ISSN:0007-1323    

DOI:10.1002/bjs.1800760302

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800760303

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractIn a consecutive series of 284 patients with a perforated peptic ulcer (229 pyloroduodenal, 55 gastric) there was a 26 per cent hospital mortality rate, and patients aged ⩾ 70 years (n = 176) had a significantly higher mortality rate (34 per cent) than patients aged<70 years (14 per cent, P<0·001). Multiple clinical variables were significantly more common in the elderly group of patients (65 per cent), in those having non‐steroidal anti‐inflammatory drugs or steroid therapy (56 per cent), in patients where there is an absence of a previous dyspeptic history (69 per cent), and when risk factors such as delayed presentation (33 per cent) and the presence of shock on admission to hospital (27 per cent) are present. Definitive operations (vagotomy or gastrectomy) had an increased mortality rate in the elderly (P = 0·018). Risk scores based upon the presence of shock, delayed presentation or concurrent medical illness could have predicted 87 per cent of postoperative deaths in elderly subjects, and it is suggested that risk stratification and greater caution in the use of definitive operations for perforated ulcer may result in a reduction in the high mortality rate in elderly s

ISSN:0007-1323    

DOI:10.1002/bjs.1800760304

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractEndoscopic haemostasis can be effective in non‐variceal upper gastrointestinal haemorrhage, and should be regarded as potential front‐line treatment. Diverse methods are available, and although no single technique has become firmly established, current evidence favours thermal coagulation and injection ther

ISSN:0007-1323    

DOI:10.1002/bjs.1800760305

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractIn the past 9 years, we have operated on 56 patients with gastrointestinal bleeding of obscure origin. Selective visceral angiography demonstrated the bleeding lesions in 24 of the 30 patients who underwent this investigation. Six of these 24 patients, however, had a negative angiogram initially and the lesions were only demonstrated on a repeat angiogram. The negative initial angiograms were due to: (1) slow bleeding from lesions in two patients; (2) a small bleeding tumour that caused only intermittent jejunojejunal intussusception in one patient; (3) technical fault in one patient; and (4) spasm of the bleeding vascular lesions and their feeding arteries in two patients. We advocate repeat angiography the following day in all patients in whom profuse bleeding continues, and during the next intestinal bleeding in those whose bleeding stops after the initial negative angiography. In patients who have repeated episodes of massive bleeding, and in whom full investigations fail to reveal the bleeding source, repeat angiography carried out 4 weeks after the bleeding has stopped can sometimes demonstrate the vascular lesions.

ISSN:0007-1323    

DOI:10.1002/bjs.1800760306

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractThe admission rates for duodenal ulcer (DU) and the effect of H2‐receptor antagonists (H2RA), introduced in the Trent Region of the UK in 1977, were examined. The admission rates are expressed per 106of resident population. The use of H2RA has risen 3·7‐fold (from 1978 to 1983), yet overall admission rates for perforation have changed little: 99 in 1972‐76 (pre‐H2RA period) compared with 103 in 1977‐84 (H2RA period). Admission rates for haemorrhage have risen by 8 per cent, from 130 to 140 (P<0·01). However, the overall rates conceal large increases (P<0·01) in the admission rates for those aged ⩽ 65 years, of 33 per cent (from 264 to 352) for perforation and of 28 per cent (from 381 to 489) for haemorrhage. Emergency admissions for uncomplicated DU were unchanged: 88 in 1972‐76 and 89 in 1977‐84. However, the proportions operated on fell by 58 per cent (P<0·01), from 30 per cent of admissions in the pre‐H2RA period compared with only 12 per cent in the H2RA period. Waiting‐list admissions for uncomplicated DU fell by 43 per cent, from 187 to 106 (P<0·01), and the proportions operated on fell from 162 to 76; the combined effect resulted in a reduction of 53 per cent in the operation rates (P<0·01). In Rotherham, the use of H2RA has risen 6·2‐fold (from 1978 to 1983) and they were generally used intermittently in 1976‐78 and later for maintenance therapy and high‐dose treatment. Yet admissions for perforation and for haemorrhage were unchanged. Emergency admissions for uncomplicated DU rose by 40 per cent, from 130 in 1972‐75 to 182 in 1976‐84, but the proportions operated on fell markedly, from 20 to 6 per cent (P<0·01); waiting‐list admissions fell in 1976‐78 by 29 per cent and in 1979‐84 by 73 per cent. The proportions operated on in the three periods fell from 74 to 53 per cent and 25 per cent respectively and these two factors led to decreases in elective surgery of 50 per cent in 1976‐78 and 91 per cent in 1979‐84 (P<0·01). Thus, H2RA have not reduced emergency admissions in DU patients but they are associated with a reduction in waiting‐list admissions and in the numbers operated on for uncomplicated DU; where the drugs have been used more intensively, the decrease has been even more marked. Much of this decline can be attributed to the changing natural history of the disease; however, when used inte

ISSN:0007-1323    

DOI:10.1002/bjs.1800760307

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractIn a 7 1/2‐year period (from 1 January 1980 to 30 June 1987), 997 patients with gastric cancer underwent gastric resection at the Department of Surgery, Matsuyama Red Cross Hospital, Japan. We studied clinico‐pathologically 83 patients (182 lesions) with synchronous multiple gastric cancer and compared them with patients who had solitary cancers only in the same period. We found that elderly men had a relatively high incidence of multiple gastric cancer, and that early cancer of the elevated well differentiated type was the most common. Of the 182 lesions, as many as 42 (23·1 per cent) were missed in the preoperative examination. Eighteen of these 42 lesions were found only with the aid of a microscope in sections almost incidentally excised. Small flat lesions tended to be missed. We should always be conscious that other gastric lesions may be present when treating patients with gastric ca

ISSN:0007-1323    

DOI:10.1002/bjs.1800760308

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractGastro‐oesophageal reflux was measured by 24‐h ambulatory oesophageal pH monitoring in 220 patients with symptoms suggestive of gastro‐oesophageal reflux disease. By multiple regression analysis it was found that the pressure in the distal oesophageal high pressure zone, the presence of a hiatal hernia, the intra‐abdominal length of the high pressure zone, the amplitude of the contraction waves in the distal oesophagus and age all significantly participated in the determination of the amount of gastro‐oesophageal reflux. The pressure in the distal oesophageal high pressure zone was the single variable that correlated most strongly to the amount of reflux. Although the amount of reflux increased significantly with increasing weight as measured by Broca's index, this variable did not participate in the determination of reflux by the multiple regression test. The study emphasizes the role of the pressure and intra‐abdominal length of the distal oesophageal high pressure zone as the primary antireflux barrier. It also shows that a hiatal hernia plays a role in generating gastro‐oesophageal reflux through a mechanism other than affecting the pressure and the intra‐abdominal length of the hig

ISSN:0007-1323    

DOI:10.1002/bjs.1800760309

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractThe oesophageal transit time of half a marshmallow was measured radiologically in 17 controls, 28 patients with gastro‐oesophageal reflux pre‐operatively, 36 patients soon after implantation of the Angelchik prosthesis (2–9 weeks) and in 23 patients later postoperatively (9–48 months). Sixteen postoperative patients also underwent oesophageal manometry. All control and pre‐operative patients had a marshmallow transit time of less than 1 min; 67 percent of the early postoperative patients had prolonged transit and 70 per cent of the late tests were similarly abnormal. Prolonged oesophageal transit as measured by marshmallow' swallow correlated well with symptoms of solid food dysphagia. Most, but not all, patients with an abnormal marshmallow swallow had abnormal manometric findings. The oesophageal transit of solid food is significantly slowed after the Angelchik procedure and this is not a transient postoperative p

ISSN:0007-1323    

DOI:10.1002/bjs.1800760310

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractFour patients underwent liver transplantation in the Cambridge/King's College Hospital programme for malignant primary and secondary apudomas, secreting various peptide hormones and uncontrollable by standard treatment techniques. After transplantation all patients had excellent symptomatic relief and specific peptide hormone levels fell to normal ranges. Two patients remain alive and well after 38 and 22 months, the latter with recurrence of slight tumour‐related symptoms and elevation of the specific secretory product. The other two patients died from chronic graft rejection 7 and 8 months after transplantatio

ISSN:0007-1323    

DOI:10.1002/bjs.1800760311

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY