ISSN:0007-1323    

DOI:10.1002/bjs.1800780902

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractPlatelet thrombosis, intimal hyperplasia and progression of atherosclerosis are the most important factors determining the patency of vein grafts for arterial occlusive disease. Interactions between aggregating platelets and the vessel wall play an important role in all of these processes. Recently, it has become evident that the endothelium modulates the underlying vascular smooth muscle by releasing an endothelium‐derived relaxing factor, a potent vasodilator and anti‐aggregating substance. Little information is available, however, on such endothelial functions of autogenous vein grafts. This review focuses on vascular modulation by endothelium‐derived relaxing factor in vein g

ISSN:0007-1323    

DOI:10.1002/bjs.1800780903

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractA collective critical review of the literature on postsplenectomy sepsis from 1952 to 1987 has been undertaken. The reports cover a cohort of 12 514 patients undergoing splenectomy but of these only 5902 reports were sufficiently detailed to allow a useful analysis. The incidence of infection after splenectomy in children under 16 years old was 4.4 per cent with a mortality rate of 2.2 per cent. The corresponding figures for adults were 0.9 per cent and 0.8 per cent respectively. The present analysis of well documented patients has shown that severe infection after splenectomy for benign disease is very uncommon except in infants (infection rate 15.7 per cent) and children below the age of 5 years (infection rate 10.4 per cent). Many of these reported postsplenectomy infections may have been coincidental. It is also apparent that children contract a different type of infection after splenectomy than adults, predominantly a meningitis which is less frequently fatal. Adults, in contrast, appear to develop a septicaemic type of illness associated with a higher mortality rate. This survey has also shown that children are reported to be no more susceptible to pneumococcal sepsis than to infection caused by any other organism. Although the removal of the spleen in otherwise normal people does not appear to be associated with an increased frequency of infection, the presence of a coexistent disorder, notably hepatic disease, can increase the risk substantially.

ISSN:0007-1323    

DOI:10.1002/bjs.1800780904

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractRestorative proctocolectomy and ileal pouch‐anal anastomosis (IPAA) has been carried out on 88 patients since 1982. Three different pouch designs (J, S and W) were used. Ten pouches had to be removed. Detailed analysis was performed on 61 patients (J = 23, S = 15, W = 23) whose pouches had been functioning for at least 6 months. There was no significant difference in surgical complications before or after ileostomy closure between pouch designs but the hospital stay was greater after construction of an S pouch (P<0.05). There were no significant differences in stool frequency, degree of continence or urgency between the three types. Twelve patients with J pouches required antidiarrhoeal medication compared with only one with S and five with W pouches. Only seven patients with S pouches could defaecate spontaneously compared with 22 with W pouches and all patients with J pouches (P<0.001). Twenty‐five of 29 patients who had preservation of the anal transition zone had perfect continence compared with 23 of 32 with a mucosal proctectomy (P = n.s.). Pouchitis occurred in 13 patients, all of whom had ulcerative colitis. In a subgroup of 23 patients, pouch evacuation was assessed scintigraphically. There was no difference in pouch capacity or total volume evacuated, but spontaneous evacuation was better in J and W pouches compared with S pouc

ISSN:0007-1323    

DOI:10.1002/bjs.1800780905

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractOver a 16‐year period, 33 newborn infants developed necrotizing enterocolitis (NEC) following some form of operation (accounting for 19 per cent of all neonates with NEC), including repair of myelomeningocele, intestinal atresia, gastroschisis and congenital diaphragmatic hernia. The neonates with postoperative NEC had a median birth‐weight of 3.05 (range 1.0–4.4) kg, and median gestational age of 40 (range 27–41) weeks. Twenty patients were treated non‐operatively. The remaining 13 required operation for complications of NEC. Twenty‐three patients are alive and have been followed for a median of 66 (range 3–168) months. If a neonate deteriorates following any operation NEC must be included in the different

ISSN:0007-1323    

DOI:10.1002/bjs.1800780906

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800780907

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe temporal and spatial expression of fibronectin and type I and III collagen genes were studied 1–14 days after surgery in the healing rat colonic anastomosis using recombinant deoxyribonucleic acid techniques. Messenger ribonucleic acids (mRNAs) coding for fibronectin and type III collagen synthesis increased from the first day after operation and type I collagen synthesis increased from the second day after operation, as demonstrated by Northern hybridizations. Maximal mRNA production for fibronectin and collagens was seen at 2 and 7 days, respectively, after anastomosis. Activation of type I and III collagen genes in the anastomotic area was confined to tissues developing in the anastomotic line, the serosal surface and the submucosal layer. Strong fibronectin expression was observed in the same areas. The results suggest that genetic events leading to collagen synthesis in the anastomotic area start immediately after surgery. Maximal gene expression is not reached until 1 week after surger

ISSN:0007-1323    

DOI:10.1002/bjs.1800780908

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractTo update our experience with palliative surgical procedures in unresectable adenocarcinoma of the pancreas, the records of 297 patients surgically treated at Memorial Sloan‐Kettering Cancer Center were reviewed. Between October 1983 and November 1989, 117 patients underwent exploratory laparotomy as a single procedure: 24 patients had gastric bypass, 38 biliary bypass, and 118 both gastric and biliary bypass. The postoperative in‐hospital mortality rate was 4.4 per cent. Overall morbidity was 20.9 per cent; the morbidity rate in patients with a double bypass was 29.7 per cent. Median(s.e.m.) survival was 231(20.3) days. Statistical analysis showed a significantly increased risk of morbidity in patients who underwent one therapeutic and one prophylactic bypass. Survival was decreased in patients who had a therapeutic gastric bypass (median(s.e.m.) survival 136(70.2) days) or a combination of two therapeutic bypasses (median(s.e.m.) survival 93(85.9) days). These data emphasize the poor prognosis of patients with pancreatic adenocarcinoma who cannot be resected. The need for therapeutic double bypass is a bad prognostic indicator, and a prophylactic bypass added to a therapeutic bypass increases morbidity without prolonging survi

ISSN:0007-1323    

DOI:10.1002/bjs.1800780909

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractSpontaneous haemorrhage associated with chronic pancreatitis in 17 patients was related to a pseudocyst in 15 (88 per cent) patients and to pancreatic lithiasis (one patient) or to infarction‐rupture of the spleen (one patient). Bleeding was massive in six patients and intermittent in 11. It resulted from erosion of the gastroduodenal or the splenic artery in four patients. Bleeding into the pancreatic duct occurred in four patients and erosion of the duodenum by a bleeding pseudocyst in five. Haemorrhage was confined to a pseudocyst in six patients and was intraperitoneal in two. Of the 15 patients with bleeding pseudocysts, ten underwent primary pancreatic resection (eight proximal and two distal pancreatectomies) with no mortality but four had early complications. Four of the five patients who underwent transcystic ligation of bleeding vessels and pseudocyst drainage had postoperative complications: one died from sepsis and liver failure and three underwent reoperation for severe postoperative bleeding. Of these, two had proximal pancreatic resection with one death. The third patient had further suture ligation and external drainage. The overall postoperative mortality rate was 12 per cent and following emergency surgery 33 per cent. Favourable results were achieved in two‐thirds of patients when the primary operative strategy could be directed towards the control of bleeding and removal of the affected pancreatic segment. Primary pancreatic resection, although technically demanding in the presence of haemorrhage, is recommended whenever possible for the treatment of bleeding pancreatic pseudocysts and pseudoaneurysms associated with chronic pancreati

ISSN:0007-1323    

DOI:10.1002/bjs.1800780910

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe pulmonary microvasculature was examined in two experimental models of acute pancreatitis by scanning electron microscopy of microvascular corrosion casts. Haemorrhagic pancreatitis was induced in eight male Sprague—Dawley rats using an intraductal injection of 5 per cent sodium taurocholate. Oedematous pancreatitis was induced in seven male Spague—Dawley rats using an intravenous infusion of supramaximal doses of caerulein (5 m̈g/kg per hour). The pulmonary vessels were cast using a polymer resin and the cast studied by scanning electron microscopy at 3 and 12 h in those with haemorrhagic and at 1 and 4 h in those with oedematous pancreatitis. Vascular abnormalities were present in both models at the initial study time with abruptly terminating vessels being more prominent in the caerulein model. At the later times, however, the abnormalities in the sodium taurocholate model were much more severe, with a substantial loss of vascular density, tortuosity and abrupt terminations of those vessels present. Micro‐vascular abnormalities may be responsible for some of the pulmonary changes seen in oedematous and haemorrhagic pancre

ISSN:0007-1323    

DOI:10.1002/bjs.1800780911

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY