ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.00517.x

出版商:Blackwell Science Ltd    

年代:1997

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.00553.x

出版商:Blackwell Science Ltd    

年代:1997

数据来源: WILEY

摘要:

Background and methodsRisk factors for recurrence of Crohn's disease and the evidence for progress in reducing recurrence following resection were reviewed. A Medline based literature review was carried out.Results and conclusionOnly smoking has been confirmed as a significant adverse risk factor for recurrence. Evidence for differing recurrence rates in fibrostenosing disease and perforating disease is inconclusive, but such a classification along with the endoscopic findings of recurrence may have a place in the analysis of therapeutic trials. Minimal resectional surgery with clearing of only macroscopic disease seems to be justified, with no clear benefits from different anastomotic techniques. Recent trials offer encouraging evidence of the usefulness of 5‐aminosalicylic acid, particularly higher‐dose regimens started early after resection, although the long‐term benefits are uncertain. The oral steroid, budesonide, offers a potent treatment with minimal side‐effects, but evidence of its prevention of recurrence is present

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.00548.x

出版商:Blackwell Science Ltd    

年代:1997

数据来源: WILEY

摘要:

BackgroundThe management of patients with concomitant coronary and carotid artery disease remains a controversial subject. The aim of this review was to develop a rational plan for the management of such patients based on a review of the literature.Method and resultsA retrospective review was carried out of relevant papers derived from the Medline database from 1964 to 1996.ConclusionThe management of patients with concomitant coronary and carotid artery disease has not yet been put to the test in a properly designed and randomized multicentre trial. It is suggested that, until the results of such a trial are available, the rational approach to combined symptomatic disease is combined carotid endarterectomy and coronary artery bypass grafting (CABG). Combined surgery is also appropriate for patients with symptomatic carotid artery disease and significant but asymptomatic cardiac disease. At present there is inadequate evidence to promote carotid endarterectomy for asymptomatic disease in combination with CABG.

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.00559.x

出版商:Blackwell Science Ltd    

年代:1997

数据来源: WILEY

摘要:

BackgroundThe recent development of adjuvant monoclonal antibody immunotherapy for patients suffering from colorectal cancer has led to a re‐evaluation of the role of these molecules in the treatment of solid tumours. In particular, interest has been directed at identifying appropriate candidates for therapy, evaluating treatment schedules and developing new molecules of therapeutic potential.MethodsThis is a review of published data on patients undergoing antibody therapy. In addition, current theories of the mechanism of action of antitumour monoclonal antibodies are presented, along with potential future therapeutic approaches.Results and conclusionMonoclonal antibody‐based adjuvant therapy of colorectal cancer appears to be effective; international multicentre trials continue. The development of new molecules, such as chimaeric antibodies, offers the potential of increased tumour targeting with reduced toxicity. Such molecules may be used alone or in combination with agents such as chemotherapy or cytoki

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.00560.x

出版商:Blackwell Science Ltd    

年代:1997

数据来源: WILEY

摘要:

Dr Keizo Sugimachi, Editor‐in‐Chief ofSurgery Today(The Japanese Journal of Surgery), has selected from the January to June 1997 issues of his journal for this 6‐monthly digest. A digest ofBJSfor the same period written by Mr Colin Johnson, European Editor, appears in the Japanese jo

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.00116.x

出版商:Blackwell Science Ltd    

年代:1997

数据来源: WILEY

摘要:

For this quarter's digest, Dr Denis Castaing, Editor ofAnnales de Chirurgie, chooses the best from issues 2, 3 and 4 of 1997. A reciprocal digest written by our European Editor, Mr Colin Johnson, appears in the French journal.

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.00113.x

出版商:Blackwell Science Ltd    

年代:1997

数据来源: WILEY

摘要:

BackgroundLiver cirrhosis is a state of protein calorie malnutrition which may induce various complications. This study aimed to elucidate if long‐term nutritional support with branched chain amino acids (BCAAs) is effective after hepatic resection for hepatocellular carcinoma (HCC).MethodsBetween 2 and 3 weeks after operation, 75 patients were randomized to receive oral BCAAs (Aminoleban EN) 100 g per day for 1 year, and another 75 patients were assigned to a control group. Mean follow‐up times were 35·8 months and 36·0 months respectively.ResultsFlapping tremor was less common, body‐weight was greater and performance status was better in the BCAA‐treated group throughout the 1‐year period. BCAA treatment significantly increased red blood cell and serum albumin level in patients with Child grade B and C disease. Substantially similar effects were observed in those with major hepatic resection. Higher Fischer molar ratios were maintained in the treated group. However, there were no differences in cumulative tumour recurrence and survival rates.ConclusionLong‐term oral nutritional support with BCAAs after resection of HCC is beneficial in improving clinical features and laboratory data without increasing the rate of tumour recurrence, particularly in patients with advanced cirrhosis or after majo

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.02810.x

出版商:Blackwell Science Ltd    

年代:1997

数据来源: WILEY

摘要:

BackgroundEarly classification of patients presenting with peritonitis and intra‐abdominal sepsis by means of objective scoring systems is desirable to select patients for ‘aggressive’ surgery and to compare results of different treatment regimens. However, none of the existing scoring systems has fulfilled all expectations.MethodsEvaluation of the value of various scoring systems (Acute Physiology And Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score, Sepsis Severity Score, Multiple Organ Failure, Mannheim Peritonitis Index (MPI), Ranson and Imrie) was performed in 50 patients. Additionally, scoring systems were combined to obtain a ‘combined score’ for the prediction of peritonitis‐related in‐hospital death. Hazard ratios were calculated in a univariate and multivariate analysis.ResultsIn the univariate analysis all scoring systems, except Ranson and Imrie, predicted the primary outcome. In the multivariate analysis, only the APACHE II score (hazard ratio 6·7) and the MPI (hazard ratio 9·8) contributed independently to the prediction of outcome. All patients with an APACHE II score of 20 or more and a MPI of 27 or more died in hospital.ConclusionCombination of the APACHE II and the MPI provides the best scoring system fitting

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.02809.x

出版商:Blackwell Science Ltd    

年代:1997

数据来源: WILEY

摘要:

IntroductionThis randomized controlled study evaluated the clinical benefit and physiological effects of prophylactic chest physiotherapy in open major abdominal surgery.MethodsA group of 174 patients received chest physiotherapy including breathing with pursed lips, huffing and coughing, and information about the importance of early mobilization. In addition high‐risk patients were given resistance training on inspiration and expiration with a mask. The resistance used during inspiration was −5 cmH2O and that during expiration +10 cmH2O. The control group (194 patients) received no information or treatment unless a pulmonary complication occurred.ResultsOxygen saturation on postoperative days 1–3 was significantly greater in the treatment group. Treated patients were mobilized significantly earlier. No difference was noted in peak expiratory flow rate or forced vital capacity. Postoperative pulmonary complications occurred in 6 per cent of patients in the treatment group and in 27 per cent of controls (P<0·001). In high‐risk patients the numbers with pulmonary complications were six of 40 and 20 of 39 respectively. Pulmonary complications were particularly common in patients with morbid obesity.ConclusionPreoperative chest physiotherapy reduced the incidence of postoperative pulmonary complications and improved mobilization and oxygen saturation after major abdom

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.02828.x

出版商:Blackwell Science Ltd    

年代:1997

数据来源: WILEY