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Biomedical subjects

G J Blatchford

Publications and source records attributed to G J Blatchford.

9 recordsLinked to original sources
PubMed1992

Rare pelvic floor hernias. Report of a case and review of the literature.

The case of a 64-year-old female who presented with difficult evacuation of stool is reported. A posterior perineal hernia was diagnosed by dynamic proctography. The patient had an unusual herniation of the upper rectum through the perineal defect. At surgery, there was no peritoneal sac, since the herniation occurred extraperitoneally. The patient was treated with repair of the pelvic floor using Marlex mesh and rectopexy. Pelvic floor hernias are rare and often difficult to diagnose. The three types, in order of decreasing frequency, are obturator, perineal, and sciatic. The etiology, diagnosis, and treatment of each is discussed.

Buttocks↗
PubMed1992

"House" advancement pedicle flap for anal stenosis.

Long strictures of the anal canal, extending from the dentate line to the perianal skin, have challenged surgeons for many years. Numerous techniques have been devised to treat anal strictures. A technique to relieve an anal stenosis that involves the entire circumference and the length of the anal canal from the dentate line onto the perianal skin is described. It has two principal advantages: 1) it provides a broad skin flap for the entire length of the involved anal canal; and 2) it provides primary closure of the donor site. In addition, it avoids extensive mobilization of tissue, the flap maintains good blood supply with minimal tension, and there is no small tip prone to necrosis.

Anal Canal↗
PubMed1992

Normal variation in anorectal manometry.

A study was performed to define the normal range of values for anorectal manometry. Normal volunteers were divided according to gender and parity. There were 20 males, 21 nulliparous females, and 18 multiparous females among the 59 subjects. Anorectal manometry using a radial eight-port catheter was performed during resting and squeezing maneuvers of the anal sphincter. Computerized data analysis and three-dimensional imaging were used to calculate sphincter length at rest and squeeze, mean maximum resting and squeeze pressures, and vector symmetry index. The sphincter length at rest and with squeezing in males was significantly greater compared with the two female groups (P < 0.007). Mean maximum squeeze pressures were also significantly elevated in the male group compared with the female groups (P = 0). Mean maximum resting pressures were significantly higher in nulliparous women than in multiparous women (P = 0.04). However, no difference in resting pressures was found between males and nulliparous females. A comparison of the symmetry of the anal canal revealed no differences among the three groups. Ranges for normal anorectal manometry are definable. Normal ranges are distinct for subgroups of patients, particularly with regard to gender and parity. Patients must be compared with their normal subgroups to correctly identify manometric abnormalities.

Adult↗
PubMed1990

Manometric diagnosis of anal sphincter injuries.

A manometric technique of anal pressure vectography has been developed for the detection of anal sphincter injuries. Manometric symmetry of the anal sphincter can be visualized on the pressure vectorgram and quantified as a vector symmetry index. The mean vector symmetry index in asymptomatic women was 0.76, compared with 0.33 in incontinent women with a known sphincter injury (p = 0.0001). Among women who were incontinent without having a recognized sphincter injury, nearly half of those who had a previous episiotomy had subnormal (less than 0.60) vector symmetry indices (p = 0.0003). The values were in the same range as those from known injuries, suggesting the presence of an occult sphincter injury. In contrast, normal symmetry indices were found in all those who had never had an episiotomy or who presented with outlet constipation. We conclude that the vector symmetry index can expose occult anal sphincter injuries and may have a role in the selection of patients for sphincter repair.

Adolescent↗
PubMed1990

Seat belts: personal choice or necessity?

The use of occupant restrains in motor vehicles has become an issue which has received increasing legislative attention in recent years. This has occurred due to the supposition that seat belt use would be effective in preventing automobile related fatalities and injuries. Twenty-five states and the District of Columbia now have mandatory safety belt laws in effect which have increased usage rates from 20% or less prior to enactment of the law to between 50% and 70% after implementation. Safety belts have proven effective in minimizing morbidity and mortality. In a study of four states enforcing mandatory usage and neighboring states without seat belt laws as a comparison, between 250 and 350 fatalities were prevented. This extrapolates to an estimated 12,000-15,000 lives saved nationally if restraints were mandatory. Nebraska is one of two states in which a seat belt law has been enacted and subsequently repealed. As a result of the repeal, seat belt usage dropped from 40% in 1986 to 29% in 1987 with an associated increase in injuries. The economic impact associated with this increase in accident related injuries is enormous. The Nebraska repeal campaign was based on the issue of individual rights versus mandatory safety requirements. As health care providers we need to examine the validity of personal rights in comparison to the documented impact of personal restraints on the morbidity and mortality of accident victims.

Accidents, Traffic↗
PubMed1989

Rectopexy without resection for rectal prolapse.

Forty-three patients underwent simple posterior suture rectopexy for repair of rectal prolapse. Follow-up was obtained in 42 patients (mean 28 months). The recurrence rate was 2 percent (one patient). Postoperative morbidity and mortality were 20 percent and 0, respectively. The proportion of continent patients increased from 36 percent preoperatively to 74 percent postoperatively. Constipation increased after suture rectopexy but was managed conservatively. We believe that simple suture rectopexy offers a safe and effective alternative to other, more complex procedures for the treatment of rectal prolapse.

Aged↗
PubMed1989

Should intestinal continuity be restored after massive intestinal resection?

We reviewed our experience with 32 patients who underwent massive intestinal resection to determine when intestinal continuity should be maintained. An enterostomy was created in 21 patients (66 percent) at the initial resection because of questionable bowel viability and an unstable condition or the need for colonic anastomosis. Intestinal continuity was restored in only 20 percent of these patients. In 11 patients (34 percent), intestinal continuity was maintained at the time of resection. Only four of these patients (36 percent) had a satisfactory long-term outcome. Overall, intestinal continuity was maintained in 10 of the 22 patients (45 percent) followed over the long-term. Three quarters of patients with intestinal remnants shorter than 3 feet had an enterostomy. We believe intestinal continuity should be restored at the time of massive resection only in carefully selected patients when bowel viability is ensured, remnant length is greater than 3 feet, and a colonic anastomosis is not required. Maintaining intestinal continuity eliminates the inconvenience of the stoma but may cause dietary restriction and perianal discomfort.

Adolescent↗
PubMed1989

Rectal prolapse: rational therapy without foreign material.

A number of operations are available for the correction of rectal prolapse. Rational judgement is required for the selection of the most appropriate procedure for each patient. Perineal rectosigmoidectomy offers a reasonable alternative to an abdominal procedure in patients who are elderly and debilitated. Simple suture rectopexy is our procedure of choice for an abdominal prolapse repair. We believe that simple rectopexy offers comparable results with less risk than procedures utilizing resection or foreign material. Colon resection should be reserved for those patients who require surveillance for colon polyps or have a history of diverticulitis.

Adult↗