摘要:

AbstractThirteen of 15 patients with malignant ascites ashieved an excellent response to spironolactone, with an increase in urinary sodium excretion rates from less than 35 mEq/d before treatment to between 50 and 245 mEq/d after treatment. Plasma renin activity was raised in all of 5 patients in whom it was measured, whereas aldosterone was raised in only 3; these results are similar to those found in ascites due to cirrhosis.

ISSN:0007-1323    

DOI:10.1002/bjs.1800690802

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractIt is unclear whether or not the presence of a malignancy causes an increased energy demand in the patient. As energy expenditure is normally related to body cell mass, it might be expected that an alteration in the relationship between body cell mass and energy expenditure would be observed in patients with malignant disease. This study aimed to investigate this possibility and to attempt to quantify any change in order to determine its clinical relevance.Three groups of patients were studied: a control group (group I), consisting of healthy volunteers and patients awaiting minor elective surgery for benign conditions, and two groups of patients with malignant disease the extent of which was assessed at laparotomy; group II comprised those with local disease and group III those with metastatic disease. Resting metabolic expenditure (RME) was measured by indirect calorimetry and the total body potassium (TBK) was measured as an indicator of body cell mass. The results show a close correlation between RME and TBK in all groups. The RME at a given potassium content was greatest in those patients with metastatic disease. The magnitude of the difference was small, however, amounting to a mean elevation of 289 kcal/d in this group compared to control subjects.It is concluded that malignancy may result in an increased energy demand, particularly in patients with metastatic disease. The magnitude of the increase is small and probably of little consequence when planning nutritional support, although its cumulative effect over many months may be significant.

ISSN:0007-1323    

DOI:10.1002/bjs.1800690803

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractWe studied the relationship between cell‐mediated immunity (assessed by preoperative skin reactions to four recall antigens) and postoperative infective complications in 166 patients undergoing major laparotomies. They were randomly allocated to receive ·150 mg of levamisole or placebo on the day of operation and for the following 2 days; their course was followed for at least 1 month. Neither the degree of preoperative anergy nor the administration of levamisole resulted in any significant differences in numbers of postoperative deaths or infective complications, but the levamisole group had significantly less postoperative pyrexia than the control gro

ISSN:0007-1323    

DOI:10.1002/bjs.1800690804

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThirty‐six patients were referred to the Liver Unit between 1971 and 1980 after unsuspected liver disease had been found at laparotomy. The preoperative diagnosis had been extrahepatic biliary obstruction in 16 patients and intra‐abdominal malignancy in 15. Misdiagnosis resulted from insufficient attention to the history and physical signs in 31 patients and omission or misinterpretation of liver function tests and of other hepatobiliary investigations in the remaining 5 patients. The morbidity and mortality of the 36 patients within 1 month of operation was 61 per cent and 31 per cent respectively. All patients with viral or alcoholic hepatitis died, and severe complications, which included bacterial peritonitis, wound dehiscence and hepatic failure, developed in 13 of 15 in whom ascites due to cirrhosis or the Budd–Chiari syndrome was present before oper

ISSN:0007-1323    

DOI:10.1002/bjs.1800690805

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractTo define the most important diagnostic signs, symptoms and laboratory findings related to intra‐abdominal sepsis in the early post‐operative period, 15 binary variables were prospectively assessed in 100 febrile (>39 °C) post‐laparotomy patients admitted to an intensive care unit. Intra‐abdominal sepsis was found alone in 55 patients and in association with an extra‐abdominal focus in 11 patients. Fever was related to an extra‐abdominal septic focus in 23 patients and no infectious cause was found in 11. Analysis (χ2) indicated that 6 of the 15 variables were significantly associated with an intra‐abdominal focus of infection. The predictive value of each variable, indicated by relative risk, ranked the six variables in order of diagnostic importances: no bacteraemia (1·67), leucocytosis (1·60), ileus (1·50), mental disturbances (1·41), contaminated first laparotomy (1·38), abdominal tenderness (1·22). The absence of bacteraemia was the most important finding separating intra‐ and extra‐abdominal foci of infection. In a febrile post‐laparotomy patient with any evidence of sepsis, the absence of bacteraemia should not lull the physician into a false sense of security but rather alert him to the likelihood of an i

ISSN:0007-1323    

DOI:10.1002/bjs.1800690806

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractPlasma calcitonin, parathyroid hormone, total thyroid hormones and calcium were measured in 6 patients before, during and after thyroidectomy for hyperthyroidism. In 4 patients, plasma calcium fell postoperatively by 0·23–0·46 mmol/l, but there was no change in calcitonin or parathyroid hormone levels. In one patient, in whom there was a postoperative fall in plasma calcium of 0·55 mmol/l, thyroid hormones rose to a peak at 1 h and calcitonin to a peak at 12 h after resection. However, the rise in calcitonin occurred 8 h after the initial decrease in plasma calcium. In this patient, parathyroid hormone levels showed a slight rise only. It is concluded that, while thyroid hormones and calcitonin may leak from the damaged thyroid remnant after surgery, it is unlikely that calcitonin is important in the production of postoperative hypocalcaemia. However, impaired parathyroid hormone secretion may be a contributing fa

ISSN:0007-1323    

DOI:10.1002/bjs.1800690807

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractPre‐incisional injection of cephamandole has been studied. Wound tissue levels of cephamandole have been found to be extremely high throughout the operation. Serum levels were comparable to those obtained with parenterally administered antibiotic. The use of a pre‐incisional injection of antibiotic therefore offers major theoretical advantages over the use of either conventional parenteral or topical antibiotics in the prevention of postoperative sep

ISSN:0007-1323    

DOI:10.1002/bjs.1800690808

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe effect of preoperative intraparietal (intra‐incisional) injection of cefoxitin along the site of the intended incision on the incidence of wound infection has been investigated by a randomized prospective study of 181 consecutive patients undergoing abdominal surgery. A significant reduction in wound infection was evident in the cefoxitin‐treated group (4·4 per cent) when compared with controls (16·7 per cent) (χ2= 6; P = 0·02). Administration of antibiotic by this route did not delay wound healing or produce any undesirable s

ISSN:0007-1323    

DOI:10.1002/bjs.1800690809

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractIn 62 consecutive explorations of the common bile duct during a 2‐year period, a Storz rigid choledochoscope was used to visualize the lumen of the duct before its closure over a T tube. All patients had radiological abnormalities on cholangiography; 45 had stones and 17 apparent strictures. In those with stones, the instrument was introduced after apparent removal of the stones to confirm the completeness of the manoeuvre. This examination showed that 11 patients (25 per cent) still had stones present and needed further manipulation. When the duct was seen to be clear, a T tube was inserted and the validity of the choledochoscopic findings checked by postoperative T‐tube cholangiography. This confirmed the visual accuracy in all but one patient, an accuracy of 98 per cent. Of the 17 patients explored for other radiological abnormalities, choledochoscopy correctly determined the aetiology or excluded abnormalities in all cases. No complications of the procedure were encounte

ISSN:0007-1323    

DOI:10.1002/bjs.1800690810

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe function of the 3‐loop pelvic ileal reservoir as an alternative to total proctocolectomy and ileostomy is assessed experimentally in dogs and compared with normal rectum under identical conditions. No difference was found between the pelvic ileal reservoir and normal rectum in their ability to maintain continence. The efficiency of evacuation, however, is significantly better in normal rectum (P<0·01). Observations made over a prolonged period of time suggest that frequency of defecation, tenesmus and incomplete evacuation are persistent problems with an ileal reservoir. The results of the experiments concur with clinical findings that satisfactory continence may be achieved by using the ileal reservoir but that it does not possess the ability of normal rectum to evacuate completely. Hence the frequent need for self‐catheteriza

ISSN:0007-1323    

DOI:10.1002/bjs.1800690811

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY