ISSN:0007-1323    

DOI:10.1002/bjs.1800760202

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800760203

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800760204

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractThis review examines current knowledge regarding the metabolic responses to trauma and sepsis. The factors which may mediate the responses are discussed and the potential value of pharmacological or nutritional manipulation is reviewed.

ISSN:0007-1323    

DOI:10.1002/bjs.1800760205

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractPrediction of outcome in 87 patients following acute bleeding oesophageal and gastric varices due to portal hypertension from chronic liver disease was studied at our hospital over a 30‐month period. The overall mortality rate was 26 per cent (23/87), with the operative mortality rate (50 per cent) being more than triple the non‐operative mortality rate (14 per cent). The initial prothrombin time ratio (PTR) alone was significantly different in survivors and non‐survivors both in the operated and non‐operated patients. The only survivor in the whole material with a PTR ⩾ 2·2 was a patient who was transferred and underwent successful liver transplantation elsewhere. Among operated intensive care unit (ICU) patients, the Glasgow predictor gave a mean probability of discharge of 0·81 (s.d. 0·15) in 13 survivors and of 0·35 (s.d. 0·35) in the 15 non‐survivors (P<0·001). In the 11 non‐operative ICU patients, who had failed sclerotherapy, the Glasgow predictor could not be validated. Fourteen ICU deaths were associated with significant hypotension defined as a systolic blood press

ISSN:0007-1323    

DOI:10.1002/bjs.1800760206

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractData were collected prospectively from 159 patients undergoing Lewis‐Tanner oesophagectomy for carcinoma of the lower two‐thirds of the oesophagus and analysed with regard to anastomotic leakage. The 30‐day mortality rate was 3·8 per cent and none of these deaths was due to anastomotic leakage. In hospital, mortality was 7·5 per cent. Six patients (3·8 percent) had evidence of a leak. In four patients this was from the suture line, but in the remaining two it was due to patches of gangrene in the fundus of the transposed stomach and was separate from the anastomosis. Two patients died with an unhealed leak. Anastomotic leaks were minor in three instances and healed with conservative treatment but the fourth required exploration. Gangrene of the oesophageal substitute resulted in gross leakage with mediastinitis and required exploration in both cases. An apparent predisposing cause was evident in five of the six cases with leakage and some of these might have been avoidable. Transthoracic oesophagectomy can be performed with acceptably low mortality and leak rates and may therefore be considered as the treatment of choice for most patients with oesophagea

ISSN:0007-1323    

DOI:10.1002/bjs.1800760207

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800760208

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractA series of 60 gastroplasty operations based on Mason's vertical banded procedure are described. Details of technique, modifications, complications and results are discussed. Operative treatment results in a reduction to within 40 per cent of ideal weight in 80 per cent of patients between 12 and 18 months after surgery. The constricting band should not be greater than 5 cm; if it is most procedures will fail after 18 months. Pouch size should be measured and made no greater than 20 ml. The importance of nutritional counselling is emphasized. The surgical treatment should form part of a multidisciplinary approach with careful selection and long‐term follow

ISSN:0007-1323    

DOI:10.1002/bjs.1800760209

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractFrom 1 January 1969 until 31 December 1985, gastric resections were performed in 937 patients with carcinoma of the stomach and 422 patients with carcinoma of the cardia. During this period, the general frequency of cardia carcinoma increased continuously from 6·6 per cent (1969–71) to 37·5 per cent (1984–85) and a corresponding decrease of carcinomas in other sites was observed. Early carcinomas (pT1) of the oesophageal margin (n = 10, 2·4 per cent) were diagnosed less often than early carcinomas in other sites (n = 177, 18·9 per cent). Whereas 51·4 per cent of all resected carcinomas of the stomach showed no lymph node metastases (pN0), only 14·1 percent of cardia carcinomas belonged to this category. With respect to operative treatment. Lauren's classification which defines the required margin of clearance according to diffuse type (frequency in cardia carcinoma 43 per cent, in other stomach sites 51 per cent), is of great significance. We believe that extensive oesophageal resection is necessary for patients with such difficult tumours. The pattern of metastasis in cardia carcinoma is similar to that of cancer in other stomach sites, the preferred area is the regional lymph nodes on the lesser curve (83 per cent). Histological classification and metastasis pattern show that cardia carcinoma is a type of carcinoma of the stomach which must be treated according to the criteria of stomach cance

ISSN:0007-1323    

DOI:10.1002/bjs.1800760210

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800760211

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY