摘要:

AbstractBile salts play an important role in maintaining cholesterol in aqueous solution in bile. There is evidence that in some patients at least gallstones arise as a result of bile salt deficiency. The evidence to date suggests that although oral bile salts may be of use in treating some gallstone patients they are unlikely to replace chole‐cystectomy in the foreseeable future. The instillation of bile salts via an indwelling T‐tube may well be of great use in the management of stones retained in the common duct after choledocholithotomy. There is no doubt that in this branch of medicine as in all others prevention is better than cure and our aim should be to perfect our technique so that we do not leave stones behind. However, should the situation occur we may soon have safe effective physiological solvents to dissolve our mista

ISSN:0007-1323    

DOI:10.1002/bjs.1800620702

出版商:John Wiley&Sons, Ltd.    

年代:1975

数据来源: WILEY

摘要:

AbstractInfection with Gram‐negative bacteria is frequently the cause of death in human liver transplantation. In experimental liver transplantation in mongrel dogs we detected Gram‐negative septicaemia in 73 per cent of our first 15 cases; maximal survival was 26 days.In a second series of 27 orthotopic liver transplantations in tissue‐typed littermate dogs and littermate pigs the standard surgical technique and aftercare were changed with regard to four factors: an end‐to‐end common bile duct anastomosis was made instead of a gallbladder to duodenum anastomosis; the continuous postoperative bacteriostatic antibiotic therapy was changed to a single 2‐day course of bactericidal antibiotics; preoperative selective bowel decontamination combined with postoperative protective isolation was introduced; the dosage of azathioprine used for immuno‐suppression was reduced.Infectious complications decreased markedly to 8 per cent, with survival beyond 1 year in 37 per cent of the animals. Therefore under experimental conditions Gram‐negative septicaemia can be prevented in liver transplantation; whether all the factors cited above are important in this regard remains t

ISSN:0007-1323    

DOI:10.1002/bjs.1800620703

出版商:John Wiley&Sons, Ltd.    

年代:1975

数据来源: WILEY

摘要:

AbstractA case of Clostridium welchii septicamia following acute cholecystitis is described. The onset was acute and a rapidly fatal outcome ensued. Radiological findings were negative. An approach to the antibiotic treatment and general management is discussed.

ISSN:0007-1323    

DOI:10.1002/bjs.1800620704

出版商:John Wiley&Sons, Ltd.    

年代:1975

数据来源: WILEY

摘要:

AbstractThe use of cholic acid T tube infusion and of the Burhenne catheter has been investigated in the management of gallstones retained in the common bile duct following biliary surgery in 9 patients. Four of 7 patients treated with cholic acid infusion showed disappearance of the stones during treatment. The stones in a fifth subject were removed by a combination of cholic acid infusion (1 stone disappeared) and instrumentation with a Burhenne catheter (a second stone removed). Use of a Burhenne catheter was unsuccessful in 3 of 4 patients. Details of the technique of cholic acid infusion are given, and possible complications of the treatment are discussed. The use of cholic acid infusion for the dissolution of stones in the common bile duct is recommended.

ISSN:0007-1323    

DOI:10.1002/bjs.1800620705

出版商:John Wiley&Sons, Ltd.    

年代:1975

数据来源: WILEY

摘要:

AbstractIn 10 patients with inflammatory bowel disease, total body water, total body potassium and total exchangeable sodium were measured both before and 6 months after the establishment of a permanent ileostomy. All 10 patients underwent elective surgery for their inflammatory bowel disease but all were malnourished before surgery when their body composition was first measured.Six months later, when the body composition was again determined, all the patients were in good health and had normally functioning ileostomies. As a group they had gained 6‐8 kg in body weight and 372 mEq total body potassium over the 6‐month period. When the “normal” total body water was calculated for each patient, a deficit of 12‐4 per cent for the group was found before surgery and this was still present (11.1 per cent) 6 months later. The concentration of exchangeable sodium in the body water fell from an abnormally high level before surgery to within the normal range 6 months later.These data show that deficits in total body water occurring preoperatively are not repaired in the months following the establishment of a well‐functioning ileostomy, and that a reduction of total exchangeable sodium is present in patients with an ileostomy who are otherwise well. It is suggested that these findings should encourage the surgeon managing patients with intractable inflammatory bowel disease to strive for good nutrition and normal body composition before embarking on excisional surgery and the establishment of a permanen

ISSN:0007-1323    

DOI:10.1002/bjs.1800620706

出版商:John Wiley&Sons, Ltd.    

年代:1975

数据来源: WILEY

摘要:

AbstractDuring the period 1961–70,283 patients in the Glasgow region have been studied with regard to the outcome of 418 surgical procedures performed for Crohn's disease.Resection was followed by an overall recurrence rate of 33 per cent, but in disease confined to the large bowel the rate was 18 per cent.Exploratory operations and bypass procedures were followed by a recurrence rate of 70 per cent. Evidence is provided that recurrence following bypass procedures for small bowel disease and ileocolitis occurs at a later stage than after exploratory operations alone.By the end of the study period 77 per cent of patients in this series had required one or more resection

ISSN:0007-1323    

DOI:10.1002/bjs.1800620707

出版商:John Wiley&Sons, Ltd.    

年代:1975

数据来源: WILEY

摘要:

AbstractThree cases are presented which demonstrate the significance of faecoliths in the diagnosis of acute appendicitis in infants. A wide spectrum of symptoms is noteworthy. The usefulness of a plain X‐ray of the abdomen in infants with acute abdomen is stresse

ISSN:0007-1323    

DOI:10.1002/bjs.1800620708

出版商:John Wiley&Sons, Ltd.    

年代:1975

数据来源: WILEY

摘要:

AbstractHospital admissions for symptomatic diverticular disease of the colon were studied during two periods, 1958–61 and 1968–71, in a relatively closed community in north‐east Scotland. There was a significant increase in the numbers admitted, from 206 to 366. In the earlier 4‐year period among patients aged 70 years and over there was a preponderance of females, but in the later study period the risk of developing symptomatic disease was almost as great among elderly males. Most of the elderly female patients were widowed city dwellers. The proportion of patients requiring operation for or dying from diverticular disease declined, but perforation remained as a frequent complication carrying a high mo

ISSN:0007-1323    

DOI:10.1002/bjs.1800620709

出版商:John Wiley&Sons, Ltd.    

年代:1975

数据来源: WILEY

摘要:

AbstractAn anatomical and clinical study aimed at uncovering factors likely to be helpful in understanding the true nature of haemorrhoids is described. The main finding was of specialized “cushions” of submucosal tissue lining the anal canal; it is argued that piles are merely the result of their displacem

ISSN:0007-1323    

DOI:10.1002/bjs.1800620710

出版商:John Wiley&Sons, Ltd.    

年代:1975

数据来源: WILEY

摘要:

AbstractIn an attempt to localize adenomas of the parathyroid glands 36 patients with suspected hyperparathyroidism were studied with a computer‐assisted double isotope scanning technique. Six patients were excluded from the statistical analysis because of uninterpretable scans. A definite localization was made with the computer‐assisted scan in 16 patients. In 14 of these patients the site of the tumours was correctly predicted. In 14 patients no localization was seen on the scan. Four of these patients were classified as false negatives.In 14 out of the 16 correctly localized tumours two‐thirds had weights equal to or less than

ISSN:0007-1323    

DOI:10.1002/bjs.1800620711

出版商:John Wiley&Sons, Ltd.    

年代:1975

数据来源: WILEY