摘要:

Abstract‘Spontaneous’ rupture of the oesophagus usually affects the lower third, less commonly the middle third and rarely the cervical oesophagus. Rupture limited to the intra‐abdominal oesophagus is rare. Such a case is described here and previously reported cases are reviewed. Vomiting‐induced gastro‐oesophageal injuries and their aetiology are discussed and the management of spontaneous rupture is

ISSN:0007-1323    

DOI:10.1002/bjs.1800660902

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractProgression of dysphagia after vagotomy to the stage of complete obstruction due to a peri‐oesophageal fibrotic collar needing operaton is a rare event. Review of the 4 such cases previously described, all needing further operation and all after truncal vagotomy, indicates that the oesophageal mucosa was normal on oesophagoscopy and that bouginage appeared to make the condition worse. This paper describes the first patient in whom (a) the vagotomy was selective and (b) no bouginage was carried out before the condition was relieved by a further surgical operatio

ISSN:0007-1323    

DOI:10.1002/bjs.1800660903

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractGastric adenocarcinomas often spread to the distal oesophagus. Failure to control the disease in this area during total and proximal subtotal gastrectomy results in recurrence at the oesophageal anastomosis. The incidence of recurrence in a series of 351 such patients was 10 per cent and was influenced by the location of the main lesion, the stage of the disease, the presence of tumour at the margin of resection and the length of clearance of the oesophageal margin. Recurrences were prevented only with invivomargins greater than 12 cm. Dysphagia combined with radiological signs of oesophageal obstruction was diagnostic of anastomotic recurrence regardless of the results obtained by oesophagoscopy and biopsy.Treatment was seldom effective in patients developing recurrence. Complete excision of the entire recurrent process offered the only hope for a long survival in these patients. Prevention by obtaining adequate oesophageal clearance at the time of gastrectomy is the only reasonable approach to this problem. The adequacy of resection cannot be judged accurately by intraoperative palpation of the oesophagus or by frozen section examination of the surgical margins.

ISSN:0007-1323    

DOI:10.1002/bjs.1800660904

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractBilio‐pancreatic bypass is a new procedure that tries to obtain a maldigestion syndrome with selective malabsorption of the main high calorie foods. The operation consists of a gastric resection and division of the proximal jejunum just distal to the ligament of Treitz. A gastroentero‐anastomosis is then constructed using the distal end of the transected jejunum, while the proximal jejunum is anastomosed to the side of the distal ileum.An experimental study carried out on 12 dogs confirmed that the operation causes a selective malabsorption with loss of weight and no complications. On the basis of this study it is suggested that this procedure has the following advantages over jejuno‐ileal bypass: (a) normal absorption of bile salts, water and electrolytes; (b) slow recovery of absorption; (c) absence of a blind

ISSN:0007-1323    

DOI:10.1002/bjs.1800660905

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractAfter a successful trial of bilio‐pancreatic bypass in dogs, a clinical study has been completed in 18 patients followed for more than 1 year. The operation has been modified to achieve the best weight reduction, and forming the bilio‐pancreatic tract of equal length to the alimentary tract with a short common ileal tract, the average weight loss as a percentage of the preoperative body weight was 24·1 ± 5·4 per cent (mean ± s.d.) at 6 months and 33·7 ± 4·1 per cent at 12 months. The only immediate complication was a wound dehiscence, and there were no late complications. Liver function studies showed the absence of hepatic deterioration and liver biopsies showed improvement of liver morphology 1 year after the operation. It is suggested that this procedure may be an alternative to jejuno‐ileal bypass in the managemen

ISSN:0007-1323    

DOI:10.1002/bjs.1800660906

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractIn a 10‐years survey of large bowel carcinoma at Groote Schuur Hospital 926 cases were studied retrospectively. A marked difference was seen in both the age of presentation and histological differentiation in two different racial groups. All patients who were 29 years of age or less at the time of presentation have been studied in detail. Predisposing factors, symptomatology, treatment, pathology and prgnosis are discussed. It is apparent that large bowel carcinoma in the young has a very poor prognosi

ISSN:0007-1323    

DOI:10.1002/bjs.1800660907

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractRestorative resection is being used increasingly for carcinoma of the mid rectum but it is not yet certain whether this operation is as curative as total excision. Between 1963 and 1972, 209 patients left St Mark's Hospital after a radical operation for a single rectal carcinoma situated between 8 and 12 cm from the anal verge. A total of 199 patients was followed up for 5 years. Of these, 112 had been treated by total excision of the rectum and 87 by restorative operation. Survival was correlated with the Dukes' stage, histological grade and extent of local spread in the two groups.There was no significant difference in 5‐year survival after either total excision or restorative resection for Dukes' B (74 per cent, 71 per cent respectively) or average grade (61 per cent, 73 per cent respectively) tumours. Patients with Dukes' C tumours fared better when treated by restorative resection (36 per cent, 63 per cent), probably due to fewer high grade tumours in the restorative group (38 per cent, 18 per cent). Combining two variables, survival was not significantly different for patients with Dukes' B tumours of average grade (69 per cent, 62 per cent) or for Dukes' C tumours of average grade (48 per cent, 76 per cent). When the three pathological variables were combined, there was an improved survival after restorative resection for some pathological combination

ISSN:0007-1323    

DOI:10.1002/bjs.1800660908

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractVaginoplasty was used in a consecutive series of 45 patients undergoing rectal excision for neoplastic and inflammatory bowel disease. Forty‐three patients achieved primary perineal healing and none developed a persistent perineal fistula.One patient with Crohn's disease developed a perianal fistula a year after operation but healing occurred after minor surgery. Another developed a pre‐sacral abscess 9 years after operation; spontaneous discharge into the vagina occur

ISSN:0007-1323    

DOI:10.1002/bjs.1800660909

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractEleven cases of fulminating amoebic colits seen in 5 years are reported. Only people of low socioeconomic status were affected and most were in good health previously. The disease appeared to follow a fulminant course from the onset and was rarely a secondary phenomenon superimposing on the chronic amoebic dysentery. The diagnosis was difficult due to severe systemic manifestations and the periodic absence of Entamoeba histolytica in the stool. The development of colonic necrosis was often masked by the severe preexisting local signs and perforation could occur in spite of adequate anti‐amoebic therapy. Mortality was related to late diagnosis, delayed recognition of irreversible colonic necrosis and inadequate surgical treatment.To reduce the present 55 per cent mortality further it is proposed that, in an endemic area, early specific antiamoebic therapy is justified in severe and undiagnosed colitis. Even under specific anti‐amoebic treatment the patient with severe amoebic colitis remains a potential surgical candidate. Surgery is indicated when the patient continues to deteriorate in spite of the therapy, when there is an acute episode which signifies perforation, or when severe diarrhoea, toxaemia and abdominal tenderness persist after a full course of specific anti‐amoebic therapy. Primary total resection of the diseased colon is the treatment of c

ISSN:0007-1323    

DOI:10.1002/bjs.1800660910

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractIn a 6‐year prospective study from 1972 to 1978 266 patients were admitted to a haematemesis and melaena unit with bleeding duodenal ulcer. There were 13 deaths, a mortality of 5 per cent. A comparison between the three consecutive 2‐year periods of study showed an intial mortality of 6 per cent for the first 4 years falling to 2 per cent for the 93 admissions during the final 2 years of experience. Of the 120 patients treated surgically, 10 died in hospital, giving an operative mortality of 8 per cent. The trend in operative mortality was from 13 per cent for the initial 2‐year period to 8 per cent for the second period and to 3 per cent for the final 2 years. The operative rate was consecutively 45, 50 and 34 per cent. There was 1 death in conservatively treated patients during each 2‐year period of study. Three types of operation were performed: vagotomy, pyloroplasty and oversewing of the ulcer; Polya gastrectomy; and vagotomy and antrectomy. There was no difference in morbidity and mortality between these operations. At a mean follow‐up of 3·1 years, 90 per cent of the patients had a good result from their operation. It is concluded that a prospective system of management with an active policy of early endoscopy, surgery and regular audit reduces the mortality from bleeding duod

ISSN:0007-1323    

DOI:10.1002/bjs.1800660911

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY