Browsing by Author "Shuttleworth, R. D."
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- ItemThe bleeding gastric ulcer - will it bleed again, and if so, why(Health & Medical Publishing Group, 1984-07) Shuttleworth, R. D.; Falck, V. G.Nine patients qualified for surgery for a bleeding gastric ulcer - all had a 'visible vessel'. Three of these vessels were thrombosed including 2 in patients who had been in shock. The smallest patent vessel was 0,35 mm in diameter, and 6 of the bleeding vessels were subserosal. The features thought to predispose to further bleeding were vessel size, a lateral hole in the main trunk of the vessel and, possibly, previous recanalization or ingestion of a drug which affected haemostasis. Five of 6 patent arteries had a cap of thrombus over the breach forming a false aneurysm. It is suggested that clinically these should pulsate, enlarge, leak - with persistent fresh thrombus in the ulcer crater on repeat endoscopy - and finally rupture. Where the underlying vessel is thrombosed the stigmata of a non-pulsatile 'visible vessel' or thrombus in the ulcer should disappear on repeat endoscopy. The sizes of the arteries in the normal antrum are tabulated.
- ItemDuodenal erosion with bleeding from a non-functioning islet cell tumour. A case report(Health & Medical Publishing Group, 1988-05) Shuttleworth, R. D.A patient with a clinically non-functioning pancreatic islet cell tumour in the medial wall of the duodenum with erosion of the overlying mucosa presented with gastro-intestinal bleeding. At gastroduodenoscopy, the tumour with its apical ulcer was thought to be a leiomyoma. The lesion was excised locally and two other non-functioning APUDomas were shelled out of the body and tail of the pancreas.
- ItemSubclavian vein stenosis and axillary vein effort thrombosis: Age and the first rib bypass collateral, thrombolytic therapy and first rib resection(Health & Medical Publishing Group, 1987-05) Shuttleworth, R. D.; Van der Merwe, D. M.; Mitchell, W. L.ENGLISH ABSTRACT: Three patients presented with axillary vein 'effort thrombosis'. Intravenous streptokinase for 3 days followed by heparin for 10 days restored patency and relieved symptoms. Pretreatment diagnosis and the effect of streptokinase were confirmed venographically and an abnormality in the subclavian vein just medial to the first rib was demonstrated. This stenosis was most severe and had a prominent bypass collateral in the oldest patient. It is proposed that, in the absence of superimposed thrombosis, the damage to the vein in predisposed patients is progressive with age, with establishment of permanent collaterals. Transaxillary first rib resection is advised to prevent compression of the veins in the thoracic outlet.