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Biomedical subjects

C S Winans

Publications and source records attributed to C S Winans.

At least 19 recordsLinked to original sources
PubMed1990

Randomized clinical trial of two colonoscopy preparation methods for elderly patients.

Colonic lavage with enemas or with Golytely are standard preparation methods for colonoscopy. Previous studies have demonstrated that Golytely has a statistically significant advantage in both adequacy of preparation and patient tolerance. To determine if these effects are present in the elderly, we performed a randomized clinical trial on 124 consecutive patients scheduled for colonoscopy who were greater than or equal to 75 years of age. Sixty-three patients were randomized to receive Golytely; 17 were inpatients, 33 were outpatients, and colonoscopy was canceled in 13. Sixty-one patients were randomized to receive the enema preparation; 17 were inpatients, 30 were outpatients, and colonoscopy was canceled in 14. For adequacy of the preparation, no differences were statistically significant, but the enema preparation was superior in outpatients while Golytely was superior in inpatients. Patients tolerated the enema preparation better, a finding present in both outpatients and inpatients. Contrary to previous reports of a significant advantage with Golytely, patients greater than or equal to 75 years old did not enjoy this advantage, but seemed to tolerate enemas better than Golytely with little difference in adequacy of the preparation.

Aged↗
PubMed1988

Surgical treatment of achalasia: results with esophagomyotomy and Belsey repair.

To address the controversy regarding the choice of operation for achalasia, the cases of 57 patients having operation, 38 for the first time (Group 1) and 19 with a previous procedure (Group 2), were reviewed. Surgical emphasis was on hiatal dissection to maximize exposure and use of the Belsey fundoplication to achieve cardiac competence without obstruction. Operative mortality was 1 (1.8%) of 57 patients. In group 1, 21 of the 38 had prior pneumatic dilations. All were treated with esophagomyotomy and a Belsey fundoplication. Clinical results are excellent or good in 30 (88%) of the 34 patients for whom follow-up is available, and are similar in patients with and without prior dilation. Lower esophageal sphincter (LES) pressure decreased from 22.3 to 7.7 mm Hg (p less than 0.001), and pH testing shows no reflux in any of 13 patients. In Group 2, previous operations were esophagomyotomy in 13, esophagomyotomy plus a Nissen fundoplication in 3, and a Nissen fundoplication only in 3. The initial operation failed because of inadequate myotomy in 6 patients, an obstructive Nissen fundoplication in 6, and reflux esophagitis in 7. In these 7 patients, acid reflux testing documented reflux due to cardiac incompetence and delayed clearance. Reoperations included takedown of a Nissen fundoplication in 6, esophagomyotomy and Belsey procedure in 15, Belsey procedure in 1, and resection plus colon interposition in 2. Clinical results are excellent or good in 12 (75%) of the patients with follow-up. These conclusions can be drawn. (1) Esophagomyotomy and Belsey fundoplication lowers LES pressure and provides good results with low risk, even after pneumatic dilation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Sarcomas arising after radiotherapy for peptic ulcer disease.

Therapeutic gastric irradiation has been used to reduce peptic juice secretion in patients with peptic ulcer disease. Between 1937 and 1968 a total of 2049 patients received such therapy at the University of Chicago. Three of these patients are known to have developed sarcomas in the field of radiation. Two gastric leiomyosarcomas of the stomach were diagnosed 26 and 14 years after treatment and a malignant fibrous histiocytoma of the anterior chest wall was removed six years after gastric irradiation. Of 743 peptic ulcer patients treated without irradiation and constituted as a control group for the study of therapeutic gastric radiation, none is known to have developed sarcoma. As the incidence of sarcoma in these patient groups is known only from the tumor registry of the University of Chicago, other cases of sarcoma may exist in the groups. While an increased incidence of sarcoma has not been proven to occur in patients who received therapeutic gastric irradiation for peptic ulcer disease, the possibility of such a risk should be borne in mind by physicians caring for such patients.

Adult↗
PubMed1979

Discordance for achalasia in identical twins.

Twenty-year-old twin sisters, believed monozygotic on the basis of extensive blood grouping and cytogenetic studies, are reported. One twin demonstrated classical clinical, radiologic, and manometric features of achalasia, while similar studies in her sister documented perfectly normal esophageal motor function. Genetically determined damage to the esophageal parasympathetic innervation is, therefore, not a likely cause for the esophageal motor dysfunction in achalasia.

Adult↗
PubMed1979

Circumscribed eosinophilic gastroenteritis.

A case of eosinophilic gastroenteritis with peripheral blood eosinophilia and typical histology is described. The location, radiographic appearance, and gross pathologic appearance of the lesion were unique in that they resembled eosinophilic granuloma of the stomach. Also unique was the fact that the distal esophagus as well as the stomach was involved. This case demonstrates that eosinophilic gastroenteritis may involve any portion of the gastrointestinal tract and that the radiologic distinction between eosinophilic gastroenteritis and eosinophilic granuloma may not be as clear cut as previously thought.

Adult↗
PubMed1978

Cimetidine in the treatment of symptomatic gastroesophageal reflux: a double blind controlled trial.

The effectiveness of cimetidine for symptomatic relief in patients with chronic gastroesophageal reflux was studied in a multicenter, double blind clinical trial. Patients were entered into the study for a total of 8 weeks, receiving either cimetidine, 300 mg four times daily, or identical placebo tablets. Throughout the trial, frequent assessments were made of symptom severity and frequency, combined with careful measurement of antacid use. Esophagoscopy, esophageal acid sensitivity, and lower esophageal pressures were performed before and at the completion of the treatment period. Significant (P less than 0.05) decreases in symptom frequency and severity were noted throughout the study in the cimetidine-treated patients, as compared with the placebo group. This subjective improvement was corroborated by a concomitant decrease in antacid use, which was significantly (P less than 0.05) reduced in the cimetidine-treated group. In addition, significant improvement in esophageal acid sensitivity resulted from cimetidine therapy. No objective improvement in esophageal endoscopic appearance or sphincter pressures was noted. The results of this double blind trial indicate that cimetidine is more effective than the placebo for the relief of symptoms of gastroesophageal reflux.

Adult↗
PubMed1977

Manometric asymmetry of the lower-esophageal high-pressure zone.

The lower-esophageal high-pressure zones (LEHPZ) of 10 normal subjects, 8 patients with hiatus hernia and one patient with progressive systemic sclerosis (PSS) were investigated using a special 8-lumen recording catheter, and lateral orifices of which were spaced at 45 degree intervals around the circumference of the catheter. While similar pressures were recorded from all orifices within the stomach and esophageal body, pressures within the LEHPZ were found to be related to spatial orifice position. In normal subjects, but not in patients with hiatus hernia, a significnatly higher localized pressure was detected by orifices directed toward the left posterior quadrant of the circumference of the distal esophagus, while a lesser, rather uniform, pressure was recorded from the other three quadrants. From the PSS patient, who had severe gastroesophageal reflux, a LEHPZ was detected only in the left posterior quadrant. The results suggest that the recorded LEHPZ represents the summation of two factors; an intrinsic force possibly due to a physiologic lower-esophageal sphincter and an extrinsic force possibly resulting from compression of the distal esophagus by the lateral margin of the diaphragmatic hiatus.

Adolescent↗
PubMed1977

Lower-esophageal sphincter function does not determine resting upper-esophageal sphincter pressure.

Records of 269 esophageal motility studies were reviewed to determine the relationship between lower-esophageal sphincter (LES) function and upper-esophageal sphincter (UES) pressure. Average and greatest UES pressures were similar in patients with LES pressures less than 10 mm Hg or greater than 20 mm Hg, and in patients with and without gastroesophageal reflux as determined by an intraesophageal pH electrode test. Although teliologically appealing, the belief that patients with weak lower-esophageal sphincters and gastroesophageal reflux have stronger upper-esophageal sphincters to guard against pharyngeal reflux and aspiration cannot be confirmed by current manometric techniques.

Electrodes↗
PubMed1976

Effect of fifty percent small bowel resection on gastric secretory function in rhesus monkeys.

Basal acid output (BAO) and histamine-stimulated acid output (MAO) were studied in 11 fasting rhesus monkeys. Serum gastrin and gastric inhibitory polypeptide (GIP) were assayed in eight. Fifty percent distal small bowel resection was performed and the studies were repeated at 6 weeks and 6 months. Highly significant increases were seen in BAO (0.37 "/- 0.05 to 1.73 +/- 0.37 mEq. per hour; P less than 0.005) and MAO (1.7 +/- 0.22 to 3.21 +/- 0.45 mEq. per hour P less than 0.01) at 6 weeks. These levels persisted at 6 months. The ratio BAO:MAO increased throughout the experiment, the changes being significant at both time intervals. A significant rise was noted in the levels of both fasting serum gastrin (P less than 0.05) and GIP (P less than 0.01) during the early phase. By 6 months the levels of both hormones had fallen and were not significantly different from the control values. It was concluded that 50 percent small bowel resection causes a persistent increase in gastric acid secretion. No corresponding sustained change in serum gastrin or GIP occurs.

Animals↗