Biomedical subjects
Publications and source records attributed to H Griffith.
The presence of heterotopic gastric mucosa in the upper oesophagus has been reported to occur in up to 10 per cent of individuals but it is usually asymptomatic. We present two patients with symptomatic oesophageal heterotopic gastric mucosa and discuss the aetiology, pathogenesis, and management of the condition.
The clinical problem of unrelieved pain has received much attention over the previous decade with a major focus on cancer pain and acute postoperative pain. Organizations such as the World Health Organization (WHO), the National Cancer Institute, the American Pain Society (APS), and others have addressed the previously neglected areas of pain assessment, pharmacologic treatment, and the knowledge and attitudes of health-care providers. Health-policy issues related to pain, including areas of cost, access to care, regulatory perspectives, and ethical and legal issues, have likewise been neglected. To explore the costs associated with pain, the following framework has been developed through the Agency for Health Care Policy and Research (AHCPR) pain panel. This 13-point framework is an attempt to isolate specific cost issues, identify what is known in these areas, and address implications for future research. A brief synopsis of these 13 areas of cost analysis is provided including comments regarding work in progress by the panel and directions for future health-policy research related to pain management.
Microdiscectomy for lumbar disc prolapse on a day-patient basis was introduced by our department in 1985 and first reported in 1987, but has not been generally adopted in the United Kingdom. We now report our experience of the first 100 patients with lumbar disc prolapse treated by day-case microdiscectomy. Post-operative assessment was in the out-patient clinic and by subsequent postal questionnaire (average follow-up 37 months, range 3-64 months). Complications were few and are described. Only three patients developed a recurrent disc prolapse. Patient feedback was favourable and the majority (85%) said that, if necessary, they would be prepared to have the operation again on a day-case basis. For selected patients, lumbar microdiscectomy is a suitable procedure for day-case surgery.
Chronic lymphocytic leukemia (CLL) is a disorder with multiple defects leading to an increased susceptibility to infection. Hypogammaglobulinemia is present in about 20% to 70% of patients with CLL. Intravenous immunoglobulin (IVIG) supplementation (400 mg/kg body weight every 3 weeks) prevented bacterial infections in these patients. An ongoing study is being conducted to compare doses of 250 mg/kg/mo with those of 500 mg/kg/mo in 36 patients included so far. As of this writing, the rate of infection in the two treatment groups was not significantly different, and no substantial loss of protection against bacterial infection was found in the lower-dose group. It seems likely that the lower dose is almost as effective as the standard therapy. If this is so, cost savings would be substantial.
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A selected series of 14 patients with lumbar disc prolapse causing sciatica have been operated successfully with outpatient (daycase) surgery. Postoperative pain has been much less than expected. This form of surgery has proved very acceptable to patients and to their family doctors.
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