摘要:

AbstractAlthough sympathetic innervation of the extremities has been studied voluminously, the clinical efficacy of sympathectomy remains controversial. This review will be limited to a consideration of the appropriate role of lumbar sympathectomy for primary treatment of intermittent claudication and skin ischaemia manifested by rest pain or superficial tissue loss.

ISSN:0007-1323    

DOI:10.1002/bjs.1800691312

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800691313

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractProsthetic graft occlusion is most frequent in the early postoperative period when the luminal surface is highly thrombogenic. It is generally believed that graft maturation ultimately results in a non‐thrombogenic surface. The accumulation of 111‐indium‐labelled autologous platelets in Dacron aortofemoral grafts has been measured 1 week following surgery and at intervals of 6 months to 1 year.Platelets from 9 patients were labelled with 111‐indium oxine and re‐injected. Isotope emissions over the graft and a reference site (aortic arch) were measured daily for 8 days and gamma camera images taken on alternate days. Graft thrombogenicity was calculated as the daily rise in the graft: reference ratio of emissions.All grafts, regardless of age, accumulated platelets and were imaged by gamma camera. Mean thrombogenicity (± s.e.mean) 1 week after surgery was 0·21 ± 0·04 compared with 0·08 ± 0·03 at follow‐up (P<0·01). The platelet survival during the early study was reduced at 6·8 ± 0·6 days but recovered to a value of 8·6 ± 0·8 days (P<0·01) at follow‐up. Further grafts, 2, 5 and 9 years old, were studied and all accumulated platelets, especially near the anastomoses.Platelet accumulation on Dacron grafts does diminish with time but persists beyond the period of altered platelet survi

ISSN:0007-1323    

DOI:10.1002/bjs.1800691314

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractStudies evaluating the static and dynamic characteristics of the common carotid bifurcation are described. Slow motion angiographic frames, real time B‐mode images and time position M‐mode tracings have demonstrated appreciable vessel wall motion with an increase in distensibility at the carotid bulb compared to the proximal common carotid artery. Histopathological studies suggest that changes in the carotid artery elastin and collagen structure may contribute to the increased distensibility at the carotid bulb. The presence or absence of a cervical bruit did not correlate with the ultrasonic demonstration of plaque or blood flow turbulence. Mechanical factors relating to the development of symptoms of cerebral ischaemia are discus

ISSN:0007-1323    

DOI:10.1002/bjs.1800691315

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe English literature on extrathoracic procedures for aortic arch syndrome spanning the 19‐year period 1962–1980 has been reviewed. Fifty publications reporting on 787 operations were selected for analysis. The overall results were excellent in terms of safety and long term symptomatic relief. Unilateral carotid‐based operations appear preferable to longer crossover bypasses in the majority of patients. It is suggested that transthoracic reconstruction remain the approach of choice for innominate artery disease and multiple bilateral arch branch occlusions in good‐risk p

ISSN:0007-1323    

DOI:10.1002/bjs.1800691316

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractIntestinal ischaemia with ensuing gangrene has been a serious clinical problem. Delay in diagnosis has inevitably led to either massive gut resection or death.It has been shown that the bowel contains high concentrations of both organic and inorganic phosphate. With gut ischaemia, phosphate is released from the bowel and elevated concentrations may be measured in peripheral blood, peritoneal fluid and urine. Associated leucocytosis and acidosis constitute a diagnostic laboratory triad.The alteration in gut phosphate metabolism has been studied extensively in dogs and humans. Under hypoxic conditions, a time period exists before irretrievable gut necrosis ensues. During this vital interval serum phosphate is elevated.In 20 clinical cases an accurate diagnosis of bowel ischaemia was made utilizing phosphate measurements. Three cases had an early diagnosis which led to embolectomy with no loss of gut.Elevated serum phosphate is an accurate diagnostic finding in early cases of massive gut ischaemia. It is hoped that this simple test may help lower the staggering mortality and morbidity associated with massive intestinal ischaemia.

ISSN:0007-1323    

DOI:10.1002/bjs.1800691317

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractEight thousand and one patients were admitted to a prospective, randomized multicentre trial comparing the prophylactic efficacy of heparin‐dihydroergotamine (DHE) and Dextran 70 against fatal pulmonary embolism after emergency or elective orthopaedic surgery. Of the 7413 patients correctly admitted to the trial, 3698 were allocated to receive heparin‐DHE and 3715 to receive Dextran 70. Twenty‐eight patients in the heparin‐DHE and 27 in the dextran group died within 40 days of operation. Necropsy was performed in 19 cases in each group. In 6 patients in the heparin‐DHE and in 9 in the dextran group pulmonary embolism was the sole or a contributory cause of death (n.s.). In the dextran group there were more diffuse intraoperative bleeding complications (P<0·01), more massive postoperative haemorrhages (P<0·01), more small wound haematomas (P<0·05) and more allergic reactions (P<0·05). This is the first large multicentre trial dealing with elective and emergency procedures in orthopa

ISSN:0007-1323    

DOI:10.1002/bjs.1800691318

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe post‐phlebitic syndrome which succeeds deep vein thrombophlebitis may be treated by various surgical interventions. Removal of incompetent perforating veins and excision of any concomitant skin ulcer with grafting is a usual course of therapy. However, if the skin ulceration and symptoms are actually due to deep venous incompetence then a more direct approach should be attempted.Numerous procedures have been advocated, such as valvoplasty, homologous vein transplant, synthetic valve procedures and autogenous vein valve transplant.It has been demonstrated that autogenous vein valve transplant yields a satisfactory haemodynamically stable result with high valve competency rates.The authors have operated on 10 patients utilizing an autogenous vein valve with good results. Pre‐ and postoperative data including ascending and descending venography indicate that valvular competence is restored and ulcers h

ISSN:0007-1323    

DOI:10.1002/bjs.1800691319

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThree hundred and thirteen patients exhibiting renal artery occlusive disease underwent operation for renovascular hypertension. These included 34 paediatric and 144 adult patients with fibrodysplastic disease. Atherosclerotic lesions affected an additional 64 patients without and 71 patients with clinically overt extrarenal arteriosclerotic cardiovascular disease. Ischaemic kidney renin hypersecretion (renal: systemic renin index>0·48), associated with suppressed contralateral kidney renin secretion (renal: systemic renin index approaching 0·0), predicted curability most reliably. Four hundred and fifteen operations were performed of which 356 were primary and 59 were secondary procedures. Aortorenal bypass using autogenous vein (227 cases) or prosthetic grafts (62 cases) was the most common primary operation. Nephrectomy was the initial therapy in 17 cases. Six operative deaths occurred in patients manifesting overt extrarenal arteriosclerotic disease. No operative mortality was encountered among the remaining 242 patients. Improvement was seen following operation in 97 per cent of paediatric patients and 94 per cent of adults with fibrodysplastic disease, in 91 per cent of patients with focal renal arteriosclerosis and in 72 per cent of those exhibiting overt extrarenal arteriosclerosi

ISSN:0007-1323    

DOI:10.1002/bjs.1800691320

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800691301

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY