摘要:

AbstractAn extracorporeal glucose monitor (EGM) has been used in a patient with an insulinoma. This system, which continuously measures blood glucose, can be used in combination with a feedback‐controlled glucose infusion to maintain glycaemia at any preselected level. It prevents the risk of severe hypoglycaemia during diagnostic tests (total fast, tolbutamide and insulin tolerance tests) as well as during surgery. It also helps in determining whether all the insulin‐secreting tumour tissue has been removed. The EGM is thus helpful in the diagnosis and surgical treatment of insulino

ISSN:0007-1323    

DOI:10.1002/bjs.1800671202

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractFrom 1969 to 1979 39 injuries of the pancreas and duodenum were treated at the Royal Victoria Hospital, Belfast. The mortality was 31 per cent. Twenty‐six injuries were due to stab, bomb or bullet. Two of the 17 with low velocity gunshot wounds died, whereas all 5 cases of high velocity missile injury died (P<0·001). Ten of the 13 cases of blunt trauma were due to road traffic accidents. In 21 cases the body and tail of the gland were injured, and in 13 the head and neck. There were 5 isolated duodenal injuries and in 7 a combined pancreaticoduodenal injury. The mortality was directly related to the number of other organs damaged.Three main methods of treatment were used—simple drainage, suture and drainage, and primary distal pancreatic resection. Serious complications, pancreatitis, fistula, secondary haemorrhage and sepsis were frequent after the first two methods but rare after distal resection.Diagnosis was delayed in 4 cases of closed injury and 1 of these patients died. Pancreatic injury was missed 6 times at operation; in 4 cases retroperitoneal haematoma was not explored and 2 of these patients died.Five of the 12 deaths were due to overwhelming bomb and bullet injury. In one case resuscitation was inadequate. The remaining 6 died of the complications of the original pancreatic injury, either because operation was delayed or because the injury was missed.Our management was deficient in three areas: awareness of the need for laparotomy, recognition of the injury at operation and inadequate surgery. All open abdominal injuries must be explored; suspicion and careful assessment are essential in closed trauma. At operation the pancreas must be carefully examined; an upper retroperitoneal haematoma is an absolute indication for this. Simple drainage is only sufficient for trivial injury; for major injury of the body and tail we prefer distal resection. Roux loop drainage is suggested for injury to the head and neck, especially when associated with duodenal in

ISSN:0007-1323    

DOI:10.1002/bjs.1800671203

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800671204

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractLocal infection was introduced into rat abdominal wounds using a 108bacterial/ml inoculum. Three groups of infection were used: Staphylococcus aureus, Pseudomonas aeruginosa and a combination group of Escherichia coli and Proteus mirabilis. Infection was shown to delay healing as judged by bursting tests. Fibroblast proliferation was depressed at the wound edges but there was an increase in the total amount of hydroxyproline present. Small vessel angiogenesis was increased in areas of abscess formation but larger vessels were commonly blocked by thrombus or distorted by surrounding inflamed tissue. The possible causes of these effects are discussed.

ISSN:0007-1323    

DOI:10.1002/bjs.1800671205

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800671206

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractSutureless wound closure employing a new product, Op‐Site Skin Closure, was evaluated in comparison with two standard techniques of skin closure, using interrupted nylon sutures and Michel clips. The trial involved 110 patients undergoing elective and emergency abdominal surgery. The results showed that Op‐Site Skin Closure was good as the conventional techniques of skin closure with the advantages that it is easier and quicker to apply, produces a superior cosmetic result and, consequently, has gained excellent patient and nurse accepta

ISSN:0007-1323    

DOI:10.1002/bjs.1800671207

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractFifty patients having a variety of intra‐abdominal operations necessitating postoperative infusion were randomly allocated to receive antiseptic skin preparation and daily care of the cannula site or no skin preparation either before or after cannula insertion. The study shows that without skin preparation superficial thrombophlebitis is inevitable after about 3 days. However, simple skin preparation and daily care of peripheral infusion sites significantly reduces the incidence of superficial thrombophlebiti

ISSN:0007-1323    

DOI:10.1002/bjs.1800671208

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractA method of biliary manometry is described which enables simultaneous recording of both the pressure changes in the common duct during perfusion and the cholangiographic appearances. This examination has been performed on 86 patients undergoing cholecystectomy for gallstone disease, 17 of whom had demonstrable stones in the common duct. Ten patients received opiates or similar drugs as premedication and are considered separately. The remaining 76 patients were anaesthetized by a standard technique involving no opiates. On the basis of the pressure tracings they could be divided into two groups: group I (56 patients, 4 with stones in the common bile duct) showed a minimal rise in pressure during infusion of the common bile duct, with a rapid return to basal level: group II (20 patients, 13 with demonstrable stones in the common bile duct) showed a marked rise in pressure, with a delayed and often incomplete return to basal level. In 2 patients in group II a sudden fall in pressure during perfusion was associated with the passage of a stone, and the evidence suggests that 6 of the 7 patients with no demonstrable stones in the duct had in fact small stones in the duct, some of which may have passed during the examination. Clinical follow‐up of the patients showed that only 3 of the patients had significant postoperative abdominal symptoms, for which there was an apparent extra‐biliary cause in all 3.This study provides no evidence in support of the hypothesis that there is a condition of sphincteric spasm which can cause symptoms after cholecystectomy, and which can be detected by pressure studies at the time of cholecystect

ISSN:0007-1323    

DOI:10.1002/bjs.1800671209

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractA series of 500 cholecystectomies performed over a 7‐year period was reviewed retrospectively. The reliability of preoperative clinical features such as jaundice and pancreatitis was assessed in determining the presence of choledocholithiasis, and was found to be of limited value. Investigations such as intravenous cholangiography and liver function tests were found also to be inaccurate in the detection of common duct stones as was the appearance of the duct at operation. The usefulness of the peroperative cholangiogram in the detection of common duct stones that would otherwise have been overlooked is emphasized. Common duct stones would have remained undetected in 25 per cent of patients with choledocholithiasis. Despite the use of routine peroperative cholangiography common duct stones were overlooked in 11·25 per cent of patients who underwent explorati

ISSN:0007-1323    

DOI:10.1002/bjs.1800671210

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractTopical 16,16‐dimethyl (dm) prostaglandin E2produces an alkaline secretion from the canine stomach. This study attempts to assess whether this prostaglandin‐induced secretion might have a cytoprotective role. Chambered ex vivo perfused wedges of canine stomach were divided into equal halves: a control and test side. The mucosa of each half was sequentially exposed to isosmotic hydrochloric acid, 20μg, of 16,16 dm PGE2in acid, 20 mmol aspirin + 20 μg of dm PGE2in acid then isosmotic acid. The test side received 40 mmHg pneumatic counterpressure to reduce the prostaglandin‐induced fluid movement before, during and after the aspirin exposure. The mucosal lesions produced on each side were graded 0 to 4. If prostaglandin exerts its cytoprotective effect by stimulating an alkaline secretion, elimination of that secretion with counterpressure should prevent a cytoprotective action. Nine dogs were studied.Topical prostaglandin increased transmucosal fluid movement from 10 μl/min to 65 μl/min. Counterpressure decreased this volume flow by 50 per cent (P<0·01); it also decreased mucosal blood flow on the test side by 20 per cent (P<0·05). The lesions on the counterpressure side were worse 2·0·0·6 v. 0·8 ± 0·3 (P<0·01). Thus the greater damage in the counterpressure group could have been caused by diminished fluid movement or by reduced blood flow or a combination of both factors. Although this study cannot distinguish between these possibilities, it seems likely that the prostaglandin‐induced alkaline secretion has a

ISSN:0007-1323    

DOI:10.1002/bjs.1800671211

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY