ISSN:0007-1323    

DOI:10.1002/bjs.1800750202

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800750203

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractTo assess the functional results of treatment of faecal incontinence we carried out physiological and radiological measurements in 46 patients and 20 controls. Twenty patients were selected for conservative treatment and 26 for surgery (including 17 postanal repairs and 6 anterior sphincter repairs). The degree of incontinence was scored before and after treatment and postoperative investigations carried out on 17 patients (11 postanal repairs). Forty per cent of the conservative treatment group had a successful result compared with sixty‐five per cent of the operative group as a whole and fifty‐nine per cent of the postanal repair patients. Resting and ‘squeeze’ anal canal pressures were improved following postanal repair as was upper anal canal sensation but there was no change in the anorectal angle. We conclude that the anorectal angle is not crucial in maintaining con

ISSN:0007-1323    

DOI:10.1002/bjs.1800750204

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractIn a consecutive series of 122 patients with gastric carcinoma, 9 per cent had no operation, 27 per cent had incurable disease at laparotomy, and 64 per cent underwent gastric resection. R1gastrectomy was performed in 73 of the 78 resections. The operative mortality after gastric resection was 4 per cent, but there were no deaths after potentially curative resections. The actuarial 5‐year survival was 20 per cent overall, 60 per cent in patients undergoing a ‘curative’ resection with N0disease, and 18 per cent in patients with N1disease. Local or regional recurrence without evidence of distant metastases was identified in 11 per cent of cases after ‘curative’ resections. The probability of survival was adversely affected by N1nodal involvement (P<0.005) and by the presence of poorly differentiated or anaplastic tumours (P<0.001). Only 6 per cent of patients had early gastric cancer, and absolute curative resections by Japanese criteria were possible in only 5 per cent of cases. The results suggest that the unfavourable presenting pathology is the principal determinant of the poor prognosis of gastric cancer. A more radical or extended lymphadenectomy (R2/3gastrectomy) might have cured more patients with N1metastases, but only 12 per cent of potentially curable patients had N1disease in this study, and it appears that more radical surgery may have little effect on the overall survival rates for gastr

ISSN:0007-1323    

DOI:10.1002/bjs.1800750205

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractThe contention that the R2radical gastrectomy for localized and potentially curable gastric carcinoma may be superior to gastrectomy without lymphadenectomy (R1) was assessed by randomized trial. Five years after commencement 403 patients have been evaluated at surgery and only 43 (11 per cent) found eligible (S0–2, P0, H0, N0–1), 22 of whom underwent R1and 21 R2gastrectomy. Seven patients had final histological stages in excess of the protocol. The R2group had a longer operating time (P<0.005), a greater blood transfusion requirement (P0.025) and required reoperation in four cases. There were no postoperative deaths. Four patients have died from the disease in the R1group and five in the R2group, there being no difference in the probability of survival at a median follow‐up of 3.1 years. The small proportion of patients suitable for radical R2surgery, the high associated morbidity and the fact that survival advantage has yet to be proven in trial suggest that this procedure should not yet be performed outside of controlled clinical t

ISSN:0007-1323    

DOI:10.1002/bjs.1800750206

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800750207

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractRegeneration of canine oesophageal mucosa was studied under basal conditions and in the presence of gastro‐oesophageal reflux. In normal circumstances mucosal defects in the oesophagus regenerate by squamous epithelium. In the presence of gastro‐oesophageal reflux of either acid or a combination of acid and bile, regeneration was frequently by columnar epithelium (Barrett's oesophagus). This columnar regeneration was not seen with bile reflux alone. By the use of squamous barriers to proximal migration of columnar epithelium in the stomach, it was demonstrated that columnar re‐epithelialization may occur from cells intrinsic to the oesophagus and is not dependent on proximal migration of cardiac columnar epithelium. The cell of origin of this epithelium may be located in oesophageal gland ducts and is likely to be a multipotential stem cell since the regenerated columnar epithelium may contain goblet and parietal cells not normally found in the oesophagus. This epithelium is morphologically distinct on mucin histochemistry from cardiac columnar epithelium. These findings support the concept that Barrett's epithelium is metapl

ISSN:0007-1323    

DOI:10.1002/bjs.1800750208

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractBorrmann type 4 gastric carcinoma, including linitis plastica, is difficult to detect at an early stage and the results of surgical treatment remain poor. We have used ‘left upper abdominal evisceration plus Appleby's method (LUAE + Apl.)’ as a radical surgical procedure for this disease. During the period 1983–86, 30 cases of Borrmann type 4 gastric carcinoma underwent this procedure (Group A). These cases were compared with 30 patients who underwent total gastrectomy with pancreaticosplenectomy (Group B) during the period 1980–82. Although this is not a randomized study and the extent of resection was greater in Group A, the operation time, amount of blood loss, and number of complications were similar for both methods. When the survival rates were compared, the 3‐year survival rate in stage II‐III cases was higher for Group A (83.3 per cent) than for Group B (42.2 per cent) (P<0.05). One patient in Group A and 12 patients in Group B died with peritoneal metastasis within 3 years of operation in stage II‐III. The LUAE + Apl. method is a rational and useful technique for the surgical treatment of Borrmann type 4 gast

ISSN:0007-1323    

DOI:10.1002/bjs.1800750209

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800750210

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractIn a prospective randomized trial anterior lesser curve seromyotomy with posterior truncal vagotomy (ASPTV, n=48) has been compared with proximal gastric vagotomy (PGV, n=43). Eighty‐eight and eighty‐three patients were available for follow‐up studies at 1 year and 2 years, respectively. Six months postoperatively the mean reduction in pentagastrin‐stimulated peak acid output (PAO) was 48.5 per cent (s.d. 26.3) after PGV and 50.5 per cent (s.d. 23.3) after ASPTV. Two years after the operation satisfactory clinical results (Visick I + II) were found in 84.2 per cent of the patients after PGV and in 88.9 per cent after ASPTV. There was a significant difference in the duration of surgery. No serious postoperative gastric sequelae were encountered after either operation. Up till January 1987, eight endoscopically proven, symptomatic recurrent ulcers have been diagnosed: four in the PGV group (9.3 per cent) and four in the ASPTV group (8.7 per cent). The results of this randomized study suggest that ASPTV is as good as PGV in the surgical treatment of chronic duodenal

ISSN:0007-1323    

DOI:10.1002/bjs.1800750211

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY