摘要:

AbstractVeins taken from patients undergoing surgery for varicose veins were compared with those obtained from patients undergoing other surgical procedures (‘normals’). Varicose veins had a lower breaking strength and breaking energy than normal veins. Elastic stiffness was less in normals (tan θ = 41 (24)) than in varicose veins (tan θ = 55 (18); P<0·01). There was no difference in viscoelastic behaviour between samples taken above, at, or below the valve leaflet insertion. In normals, perivalvular vein wall exhibited a 50 per cent lower breaking strength and elastic stiffness than vein from other sites. Collagen content was significantly higher in normal vein specimens in all sites examined (mean collagen content = 70 (21) μg/mg, versus 51 (20) μg/mg for varicose veins; P<0·001). We conclude that significant structural changes are seen in varicose veins. In normal veins, the perivalvular vein wall has distinct viscoelastic features when compared with vein wall from other sites. This difference was not found in veins which became

ISSN:0007-1323    

DOI:10.1002/bjs.1800760112

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractTwelve patients with a clinical diagnosis of possible vascular graft infection have been studied over the last 3 years. All patients had their leucocytes labelled with indium‐111 and γ‐camera imaging after 24 and 48h. Subsequent management was according to established surgical techniques. Eight patients proved to have vascular graft infection and indium uptake was seen along the length of the graft in six. Two patients with open wound infections and synthetic grafts had localized uptake only on leucocyte scanning. Four patients, all of whom had negative scans were not thought to have infected grafts after further investigation using digital subtraction angiography and computed tomography scanning. These patients have been followed up for a median period of 19 months (range 5–25 months) and have remained symptom free. Initial experience with111In‐labelled leucocyte scanning has been encouraging, both in diagnosis and in planning the management of patients with graft in

ISSN:0007-1323    

DOI:10.1002/bjs.1800760113

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractA study is described in which the normal toes of 50 patients with unilateral ingrowing toenails were compared with those of 50 healthy subjects matched for age and sex. Twenty‐one potential risk factors were compared between the groups. All measurements on patients were derived from unaffected toes in order to avoid anatomical distortion due to the disease process. Statistical analysis revealed significant differences between the groups for three anatomical measures, namely nail fold width (P<0·001), medial rotation (eversion) of the great toe (P<0·02) and nail thickness (P<0·03). Possible discriminating variables were assessed using linear discriminant function analysis and a mathematical equation was derived based on these three factors. This equation was found to possess a potentially high predictive value in that it correctly classified 86 per cent of the patients and 77 per cent of the controls. A further group of 62 unselected patients presenting with unilateral onychocryptosis and 35 unaffected controls were assessed for these three parameters. Of these, 80 per cent of controls and 85 per cent of patients could be classified correctly by the equation. It is thus proposed that, in the majority of subjects with onychocryptosis, a discrete anatomical predisposition exists and that the other factors act only as triggers in the development of the condition. This study provides a rationale for less traumatic surgical approaches to ingrown nail than nail avulsion, with or without nail bed ablation and may also provide a means of identifying high‐risk

ISSN:0007-1323    

DOI:10.1002/bjs.1800760114

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractIn a planned sequential policy for the emergency control of continued bleeding from oesophageal varices, oesophageal transection was performed after failure of conservative treatment, including injection sclerotherapy. In 15 patients who underwent emergency oesophageal transection, bleeding was controlled by operation in the majority (87 per cent), but 11 of the 15 patients died in hospital. Mortality in patients with poor liver function (Child's C) was 100 per cent, the majority of deaths resulting from hepatic and renal failure. The results of this study suggest that emergency oesophageal transection to control acute variceal haemorrhage is associated with a poor prognosis in patients with poor liver function and questions its role in a sequential emergency treatment policy.

ISSN:0007-1323    

DOI:10.1002/bjs.1800760115

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractWhen prophylactic antibiotics are used in abdominal surgery it is customary to give the first dose before the operation. Whilst intra‐operative antibiotics may be effective in elective surgery, there may be an advantage to starting pre‐operatively when there is already an infective focus such as appendicitis. Antibiotics started pre‐operatively (group P) have been compared with antibiotics started after initial abdominal exploration (group T). Three intravenous doses of 500 mg metronidazole plus 1 g cephazolin were given in a randomized, double‐blind study of 700 emergency and elective high‐risk abdominal operations. Antibiotic plasma concentrations at the end of the operation were significantly lower in group P but lay well within the therapeutic range. Wound infection rates, which included minor and delayed infections, were similar in both groups (group P, 57 of 342, 16·7 per cent; group T, 55 of 358, 15·4 per cent; 95 per cent confidence intervals for the difference being −4·1 to +6·7 per cent. In appendicitis, wound infection rates were 12·1 and 13·9 per cent for groups P and T respectively. However, non‐fatal deep sepsis was more common in group P (nine cases) than in group T (two cases) (χ2= 4·9, P<0·05). Postoperative infection was twice as common in obese patients whose body mass index (BMI) was ⩾ 26 (39 of 132, 30 per cent) than in thin patients whose BMI was<24 (41 of 288, 14 per cent; χ2= 13·8, P<0·001). This study failed to show any advantage to starting antibiotics pre‐oper

ISSN:0007-1323    

DOI:10.1002/bjs.1800760116

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractA prospective study was carried out in 12 consecutive patients (7 boys and 5 girls), to evaluate posterior sagittal anorectoplasty for patients incontinent of faeces after anorectal reconstruction. Examination revealed anatomical problems such as: recurrent fistula (two), massive urethral diverticulum (one), absent vagina (one), and a missed urogenital sinus (one). Preliminary electromyography showed the external sphincter to be displaced from the anus in nine patients. Posterior sagittal anorectoplasty, with correction of anatomical defects and precise reconstruction of bowel within the sphincters, was carried out after the formation of a loop colostomy. No postoperative complications were observed. Contrast studies confirmed healed suture lines before stoma closure. Follow‐up, between 4 and 46 months, revealed good faecal control in only two patients, with a significant improvement in two others. The rest remained incontinent although sensation was improved. These disappointing results, at variance with other published reports, lead us to conclude that posterior sagittal anorectoplasty, when used as a secondary procedure, is good for correcting anatomical defects but not for improving faecal continenc

ISSN:0007-1323    

DOI:10.1002/bjs.1800760117

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800760118

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractPaget's disease of the anus is a rare disorder of controversial origin and is frequently associated with malignancy. We studied eight patients and carried out immunohistochemical studies to determine whether particular functional profiles might be indicators of a malignant association. One patient presented with synchronous carcinoma and two developed carcinomas 3 and 10 years after excision of Paget's disease. Five patients underwent wide local excision and have not developed cancer (median follow‐up 6 years, range 5‐13 years). However, four patients developed recurrent Paget's disease. Immunohistochemical studies showed that in general Paget cells stained positively with CAM 5·2 (a cytokeratin marker), gross cystic disease fluid protein (a marker for apocrine cells), human milk fat globule glycoprotein (HMFG 1 and 2) and carcinoembryonic antigen but negatively for PR3A5 (a marker for colonic goblet cells). Three cases had a staining profile which was quite different from that usually observed and these were associated with malignancy. One showed an antigenic profile more typical of a large bowel carcinoma. Paget's disease of the anus appears to run one of two clinical courses: to develop malignancy; or to recur locally, often on repeated occasions. Wide local excision is the treatment of choice but long‐term follow‐up is necessary because of the cancer risk. An immunohistochemical staining pattern which is different from usual may indicate a higher malignant risk and/or identify some cases of Paget's disease as representing a downward ‘pagetoid’ extension from a anorectal adenocarcinoma rather than a true epidermotropic apocrine neoplasm of the p

ISSN:0007-1323    

DOI:10.1002/bjs.1800760119

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractPosterior abdominal rectopexy was performed in 12 patients with a full‐thickness rectal prolapse: 9 had faecal incontinence. The prolapse was successfully controlled in all cases and six of nine patients were rendered continent. Physiological studies in patients were compared with age‐ and sex‐matched controls. Preoperative anal pressures were significantly lower than in controls at rest (R), during maximum pelvic floor contraction (Sq) and attempted defaecation (St) (R, P<0·005; Sq, P<0·005; St, P<0·005). Anorectal angles were significantly more obtuse in patients than in controls (R, P<0·05; St, P<0·025). None of these parameters changed significantly after abdominal rectopexy. Median rectal emptying significantly decreased after operation (preoperative 83 per cent/min; postoperative, 58 per cent/min, P<0·05). Median perineal descent during attempted defaecation also significantly decreased after operation (preoperative, 8·5 cm; postoperative, 7·1 cm; P<0·025). Parameters which predicted return of continence included: delayed leakage during the saline infusion test (P<0·025), a narrow anorectal angle during pelvic floor contraction (P<0·025), minimal pelvic floor descent during contraction (P<0·05), and a long anal canal at rest (P<0·05) and during pelvic floor con

ISSN:0007-1323    

DOI:10.1002/bjs.1800760120

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractThe physiological variation in anal manometry using a perfused catheter with radiating sideholes was studied in 78 healthy volunteers. The maximum intraindividual variation in the length of the anal high pressure zone, resting pressure and squeeze pressure was 10 mm, 26 mmHg and 68 mmHg respectively. The median 95 per cent confidence interval for length of the pressure zone was 4 mm; for resting pressure it was 15 mmHg and for squeeze pressure it was 48 mmHg. Day‐to‐day variation did not exceed the intraindividual variation. Constant recording with the catheter fixed in the high pressure zone revealed slow waves and ultraslow waves with amplitudes of 6–24 mmHg which could account for most of the intraindividual variation. No sex difference was found in the length of the high pressure zone whereas resting pressure and squeeze pressure were higher in men than in women. Although a tendency towards a decrease in the length of the high pressure zone, resting pressure and squeeze pressure was observed with increasing age, no significant age‐related difference could be demon

ISSN:0007-1323    

DOI:10.1002/bjs.1800760121

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY