Stapled haemorrhoidectomy.
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Biomedical subjects
Publications and source records attributed to G J Oettlé.
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PURPOSE: This study was undertaken to compare local application of a glyceryl trinitrate ointment with lateral internal sphincterotomy for the treatment of chronic fissure-in-ano. PATIENTS AND METHODS: A sample of 24 consecutive patients with chronic anal fissure was randomly allocated to treatment with sphincterotomy or local glyceryl trinitrate. Patients were followed-up for a median of 22 months. RESULTS: All 12 patients healed following sphincterotomy; 10 of 12 healed with local glyceryl trinitrate (P = 0.239). There were no recurrences or side-effects in either group. CONCLUSIONS: Local application of glyceryl trinitrate can avoid surgery in more than 80 percent of patients with chronic anal fissure.
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Ten healthy volunteers (six men and four women, aged 22-41 years) were studied in a crossover trial. The study was divided into three one week periods. During each period the subjects either ran on a treadmill, cycled on a bicycle ergometer, or rested in a chair for 1 hour every day. The exercise was performed at two thirds predicted maximum heart rate (equivalent to 50% VO2 max). The sequences were rotated; no studies were performed in the perimenstrual period. Transit was measured by the method of measuring the excretion of a single dose of radio-opaque markers; all stools were collected, weighed, and x rayed after the ingestion of radio-opaque markers. Dietary fibre and fluid intake were measured on the fourth day of each test period by 24 hour record. Lifestyle was otherwise unchanged. Transit time was dramatically accelerated by moderate exercise (both jogging and cycling); however, stool weight, defecation frequency, dietary fibre intake, and fluid intake did not change significantly. Whole gut transit changed from 51.2 hours (95% confidence intervals 41.9 to 60.5) at rest to 36.6 hours (31.6 to 39.2) when riding and 34.0 hours (28.8 to 39.2) when jogging. Riding and running both differed significantly from resting (p less than 0.01); the difference between riding and running was not significant.
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To determine whether realistic snacks containing added sugar evoke excessive insulin responses, 10 healthy subjects consumed four different snack meals, similar in fat and total energy content. Two snacks were based on sugary, manufactured products (chocolate-coated candy bar; cola drink with crisps) and two on whole foods (raisins and peanuts; bananas and peanuts). After the processed-food snacks, plasma-glucose levels tended to rise higher and to fall lower than after the whole-food snacks. The area under the plasma insulin curve was 70% greater after the manufactured snacks than after the raisin-peanut snack. The banana-peanut snack evoked an intermediate insulin response. One subject had pathological insulinaemia after both manufactured snacks but normal responses after both whole-food snacks. These findings suggest that foods and drinks containing added fiber-depleted sugars stress and sometimes overwhelm homeostatic mechanisms but also suggest that the insulin response to food is influenced by the physical state of the food.
Four patients with the irritable bowel syndrome completed 28 day continuous stool collections and concurrent symptom diaries. The diaries revealed that three patients had multiple pains. When the diaries were compared with objective measurements, no relationship could be detected between the occurrence of pain or any other symptom on the one hand and stool weight, stool form or consistency, mean whole gut transit time, or interdefecatory transit on the other. Patients' descriptions of urgency, looseness and frequency of defecation give little guide to intestinal events, at least using currently available techniques.
A previously unreported high incidence of endoscopically identifiable, diffuse, largely nonulcerative esophagitis, is described in a selected population of Southern African blacks at risk of cancer of the esophagus. This is comparable with findings in similar groups in Iran and China. The incidence of dysplasia and "early" cancer is still undefined in South Africa.
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Conventional radiographic and manometric criteria failed to distinguish 9 irritable bowel syndrome patients with the symptom of rectal dissatisfaction from 6 without it. Manometric values (including sphincter length, resting and squeeze pressures, and the rectoanal inhibitory reflex, as well as rectal compliance and maximum tolerable volume), radiographic indices (anorectal angle and level of pelvic floor at rest and on straining), and tests of anal and rectal sensitivity were all statistically indistinguishable. Conceivably, the symptom results from incomplete rectal emptying; it may also be an early warning of abnormal perineal descent. Only 4 of the 15 patients with irritable bowel syndrome in this study were able to expel a 50-ml balloon from the rectum in the left lateral position.
We report the causes of obstructive jaundice in 56 black South African patients. Chronic pancreatitis and malignant biliary obstruction occurred with equal frequency. These two conditions may be difficult to differentiate clinically and radiologically, and only operative pancreatic biopsy may be diagnostic. Choledocholithiasis caused jaundice in only 7.1% of the patients, reflecting the relatively low prevalence of gallstones in this population.
Despite a low daily dietary fiber intake, an urbanized black African population in southern Africa has a low incidence of those diseases associated with fiber deficiency. Stool weights, defecation frequencies, and transit times in this group are much closer to those of westernized whites than to rural blacks.
Duodenal ulcer is being observed with increasing frequency in the Black population of South Africa, this increase occurring pari passu with industrialization. It is noteworthy that the type of ulcer seen is the 'Western' type of duodenal ulcer, haemorrhage and perforation being the major complications. This picture contrasts with that of gastric outlet obstruction resulting from the 'stenosing' type of ulcer which occurs in rural, non-westernized areas of Africa. The specific characteristics of gastric ulcer in the Sowetan population are outlined, and it is emphasized that gastric ulcer is still uncommon among South African urban Blacks. Protective factors may account for the paucity of gastric ulcer in this group.