摘要:

AbstractWe reviewed 100 patients who underwent formal parotidectomy. Seventy‐two were new patients in whom a parotid lump proved to be a pleomorphic adenoma. Twenty‐eight were patients in whom a tumour had recurred after treatment for pleomorphic adenoma by local excision (with or without irradiation) elsewhere. After a follow‐up of 1–15 years (median 4 years), there were no recurrences in the primary group but 5 recurrences among the secondary cases. Permanent facial nerve damage was not seen in the primary group, but 11 patients undergoing secondary parotidectomy were left with some permanent facial weakness. Malignant change occurred in 4 patients in the secondar

ISSN:0007-1323    

DOI:10.1002/bjs.1800690102

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractTwenty patients with advanced testicular teratoma and 1 with advanced seminoma have undergone abdominal surgery for the removal of residual disease following treatment by sequential chemotherapy (1). Fourteen out of the 21 patients (66 per cent) have achieved complete remission with a follow‐up period of 6–41 months. In 12 patients (57 per cent) the tumour had undergone histological maturation or necrosis following chemotherapy, those patients in whom the tumour remained histologically active having a worse prognosis. Raised preoperative serum levels of the tumour markers human chorionic gonadotrophin (hCG) and alpha‐fetoprotein (AFP) indicating active disease, forecast a particularly poor prognosis, 5 out of 9 such patients (55 per cent) having died. Computerized tomography gave false negative results in 3 patients (14 per cent). Postoperative complications were few, and only 2 patients (9 per cent) suffered with failure of ejaculation. At present our policy is surgical removal of any residual mass after chemotherapy to determine the histology, and, wherever possible, to achieve complete clinical and biochemical remission. Six patients with an apparently poor prognosis have benefited directly from surgery and remain in long term remission. The selection of patients who benefit most from surgery can only be determined by more experience and longer foll

ISSN:0007-1323    

DOI:10.1002/bjs.1800690103

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractFrom 1970 to 1974 proximal gastric vagotomy without drainage was performed in 158 patients for duodenal ulcer. One patient died, giving an operative mortality of 0·6 per cent. Nine unrelated deaths occurred during the period of survey and 5 other patients were lost to follow‐up. The remaining 143 patients were followed‐up for a minimum of 5 years and a maximum of 9 years.The most frequent symptoms were epigastric fullness and intolerance to milk. Early dumping, detected in 6·7 per cent of the patients, was always mild. Diarrhoea, also very slight and often only related to the ingestion of milk, was seen in 9·6 per cent. Recurrent duodenal ulcer was proved in 7·7 per cent and strongly suspected in 0·7 per cent and the presence of a new gastric ulcer was also proved in 1·4 per cent of patients, making a total incidence of recurrence of 9·8 per cent. Approximately 89 per cent of the patients were classed as having a satisfactory result and 11 per cent were classed as unsatisfactory.Proximal gastric vagotomy is clearly effective in reducing the side‐effects of gastric surgery, while the incidence of recurrent ulceration in the long term is similar to the incidence of recurrence after truncal or selective vagotomy with a drainage procedure. For these reasons, consideration should be given to the wider use of proximal gastric vagotomy in the elective surgical treatment of du

ISSN:0007-1323    

DOI:10.1002/bjs.1800690104

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractImpaired gastric emptying in gastric ulcer patients has generally been explained by gastric hypomotility.The gastric motor response to an electrical vagal stimulus was measured intraoperatively in patients with gastric ulcers (GU, n = 21), duodenal ulcers (DU, n = 25) and combined ulcers (GDU, n = 6).Amplitude and duration of the contraction and integrated motor response were found to be significantly greater in GU patients than in patients with duodenal and combined ulcers.Thus, hypermotility of the gastric muscle exists in GU patients and the delayed gastric emptying in GU disease may be the result of antropyloric motor dysfunction rather than of gastric hypotony. Abnormal motility associated with duodenogastric reflux appears to be a key feature in the pathogenesis of gastric ulcer.

ISSN:0007-1323    

DOI:10.1002/bjs.1800690105

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractLuminal nutrition is known to have a trophic effect on small bowel mucosa after intestinal resection. Humoral agents, however, may also contribute to this process. Two of the proposed humoral agents, enteroglucagon and gastrin, were therefore investigated after intestinal resection and transection in the rat, and changes in their concentration in the plasma were related to cellular proliferation.Forty‐eight male Wistar rats had either 75 per cent proximal small bowel resection or jejunal transection. The animals were further divided into three groups, each with a different nutritional intake. The first group were allowed food ad libitum. The second group were kept under hypothermic conditions which resulted in hyperphagia, while the last group were nourished intravenously. A further 8 animals had a laparotomy only (sham operation). All animals were killed 12 days after operation, plasma enteroglucagon and gastrin were measured, while determination of the crypt cell production rate (CCPR) was used to denote cellular proliferation.In each group resected rats had significantly higher crypt cell production rates and greater enteroglucagon levels compared with transected animals. However, only in the normally fed group was plasma gastrin increased in resected animals, there being no significant difference in the plasma concentration of this peptide in transected compared with resected rats, in both the intravenously fed and hyperphagic groups.In the models studied enteroglucagon appears to be a more likely candidate for a humoral trophic agent than gastrin in intestinal adaptatio

ISSN:0007-1323    

DOI:10.1002/bjs.1800690106

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe short term results of colorectal anastomosis using the Russian SPTU and American EEA circular staplers are compared. Anastomoses with these stapling devices were attempted in 61 patients between October 1978 and December 1980. In 1 patient the stapling method failed at operation, so that 60 patients had a stapled anastomosis as their definitive form of anastomosis. Of these, 31 were stapled using the Russian SPTU device and 29 using the American EEA device. Parameters of age, indication for operation, surgical assessment of curability, tumour stage and distance from the anal verge are compared to demonstrate similarity of the groups. Practical aspects of the use of the staplers are discussed. Local complications of dehiscence, anastomotic haemorrhage, stenosis and fistula formation occurred in 17 patients. Complications related specifically to the stapling procedure occurred with similar frequency in both groups: 8 patients treated with the SPTU stapler and 9 patients treated with the EEA stapler. No significant advantage was demonstrated for either stapler with respect to overall local complications; however, the authors have found the EEA stapler both easier to use and easier to maintain.

ISSN:0007-1323    

DOI:10.1002/bjs.1800690107

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractSodium and water absorption were measured in defunctioned loops of colon of dogs either in the presence or in the absence of the bacterial fatty acid, n‐butyrate.In freshly defunctioned colonic loops n‐butyrate enhanced sodium absorption twofold (P<0·05) and promoted sodium absorption for 48 h. In the absence of n‐butyrate, defunctioned loops lost the ability to absorb sodium and water within 48 h. Pre‐treatment of colonic loops with fatty acids for 3 h significantly diminished (P<0·05) sodium and water losses into the colonic lumen compared with loops pre‐treated with saline only. Butyrate was absorbed at a steady rate even when no sodium was aborbed.Results suggest that fatty acids act on the colonic mucosa to exert a trophic effect on absorption of sodium. This trophic effect determines the efficiency of absorption of ions and could have clinical implications in the genesis of postoperativ

ISSN:0007-1323    

DOI:10.1002/bjs.1800690108

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractAdmissions for acute cholecystitis to the Radcliffe Infirmary, Oxford, during the period 1974–1978 have been reviewed and compared with figures previously published for the period 1953–1962 (I).There was a small overall increase in the annual rate of female admissions for acute cholecystitis between the two periods and this increase can be accounted for by population changes in all age groups above the age of 40 years. However, there was a significant increase in the admission rate of women under the age of 40 which could not be accounted for by changes in population alone. This apparent increase in acute gallbladder disease in young women coincides with the growth between 1960 and 1970 of the number of women taking oral contraceptives, and is further evidence of a causal relationship between the use of the contraceptive pill and the development of gallstones. Women taking oral contraceptive steroids had a higher rate of common bile duct exploration and of sphincteroplasty than did those not taking oral contraceptives.The annual rate of male admissions almost doubled between the two periods and this increase cannot be accounted for by population changes. There has also been a virtual disappearance of acute cholecystitis in children over the same t

ISSN:0007-1323    

DOI:10.1002/bjs.1800690109

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractIt was felt that the apparent specificity of the amylase‐to‐creatinine clearance ratio (ACCR) in several previous studies of pancreatitis might reflect a failure to utilize adequately ill control subjects. The ACCR and the renal clearances of beta 2‐microglobulin (B2‐m), similarly related to creatinine (BCCR) as well as the urinary concentration of albumin, were compared in 27 patients with acute pancreatitis, 8 with a perforated peptic ulcer and 7 with mild biliary colic, during the first 5 days in hospital. Acute pancreatitis was graded as mild (6), moderate (14) or severe (7), using a combination of clinical data, diagnostic peritoneal lavage and multiple criteria. Further assessment of the severity of the acute illness was obtained from measurement of C‐reactive protein (C‐RP). Lowest C‐RP levels were found in the patients with mild pancreatitis and biliary colic, and highest levels in the patients with severe pancreatitis and perforated ulcer (P<0.002). Similarly, ACCR and BCCR levels were significantly lower in the two mild groups than in the two severe ones (P<0.01 and<0.002 respectively), although plasma amylase was raised only in patients with pancreatitis and plasma B2‐m was similar in all groups. Electrophoresis of urine showed dense bands of tubuloprotein in patients from both severe groups. Urine albumin was higher in severe pancreatitis than in perforated ulcer (P<0.1), perhaps indicating a more specific glomerular lesion in pancreatitis. Thus a rise in amylase clearance appeared to be related to the severity of the acute illness, and may be a component of a non‐specific tubuloproteinuria. In this study patients with a perforated peptic ulcer had increases in ACCR similar to those seen in patients with severe pancreatitis, and we are therefore doubtful whether ACCR has any role in the clinical diagnosis of p

ISSN:0007-1323    

DOI:10.1002/bjs.1800690110

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractA prospective randomized controlled trial of dextranomer beads (Debrisan) and silicone foam elastomer (Silastic) dressings in open infected surgical wounds has been performed. The results indicate that the healing time for wounds treated by Debrisan (n = 25) and elastomer (n = 25) is similar, being 40.92 ± 3.98 and 36.90 ± 3.18 days respectively. The time taken for wounds to become pain‐free was similar in both treatment groups, as was the persistence of signs in the wounds of erythema, oedema and slough. Comparison of cost reveals the elastomer dressing to be considerably cheaper than Debri

ISSN:0007-1323    

DOI:10.1002/bjs.1800690111

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY