ISSN:0007-1323    

DOI:10.1002/bjs.1800740302

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800740303

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractThe pressure and intra‐abdominal length of the lower oesophageal sphincter (LOS) were measured by oesophageal manometry before and after floppy Nissen fundoplication (FNP) for intractable gastro‐oesophageal reflux. Control of reflux was assessed by 24 h pH recording and endoscopy. It was complete in 67 cases (84·8 per cent) in this non‐consecutive series. In the group as a whole LOS pressure increased significantly after FNP, but the intra‐abdominal length did not. LOS pressure decreased in 21 cases of whom 16 (76·2 per cent) still had perfect reflux control. Likewise, intra‐abdominal length decreased in 41 cases of whom 36 (87·8 per cent) had good reflux control. There was no evidence of a compensatory increase in length to account for reflux control when LOS pressure decreased. When a length—pressure diagram was plotted for the postoperative measurements no clear separation of those with persistent reflux could be seen. These results suggest that the measured changes in LOS pressure and length following FNP are an artefact of surgery rather than the means by which the operation controls gastro‐oe

ISSN:0007-1323    

DOI:10.1002/bjs.1800740304

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractDuring the period 1978–1984, 525 patients referred with cancer of the oesophagus or gastro‐oesophageal junction were assessed for operation and cure. After investigation, 276 patients were selected and operaten upon, as a rule, 4 weeks after radiotherapy (40 Gy/4 weeks). In 224 patients (81 per cent) the oesophagus and cardia were resected and reconstructed with stomach (69 per cent), colon (21 per cent), free ileal graft (7 per cent) or Roux‐en‐Y‐oesophagojejunostomy (3 per cent). The postresectional hospital mortality was 14 per cent in all patients and decreased to 5 per cent in 1983. Mortality was higher when the colon was used for reconstruction than when the stomach was used. By postresection staging, 82 patients were found to have stages I and II tumours and 14. patients stage III tumours. Estimated 3‐year survival after resection for all male patients was 28 per cent and for all female patients was 42 per cent. Estimated 3‐year survival for all patients treated for adenocarcinoma was 31 per cent. Survival was better for stages I and II patients with adenocarcinoma (52 per cent) than for stage III patients (18 per cent) (P<0·01). Estimated 3‐year survival for all patients treated for squamous cell carcinoma was 33 per cent. Estimated 3‐year survival was better for stages I and II patients with squamous cell carcinoma (48 per cent) than for stage III patients (25 per cent) (P<0·001). It can be concluded from this study that resection of oesophagus and cardia after radiotherapy offers hope for cure in a subgroup of patients with non‐advanced oesophageal cancer. The operation can be performed with acceptable mortality by experienced surgeons, especially when the stomach is us

ISSN:0007-1323    

DOI:10.1002/bjs.1800740305

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractThe dietary habits after colon interposition following oesophagectomy in patients without symptoms (n = 8), with regurgitation (n = 22) and in sex‐and age‐matched healthy controls (n = 20) were studied by a 7‐day diary method. The patients ate smaller meals (1080 ± 90 kJ versus 1810 ± 151 for the controls, P<0·01), more frequently during the day (eight versus five in the controls). Solid and sour foods were preferred, especially by those with regurgitation, compared with controls. The asymptomatic patients consumed more milk and coffee and less cheese, sour milk, meat, fish, eggs, tea and orange juice than the patients with regurgitation. Vegetable fats and medium chain triglycerides were consumed in negligible amounts. The patients with regurgitation had more fluids separately from meals than the asymptomatic patients. The results suggest that intake of vitamin supplements and replacement of animal fats by vegetable fats may be useful in these patients. Much of the dietary difficulties after colon interposition might be the result of the intra‐abdominal colon graft loop anastomosed to the antrum; a short graft with a more proximal anastomosis to the lesser curvature merits study in th

ISSN:0007-1323    

DOI:10.1002/bjs.1800740306

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800740307

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractTraumatic rupture of the diaphragm is a potentially serious injury which presents in different forms depending on the mechanism of the causative trauma. Over a 7 year period, 20 patients (17 male and 3 female) with traumatic rupture of the diaphragm were seen in our unit; their mean age was 25·6 years. Automobile accidents caused the diaphragmatic injuries in 65 per cent of cases while falls from trees were the cause of injury in 10 per cent. Ten patients (50 per cent) were seen within 7 days of the injury and 95 per cent within 3 months. The left hemidiaphragm was ruptured in 85 per cent and the right in 15 per cent of cases. Fifty ribs were fractured in fourteen patients (70 per cent) but there were no pelvic fractures. Fourteen patients (70 per cent) had gastrointestinal visceral herniation into the thorax, the stomach, omentum, colon and spleen being the commonest herniating organs. Successful surgical repair was achieved in 18 patients, 4 of whom also had splenectomy; 2 patients were treated conservatively. A high index of suspicion and early surgical treatment are the mainstay of successful management of traumatic rupture of the diaphragm with or without herniation of abdominal organs

ISSN:0007-1323    

DOI:10.1002/bjs.1800740308

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractThe extensive morbidity and mortality of intra‐abdominal abscess is mainly due to the delay in a diagnosis. The diagnostic accuracy of111In‐labelled mixed leucocytes with gamma imaging has been investigated in 100 consecutive patients including 34 following surgery and 36 with inflammatory bowel disease. White cell scans were performed 24 h following infection of autologous111In‐labelled leucocytes and were compared with clinical outcome where abscess was only diagnosed when pus either discharged or was drained at operation. Gamma images detected 28 of the 30 abscesses with no false positives giving 93 per cent sensitivity and 100 per cent specificity. Loculi of pus were identified in 11 of the 36 patients with inflammatory bowel disease with no errors in interpretation. Inflammation was reported in 15 of the remaining 25 patients with known but not necessarily active inflammatory bowel disease.111In‐labelled leucocyte imaging provides a rapid, safe and precise method for detecting intra‐abdominal abscess even in the presence of inflammatory bowe

ISSN:0007-1323    

DOI:10.1002/bjs.1800740309

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800740310

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractIn 24 dogs a 100 cm length of terminal ileum was autografted as an orthotopically vascularized Thiry—Vella segment. In six dogs absorption, motility and histology were studied in detail and in two intestinal myo‐electrical activity was recorded. At a second operation 5 weeks after autotransplantation the Thiry—Vella segment was returned to its normal anatomical position in the intestinal stream and 2 months later all the non‐transplanted intestine was resected. Eighteen grafts were technically successful. Intestinal myo‐electrical activity was normal by the second day after transplantation while intestinal transit and contractile activity recovered within 10 days. Mucosal morphology and intestinal absorption had largely recovered by 10 days after grafting but absorption of oleic acid was impaired for 4 weeks. Ten dogs with severe short bowel syndrome but intact ileocaecal valve were maintained in good health for more than 7 months by a 100 cm ileal

ISSN:0007-1323    

DOI:10.1002/bjs.1800740311

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY