摘要:

AbstractOne hundred and eighty patients had a jejunoileal bypass performed during the years 1971‐1982. By leaving only 14 in. (35 cm) of intestine in continuity a mean weight loss of 34.4 per cent (s.d. = 8.5) was achieved over 2 years and, unless the operation had to be reversed for complications, this weight loss was maintained. The improvement in quality of life for a majority of patients should not be undervalued. Two‐thirds of patients required admission for complications and eight patients died (4 per cent). Many of these problems were provoked by an inability to control eating. There have been no hospital deaths since 1976 which we attribute to better management of complications and a policy of early reversal for patients with excessive weight loss and signs of metabolic failure. Despite performing jejunoileal bypass less often in recent years we are still frequently reversing patients with electrolyte disturbances, metabolic failure, urinary calculi or arthritis. Thirty patients (16‐7 per cent) have been reversed, half more than 5 years after bypass. Metabolic failure may occur even after many years of stable weight reduction. Because this is not well known the insidious onset of new weight loss and malaise may not be recognized, or not associated with the bypass many years before. Indefinite outpatient surveillance is mandatory. Changes in the operation have not significantly affected results. There has been no serious liver dysfunction in the 7:7:CJ group but this may reflect better management of lesser metabolic disturbances. Jejunoileal bypass remains the most effective operation for gross obesity and, with experience, can be performed safely. However, the complication rate and difficulty maintaining satisfactory follow‐up on large numbers of young patients makes it an unacceptable procedure on any majo

ISSN:0007-1323    

DOI:10.1002/bjs.1800720202

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800720203

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800720204

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractIn order to identify factors predicting survival following acute variceal haemorrhage, data were collected prospectively from 100 admissions in 70 patients managed by a standard policy employing oesophageal tamponade, injection sclerotherapy and, if necessary, oesophageal transection. Of the ten predictive factors identified by univariate analysis, only prothrombin ratio, serum creatinine and the presence of encephalopathy on admission were shown by stepwise logistic regression to have independent significance. The derived regression equation allowed clearer identification than conventional scoring systems of high and low risk groups and successfully predicted outcome in 90 per cent of admissions.

ISSN:0007-1323    

DOI:10.1002/bjs.1800720205

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800720206

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractThirteen patients who had recently bled from varices underwent oesophageal manometry. A control group of 13 asymptomatic subjects were also studied. Seven of the thirteen variceal patients had manometry before oesophageal transection and repeat manometry at least 1 month following operation. A further group of 17 post‐transection patients also underwent manometry at a mean 27.6 months following operation. Comparison between variceal (13) and control subjects (13) showed that the lower oesophageal sphincter pressure, total length and length of the abdominal and proximal portions of the sphincter were similar in the two groups. Pre‐ and postoperative manometry (7) revealed a significant reduction in lower oesophageal sphincter pressure following transection. The total length of the lower sphincter was shorter postoperatively compared to the pre‐operative length. Both the abdominal and the proximal portion of the sphincter were significantly shorter postoperatively. Comparison between post‐transection group (24) and control subjects (13) showed that lower oesophageal sphincter pressure was significantly less following transection. Both total length and the length of the abdominal portion of the sphincter were significantly lower in the post‐transect

ISSN:0007-1323    

DOI:10.1002/bjs.1800720207

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractProlonged ambulatory oesophageal pH monitoring using a radiopill was carried out in 19 patients following oesophageal transection for varices. The results were compared with 14 asymptomatic control subjects. The duration of oesophageal pH less than five while erect was significantly greater in the post‐transection group than in the control subjects. The duration of pH less than 4 while erect was also greater following transection but this did not quite reach statistical significance. The number of reflux episodes did not differ between the two groups. There was no significant difference in duration or number of reflux episodes while supine between the two group

ISSN:0007-1323    

DOI:10.1002/bjs.1800720208

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800720209

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractIn an effort to meet the increasing demands for blood to cover routine surgery and in order to reduce the amount of time‐expired blood, we have adopted a system of grouping and screening patients' blood pre‐operatively but not crossmatching blood unless there is more than a 30 per cent chance that it will be used. This approach is based on schemes developed in the USA over the past three decades. If there is unexpected haemorrhage at operation and the patient's serum is known to be free of irregular antibodies, blood of the same ABO group is provided, with only an abbreviated crossmatch to check ABO compatibility. During the first 6 months in which the new scheme was in operation it is estimated that the laboratory crossmatched at least 3000 units of blood (44 per cent) less than it would otherwise have done. 336 units were transfused after an abbreviated crossmatch and, as expected, there were no haemolytic transfusion reacti

ISSN:0007-1323    

DOI:10.1002/bjs.1800720210

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractA retrospective study was undertaken of all surgical patients in Malmö, Sweden, during the period 1951‐1980, in whom pulmonary emboli were found at autopsy. The autopsy rate was high throughout the period, ranging from 73 to 100 per cent. Of 5477 patients who died during the period, 1274 had pulmonary emboli (23.6 per cent), 349 of which were considered fatal, 353 contributory to death and 572 incidental. Fifty‐one per cent of the patients were not operated upon. The number of contributory and incidental emboli increased over the period, to some extent probably reflecting greater thoroughness in postmortems. The frequency of fatal pulmonary emboli decreased in the last 5 year period. Pulmonary embolism was more rare in patients under 50 years of age. The proportion of females increased. In 24 cases major embolism emanated from thrombi around central venous catheters. This retrospective analysis of a large number of patients shows that pulmonary embolism continues to be a major cause of death in surgical patients, and in Malmö as common a cause of death in operated as in nonoperated pat

ISSN:0007-1323    

DOI:10.1002/bjs.1800720211

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY