ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.02873.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.00518.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundHereditary breast cancer is thought to account for less than 10 per cent of all breast cancers. Recently there have been significant advances in understanding of the genetics, with the sequencing of the genesBRCA1andBRCA2which are associated with hereditary breast cancer.Methods and resultsCurrent understanding of hereditary breast cancer and its impact on the management of women with this disease is reviewed.ConclusionProblems in accurate testing for breast cancer‐associated genes remain. No reliable simple test exists because of the large number of mutations present in these genes. The implications of different mutations remain poorly understood. Guidelines for the management of carriers of the breast cancer‐associated genes remain controvers

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.00527.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundA body of evidence exists for the occurrence of bacterial translocation and its relationship to multiple organ failure (MOF).MethodsRelevant articles on bacterial translocation (the phenomenon defined as the passage of microbes and endotoxin across the intestinal barrier) in patients prone to develop MOF and in representative animal studies were selected. To interpret and evaluate the evidence for bacterial translocation in current literature, the endpoints generally used are discussed.ResultsFractional data from individual manuscripts were tabulated and assessed for statistical significance with χ2analysis. Various clinically relevant stimuli, postulated as important causative factors for the development of MOF, appeared to be interrelated and related to bacterial translocation itself.ConclusionsConvincing evidence exists that bacterial translocation can occur in humans during various disease processes. However, it remains to be determined whether a causal relationship between bacterial translocation and MOF exists. MOF is probably multifactorial and not uniform in origin; when evaluating translocation as a causative factor in the absence of an infective focus, the type of initiating event and the period of time after which MOF develops should be taken into account. The origin of early MOF is probably a non‐bacterial, extensive, inflammatory response resulting in massive generalized endothelial cell activation. Late MOF may be caused primarily by bacterial translocation inducing an imbalance between proinflammatory and anti‐inflammatory cytok

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.00520.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundMany technical difficulties of the ileoanal reservoir operation have been overcome, allowing acceptable morbidity in the hands of both the frequent and less frequent operator. However, a minority of patients have persistently unsatisfactory pouch function, which can be a difficult problem to manage.MethodsA Medline search was carried out to identify relevant papers published from November 1996 to January 1978. For clinical information more emphasis was given to recent publications with larger numbers. Where appropriate, information from other sources and some local data were included.ResultsMost patients empty the pouch four to eight times a day with perfect continence and no urgency, and are considered to have acceptable function with which they are satisfied. Patients who have poor function beyond an easily treated episode of pouchitis require the expertise of a multidisciplinary team offering some understanding of the anatomy, physiology and pathology of the gastrointestinal tract in general and of the ileal reservoir in particular. A thorough and persistent approach to difficult cases is often rewarded with a good outcome, with the exception of problems arising from postoperative sepsis. The temptation to use pouchitis as a waste‐basket diagnosis for poorly understood dysfunction should be avoided. Problems causing poor function may originate in the pouch (including pelvic sepsis), the pouch outlet, or the small bowel above the pouch, and these areas need to be considered in each case.ConclusionTo optimize the benefits of restorative pouch surgery, both patients and physicians need to understand aspects of fine tuning of pouch function, including diet, medication and lifestyle. In managing ileoanal reservoir dysfunction the temptation to procrastinate should be resisted; an approach that is systematic and sympathetic should be adopte

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.00521.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundThis study was a prospective evaluation of colour duplex imaging for the assessment of distal run‐off before femorocrural reconstruction.MethodsPatients with critical ischaemia who required a distal bypass underwent preoperative run‐off assessments using dependent Doppler, arteriography and duplex imaging by a vascular surgeon, radiologist and technologist respectively; each was blinded to the findings of the others. Preoperative data were compared with intraoperative clinical findings and completion flow studies/ arteriograms.ResultsForty‐three consecutive patients (33 men, ten women; mean age 78 (range 53–95) years; 12 diabetic) undergoing 44 femorocrural reconstructions for critical ischaemia were assessed. The 30‐day primary cumulative graft patency for the series was 86 per cent. Dependent Doppler correctly predicted a suitable run‐off vessel in 21 limbs but was indeterminate in four and unrecordable in 19. Arteriography correctly predicted a suitable run‐off vessel in 32 cases, but was indeterminate in six and failed to demonstrate run‐off in three patients. Arteriography suggested an inferior vessel in three cases. Duplex correctly predicted a suitable run‐off vessel for all 44 grafts.ConclusionDuplex imaging is superior to arteriography for preoperative assessment of distal run‐off for femorocr

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.00595.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundSubfascial endoscopic perforator surgery (SEPS) is the minimally invasive alternative to the open (Linton's) procedure. This new technique may allow perforating vein interruption with fewer complications and a shorter postoperative hospital stay.MethodsThis study was a case note review of 67 procedures: 30 SEPS and 37 Linton's.ResultsThere were no significant differences between the two groups in age, sex and indication for surgery. SEPS was associated with a significantly reduced postoperative stay in hospital (median 2 (range 1–49) days) compared with the Linton's procedure (median 9 (range 3–36) days) (P<0·0l). Nine patients who had Linton's procedure suffered a calf wound complication compared with none who had SEPS. The presence of an open ulcer at the time of surgery did not prolong the duration of stay in either group, nor did it increase the incidence of calf wound complications.ConclusionIn patients undergoing calf perforator interruption for chronic venous insufficiency, SEPS is associated with significantly less morbidity and a shorter hospital stay than Linton's procedure. SEPS can be performed safely at the same time as skin grafting and in the presence of an open ulcer without any increase in wound complicat

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.00600.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundConventional ultrasonography is used widely in the investigation of gallstone disease but is limited in the detection of bile duct stones due to poor visualization of the distal bile duct. Endoscopic retrograde cholangiopancreatography (ERCP) is currently the investigation of choice for suspected choledocholithiasis, but is not without morbidity. Endoscopic ultrasonography clearly visualizes the entire extrahepatic biliary tree and avoids the need for ERCP in many patients.MethodsSome 50 patients with suspected duct stones underwent endoscopic ultrasonography followed by ERCP. All cholangiograms were performed or interpreted by a second doctor blinded to the results of endoscopic ultrasonography.ResultsBoth tests were successful in 46 patients; both tests failed in two patients and ERCP alone failed in a further two. Duct stones were confirmed in 24 patients. Sensitivity (95 per cent confidence interval (c.i.)) of ERCP and endoscopic ultrasonography in identifying these stones was 79 (58–93) per cent and 88 (68–97) per cent respectively; specificity (95 per cent c.i.) was 92 (75–99) per cent and 96 (80–100) per cent.ConclusionEndoscopic ultrasonography accurately identifies bile duct stones. It is recommended in all patients with a risk of duct stones but especially in those with a history of ERCP‐induced pancreatitis, when other pathology is suspected, when ERCP has failed, when bile duct abnormalities are suspected during pregnancy and in patients with acute pan

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.00597.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundRecent studies have suggested that the mortality rate from pancreatic resection for cancer is high in the UK compared with that in published series. A survey of specialist units was conducted to determine whether the results differed from those in general units.MethodsThe postoperative outcome following resection of pancreatic and periampullary tumours was analysed from specialist units in the UK and compared with that of other multi‐institutional and large single institutional studies published recently (1900–1996).ResultsA total of 1026 resections was reported from 21 units (33 surgeons). Postoperative complications necessitated reoperation in 57 patients (6 per cent) and there were 58 deaths (6 per cent) in hospital. Pylorus‐preserving resections were performed in 102 (41 per cent) of 250 patients with ampullary adenocarcinoma undergoing a major right‐sided resection and in 123 (32 per cent) of 381 patients with ductal adenocarcinoma of the head of the pancreas undergoing right‐sided resection (χ2= 4·01, 1 d.f., 2P= 0·04). The mean number of resections for pancreatic ductal adenocarcinoma was 3·41 (range 1·0–7·1) per institution per year. Combining these data with those from the nine published series from specialist units, there was a lower mortality rate compared with the results of five published general surveys (median 4·9 per cent (95 per cent confidence interval (ci) 3·1–8·0 per cent)versus9·8 (2·5–23·2 per cent), 2P<0·01) and specialist units had a higher volume caseload (median 5·5 (95 per cent c.i. 4·2–8·1)versus0·5 (−0·2–2·0) cases per institution per year, 2P<0·001). Postoperative mortality was related to caseload both for the UK (χ2= 7·17, 1 d.f.,P<0·0l) and for all the data combined (χ2= 40·4, 1 d.f.,P<0·0001).ConclusionThe results from specialist units in the UK compare favourably with those from specialist units outside the UK and are superior to those from non‐specialist units. The mortality rate i

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.00504.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundThe advantages of preoperative localization in the management of primary hyperparathyroidism have not been clearly demonstrated. The aim of this study was to investigate prospectively the accuracy of three localization techniques in patients with this condition.MethodsForty‐nine consecutive patients with primary hyperparathyroidism underwent ultrasonography, magnetic resonance imaging (MRI) and technetium‐thallium (Tc‐TI) subtraction scanning before surgery, during which an attempt was made to identify all parathyroid glands. A scan was regarded as correct if it identified an enlarged parathyroid gland on the correct side of the neck as subsequently demonstrated at surgery.ResultsUltrasonography had a sensitivity of 38 per cent (18 correct scans in 47 patients) with a positive predictive value of 78 per cent. The sensitivity of MRI was 72 per cent (34 of 47) with a predictive value of 92 per cent. Tc‐TI scanning was 60 per cent sensitive (28 of 47) with a predictive value of 85 per cent. Two patients with negative neck explorations were subsequently found to have mediastinal adenomas.ConclusionUltrasonography, MRI and Tc‐TI scanning have limited value as localization techniques and the relatively low sensitivity of these investigations means they are of no value before first‐t

ISSN:0007-1323    

DOI:10.1111/j.1365-2168.1997.00598.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY