ISSN:0007-1323    

DOI:10.1002/bjs.1800720502

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe bulk of available evidence supports the view that Barrett's oesophagus is an acquired condition due to chronic gastro‐oesophageal reflux. It is possible that a few cases are congenital. Barrett's oesophagus gives rise to severe stricture and ulceration and has a significant malignant potential. Treatment is designed to prevent reflux and, if possible, to reverse the metaplastic change. Dysplasia is of ominous significance and requires frequent careful surveillanc

ISSN:0007-1323    

DOI:10.1002/bjs.1800720503

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractFifteen children with achalasia treated surgically over a period of 21 years are reported. All had a modified Heller's myotomy as a primary treatment. The thoracic approach was used in five and the abdominal route in ten. In three patients the myotomy was confined to the oesophagus. Six patients had antireflux procedures at the time of initial myotomy. The mean follow‐up period was 6.2 years. Nine patients had excellent results, three had good results, two had fair results and one had a poor result. Of the nine children who did not have an antireflux procedure, three developed symptomatic and radiologically proven gastro‐oesophageal reflux. The results of myotomy in children with achalasia are satisfactory but a significant number may develop gastro‐oesophageal reflux. We believe that a modified Heller's myotomy combined with a short loose Nissen fundoplication should be the primary treatment of achalasia in chi

ISSN:0007-1323    

DOI:10.1002/bjs.1800720504

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractA dual isotope radionuclide technique has been used to assess solid and liquid gastric emptying simultaneously in 72 patients with symptomatic gastro‐oesophageal reflux and 22 normal controls. Objective evidence of gastro‐oesophageal reflux was obtained from standard acid reflux testing and/or endoscopy in all patients. Solid emptying was delayed in 32 patients (44 per cent), liquid emptying was delayed in 27 patients (37 per cent) and 16 of those two groups had delayed solid and liquid emptying. Thus 29 patients (40 per cent) had normal solid and liquid emptying. The solid lag period was significantly delayed in the patient group (P<0.01). There was a significant correlation (P<0.01) between the solid and liquid gastric emptying values obtained in patients. No significant correlation was found between gastric emptying and the resting lower oesophageal sphincter pressure or the presence of symptoms of regurgitation and epigastric fullness. In the patients with delayed solid emptying there was a higher incidence of oesophagitis than in patients with normal emptying (P<0.

ISSN:0007-1323    

DOI:10.1002/bjs.1800720505

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractResting cerebral blood flow (CBF) and the response to inhalation of 7 per cent CO2was measured in 74 patients with symptoms of cerebrovascular disease. In order to evaluate their role in the identification of patients with significant arterial lesions, these measurements were correlated with the angiographic appearances, the clinical picture and the presence or absence of infarction on CT scan. Patients with carotid stenosis of 60 per cent or more had normal resting flows, but reduced responsiveness to CO2inhalation. Patients with carotid occlusion had both reduced resting flow and reduced CO2responsiveness. Infarcts were visible in 25 per cent of the hemispheres studied, and were more common in patients with fixed neurological deficits, but were also present in 17 per cent of patients with transient ischaemic attacks (TIAs). Reduction in the collateral supply from the contralateral carotid artery via the Circle of Willis further reduced CO2responsiveness with ipsilateral internal carotid occlusion. The normal increase in CBF which occurs with the inhalation of carbon dioxide is diminished with increasingly severe bilateral disease, with infarction and with a fixed neurological deficit.

ISSN:0007-1323    

DOI:10.1002/bjs.1800720506

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractIt has been suggested that patients with abdominal aortic aneurysms are deficient in tissue copper. Levels of copper and zinc in liver and aortic wall were therefore measured in 11 patients with aortic aneurysms and 11 fresh cadavers with normal aortas. The concentrations of copper were similar in both groups. Zinc concentration was higher in the normal aortic wall, probably because of the greater thickness of the media in the normal aorta. We found no evidence that aortic aneurysms are associated with reduced tissue copper concentrations.

ISSN:0007-1323    

DOI:10.1002/bjs.1800720507

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe effects of systemic and intraportal administration of propranolol on hepatic haemodynamics were studied in cirrhotic and non‐cirrhotic rats. In the non‐cirrhotic rat systemic infusion of 4 μg (kg body wt)−1min−1propranolol significantly decreased portal pressure, wedged hepatic venous pressure, portal venous flow and liver blood flow without affecting heart rate. Similar changes were observed in the cirrhotic rat following an infusion of 2 μg (kg body wt)−1min−1propranolol. Higher rates of propranolol infusion produced greater reductions in portal pressure, wedged hepatic venous pressure, portal venous flow and liver blood flow in cirrhotic and non‐cirrhotic rats but these changes were accompanied by a bradycardia. The reduction in portal pressure effected by propranolol was accompanied by an increased splanchnic vascular resistance. Intraportal injection of propranolol resulted in a rapid but transient fall in portal pressure. The decrease in portal pressure was sustained if propranolol was infused intraportally. The results indicate that propranolol effects a reduction in portal pressure via a combination of increased splanchnic vascular resistance, increased hepatic arterial resistance and reduced cardiac output. The observation that propranolol can significantly reduce portal pressure without affecting heart rate may be clinically important in the long‐term management of portal hypertension. Furthermore, the rapid reduction in portal pressure following intravenous administration suggests that propranolol may be of value in the acute control of var

ISSN:0007-1323    

DOI:10.1002/bjs.1800720508

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractIn this randomized trial adjuvant cytotoxic portal vein perfusion in patients undergoing surgery for colorectal cancer without liver metastases was assessed to determine whether the incidence of meta‐chronous liver metastases could be reduced and survival thereby improved. There were 127 control patients and 117 patients who received adjuvant perfusion. A further 13 patients were excluded following randomization because of cirrhosis in 1, liver metastases at laparotomy in 3 and technical problems with cannulation in 9. Dukes' staging and degree of differentiation were similar in the two groups. There were fewer liver metastases in the perfusion patients and overall survival was improved. However, the benefit appears to be greatest in patients with Dukes' B colon cance

ISSN:0007-1323    

DOI:10.1002/bjs.1800720509

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800720510

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractThere is a risk of overlooking lymph node metastases and thereby contributing to inaccurate nodal staging when performing partial axillary dissection in conjunction with total mastectomy in female breast cancer. The Danish Breast Cancer Cooperative Group (DBCG) analysed this risk in a prospective nation‐wide adjuvant trial dealing with primary operable breast carcinoma. The series comprised 3114 patients, initially found to have lymph node negative axillae, followed for a median of 24 months (quartiles 12‐40). It was found that the probability of early ipsilateral axillary relapse of cancer, estimated by means of the life table method, decreased with the number of nodes removed. After 2 years the recurrence rate was 12 per cent for patients with no lymph nodes removed, 7 per cent with one or two nodes removed and 2 per cent with three or more nodes removed. It is concluded that the risk of false negative nodal staging in conjunction with partial axillary dissection is modest, provided at least three lymph nodes are removed and found to be negative on histological examinat

ISSN:0007-1323    

DOI:10.1002/bjs.1800720511

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY