ISSN:0007-1323    

DOI:10.1002/bjs.1800760602

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800760603

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractBetween 1957 and 1981, 31716 cases of gastric cancer were registered in the West Midlands, UK. The age‐standardized incidence has shown a decrease from 17·42 per 100000 population during the first quinquennium to 15·30 per 100000 in the last. There was an apparent increase in the proportion of proximal lesions with a decrease in the proportion of distal, antral cancers. The stage of disease at diagnosis remained constant with 79 per cent of patients having stage IV disease. Less than 1 per cent presented with stage I disease. As a result, the curative resection rate was 21 per cent. The operative mortality rates for curative partial gastrectomy and total gastrectomy were 13 and 29 per cent respectively. Surgeons undertaking more than nine total gastrectomies annually had an overall mean operative mortality rate of 22 per cent. Overall age‐adjusted survival at 5 years was 5 per cent. Survival at 5 years for stage I, II and III disease was 72, 32 and 10 per cent respectively. There was a significant increase in survival time for those treated by curative resection between 1972 and 1981 compared with the previous decade. The implications for the management of gastric cancer are disc

ISSN:0007-1323    

DOI:10.1002/bjs.1800760604

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800760605

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractA prospective randomized controlled trial of endoscopic heater probe therapy in bleeding peptic ulcers was performed to determine whether probe therapy can reduce rebleeding rates. Of 630 patients endoscoped for suspected upper gastrointestinal haemorrhage over a 16‐month period, 166 (26 per cent) were found to have a peptic ulcer. Either minor or no stigmata of recent haemorrhage were found in 115 patients at the time of endoscopy. A single peptic ulcer with either active haemorrhage or a visible vessel was found in 51 patients, 43 of whom were entered into the trial. There were eight exclusions: four were inaccessible, one was a torrential haemorrhage and three were excluded for non‐technical reasons. Patients were randomized to receive either heater probe (n = 20) or sham (n = 23) therapy. In actively bleeding ulcers, immediate haemostasis was achieved following probe therapy in 14 of 18 patients (78 per cent) compared with none of 21 having sham treatment (P<0·002). No rebleeding occurred in the probe therapy group (n = 20) compared with rebleeding in five of 23 sham treated patients (P = 0·05). Urgent surgery for haemostasis was required in three of the five sham treated patients who rebled. It is concluded that heater probe therapy may be effective in reducing rebleeding rates in peptic ulcers accessible to the endo

ISSN:0007-1323    

DOI:10.1002/bjs.1800760606

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractThe portal vein contributes little to the blood supply of established liver metastases in the presence of a patent hepatic artery. However, its role in the perfusion of early metastatic liver disease remains controversial. We have quantified the relative contribution of the portal vein and hepatic artery to the internal circulation of small liver tumours. These studies were conducted in a new rat model of liver metastases generated by the intraportal injection of cultured tumour spheroids. A total of 633 lesions were studied in 18 animals using radioisotope tracer microspheres. Nodules ranged from 0·5 to 6·0 mm in diameter, 92 per cent being 3·0 mm or less. The ratio of radioactivity in tumour compared with normal tissue (T:N ratio) was determined after simultaneously injecting microspheres into the portal and arterial circulation of each animal. The mean hepatic artery T:N ratio was significantly greater than that of the portal vein for all tumour sizes studied (P<0·01). Nodules 0·5 mm in diameter had a mean (s.e.m.) hepatic artery T:N ratio of 1·50 (0·12) in comparison with a mean portal vein ratio of 0·13 (0·04). Tumour nodules 2·0 mm in diameter had a mean (s.e.m.) hepatic artery T:N ratio of 1·26 (0·11) in comparison with a mean portal vein ratio of 0·06 (0·01). The overall T:N ratio for both routes decreased with increasing tumour size. These results indicate that hepatic tumours as small as 0·5 mm already have an established internal vasculature perfused predominantly by the hepatic artery. In contrast, the portal vein contributes insignificantly to the internal perfusion of these lesions. These results have significant implications for adjuvant locoregional therapy in gastroint

ISSN:0007-1323    

DOI:10.1002/bjs.1800760607

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800760608

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractBetween 1969 and 1987, 68 patients with pancreatic pseudocysts were treated. The median cyst size was 10 cm (range 2–25 cm). Nine patients were managed conservatively with resolution of the pseudocyst occurring in eight patients. These patients had significantly smaller (median 4 cm) cysts compared with those in both percutaneously and surgically treated patients (P<0·01). In 22 patients the pseudocysts (median 9 cm) were punctured percutaneously under ultrasound guidance and the cyst fluid was aspirated or drained through a catheter. Complete resolution occurred in 13 patients after 1–4 (mean 2·8) punctures per patient, regression occurred in six patients after 1–4 (mean 2·0) puncture procedures per patient and three were unchanged. No complications were noted, except that two patients treated percutaneously required additional surgery. Thirty‐seven patients were managed surgically (median cyst size 11 cm) with external drainage (12 patients), cystgast‐rostomy (17 patients), cystduodenostomy (three patients) cystjejunostomy (three patients) and pancreatic resection (two patients). Resolution of the cyst was noted in 29 patients, regression in five and three were unchanged. Five patients required additional surgery. Twelve complications were seen in ten patients (27 per cent), most frequently after external drainage. One patient died after surgical treatment. Mean hospital stay was 13 days among patients treated conservatively and 30 days in both percutaneously and surgically treated patients. Aspiration or catheter drainage of pseudocyst fluid guided by ultrasonography seems a safe and effective treatment of pancreatic pseudocysts and should be considered as initial therapy. If surgery is required cystgastrostomy

ISSN:0007-1323    

DOI:10.1002/bjs.1800760609

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractTreatment choice in primary breast cancer is wide and still controversial; it seems likely that the optimum treatment for individual patients could be dictated by biological indicators of tumour behaviour. If biopsy could provide prognostic information as well as detailed tissue diagnosis then definitive treatment, with or without adjuvant systemic therapy, could be planned from the outset. We studied 140 patients with a clinical diagnosis of primary breast cancer to determine how much information could be obtained from Tru‐Cut® needle biopsies performed at the first clinic visit. Ten patients were found to have benign disease. Of 130 carcinomas, 123 (95 per cent sensitivity) were diagnosed correctly from the needle biopsies, with seven false negative and no false positive results (100 per cent specificity). Precise histopathology was predicted in 121 (93 per cent). Grade was correctly assessed in 77 of 112 (69 per cent), but needle biopsy was not accurate for assessment of lymphatic invasion nor elastosis. Steroid hormone receptors were assayed in 59 needle biopsies, and the incidence of oestrogen receptor positivity (34, 58 per cent) was similar to the resected tumours (35, 59 per cent), but the incidence of progesterone receptor positivity (26, 44 per cent) was lower (33, 56 per cent, P<0·04). Immunostaining with monoclonal antibody human milk fat globule membrane was accurate in the needle biopsies. DNA analysis by flow cytometry was performed in 37 tumours and the concordance between needle biopsies and resected samples was high. Tru‐Cut needle biopsy obviates open biopsy and gives reliable detailed inform

ISSN:0007-1323    

DOI:10.1002/bjs.1800760610

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractAn analysis was carried out of 43 patients treated by omental transposition for locoregional problems associated with breast cancer. Indications for surgery included advanced primary tumour (five), locally recurrent tumour (32), radiation induced sarcoma (two), and radionecrosis (four). Tumours were typically extensive (mean diameter 7·2 cm) and skin ulceration affected 30 patients. Other treatment modalities had been exhausted. Surgical excision followed by reconstruction using transposed omentum resulted in worthwhile local control and symptom relief in 31 patients (median duration 22 months). Chest wall disease rapidly recurred peripheral to the omental graft in 12 patients. On multiple regression analysis, duration of local control was significantly related to tumour diameter, ulceration, and earlier radioresistance (hazard ratios 15·8, 3·8 and 14·8 respectively). Survival (median 21, range from 1·5 to 122 months) correlated with tumour size, previous chemotherapy, and early re‐recurrence (hazard ratios 7·2, 3·0 and 4·3). Omental transfer is a reliable method of restoring epithelial cover after radical surgery and is particularly useful after previous irradiation injury. In advanced and recurrent breast cancer, an aggressive surgical approach significantly improved the quality of life of most patients, but careful case selection is required to avoid inappropriate surgery for irremediabl

ISSN:0007-1323    

DOI:10.1002/bjs.1800760611

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY