Thoracoscopic vagotomy: a new use for the laparoscope.
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Biomedical subjects
Publications and source records attributed to G T Sunderland.
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The results of colectomy for constipation based only on evidence of delayed colonic markers have been disappointing. The operation may fail because these patients are unable to evacuate the rectum owing to outlet obstruction. In the present study, we have used a combination of videoproctography and transit marker studies in an attempt to predict patients who will have a favorable outcome after colectomy by excluding patients with outlet obstruction. Videoproctography was performed in 228 patients referred for consideration of surgery for constipation. Only 111 (38 percent) had a normal proctogram with complete evacuation of liquid barium. Of these 111 patients, 21 (19 percent) had delayed colonic marker studies. Colectomy and ileorectal anastomosis were performed in 18 of these 21 patients; two years later, 16 were symptom free, with a median daily bowel frequency of four (range, two to six). The remaining two patients failed to respond to surgery. These data suggest that true idiopathic, slow-transit constipation is uncommon, but, when identified on the basis of delayed markers and the ability to expel liquid on proctography, an excellent result can be anticipated from colectomy and ileorectal anastomosis.
Nine patients with bleeding from a ruptured hepatocellular carcinoma had absolute alcohol injection. Laparotomy and alcohol injection stopped the bleeding in seven patients. Injection under laparoscopic visualization was attempted in two patients and in one patient haemostatis was achieved initially. He rebled, however, 4 h later and laparotomy failed to control the bleeding. He died 2 days later because of coagulopathy and renal failure. In the second patient, bleeding was not controlled laparoscopically and immediate laparotomy and alcohol injection stopped the bleeding. The eight patients who survived left hospital between 8 and 21 days after surgery (median 10 days). In our experience, laparotomy and alcohol injection achieved good results in bleeding hepatocellular carcinoma.
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Injection of contrast is a prerequisite for endoscopic retrograde cholangiopancreatography. Such injection into the biliary and pancreatic duct systems may require considerable force. This paper reports the changes in pressure that result within the duct systems and highlights the significant pressure rise that occurs within the pancreatic duct.
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This paper reviews the value of administration of cholecystokinin (CCK) in the assessment of patients thought to have acalculous biliary pain. The literature contains conflicting reports and there is no unequivocal evidence to support the use of CCK provocation tests as a basis for deciding the need for cholecystectomy.
Data base systems for microcomputers are generally available. Most are reasonable priced and easy to use. Their disadvantages are restrictions placed on the amount of data stored in a single field, and the output format--usually tabular or label in style. This article describes the use of word processor text files as a data base allowing search and retrieval, with special reference to abstracting and storage of literature citations. Size of text entry and ultimate output format are extremely flexible using this method.
The peripheral vasospastic symptoms associated with Raynaud's disease continue to be an unsolved clinical problem. Hexopal (Hexanicotinate inositol) has shown promise in uncontrolled studies and its use in patients with Raynaud's disease may reduce such vasospasm. This study examines the effects of 4 g/day of Hexopal or placebo, during cold weather, in 23 patients with primary Raynaud's disease. The Hexopal group felt subjectively better and had demonstrably shorter and fewer attacks of vasospasm during the trial period. Serum biochemistry and rheology was not significantly different between the two groups. Although the mechanism of action remains unclear Hexopal is safe and is effective in reducing the vasospasm of primary Raynaud's disease during the winter months.
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Blood transfusion has been reported adversely to affect survival following surgery for a number of malignancies. We have examined retrospectively the records of 126 patients undergoing nephrectomy for renal carcinoma and established that 80 (63%) were transfused. Comparison of the two groups of patients, after controlling for differences in age, sex, tumour stage and haemoglobin level, showed that the transfused patients did not necessarily have poorer survival. In this study, peri-operative transfusion did not appear to have an adverse effect on long-term survival following surgery for renal cancer.
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