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Biomedical subjects

G F Gowen

Publications and source records attributed to G F Gowen.

15 recordsLinked to original sources
PubMed1992

Delayed gastric emptying after Roux-en-Y due to four types of partial obstruction.

Partial obstruction was the cause of delayed gastric emptying in 12 patients after a Roux-en-Y gastrojejunostomy in a consecutive personal series of 42 patients between 1975 and 1989. Four types of obstruction were identified. Type I was due to a kinked loop of jejunum where it passed through the mesocolon. Type II had the anastomosis too high on the gastric pouch, type III was due to an obstructing marginal ulcer, and type IV had a pouchlike deformity develop in the upper jejunum at the anastomosis that gradually compressed the outflow tract. No patient had stenosis of the anastomosis. The upper gastrointestinal (GI) series plus nuclear studies of the liquid and solid phase gastric emptying provided evidence of the presence and degree of delayed gastric emptying but not the site or cause of the obstruction. Upper GI endoscopy provided precise evidence of the site of the partial obstruction, its anatomic nature, and the presence of a bezoar or marginal ulcer. Of the 42 patients, 4 had surgical correction, and in 6 patients the obstruction was relieved by endoscopic manipulation; all patients have been relieved of their symptoms. Partial obstruction was the only cause of delayed gastric emptying in this series, and contrary to recent reports, no patient required a total or near total gastrectomy.

Adult↗
PubMed1991

The impact of colonoscopy on colorectal carcinoma.

In an eight-year, ongoing study of 120 patients, 39 with carcinomas and 81 with adenomas, no patient has produced a new carcinoma despite a high incidence of metachronous adenomas. Colonoscopy can identify early carcinomas that can be resected for cure. In addition, colonoscopy can identify the adenomatous polyps and with polypectectomy prevent the progression to carcinoma. Colonoscopy is more accurate than air contrast barium enema, provides a tissue diagnosis, and allows polypectomy. When applied according to risk factors known to be cost effective, colonoscopy leads to earlier diagnosis and thus improved long-term survival.

Adenocarcinoma↗
PubMed1989

A second look at the neostigmine morphine test.

In a prospective five-year study of 65 consecutive patients with upper abdominal pain the Neostigmine Morphine Test (NMT) was applied as a screen for biliary, ampullary, and pancreatic disease. Three facts emerged from this study: 1) the amylase and lipase were overly sensitive, but not specific and had only a 10 per cent predictive value for ampullary obstruction; 2) the bilirubin, alkaline phosphatase, and serum glutamic oxaloacetic transaminase (SGOT) were positive in patients with ampullary obstruction if they were postcholecystectomy but not so in patients with an intact gallbladder, which may be explained by the third observation; 3) the gallbladder can compensate for partial ampullary obstruction by dilatation five to ten times and by its ability to absorb 90 per cent of the water content of the bile. The Neostigmine Morphine Test is not a reliable screen for ampullary obstruction and positive findings must be confirmed by other studies.

Alkaline Phosphatase↗
PubMed1988

The management of complications of Foley feeding gastrostomies.

The recent modification of the Ponsky technique of percutaneous endoscopic gastrostomy places a Foley catheter in the stomach instead of a mushroom catheter. Experience with four patients with long term Foley feeding gastrostomies revealed two types of complications that occurred 23 times, a) the rupture of the balloon fourteen times allowing the catheter to slip out and b) distal migration of the balloon causing intestinal obstruction nine times. Since long term feeding gastrostomies using a Foley catheter will continue to be used and probably increase with the recent modifications of the PEG it is essential that physicians and emergency room personnel be informed of those two complications. If and when either rupture of the balloon or distal migration occur, the Foley should be replaced with a mushroom catheter. Once the gastrocutaneous fistula is mature, usually after 2 weeks, it is safe to insert a mushroom catheter, which is not subject to those complications.

Adult↗
PubMed1987

Immediate endoscopic placement of long intestinal tube in partial obstruction of the small intestine.

A technique that allows for endoscopic placement of a long intestinal tube with an inflatable balloon well beyond the pylorus is described. This procedure has been successful in 24 patients; is well tolerated; removes air and fluid from the stomach, duodenum and upper part of the jejunum, and can be performed in less than 45 minutes. It uses equipment that is standard in all hospitals and can be performed by anyone experienced in performing endoscopy of the upper part of the gastrointestinal tract. It is safe, easy to perform and improves the efficacy of long tube decompression and, therefore, can be recommended in properly selected patients, with partial obstruction of the small intestine.

Endoscopy↗
PubMed1985

Endoscopic decompression in partial small bowel obstruction.

Upper gastrointestinal endoscopy has been applied successfully in the management of patients with small bowel obstruction. In one group of patients after gastrectomy with a Roux-Y limb obstructed at the level of the transverse mesocolon, the endoscope was manipulated into this segment, and the tip was deflected in four directions with release of the kink. Conventional wisdom depends heavily on the interpretation of the upper gastrointestinal series, which in all five patients in this report proved to be incorrect. It was only through the endoscopic examination that the anastomoses were found to be patent, and the kinked segment of jejunum, once identified, could be released by endoscopic manipulation. Two patients required repeat endoscopy, and at last follow-up, all patients were eating well with no recurrence of symptoms. In the second group of patients with distal small bowel obstruction who normally would be considered for Miller-Abbott tube management, it was possible to decompress the stomach, duodenum, and upper jejunum endoscopically with immediate clinical and radiographic improvement. In addition, it was also possible to place the Miller-Abbott tube into the small bowel at the same time and thus avoid the 2 to 3 days of delay in advancing the tube beyond the pylorus. All patients had improvement and there were no complications. Although two required laparotomy several weeks later, they too were improved by the endoscopic procedures. The immediate decompression and rapid intubation represent significant advances in the management of patients with small bowel obstruction.

Aged↗
PubMed1985

Spontaneous enterogastric reflux gastritis and esophagitis.

Enterogastric reflux gastritis and esophagitis is best known after gastric resections and pyloroplasty but it also occurs spontaneously in the nonoperated patient. Forty-two patients are presented who meet the criteria for the diagnosis: constant burning epigastric pain, worse after meals, unrelieved by antacids and diet; endoscopic demonstration of a gastric bile pool; endoscopic biopsy proof of gastritis and esophagitis; and hypochlorhydria. Patients with mild and moderate stages of the disease can benefit from metoclopramide therapy which improves the gastric emptying mechanism. Of the surgical patients with intractable symptoms, 90% were women, 90% had marked hypochlorhydria, 83% had biliary disease, current or remote, and 50% had anemia. With vagotomy, antrectomy, and Roux-Y anastomosis 45-60 cm downstream, the clinical response has been most encouraging.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1984

Endoscopic retrograde cholangiopancreatography in the diagnosis of cystic duct syndrome.

The use of ERCP to identify cystic duct syndrome is reported for the first time herein. Nine patients with obscure biliary colic were further investigated with fat meal or CCK, cholecystogram or ERCP, or both, to identify the partial obstruction in the cystic duct. Cholecystectomy is curative in this disease. Because about one-third of the patients with disease of the gastrointestinal or biliary tracts or pancreas have two of these diseases simultaneously, it is essential that a thorough evaluation both preoperatively and at operation be performed so that a single well designed operation can be performed. ERCP has been helpful in defining the nature and extent of this disease.

Adult↗
PubMedDate not supplied

A new method of recording endoscopic and operative findings in colorectal neoplasia.

A new method of recording 12 relevant facts concerning patients with colorectal neoplasia has provided a neoplastic profile for each patient. With this information recorded on an outline of the colon one can see at a glance the date, histology, and location of the initial lesion; the number and timing of both synchronous and metachronous lesions and their histology; the size, differentiation, and location of each lesion; plus a family tree. This method provides pertinent clinical facts in chronological order and characterizes each patient's neoplastic activity without the need to refer to operative notes and laboratory reports. With this method, it is easy to record and easy to interpret, and it has been extremely useful in the clinical assessment of patients with colorectal neoplasia and in arranging appropriate surveillance for these patients.

Aged↗