摘要:

AbstractNine patients with an unusual and serious intraabdominal complication of the beta‐adrenergic blocking agent practolol seen since 1973 are reported. The striking and bizarre peritoneal changes induced by the drug have distinctive features that are not shown by other forms of peritoneal disease.The cases presented with small bowel obstruction, usually chronic in type and often associated with profound weight loss and an abdominal mass. Characteristic radiological features were present. The abnormalities at laparotomy were impressive, with a gross proliferation of the visceral peritoneum which formed a dense white cocoon which encased, constricted and markedly shortened the small bowel, usually from the duodenojejunal flexure to the ileocaecal valve. The obstruction was relieved by mobilizing the small bowel from the ensheathing tissue. Restoration of alimentary function after surgery was delayed but the long term result was satisfactory with full relief of symptoms and the absence of recurrent obstruction during the follow‐up period.This complication may arise after treatment with the drug has been stopped, and although long term oral therapy has been discontinued, further cases will almost certainly present for some time to c

ISSN:0007-1323    

DOI:10.1002/bjs.1800640402

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractThe value of extraperitoneal wound drainage and a 3‐day course of prophylactic systemic cephaloridine used both separately and together have been assessed in a prospective controlled randomized trial involving 246 patients undergoing appendicectomy at the Leicester Royal Infirmary. Extraperitoneal wound drainage was shown to reduce significantly the incidence of post‐operative wound infection in patients with a gangrenous or perforated appendix (P<0·025). Prophylactic cephaloridine significantly reduced the overall incidence of wound infection (P<0·02) and was also effective when the appendix was gangrenous or perforated (P<0·01). A highly significant reduction in wound infection was achieved when the appendix was gangrenous or perforated by the addition of wound drainage to the antibiotic regimen (P<

ISSN:0007-1323    

DOI:10.1002/bjs.1800640403

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractThe successful management of 2 patients is reported, each involving the closure of a fistula into the inferior vena cava as a sequel to the rupture of an atherosclerotic aortic aneurysm. It is an uncommon complication which should be suspected in the presence of an aortic aneurysm with a loud machinery bruit. Associated peripheral cyanosis and venous pulsation in the accessible proximal veins of the lower extremity and priapism afford strong supporting evidence.

ISSN:0007-1323    

DOI:10.1002/bjs.1800640404

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractData were collected concerning 314 internal arteriovenous fistulas created in 242 adult patients (92 women and 150 men). The immediate failure rate for the various techniques used ranged from 7·7 to 12·0 percent, except for ulnar fistulas which had a rate of immediate thrombosis of 20·7 per cent. Survival rates were significantly lower for patients submitted to a combined therapy of dialysis and kidney transplantation when compared with patients treated with dialysis alone. The probability of survival of an arteriovenous fistula was lower in women than in men but the difference was significant only in patients undergoing transplantation. Survival rates at 2 years in dialysed patients were 87·6 per cent for distal radial—cephalic side‐to‐side fistulas, 100 per cent for radial—cephalic end‐to‐side fistulas located in the mid‐forearm, 78·5 per cent for radial—cephalic end‐to‐side fistulas created near the wrist, 53·1 per cent for distal radial—cephalic end‐to‐end fistulas and 60·9 per cent for ulnar fistulas. Thrombosis was responsible for 87·2 per cent of 109 late failures. The incidence of infection was 1 case|

ISSN:0007-1323    

DOI:10.1002/bjs.1800640405

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractIn a retrospective study of 195 patients with a perforated peptic ulcer 18 per cent of the patients had taken aspirn, phenylbutzone or corticosteroids during the period before the perforation. In a controlled prospective trial, 18 of 22 patients (82 per cent) had taken drugs known to be potentially harmful to the stomach. Aspirin was the drug mainly used. Thirteen of 22 patients had taken the drugs within 12 hours of the perforation, usually because of symptoms not related to the gastro‐intestinal tract. Drug consumption and perforation of pre‐pyloric ulcers were most closely associated; the latter applies particularly to female patients, who either had only a short history of upper gastro‐intenstinal dyspepsia or were asympto

ISSN:0007-1323    

DOI:10.1002/bjs.1800640406

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractThis paper reports the findings in a study involving 1537 patients with ‘acute abdominal pain’ presenting over a 13‐month period to the Accident and Emergency Department of the General Infirmary at Leeds. Of these, 341 patients who proved to have pain of greater duration than a week, pain incidental to some other identifiable condition or no pain at the time of their attendance were excluded. The remaining 1196 were diagnosed clinically (using a structured case sheet) and subsequently by a Bayesian computer system. Feedback of the results of clinical and computer systems was given to clinicians at regular intervals. Clinical diagnostic accuracy in patients with surgical disorders rose from 40 per cent before the study to 61 per cent. Computer accuracy in these patients was 69·9 per cent. The proportion of patients sent home without ill effects rose from 20 per cent to 39 per cent. In other areas (e.g. gynaecology) the effects were less marked. It is suggested that the introduction of a simple postgraduate educational service, aided by a small computer, might prove of practical benefit in this clinical sit

ISSN:0007-1323    

DOI:10.1002/bjs.1800640407

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractA detailed and illustrated account is given of the surgical operation needed to treat practolol‐induced sclerosing peritonitis, based on the personal experience of 6 patient

ISSN:0007-1323    

DOI:10.1002/bjs.1800640408

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractThe use of two recently introduced skin protective preparations in the treatment of perifistular skin inflammation is described. Karaya gum in paste form (karaya paste) and a compressed wafer of gelatin, pectin and methyl cellulose (Stomahesive) were used, alone or in combination, with drainable collecting appliances. The method protects the inflamed skin from fistula discharge and allows healing to proceed beneath the dressing. A technique to improve the adhesion of the appliance, in spite of large fluid losses, is outlined.The use of two recently introduced skin protective preparations in the treatment of perifistular skin inflammation is described. Karaya gum in paste form (karaya paste) and a compressed wafer of gelatin, pectin and methyl cellulose (Stomahesive) were used, alone or in combination, with drainable collecting appliances. The method protects the inflamed skin from fistula discharge and allows healing to proceed beneath the dressing. A technique to improve the adhesion of the appliance, in spite of large fluid losses, is outlined.Healing of skin excoriation was obtained in nearly all cases. Complete control of leakage was achieved in a group of patients with a high output fistula.

ISSN:0007-1323    

DOI:10.1002/bjs.1800640409

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractA total of 219 acute superficial abscesses was treated. Patients were randomly allocated to one of four treatment groups—primary suture with or without antibiotics and free drainage with or without antibiotics. No difference could be detected between the groups in duration of healing time. Eleven per cent of all abscesses sutured recurred and antibiotics did not affect this rate. It is suggested that free drainage following incision and drainage is the safest treatment for the majority of abscesses. Antibiotics do not have any significant effect on healing time or recurrence and their routine use is not recommende

ISSN:0007-1323    

DOI:10.1002/bjs.1800640410

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractA policy of early mobilization of elderly leg amputees using a simple temporary prosthesis has been assessed in the context of a district general hospital.Close cooperation between members of the hospital management team, adequate rehabilitation facilities and close liaison with the limb‐fitting centre and domiciliary services were found to be essential to support this policy.Of 42 elderly amputees, 34 were supplied as early as possible with temporary prostheses. Nearly 80 per cent of them were able to walk without assistance on discharge from hospital care. Delays in discharge were mainly for socio‐domestic reasons.Early prosthetic mobilization in this aged and often frail group of patients led to a reduced morbidity and mortality. There was improved morale in patients and staff, rapid clearance of acute surgical beds and the all‐important early achievement of domestic mobility and independence for the am

ISSN:0007-1323    

DOI:10.1002/bjs.1800640411

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY