commensal or contaminant.
Adult↗
Comparative intragastric pH profile of Algicon versus Gaviscon.
Explore the source record for details and available documents.
Adult↗
Achalasia or malignancy? Confirmation of the diagnosis by oesophageal manometry.
Malignancy involving the gastro-oesophageal junction can present with features very similar to those of idiopathic achalasia. Failure to identify such cases may delay effective treatment of a curable tumour. We report four patients with malignant dysphagia who were initially referred for treatment of achalasia--the diagnosis based on clinical, radiographic and endoscopic findings in each case. In all four, oesophageal manometry suggested, correctly, that the diagnosis of achalasia was incorrect, allowing early surgical exploration. We suggest that the diagnosis of achalasia should be confirmed by manometric studies--particularly in elderly patients with a short history and weight loss as these features are frequently associated with malignancy.
Aged↗
Histological and histochemical changes in the columnar lined (Barrett's) oesophagus.
Multiple endoscopic specimens were obtained from 58 patients with a columnar lined gesophagus to study the histological and histochemical features of this metaplastic epithelium. Five patients (8.6%) had presented with a primary oesophageal adenocarcinoma. Three different epithelial types, junctional, atrophic fundic and intestinal were identified. Twenty two (38%) patients had just one type of epithelium present, the other 36 (62%) having a combination of two or three different types. Intestinal type of epithelium, either alone or in combination with gastric type epithelium was present in 48 (83%) patients. In every case this intestinal type epithelium took the form of an incompletely differentiated variant of intestinal metaplasia, although complete intestinal metaplasia as a focal change was also present in 14 of these patients. Histochemically, sulphomucins were present in the biopsies of 43 (74%) of the patients studied. They were seen in both goblet and columnar mucous cells with almost equal frequency. Incomplete intestinal metaplasia with sulphomucin production was present in four of the five patients with an oesophageal adenocarcinoma. In the columnar lined oesophagus sulphomucin production is common and its presence does not help to identify those individuals at particular risk of developing an adenocarcinoma.
Adult↗
Gastro-oesophageal reflux and oesophagitis before and after vagotomy for duodenal ulcer.
Fifty patients undergoing elective vagotomy for the treatment of chronic duodenal ulceration have been investigated pre-operatively and again 3 months postoperatively to determine the extent and severity of associated gastro-oesophageal reflux. Pre-operatively all patients had a normal lower oesophageal sphincter pressure but 50 per cent had symptoms of gastro-oesophageal reflux, 42 per cent had excessive reflux on 24 h pH monitoring and 30 per cent had oesophagitis on endoscopy and/or oesophageal biopsy. Postoperatively, reflux symptoms were present in only 12 per cent of patients but pH studies were still abnormal in 36 per cent and oesophagitis was observed in 32 per cent. Lower oesophageal sphincter pressure was unaffected by vagotomy. Gastro-oesophageal reflux is common in pre-operative duodenal ulcer patients and is not significantly reduced by vagotomy. Careful pre-operative oesophageal assessment is necessary to determine which duodenal ulcer patients require an anti-reflux procedure in addition to vagotomy.
Chronic Disease↗
Dilatation of benign oesophageal strictures in the outpatient department.
Maloney's mercury weighted dilators have been used to dilate benign oesophageal strictures in 109 patients in the outpatient department. A total of 524 dilatations have been performed. Following dilatation two patients had a small haematemesis but there have been no oesophageal perforations. Maloney's dilators can be used in the outpatient department effectively to dilate benign oesophageal strictures and the risk of complications is low.
Adult↗
The four to eight year results of the Sheffield trial of elective duodenal ulcer surgery--highly selective or truncal vagotomy?
In a prospective randomized trial between June 1973 and July 1978 highly selective vagotomy (HSV) was compared with truncal vagotomy and pyloroplasty (TVP) in 137 male patients undergoing elective surgery for chronic duodenal ulceration. Ninety per cent of patients were followed up for between 49 and 102 months (mean 77). A good result was obtained in 49 of 59 patients (83 per cent) after HSV compared with 41 of 64 (64 per cent) after TVP (P less than 0.02). The recurrent ulcer rate was 8.8 per cent after HSV and 9.4 per cent after TVP. Dumping and diarrhoea were significantly commoner after TVP (P less than 0.05). We believe that HSV is a better operation than TVP for the treatment of uncomplicated duodenal ulcer.
Adult↗
Controlled trial of the Grassi (pH) intraoperative test for completion of proximal gastric vagotomy.
Forty-eight patients undergoing PGV for duodenal ulcer were randomized to Grassi test (24) or no test (24). Operations were performed by surgeons who were Fellows of the Royal College of Surgeons trained in the technique of PGV and every effort was made to complete the vagotomy if the test was positive. Patients were assessed by standard pentagastrin test preoperatively and postoperatively. The two groups were closely matched for age (Grassi 48, non-Grassi 43), sex (Grassi 20 males; non-Grassi, 21 males), preoperative BAO (6.4 +/- 1.2 S.E.M. millimols hydrogen ions per hour and 6.6 +/- 0.9 S.E.M. millimols hydrogen ions per hour) and preoperative PAO (45.5 +/- 2.1 S.E.M. millimols hydrogen ions per hour and 40.5 +/- 2.6 S.E.M. millimols hydrogen ions per hour). Postoperatively, the BAO was 1.2 +/- 0.4 S.E.M. millimols hydrogen ions per hour for the Grassi group and 0.8 +/- 0.2 S.E.M. millimol hydrogen ions per hour. The postoperative PAO (pg) for the Grassi group was 19.1 +/- 0.9 S.E.M. millimols hydrogen ions per hour and for the non-Grassi group, it was 19.5 +/- 1.9 S.E.M. millimols hydrogen ions per hour. The mean reduction in PAO (pg) were 57.0 +/- 4.3 per cent for the Grassi group and 51 +/- 4 per cent for the non-Grassi group, but two patients in the non-Grassi group had a reduction of less than 10 per cent, one of whom has had recurrent symptoms at three months. Eight Grassi and four non-Grassi patients had reductions of greater than 65 per cent. The mean operating was 110.0 +/- 6.8 minutes for the Grassi patients and 87.0 +/- 3.1 for the non-Grassi patients.
Adult↗
Low-dose aspirin inhibits platelet and venous cyclo-oxygenase in man.
In a group of normal subjects we have compared rates of recovery of venous prostacyclin (PGI2) and platelet thromboxane B2 (TXB2) production after a single 300 mg dose of aspirin. Marked inhibition of both venous PGI2 synthesis and platelet TXB2 synthesis persisted for the 72 hours duration of the study. We also examined the effect of four daily doses of 40 mg aspirin on platelet and vessel wall prostaglandin biosynthesis. This produced a cumulative inhibitory effect on TXB2 production with 98.6 per cent mean inhibition at 72 hours. At this time 81-100 per cent inhibition of PGI2 was demonstrated in the four subjects studied. We conclude that the cyclo-oxygenase enzyme in human vein is sensitive to inhibition by very low doses of aspirin. No evidence was found to substantiate the view that rapid recovery of vessel wall cyclo-oxygenase activity occurs after inhibition by a single dose of aspirin.
Aspirin↗
Achalasia in siblings.
The occurrence of achalasia in two brothers who were successfully treated by oesophagomyotomy is reported. There was no evidence of oesophageal motor dysfunction in their parents or two other siblings who were also studied. The possibility that genetic factors may be important in the aetiology of achalasia is discussed.
Adolescent↗
Do women do worse after proximal gastric vagotomy?
The view that woman fare worse than men following gastric surgery led us to examine the results of proximal gastric vagotomy (PGV) performed in 25 women with chronic duodenal ulcer. Follow-up was from 6 months to 8 years, with an average of 45 months. These were compared with men undergoing PGV for the same condition over the same period. The age, duration of symptoms and complication and recurrence rates were similar. Modified Visick grading rated the result as good as in more than 90 per cent of both men and women. Flatulence and postprandial fullness were the most common complaints but were usually mild. The results of PGV in women are just as good as those in men.
Adolescent↗
Inhibition of prostacyclin and platelet thromboxane A2 after low-dose aspirin.
To compare the inhibitory effects of aspirin on prostaglandin synthesized by vessel walls and platelets, we obtained vein segments from five subjects before they were given 150 or 300 mg of aspirin and at various intervals afterward. We then measured prostacyclin (PGI2) synthesis with a radioimmunoassay for its stable metabolite, 6-keto-prostaglandin F1 alpha. Platelet production of thromboxane A2 was measured with a radioimmunoassay for its stable metabolite, thromboxane B2. Two hours after aspirin had been given, 81 to 100 per cent inhibition of PGI2 synthesis was demonstrated; 86 per cent inhibition was still evident in one subject tested eight hours after administration. Simultaneously, platelet production of thromboxane B2 was completely inhibited for more than 24 hours. We conclude that there is little difference between the initial inhibitory response of platelet cyclooxygenase and that of vessel-wall cyclooxygenase to these doses of aspirin. Our results also indicate that in male subjects the prolonged template bleeding time after aspirin is not the consequence of selective inhibition of platelet production of thromboxane.
Adult↗