摘要:

AbstractEighty‐one patients who had had colectomy and ileorectal anastomosis for ulcerative colitis or Crohn's disease of the colon from 1 to 13 years previously were interviewed and examined by a surgeon with whom they had had no previous contact.Sixty‐four patients (79 per cent) had a satisfactory result. In 12 patients the operation had failed and an ileostomy had been established, and in a further 5 patients the result was considered unsatisfactory.Despite a high incidence of frequent loose stools and minor anorectal complications, most of the patients were satisfied with the result and would not contemplate the alternative of an ileostomy. No patient had developed rectal cancer.Provided that the rectum is examined regularly for pre‐malignant or malignant change, colectomy and ileorectal anastomosis offer a satisfactory alternative to proctocolectomy and ileostomy for many patients with ulcerative colitis or Crohn's di

ISSN:0007-1323    

DOI:10.1002/bjs.1800640202

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractThis paper presents the application of a classification of anal fistulas to an unselected consecutive series of 793 patients treated for this condition at St Mark's Hospital front 1968 to 1973 inclusive. The fistulas were divided into five categories on jheir anatomical relationships: superficial (16 per cent), intersphincteric (54 per cent), trans‐sphincteric (21 per cent), suprasphincteric (3 per cent) and extrasphincteric (3 per cent), with the remaining cases multiple or unclassified (3 per cent).There was good correlation between the categories and presentation, physical signs and treatment of the fistulas.Two hundred and forty‐nine patients had potentially difficult fistulas. Follow‐up of these patients revealed healing of almost all the fistulas, but the functional results were less satisfactory (incontinence of loose stool in 17 per cent and of flatus in 25 per cent, soiling in 31 per

ISSN:0007-1323    

DOI:10.1002/bjs.1800640203

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractThe activity of the internal anal sphincter in patients with fissure has been studied by measuring anal pressure and motility with a small balloon probe. The mean maximum anal pressure in 12 patients with fissure (116.8 ± 21.8, s.d., cm H2O) was significantly higher lhan that in 40 control subjects (85.0 ± 20.5 cm H2O; P<0.01). Ultra‐slow pressure waves were present in 80 per cent of the patients and in 5 per cent of the controls. Both the high pressure and ultra‐slow waves were due to abnormal activity of the internal sphincter. This could be corrected equally well by either dilatation or lateral subcutaneous sphincter

ISSN:0007-1323    

DOI:10.1002/bjs.1800640204

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractTwo cases of end‐to‐end and end‐to‐side jejuno‐ileal bypass for the treatment of obesity are reported in which both patients underwent reoperation 17 and 23 months later respectively. Macroscopic examination and measurements of length of the various segments of the small intestine have been performed twice in each patient: at the time of the bypass and at the second surgical procedure. In one patient a histological study of both the excluded and functioning small intestine was carried out at the time of each surgical procedure. The functioning intestine had increased in size while the excluded segment had become narrowed. The height of the villi had increased slightly in the functioning ileum and more so in the functioning jejunum compared with the preoperative measurements. In contrast, the height of the villi was moderately reduced in both the bypassed jejunal and Heal segments. These findings confirm the results of experimental studies i

ISSN:0007-1323    

DOI:10.1002/bjs.1800640205

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractA number of experimental studies have indicated that wound healing is adversely affected by hypoxia, and it has been suggested that healing can be improved by increasing inspired oxygen tensions. However, this hypothesis is based on observations on simulated wounds or tissue implants in experimental animals, and the clinical relevance of these observations is uncertain.The effects of oxygen therapy on the healing of skin wounds and colonic anastomoses were examined in rats. Sutured skin incisions and normal and ischaemic colonic anastomoses were studied in control animals breathing air and in test animals breatliing 50 per cent oxygen. Wound healing was assessed by measurements of wound breaking strength, colonic bursting wall tension and wound collagen after 7 days' treatment with oxygen.There was no significant difference in the measurements in skin wounds or colonic anastomoses in test and control animals, and there was a similar incidence of anastomotic dehiscence in the ischaemic colon of test animals and controls.Oxygen therapy had no apparent effect on wound healing in this study, and it was concluded that further studies are required to determine whether or not there is a rational basis for the clinical use of oxygen therapy to help wound healing.

ISSN:0007-1323    

DOI:10.1002/bjs.1800640206

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractThe clinical features of gas gangrene and related infection seen in 88 patients over a 10‐year period are described. It is suggested that clostridial infection could be simply classified as either ‘gas‐forming’ or ‘non‐gas‐forming’. The gas‐forming group represents the more severe form of infection. Non‐clostridial gas gangrene may present in a variety of forms. The anaerobic streptococcus was the organism most frequently responsible, but these cases were indistinguishable from clostridial infection on clinical grounds.The treatment of gas gangrene in this series of patients is reported. Emphasis is laid on the importance of adequate prophylaxis with penicillin in patients at risk. The value of antibiotics in established infection remains equivocal. The evidence supporting the value of hyperbaric oxygen therapy is assessed and an attempt made to quantify the response to this treatment. Benefit was apparent in only a proportion of patients. A favourable response indicated clostridial infection and guaranteed immediate survival. Extensive debridement or amputation is unnecessary in this group. No response following hyperbaric oxygen therapy indicated widespread mixed clostridial and non‐clostridial infection, or infection due to organisms other than clostridia. Urgent and extensive debridement and amputation remain the predominant m

ISSN:0007-1323    

DOI:10.1002/bjs.1800640207

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractEight of 12 patients referred to an ultrasound clinic were eventually found to have a liver abscess. All 8 abscesses were confirmed positively by ultrasonic examination. Using ultrasound, an amoebic abscess can be accurately located within the liver and the optimal site for needling suggested to the clinician. Ultrasound is an accurate, non‐invasive, diagnostic aid in this conditio

ISSN:0007-1323    

DOI:10.1002/bjs.1800640208

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractMechanical suturing procedures on the bowel, lung, bronchi and pulmonary vessels have been used on 264 occasions in 180 thoracic and abdominal operations. The instruments proved simple to use and produced reliable good quality closures, for the most part without manual reinforcement. There were 2 technical failures, one ending fatally, after colo‐colostomy. Two minor postoperative suture leaks were encountered in 122 operations on the alimentary tract, but no leakage or other problem has arisen in 58 pulmonary cases.The staple‐suturing methods described are safe and straightforward, and it is believed that they represent a significant advance in the techniques of thoracic and abdominal surgery, which can usefully be applied in many situati

ISSN:0007-1323    

DOI:10.1002/bjs.1800640209

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractThis study examines the ability of penicillin to eradicate or modify the pattern of infection in experimental wounds contaminated with Staphylococcus pyogenes in the presence of chromic catgut or monofilament nylon suture. Penicillin therapy initiated within 4 days of the onset of infection was successful in eradicating infection when compared with untreated controls (P<0.O1). Infection was modified but not eradicated if penicillin was administered from the seventh day. The response of infection to penicillin was identical in wounds containing monofilament nylon or chromic catgut over a 21‐day period. Antibiotics given before wound drainage permitted healing of all chronically infected wounds even in the presence of monofilament nylon. When antibiotics were begun at the time of drainage, wound healing occurred in 50 per cent (P<0·0

ISSN:0007-1323    

DOI:10.1002/bjs.1800640210

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractNitrogen balance studies and clinical observations were made on two groups of patients suffering from obstructive carcinoma of the oesophagus.In 10 patients (group A) parenteral nutrition with a high calorie and nitrogen content was given pre‐ and early postoperatively. Five patients {group B) received intravenous dextrose saline solution pre‐ and postoperatively with no nitrogen supply.Patients in group A had a positive nitrogen balance before and after operation and had a satisfactory postoperative progress. The patients in group B had a negative nitrogen balance until the resumption of oral feeding and their postoperative progress was not as satisfactory as that of patients in grou

ISSN:0007-1323    

DOI:10.1002/bjs.1800640211

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY