Highly selective vagotomy and digital dilatation for stenosing duodenal ulcer - abstract

Twenty-eight patients (24 males and 4 females) with pyloroduodenal obstruction due to chronic duodenal ulcer had highly selective vagotomy (HSV) alone (6/28) or HSV and digital dilatation (DD) of stenosis (22/28), 1 to 4 years previously. Their ages ranged from 19 to 61 years, with a mean of 42 years. There was no post-operative death. One patient had perforation of the duodenum during dilatation. The only patient with Hb SS disease, a male aged 49, died from haemorrhage and perforation of recurrent ulcer 1 year after surgery. Two other males had easily controllable recurrent duodenal ulcers, but no stenosis. Another male died of unrelated cause after two symptom-free years. Six males were re-operated on for symptoms of gastric stasis. Only 3 of these were found to have complete fibrous stenosis for which gastro-enterostomy was done. The other three had adequate pyloroduodenal lumen. Patients with inflammatory stenosis do well after HSV and DD, but this combined procedure should be avoided in fibrous tissue stenosis (AU)

A clinical trial of Hyoscine-N-Butylbromide in labour

Buscopan was administered to 62 primigravidae in labour and its effects were compared with those in a control group receiving Pethidine. There was a significant acceleration of labour in the group receiving Buscopan, but this drug was not useful in relieving labour pains (AU)

The conjunctival sign in sickle cell anaemia: a relationship with irreversibly sickled cells

Patients with sickle cell disease were divided into 5 groups according to the extent of abnormal vessels in the conjunctival vasculature. There was a significant relationship between the degree of abnormality and the number of irreversibly sickled cells, suggesting that these cells must be related to the genesis of these vessel anomalies. Evidence is accumulating that irreversibly sickled cells are related to several pathological processes in sickle cell anaemia, and we believe the sign may be useful not only in suggesting the diagnosis but also in gauging the severity of the condition (AU)

The use of the Gibbon catheter and the Walsh catheter in genito-urinary surgery

The Gibbon catheter and the Walsh catheter have been described and their advantages over other catheters shown. The Walsh catheter is particularly useful after prostatectomy for it drains the bladder without infection or clot retention. The Gibbon catheter has largely removed the necessity of emergency prostatectomy. It is also very useful in cases of urethral fistula. A simple procedure such as dilatation of the urethra and passage of a Gibbon catheter often causes the fistula to close. This catheter is also of use in the treatment of urethral stricture and, as a temporary measure, in the treatment of retention of urine caused by carcinoma of the prostate(AU)

Rectal lymphogranuloma venereum in Jamaica

Lymphogranuloma venereum is a major public health problem in Jamaica. With improvement in the standard of living, better housing, better general education, a healthier sex education, and a more active programme of venereal disease control, the incidence of rectal lymphogranuloma should diminish. The early diagnosis and treatment of the proctocolitis by drugs is effective and should reduce the incidence of stricture. Major operations should be reserved for cases in which the more conservative methods of treatment are unlikely to succeed or have failed. At present, in Jamaica, operation necessitating a permanent colostomy should be considered more carefully than in this country. Unfortunately our attempts to eradicate the disease by operation and leave the patient with a functioning anus have been attended with only very limited success. Some of the failures may be attributed to insufficent experience with these operations, but involvement of the sphincter in the dense fibrotic process is probably responsible for the majority. In these fibrotic sphincters functional control is impossible. In a small number of cases intra-sphincter proctectomy in one stage by the method described by Dimitrui and Gregoresco (1933) has given promising results where the sphincter is free. The disease appears to be self-limiting. There has been no evidence of reactivation after removal of the affected gut even though this is rarely a complete en bloc excision or indeed even after colostomy only. Our follow up has been short. I have deliberately avoided the term "cure" because rarely has the compliment fixation reaction been reversed to negative. The significance of a persistently positive serological reaction in the absence of clinical evidence of disease is yet to be assessed. We have come a long way since John Hunter described the bubo 175 years ago and Frei placed the study of the disease on a firm aetiological basis 140 years later. In the past 35 years our knowledge of the lympho-granuloma venereum virus has increased, but the problem of treatment of rectal stricture, the most disabling complication of the disease, awaits solution. Morte (1933) stated: "The study of the stricture of the rectum is as fascinating as the treatment is discouraging. " In 1960 we can say: "Treatment of rectal stricture is often disappointing, but the results are encouraging" (Summary)

Urethral stricture and its complications

The pathology and treatment of severe urethral stricture in 66 patients treated in the University College Hospital of the West Indies have been described. Excisional surgery has been followed by: immediate end-to-end anastomosis of the urethra, reconstruction of the urethra as a second stage, permanent diversion of the urine by perineal urethrostomy when possible. Although this type of surgery is time-consuming it provides great relief to the patient and even greater relief to the attending surgeon (AU)