摘要:

AbstractThere have been three major advances in the treatment of small bowel fistulas since 1960: irrigation with lactic acid; total or parenteral nutrition; and continuous low flow enteric nutrition. The causation and clinical features of these fistulas are reviewed. The different unfavourable prognostic features are evaluated with reference to a series of 384 cases published by Edelmann et al. (1975). The different methods of treatment, both medical and surgical, are analysed.In spite of the great progress in medical management, surgery retains an important place. The guidelines for this medicosurgical policy are laid down.The mortality of intestinal fistulas was around 60 per cent before 1960 and has now diminished by half. It should be possible to lower it still further to around 10 per cent in future years, by careful application of the methods described.

ISSN:0007-1323    

DOI:10.1002/bjs.1800641002

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractIntensive nutritional treatment is now recognized as the single most important factor in achieving closure of enterocutaneous fistulas, replacing attempts at early surgical closure. Operation in the early stages of management should be confined to the drainage of abscesses, the defunctioning of diseased or disrupted bowel and the formation of feeding enterostomies. In those few cases where spontaneous closure of the fistula does not occur, definitive surgical operation can be carried out when malnutrition has been corrected. The combination of nutritional treatment, skin protection and judicious surgery can reduce the mortality to below 10 per cent.

ISSN:0007-1323    

DOI:10.1002/bjs.1800641003

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800641004

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractInterfascicular nerve grafts allowed to undergo endoneurial tube emptying in situ before transfer have been compared with grafts transferred fresh in terms of structure and function. The sciatic nerve of the rat was the model and its structure and ultrastructure were superior following degenerate grafting. More importantly, electrophysiological studies showed that function in nerves repaired with degenerate grafts was significantly better than in those repaired with fresh grafts.

ISSN:0007-1323    

DOI:10.1002/bjs.1800641005

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractUsing99Tcma non‐invasive test of gastric function has been developed which completely obviates the need for a nasogastric tube and which adds to the accuracy of existing tests by overcoming losses due to incomplete aspiration or gastric emptying.99Tcmis handled by the stomach like Cl−, the gastric secretion of which is equal to that of H+. The value of the pentagastrin stimulation test in the presence of varied gastric pathology is discussed in relation to 50 patients. Other possible diagnostic uses of the test are evaluated and a method of carrying out an insulin test by a modification of the technique is descri

ISSN:0007-1323    

DOI:10.1002/bjs.1800641006

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractDeep venous thrombosis is a common and unpredictable complication of surgery. In this study it is proposed that patients who develop this complication may be predicted by a low preoperative level of a naturally occurring inhibitor of coagulation, anti‐Xa.Two groups of patients were investigated. Women taking the oral contraceptive pill had lower preoperative anti‐Xa levels than their non‐pill controls (P<0·01) and in addition had a significantly higher incidence of deep venous thrombosis (DVT) following emergency surgery (P<0·05). In 90 patients undergoing total hip replacement, the mean preoperative anti‐Xa level of those patients who developed DVT was significantly lower than those who did not (P<0·001). Ninety‐four per cent of patients with a preoperative anti‐Xa level of less than 80 per cent developed DVT. The effect of low dose heparin on anti‐Xa was studied.The results suggest a mechanism for the cause of postoperative thrombosis which also permits selection of individual patients who will develop t

ISSN:0007-1323    

DOI:10.1002/bjs.1800641007

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractUnmatched perfusion defects occur during the early postoperative period. These defects can persist until the tenth postoperative day and their presence is not related to the transfusion of blood or to peripheral thrombosis detected by the125I‐labelled fibrinogen uptake test. It is suggested that prophylactic agents against deep venous thrombosis should be evaluated by using a combination of krypton ventilation‐perfusion lung scans and125I‐labelled fibrinogen leg

ISSN:0007-1323    

DOI:10.1002/bjs.1800641008

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractAn unselected series of 136 patients suspected of having a major intra‐abdominal pathological condition had blood drawn and stored as serum. A definitive histo‐logical diagnosis was made in all cases, usually by laparotomy. The serum was analysed with coded samples for carcino‐embryonic antigen, alpha‐fetoprotein and pancreatic oncofetal antigen and all recorded levels above the upper limit of normal for that test were taken as a positive result. Results were analysed to give the predictive value of a positive test and a negative test for each antigen. A negative pancreatic oncofetal antigen test was found to be useful in excluding a diagnosis of pancreatic

ISSN:0007-1323    

DOI:10.1002/bjs.1800641009

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractThe effects of Corynebacterium parvum on the Lewis lung tumour and its metastases have been studied. Intravenous but not intraperitoneal or subcutaneous C. parvum reduced the growth of the primary tumour. Both intravenous and intraperitoneal C. parvum significantly reduced pulmonary metastases. When combined with excision of the primary tumour, C. parvum given not more than 2 days before excision caused only slight reduction of metastases, but when given intravenously or intraperitoneally 3–4 days before excision, metastases were significantly reduced and some mice were cured of tumour. Subcutaneous C. parvum had no effects on metastases.Non‐specific operation (amputation) increased tumour metastases, but C. parvum counteracted this.Metastases were significantly increased by the administration of silica and cortisone acetate but were unaffected by trypan blue. The antimetastatic action of C. parvum was not significantly altered by these treatments. Thymectomy and irradiation did not affect tumour metastases or the antimetastatic action of C. parvum, whereas antilymphocyte serum depressed metastasis and abrogated the protective effects of C. parvum.It appears that the inhibitory effects of C. parvum on tumour metastases are mediated through macrophages in concert with a subpopulation of T2lymphocy

ISSN:0007-1323    

DOI:10.1002/bjs.1800641010

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY

摘要:

AbstractThe Edinburgh Breast Screening Clinic in its first year completed the initial screening examination of 3005 invited women, who were apparently in good health, aged between 40 and 60 years; 141 were referred for a surgical opinion; 70 women ultimately underwent biopsy and 9 proved to have carcinoma. The indications for biopsy are described together with methods of management of the various lesions.

ISSN:0007-1323    

DOI:10.1002/bjs.1800641011

出版商:John Wiley&Sons, Ltd.    

年代:1977

数据来源: WILEY