摘要:

AbstractA controlled trial of one‐ and two‐layer inverting techniques of suture for the construction of high and low colorectal anastomoses was conducted on 137 patients, the integrity of the suture lines being assessed clinically and by routine radiological examination after a small Gastrografin enema.A clinical diagnosis of anastomotic leakage was made in 9 patients (or perhaps more accurately in 5 only), but subclinical dehiscence was demonstrated radiologically in a further 39 patients (or perhaps 43). There was a slightly greater incidence of dehiscence after the one‐layer technique of suture for both high and low anterior rese

ISSN:0007-1323    

DOI:10.1002/bjs.1800640902

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractIn a consecutive series of 86 patients who required total colectomy for inflammatory bowel disease, 36 (43 per cent) had an ileorectal anastomosis. On review between 1 and 18 years after the operation, there were 25 patients who retained the anastomosis, all of whom were in good general health. Details of their clinical and sigmoidoscopic assessment and the histological grading of rectal biopsies are given. The results are compared with other published reports in a critical review of the present standing of ileorectal anastomosis.

ISSN:0007-1323    

DOI:10.1002/bjs.1800640903

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractRespiratory function has been studied in 32 consecutive patients having oesophageal resection to determine the overall pattern and to compare the effect on it of two standard surgical approaches. Eighteen patients had a left thoraco‐laparotomy and 14 a laparotomy and separate right thoracotomy.The two groups were similar in age, sex, chest symptoms and smoking habits. The average operative time and amount of blood transfused were almost identical.Arterial PO2and PCO2were determined before surgery and on the first and third postoperative days. Spirometry was done preoperatively and on the thirteenth day after operation.Before operation respiratory function was similar in the two groups. On the first postoperative day both groups showed a pronounced fall in arterial PO2, with partial recovery on the third day. This recovery was significantly greater in the double incision group (t = 2·64, P<0·02). Mean PCO2levels altered less markedly, there being a small rise on the first day, with a fall to below normal on the third. There was no difference between the groups in PCO2. Vital capacity and I‐second expiratory volume were reduced on the thirteenth day in both groups, but without a significant difference between the groups.Two patients died of pulmonary embolism, but the others recovered satisfactorily. It is concluded that:1There is pronounced hypoxaemia in the first few days after oesophageal resection in the majority of patients. This is consistent with a satisfactory clinical state.2The double incision laparotomy and right thoracotomy approach affects respiratory function less than left thoraco‐laparotomy. When technically feasible it may be preferable in patients with respiratory imp

ISSN:0007-1323    

DOI:10.1002/bjs.1800640904

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractA case of a gas‐filled intra‐abdominal abscess cavity is reported. The literature is reviewed for similar cases and with reference to the cause and differential diagnosis of abdominal air cy

ISSN:0007-1323    

DOI:10.1002/bjs.1800640905

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractThe use of ultrasonic B‐mode scanning of the liver and biliary tract in patients with persistent jaundice is described. Sixty‐seven consecutive jaundiced patients have been scanned. A correct diagnosis was obtained in 66 per cent, useful information in 26 per cent and in only 8 per cent was the information misleading or of no diagnostic value. In our opinion this simple and non‐invasive technique is of great value in the definitive diagnosis of persistent jaundice and should allow earlier surgery in the obstructive

ISSN:0007-1323    

DOI:10.1002/bjs.1800640906

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractThree cases of rectus sheath haematoma are presented in which the diagnosis was confirmed by the use of ultrasound. The aetiology and diagnosis of the disease are discussed and the use of ultrasonography in a disease with a previously low preoperative diagnostic rate is emphasized.

ISSN:0007-1323    

DOI:10.1002/bjs.1800640907

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractTraumatic haemobilia was diagnosed and treated successfully by selective arterial catheterization and embolization with Gelfoam particles, thus avoiding the hazards of surgical intervention, in a 16‐year‐old boy with tuberculous peritonitis. No ill effects to the liver parenchyma were noticed as evidenced by liver function tests and liver s

ISSN:0007-1323    

DOI:10.1002/bjs.1800640908

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractTwenty‐three cases of penetrating thoracoabdominal injury are reviewed. Abdominal pain, tenderness and rigidity were found to be the most constant indicators of diaphragmatic penetration in these injuries (65 per cent). These features may occur as referred phenomena of purely thoracic injuries and persist as a result of the presence of an intercostal drainage tube used in the treatment of such injuries. There may be no abdominal signs in injuries of the diaphragm unaccompanied by any visceral damage or in injuries confined to the lesser sac. A high index of suspicion in the presence of a wound over the lower half of the chest is necessary to detect these lesions. Negative radiological findings do not exclude a diaphragmatic injury.The thoracic component of a penetrating thoracoabdominal injury can usually be treated conservatively by aspiration or drainage of the pleural space, but laparotomy is advised for the repair of the abdominal viscera. The need for thoracotomy should be determined by the merits of the thoracic injury or the desirability of pleural toilet. The intra‐abdominal injury may then be dealt with through the diaphragm. There is a greater tendency to pleural infection in thoracoabdominal injuries than in simple penetrating thoracic injuries, which is attributable to contamination by intestinal contents through the diaphragmatic tear. The mortality in this series was due to the abdominal injuries, the early recognition and treatment of which would have improved resu

ISSN:0007-1323    

DOI:10.1002/bjs.1800640909

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractFive cases of occult or ‘spontaneous’ rupture of the spleen are described. Pathological examination of the spleen showed changes of infectious mononucleosis in 2 cases, Hodgkin's disease in 1, amyloidosis in 1 and in the remaining spleen no underlying disease process was seen. All 5 cases survived, and evidence from the literature suggests that this may have been in some measure due to the fact that prompt surgical treatment followed a correct preoperative diagnosis. The importance of awareness of the condition, radiological investigation and peritoneal lavage in reaching the correct diagnostic conclusion is discus

ISSN:0007-1323    

DOI:10.1002/bjs.1800640910

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractA series of 51 wounded soldiers with 54 arterial and 28 venous injuries is presented. Interposition of autogenous vein grafts was performed in 30 arterial injuries. Lateral suture or patch arterioplasty was performed in 7 arteries. End‐to‐end anastomosis was possible in 8 cases. Primary vein repair was performed in 14 vein injuries. Lateral suture, patch plasty, end‐to‐end anastomosis and interposition composite vein grafts were used. A distal temporary arteriovenous fistula to increase the flow through venous interposition grafts was performed in 4 cases.Hyperbaric oxygen treatment was used in 7 cases in which successful arterial repair did not reverse ischaemia, and it prevented major amputations.Neurovascular injuries are not always an indication for primary amputation. Six such cases are di

ISSN:0007-1323    

DOI:10.1002/bjs.1800640911

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY