ISSN:0007-1323    

DOI:10.1002/bjs.1800701102

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractSurgery for carcinoma of the breast is becoming less radical even to the extent of breast conservation. Subcutaneous mastectomy and implant offers itself as an alternative, retaining a breast shape and removing almost all breast tissue. Forty‐four consecutive patients who had this procedure for breast carcinoma were studied with a follow‐up of 5–44 months (mean 25·3 months). Only 4 patients (9 per cent) had local recurrences, i.e. recurrence in the skin flap or scar. This compares favourably with other series and other forms of treatment. Removal of the prosthesis was necessary in 10 patients due to local factors. The cosmetic result as assessed by the patients was almost universally pleasing. Twenty‐six of 27 patients with prostheses in situ who were interviewed in person or by postal questionnaire were pleased with the results of their surgery. The absence of high recurrence rates locally and high patient acceptance makes this a definite surgical alt

ISSN:0007-1323    

DOI:10.1002/bjs.1800701103

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractSimultaneous mastectomy with latissimus dorsi flap reconstructions have been performed on 15 women with primary central breast cancer and on 5 women with local recurrence after local excision and deep X‐ray treatment. The indications and technique are discussed. There was no mortality and no initial morbidity. No prosthesis has become infected. One prosthesis has slipped laterally, requiring removal and re‐insertion at the time of nipple reconstruction. In all patients an acceptable cosmetic result, as assessed by the patient and the surgeon, has been achieved. Follow‐up is very brief, 1–18 months, but there is as yet no sign of local rec

ISSN:0007-1323    

DOI:10.1002/bjs.1800701104

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractAnorectal manometry was carried out at rest, during balloon distension of the rectum and during rectal infusion of saline in 19 patients with haemorrhoids, 30 patients with descending perineum syndrome and 21 controls. Basal and squeeze pressures were significantly higher in patients with haemorrhoids than patients with the descending perineum syndrome. A lower rectal volume was required to inhibit internal sphincter tone in patients with descending perineum syndrome compared with control subjects or patients with haemorrhoids. During rectal infusion of saline basal and peak anal pressures in patients with the descending perineum syndrome were lower than in haemorrhoid patients. Peak rectal pressure was abnormally high in both groups. These differences in anorectal function suggest that despite a similar presentation, the two conditions have a different pathogenesis. Moreover, inappropriate anal sphincter stretch or mucosal excision in patients with descending perineum syndrome may lead to severe incontinence.

ISSN:0007-1323    

DOI:10.1002/bjs.1800701105

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractRecent studies have suggested that the latency of the cutaneo‐anal reflex is prolonged in idiopathic faecal incontinence, suggesting neuropathic damage to the external anal sphincter. Electrical responses were recorded from the external anal sphincter following stimulation of the ipsilateral and contralateral perianal skin in normal subjects and patients with idiopathic faecal incontinence. Ipsilateral stimulation gave rise to shorter latencies of the earliest responses to stimulation compared with contralateral stimulation (P<0·001). When care was taken to compare results obtained by stimulating the skin on corresponding sides of the sphincter, the latency of both the early and late components of the cutaneo‐anal reflex in incontinent patients was not significantly different from that in control subjects. The durations of the motor unit potentials, obtained by conventional electromyography, were prolonged in incontinent patients, indicating that they have external sphincter neuropathy. The data support the suggestion that external sphincter neuropathy in idiopathic faecal incontinence is due to a stretch injury to the pudendal nerve, and indicate that measurement of the latency of the cutaneo‐anal reflex may be an inadequate means of demonstrating nerve damage in patients with idiopathic faecal incont

ISSN:0007-1323    

DOI:10.1002/bjs.1800701106

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800701107

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractRecent studies have suggested that patients with idiopathic faecal incontinence have neuropathic damage to the external anal sphincter and pelvic floor musculature, though no direct assessment of puborectalis function has been made in intact man. Obstetric trauma and chronic straining at stool are thought to be possible causes for damage to the puborectalis nerve supply. In this study the motor unit potential duration in the external sphincter and puborectalis was measured by conventional electromyography in incontinent patients and two groups of continent patients who strained at stool. Our results confirm that incontinent patients had significant neuropathic damage to the puborectalis and the external sphincter compared with controls. Patients with the descending perineum syndrome, who were continent, showed partial denervation of the external sphincter and puborectalis, though the degree of abnormality in puborectalis was less than that in incontinent patients. Finally, patients with constipation showed neurogenic abnormalities in the external anal sphincter but not in the puborectalis. The findings suggest that partial denervation of the external sphincter can occur independently of partial denervation of the puborectalis in patients who strain at stool but if severe changes are present in both muscles, the patient is likely to be incontinent.

ISSN:0007-1323    

DOI:10.1002/bjs.1800701108

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractSeventy patients undergoing elective colorectal surgery for malignant and inflammatory bowel disease were allocated randomly to one of two groups. Patients in group 1 were given, after induction of anaesthesia, a single dose of metronidazole 500 mg i.v. Patients in group 2 were given in addition a single dose of cefuroxime 1·5 g i.v. of 34 patients in group 1, 4 (11·8 per cent) developed postoperative infection. of 36 patients in group 2, 5 (13.6 per cent) developed postoperative infection. No significant difference was noted in the incidence of postoperative sepsis between the two treatment group

ISSN:0007-1323    

DOI:10.1002/bjs.1800701109

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractA randomized, prospective and double blind trial was conducted on 308 patients. Thirty‐one out of 102 patients receiving metronidazole developed wound infection compared with 13 out of 103 patients receiving cefotaxime and 14 out of 103 patients receiving metronidazole and cefotaxime. The reduction in the wound sepsis by the use of cefotaxime or a combination of metronidazole and cefotaxime was statistically significant when compared with patients who received metronidazole only. For early cases including normal, acutely inflamed and gangrenous appendices, we gave a single dose of antibiotics just before operation. For late cases with perforation and abscess formation, the antibiotics were continued for 5 days. There was no statistical difference in wound infection between patients who received cefotaxime alone and these who received a combination of metronidazole and cefotaxim

ISSN:0007-1323    

DOI:10.1002/bjs.1800701110

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractA long saphenous venogram was performed on a consecutive series of 42 patients (5 bilateral) though in 4 the vein was not satisfactorily demonstrated. In all cases the long saphenous vein was dissected out and its suitability for use for a femoropopliteal bypass compared to the radiological findings. Eleven veins were unusable for a bypass and radiologically these were narrower (mean diameter 2·8 mm) than the veins which functioned satisfactorily (mean diameter 5·0mm), and had more tributaries (mean 5) than the suitable veins (mean 2). Preoperative venography is a useful technique to identify veins that will be unsuitable for a femoropopliteal bypass and thereby save an unnecessary dissectio

ISSN:0007-1323    

DOI:10.1002/bjs.1800701111

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY