Browsing by Author "Keet, A. D."
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- ItemThe anatomical extent of the pyloric sphincteric cylinder, the pyloric mucosal zone and the pyloric antrum(Health & Medical Publishing Group, 1982-8) Keet, A. D.The anatomy of the pyloric sphincteric cylinder is discussed. The pyloric ring is not a separate anatomical structure, but is an inherent part of the cylinder. Contraction of the cylinder narrows the diameter of the pyloric ring, and thus of the pyloric aperture. The extent of the sphincteric cylinder is determined on radiographs. It is seen to be 3-5 cm in length when fully contracted. Anatomical features of the pyloric mucosal zone are reviewed. On the aboral side both the cylinder and the mucosal zone end at the ring. The entire cylinder is lined by pyloric mucosa, but the mucosal zone extends orally beyond the confines of the cylinder. In gastric ulcer it may extend much further up the stomach. In contrast to the cylinder, the greatest length of the mucosal zone is on the lesser curvature. The sphincteric cylinder and the pyloric mucosal zone are clearly defined anatomically. The term 'pyloric antrum', in contrast, has been used in many different senses.
- ItemThe anatomy and movements of the pyloric sphincteric cylinder(1982) Keet, A. D.; Heydenrych, J. J.Disagreement about various aspects of the structure and function of the pylorus persists. Morbid anatomical, living anatomical, manometric and radiographic studies were done in an attempt to clarify some problems. It is shown that the pyloric ring (sphincteric ring) is not a separate anatomical structure, but that it constitutes the aboral end of the pyloric sphincteric cylinder, a muscular tube several centimeters in length. The ring does not function independently and conventional peristaltic waves do not proceed as far as the ring. Consequently the ring does not relax reciprocally with an oncoming peristaltic wave in the sense that a wave travels up to the ring, which relaxes upon its arrival. Each peristaltic wave stops on arrival at the oral end of the cylinder, simultaneously initiating a concentric or systolic contraction of the entire cylinder, including the ring. The cylinder, including the ring, is open at rest.
- ItemDubbele pilorus en piloroduodenale fistels : twee gevalbeskrywings met bespreking(Health & Medical Publishing Group, 1984) Keet, A. D.; Bezuidenhout, D. J. J.Congenital double pylorus is extremely rare; only 2 cases have been found in the English and French literature. Acquired double pylorus occurs more often; up to 1982, 66 cases had been reported. During 6,810 consecutive barium meal examinations over a period of 2 years, we diagnosed the condition in 5 patients. Two came to operation, at which the diagnosis was confirmed. These 2 cases are described. Acquired double pylorus is in reality a short pyloroduodenal fistula situated next to the pylorus, usually on the lesser curvature side. In the majority of cases it results from a pyloric ulcer penetrating into the duodenum. In a minority of cases the primary lesion is a duodenal ulcer penetrating into the pyloric area. Cases initially present with peptic ulcer symptoms. With the formation of the fistula, symptoms may disappear. Some authorities consider this to indicate spontaneous cure of the ulcer, thus obviating the need for further medical or surgical treatment. In the present 2 cases there was no remission of symptoms. None of the cases has been associated with malignant disease. It is thought that the condition may be recognized more often in future.
- ItemGiant lower oesophageal ulcer in a Bushman baby : a case report(Health & Medical Publishing Group, 1983) Heydenrych, J. J.; Keet, A. D.The case of a giant, penetrating lower oesophageal ulcer in a 14-month-old Bushman baby is reported. This would probably be classified as a Barrett's ulcer. Histological examination showed that the ulcer developed in columnar epithelium and that there was normal stratified squamous oesophageal mucosa both proximally and distally to the ulcer, indicating that it had developed in an islet of ectopic gastric mucosa. The ulcer originally described by Barrett developed in a short oesophagus, into which gastric mucosa extended in a continuous sheet. Lower oesophageal ulcers should probably be divided into a primary type, of which the present case is an example, and a secondary type, in which there is direct extension of gastric mucosa into the oesophagus due to metaplasia of oesophageal mucosa secondary to reflux oesophagitis.
- ItemHerpesvirus hominis oesophagitis and oesophageal stricture(Health & Medical Publishing Group, 1980) Heydenrych, J. J.; Keet, A. D.; Mare, J. B.; Becker, W. B.The literature on herpetic involvement of the esophagus is reviewed and a case is described in which the presumptive clinical diagnosis of primary Herpesvirus hominis stomatitis and oesophagitis and subsequently esophageal strictures was made. The differential diagnosis of an esophageal lesion and its treatment are discussed.
- ItemA new, tubeless radiological test for duodenogastric reflux(Health & Medical Publishing Group, 1982) Keet, A. D.As a modification of the double-contrast barium meal, a tubeless radiological test for duodenogastric reflux, not involving the administration of any pharmacologically active substances, is described. The procedure minimizes the possible occurrence of artefacts. It allows for the examination of duodenogastric reflux in relation to both duodenal and pyloric motility. Previously much emphasis has been laid on the role of duodenal contraction waves, but the results show that the dynamic state of the pyloric sphincteric cylinder may be of greater importance, as reflux only occurred while this structure was relaxed or partially contracted. The test can be used on a routine basis in pathological conditions (such as gastric ulceration) and may help to clarify some of the controversial aspects of duodenogastric reflux. The findings in 14 normal controls and in 100 patients are described.
- ItemOesophago-antrostomy with and without pyloroplasty - Radiological and manometric findings in the chacma baboon(Health & Medical Publishing Group, 1983) Van Rensburg, L. C. J.; Keet, A. D.Oesophago-antrostomy with and without pyloroplasty, and with preservation of Latarjet's anterior nerve with an intact pylorus, was studied in chacma baboons. Radiological and manometric studies showed that pyloroplasty is unnecessary after oesophago-antrostomy with an incidental vagotomy and that pyloroplasty in fact interferes with the muscular rhythm of the pyloric sphincteric cylinder.
- ItemSpontaneous contained transmural oesophageal rupture clinically resembling intramural rupture : a case report(Health and Medical Publishing Group (HMPG), 1985-09) Keet, A. D.; Waters, G. A.; MacGregor, L. A.[No abstract available]