ISSN:0007-1323    

DOI:10.1002/bjs.1800750902

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800750903

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractBecause of a recently completed trial which demonstrated that dietary fat reduction improved the symptoms of cyclical mastopathy, we have carried out a critical review of other studies of treatment for this disorder to determine what, if any, mechanisms of action were shared by effective treatments. Therapies were classified as ‘definitely effective’ if their effectiveness was demonstrated in at least one randomized placebo‐controlled study of women with cyclical mastopathy, ‘probably effective’ if their effectiveness in relieving breast symptoms was demonstrated in at least one study in women with premenstrual syndrome, and ‘probably not effective’ if they had not been shown to improve breast symptoms in at least two studies in women with premenstrual syndrome. Bromocriptine, danazol, evening primrose oil, tamoxifen and reduction of dietary fat intake were classified as definitely effective and norethisterone and Bellergal as probably effective. Several therapeutic manoeuvres, including reduction of methylxanthine ingestion and the administration of vitamin E or diuretics, have not been adequately evaluated in women with cyclical breast symptoms. A review of the published reports of the physiological effects of therapies that were definitely or probably effective revealed that these agents acted either to alter serum prolactin levels or lipid metabolism, or both. As evidence exists that prolactin influences lipid metabolism it is postulated that cyclical mastopathy may be a disorder of lip

ISSN:0007-1323    

DOI:10.1002/bjs.1800750904

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractA controlled trial has been conducted in which 60 women with mastalgia were randomly allocated to receive tamoxifen at a dosage of either 10 mg or 20 mg daily for either 3 or 6 months. All eligible patients had self‐rated moderate or severe mastalgia present for at least 6 months, for which no specific therapy had been given for the previous 3 months. End points of the study were pain control, measured by linear analogue scales, relapse rate and side‐effects. Pain relief was achieved in 90 per cent of those receiving 10 mg daily and 86 per cent of those given 20 mg daily. The relapse rate was also similar for both dosages, being 48 per cent and 39 per cent respectively and usually occurred within 2–3 months of discontinuing treatment. However, side‐effects were reported less frequently among those receiving 10 mg daily (21 per cent versus 64 per cent;x2=11.1, P<0.001). Prolongation of treatment from 3 months to 6 months did not materially improve the response rate (85 per cent versus 90 per cent). Side‐effects were similar, as was the relapse rate among the patients receiving the two durations of treatment. The agent proved to be significantly more effective in the relief of cyclical rather than non‐cyclical pain (94 per cent versus 56 per cent). Use of tamoxifen for the treatment of mastalgia is still experimental. Nevertheless, for the majority of women with mastalgia, pain relief can be achieved using tamoxifen 10 mg daily, given for a 3‐month course. As almost half these patients will develop relapse of breast pain it may be necessary to give longer courses of therapy, although the safety of this more protracted treatment has yet to

ISSN:0007-1323    

DOI:10.1002/bjs.1800750905

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractFine needle aspiration biopsy for cytological examination (FNAC) is becoming increasingly accepted as a means of tissue diagnosis in breast disease. This study examines the feasibility and accuracy of FNAC in ‘immediate reporting’ by a consultant cytopathologist in a busy breast clinic. Over a 2‐year period, 884 cytology reports were analysed. An initial clinical report and subsequent final cytological diagnosis was made. Fine needle aspiration provided adequate material for cytological evaluation in 635 of the 884 biopsies (71.6 per cent) and this proportion was greater when discrete lumps were considered (463 of 562 biopsies = 82.4 per cent). In diffuse and cystic disease, however, the adequacy of specimens was reduced: 50 per cent and 65 per cent respectively. On immediate reporting the diagnostic sensitivity for all patients was 88 per cent (discrete lumps only, 92.5 per cent) and the specificity was 99.8 per cent (discrete lumps only, 100 per cent). FNAC retains its diagnostic accuracy when immediate reporting is employed and this study demonstrates that this technique can be used in making a diagnosis in patients with breast di

ISSN:0007-1323    

DOI:10.1002/bjs.1800750906

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractOne hundred and five patients with discrete breast lumps were examined with a 10 MHz Doppler ultrasonic flowmeter. Doppler flow signals were analysed on an Angioscan spectrum analyser. Recordings from the opposite normal breast were taken as controls and signals from the two sides compared. In 23 patients signals from the normal breast could not be recorded and therefore results of the remaining 82 patients are reported. These included 39 patients with carcinoma, 20 with fibroadenoma, 12 with cyclical nodularity and 11 with cysts. Malignant lumps exhibited significantly higher peak systolic (S) and minimum diastolic frequencies (D) in comparison to the control breast. Fibroadenoma also had a higher S and D than those of the opposite normal breast. Signals over cysts and cyclical nodularity showed no significant difference from the recordings over the control side. Despite significantly higher systolic and diastolic frequencies in the cancer group in comparison to benign lumps and normal breast, considerable overlap in the values was seen between cancer and other groups. Therefore the patterns on 10 MHz Doppler sonography are not sufficiently specific to discriminate benign from malignant breast lumps.

ISSN:0007-1323    

DOI:10.1002/bjs.1800750907

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractThis study was designed to examine the influence of saline irrigation at different temperatures on adhesion/formation in the rat. Saline irrigation through a laparotomy incision was performed at the following temperatures: 30°C, 34°C, 37°C, 40°C, 45°C, 50°C, 55°C, and 60°C. The control group (Gc, n = 20) underwent laparotomy without irrigation. Adhesions were found in: 5/20 animals of the Gc(all slight); 6/20 of the 30°C group (all slight); 6/20 of the 34°C group (all slight); 6/20 of the 37°C group (all slight); 12/20 of the 40°C group (all slight); 12/20 of the 45°C group (11 slight, 1 moderate); 14/20 of the 50°C group (12 slight, 2 moderate); 18/19 of the 55°C group (2 slight, 6 moderate, 10 marked); and 18/18 of the 60°C group (1 moderate, 8 marked, 9 massive). These results indicate that saline irrigation below body temperature does not prevent adhesions whereas warmed saline encourages adhesion forma

ISSN:0007-1323    

DOI:10.1002/bjs.1800750908

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractA prospective audit of the frequency of infective complications after all abdominal operations was carried out between January 1977 and December 1986. A total of 3100 abdominal procedures (2041 elective; 1059 emergency) were performed in 3056 patients. There were 50 (1.6 per cent) in‐hospital and 66 (2.1 per cent) late wound infections (overall 3.7 per cent). Fifty‐four (1.8 per cent) patients developed postoperative intraperitoneal sepsis. Ninety‐eight patients died (overall mortality 3.2 per cent) and introperitoneal sepsis was a related factor in twelve (0.4 per cent). Wound infection, peritoneal sepsis and mortality were related to the degree of operative contamination and to reoperation. The results support the traditional, although sometimes inadequately stressed, teaching that technique is an important factor in preventing infection. Infection is also reduced by peroperative antibiotic lavage. The limited value and the potential difficulties of the unstructured introduction of computerized audit should be recog

ISSN:0007-1323    

DOI:10.1002/bjs.1800750909

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractForty‐six patients with pyogenic liver abscess have been treated at Paul Brousse Hospital between 1966 and 1986. The overall mortality was 24 per cent, all 11 deaths occurring in 24 patients seen prior to 1978 when there was often a considerable delay in the diagnosis of liver abscess (mean 90 ± 71 days). In seven patients the diagnosis was not made until post‐mortem examination. The mainstay of treatment was surgical drainage. Since 1978 high resolution imaging techniques for the liver, and in particular ultrasound, have been available. The diagnostic delay has been significantly reduced (mean 28±20 days,P<0.01). Patients are receiving definitive treatment at an earlier stage in the evolution of the disease process, with fewer established complications prior to treatment (P<0.05). Percutaneous drainage under ultrasound control is the preferred initial drainage procedure in high‐risk patients. There have been no deaths in 22 patients treated for pyogenic liver abscess since 1978 (P

ISSN:0007-1323    

DOI:10.1002/bjs.1800750910

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800750911

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY