The British journal of surgery
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Case Reports
Gastrointestinal bleeding, angiodysplasia of the colon and acquired von Willebrand's disease.
A 66-year-old man is reported who was found to have acquired von Willebrand's disease, which presented when the patient was 63 with iron deficiency anaemia and gastrointestinal bleeding. He subsequently bled from various sites in the gastrointestinal tract including an angiodysplasia of the right colon, which was successfully treated by right hemicolectomy. This is the second reported association between acquired von Willebrand's disease and angiodysplasia of the intestinal tract.
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One hundred and eight patients were admitted to King Edward VIII Hospital, Durban, with a penetrating wound of the neck and were managed by a conservative policy. Intervention was undertaken if, and only if, there was an indication of damage to deep structures. Data were collected prospectively. ⋯ Morbidity was higher after surgery, though local sepsis in wound haematomas was more common in those treated conservatively. A selective policy for surgical intervention is safe and justifiable. A minimum mortality and morbidity can be obtained by adequate preoperative evaluation which includes the use of contrast radiography and angiography.
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Simultaneous oesophageal manometry and pH monitoring was performed at rest and during abdominal compression in 189 subjects. The force exerted by the high pressure zone (HPZ) and by its intra-abdominal segment was reduced to the same extent in the 102 subjects who refluxed and the 87 who did not. ⋯ These results are more in keeping with a mechanical flutter valve theory of lower oesophageal competence than sphincteric reflux control. Furthermore, the results indicate that measurements of oesophageal pressure, length or force in the resting state do not account for reflux or gastrooesophageal competence, but that it is the reserve of pressure, length or force during stress which is responsible.
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The purpose of the study was to investigate the relationship between personality and ischaemic rest pain. Twenty-four patients wth peripheral vascular disease unsuitable for surgery and suffering from ischaemic rest pain were treated equally with 14 days of bed rest and intravenous naftidrofuryl and their pain analogue scores and personality structures were analysed. There was a general trend of improvement in their analogue pain scores and patients with high neuroticism (N) and extroversion (E) levels had a better response to treatment, but which only became significant on one occasion when both N and E levels were high. Levels of N and E were compared with those of the normal population both before and after treatment and were found to be similar even after amputation.