ISSN:0007-1323    

DOI:10.1002/bjs.1800750802

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800750803

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractBetween 1981 and 1986, 282 cases of abdominal aortic aneurysm were diagnosed in Waltham Forest. Rupture had occurred in 183, 15 underwent urgent operation for intact aneurysm, and 84 had elective surgery. The incidence of rupture increased from 13 to 21 per 100000 population during the 6‐year period. Operative mortality for patients with rupture was 54.7 per cent, but the mortality overall was 81.4 per cent. In 59 per cent of patients with rupture no operation was performed, and 35.0 per cent of all deaths occurred in the community. The mortality for rupture in women was significantly higher than in men, although the operative mortality was comparable. Fifty patients (27 per cent) were found to have attended hospital within 2 years of rupture and many had documented evidence of an aneurysm. One‐third of all patients admitted with rupture were undiagnosed. This study complements the previous small number of community studies and suggests that the incidence of rupture is increasing nationally particularly in women, where the mortality was exceptionally high. Early elective surgery is the key to the problem and improved clinical awareness could save many patients without elaborate and expensive programmes to screen the ‘at risk’ pop

ISSN:0007-1323    

DOI:10.1002/bjs.1800750804

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800750805

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractEighty femorodistal in situ vein bypass grafts have been evaluated at 3‐monthly intervals clinically, with ankle:brachial pressure indices (ABI), by intravenous digital subtraction angiography (IV DSA) and by Duplex scanning. Five grafts (6 per cent) failed in the perioperative period. Nineteen (25 per cent) of the remaining 75 grafts subsequently developed stenoses on IV DSA during the first 12 months. All angiographic stenoses were detected by Duplex scanning using velocity ratio criteria before the development of symptoms or a measurable decline in ABI, i.e. while non‐haemodynamically significant. This technique involves scanning the entire length of the graft but allows even minor stenoses to be detected and progression of stenoses can be determined. At a mean follow‐up of 12 months (3–18 months), four (7 per cent) of the fifty‐six grafts without stenoses occluded. Eight (42 per cent) of the nineteen stenosed grafts either occluded or developed symptoms. None of the occluded grafts in this series could be salvaged. Non‐haemodynamically significant vein stenoses can be detected non‐invasively, occur frequently and are associated with

ISSN:0007-1323    

DOI:10.1002/bjs.1800750806

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractPost‐mortem injection studies have demonstrated marked differences in the course and distribution of arterioles in the stomach, but evidence of differential perfusion in man is lacking. Using the non‐invasive laser Doppler technique, we studied 38 patients referred for gastroscopy for dyspeptic symptoms. Flux measurements were made at nine sites: distal oesophagus, cardia, mid‐body and antrum on lesser and greater curves, and pre‐ and post‐pylorus. In all cases the stomach was macroscopically normal. Flux in the proximal stomach was significantly greater than that in the antrum, (P<0.001, Student's t test). This in vivo study demonstrates a flow gradient related to the previously demonstrated anatomical di

ISSN:0007-1323    

DOI:10.1002/bjs.1800750807

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractThe reproducibility and sources of variation in ankle and brachial systolic pressures were determined for a reactive hyperaemia test used to assess peripheral arterial disease in the lower limbs. Thirty‐six subjects had repeat measurements taken by four observers on two separate days using a Doppler probe and random zero sphygmomanometer. Ankle pressures were measured before and after 4 min of arterial occlusion above the knee. The 95 per cent confidence limits for a postocclusion reduction in pressure was approximately ±25 mmHg and for the postocclusion ankle‐brachial ratio was ±20 per cent. The corresponding figures for the mean of four measurements taken by two observers on 2 days was approximately ±17 mmHg and ±13 per cent. In patients with vascular disease analysis of variance showed that the greatest sources of variation in the postocclusion ankle‐brachial ratio were the ‘biological’ variations between subjects and between legs. But for postocclusion reductions in pressure, variability due to observers and repeat readings was as important as the ‘biological’ differences between subjects and legs. Thus, in respect of variability, the ratio may be a better parameter to detect differences

ISSN:0007-1323    

DOI:10.1002/bjs.1800750808

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractOf 309 patients with portal hypertension, gastric varices were found in 48 (16 per cent). While the majority (88 per cent) of the patients had gastric varices in association with oesophageal varices, 6 (12 per cent) patients had ‘isolated’ gastric varices. Gastric varices were seen significantly (P<0.01) more often with grade 4 than with grade 3 varices. In 11 (28 per cent) of the 40 patients who completed sclerotherapy for oesophageal varices, gastric varices disappeared concurrently on eradication of oesophageal varices or during the following 6 months. Of the initial five patients with gastric varices who received direct intravariceal injections, four rebled; this technique was therefore replaced by combination (paravariceal + intravariceal) gastric variceal sclerotherapy. Emergency combination sclerotherapy successfully controlled bleeding from gastric varices in six of the eight treated patients. Thirty‐two patients entered a programme of elective combination gastric variceal sclerotherapy. Variceal obliteration was achieved in 12 cases (38 per cent) and reduction in size was noted in another 7 patients (22 per cent) after a minimum of four courses. There were 11 (23 per cent) deaths, 8 due to uncontrolled bleeding from gastric varices and 3 due to hepatic coma. The other complications of gastric variceal sclerotherapy were minor and included retrosternal pain, fever and dysphagia. It is concluded that gastric varices often coexist with large oesophageal varices. If they persist for 6 months after eradication of oesophageal varices, a combination of paravariceal and intravariceal sclerotherapy should be attempted for their obliter

ISSN:0007-1323    

DOI:10.1002/bjs.1800750809

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractForty‐five cirrhotic patients with oesophageal varices underwent endoscopic injection sclerotherapy in a prospective randomized trial carried out to compare two sclerosing agents (5 per cent ethanolamine oleate and 2 per cent sodium tetradecyl sulphate (STD)) with respect to safety, efficacy and complications. Twenty‐three patients were allocated to the ethanolamine group and twenty‐two to the STD group. The rate of control of acute bleeding was 100 per cent (6/6) in the ethanolamine group and 75 per cent (3/4) in the STD group. There was a significantly lower rate of postinjection bleeding after the over‐tube was removed at the initial session of sclerotherapy when ethanolamine was injected 0/23 versus 7/22, 32 per cent; P<0.01) and at the second session there was a significantly (P<0.01) higher rate of jet‐like bleeding from injection sites in the STD group (6/21,29 per cent) than in the ethanolamine group (0/22). The disappearance rate of red colour signs 1 week after the initial session of sclerotherapy in the ethanolamine group was 100 per cent and 62 per cent in the STD group. Early oesophageal ulcers developed less frequently in the ethanolamine group (0 and 9 per cent) than in the STD group (24 per cent and 43 per cent both after the initial (P<0.05) and the second session of sclerotherapy (P<0.01)). Early bleeding from an oesophageal ulcer occurred only in the STD group (5/21, 24 per cent) before the third session of sclerotherapy (P<0.05). The rate of early mortality did not differ between the two groups. We conclude that ethanolamine seems to be safer and more efficacious than STD for sclerosing oesophagea

ISSN:0007-1323    

DOI:10.1002/bjs.1800750810

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractThirteen children with intramural haematoma of the alimentary tract were treated in Chulalongkorn University Hospital during an 8‐year period (1978–1986). A history of trauma was obtained in 11 cases, 1 case presented as a result of a coagulation defect secondary to a haematotoxic snake bite and no causative factor was apparent in 1 patient. Profound vomiting with abdominal pain is the typical presentation. Upper gastrointestinal contrast study is usually characteristic and diagnostic. Conservative treatment was successful in 12 of the cases with no morbidity and mortal

ISSN:0007-1323    

DOI:10.1002/bjs.1800750811

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY