Biomedical subjects
Publications and source records attributed to D K Toye.
This paper reports a critical analysis of the results of the investigations used to establish a diagnosis in 37 patients submitted to a second operation for presumed recurrent or unhealed ulcer. The results of investigations have been correlated with the operative and histopathological findings.
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The accuracy of early radiology in patients with acute gastrointestinal haemorrhage has been studied by a comparison of the radiological opinion with the established diagnosis. A full examination has proved safe and uncomplicated with a high degree of accuracy and no false-positive results.Analysis of the errors shows that the presence of residue discourages the radiologist from making the correct diagnosis, and modification of the standard bariummeal technique may be needed to overcome this difficulty.
Clinical and radiological abnormalities in 12 patients with gastroduodenal involvement were encountered amongst 300 patients followed by one of us between 1944 and 1969. Symptoms of dyspepsia were relatively mild and obstructive symptoms when present were readily relieved by bypass surgery. The patients have been followed for a mean of 9.7 years (range 1-20); two have died of other causes but the remaining 10 are well.
The radiological anatomy of the pyloro-duodenal area after pyloroplasty is described. The deformity produced by pyloroplasty is shown in the patient with a normal pylorus and duodenum and in the patient with a duodenal ulcer and stenosis. From a study of 24 asymptomatic patients after pyloroplasty it is possible to recognize the radiological features that indicate a successful operation.
Barium meal studies have shown evidence of a recurrent ulcer or of stenosis in 12 out of 24 patients with recurrent dyspepsia after vagotomy and pyloroplasty. These 12 patients have been subsequently proved to have had recurrences and all but one are now cured by further surgery. Barium meals in 12 patients show no evidence of recurrence or stenosis, and follow-up clinical studies suggest that they do not have recurrent ulcer. Radiological studies appear to have great value in the interpretation of recurrent dyspeptic symptoms after vagotomy and pyloroplasty.
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