摘要:

AbstractA series of 26 patients diagnosed as having an insulin‐secreting, islet‐cell tumour of the pancreas is described. Three patients were treated medically, but in the remaining 23 the tumour was found at operation; 1 patient had a carcinoma with hepatic metastases, but in the other 22 the tumour was apparently benign and the subsequent course of these patients has confirmed this conclusion.The tumour was found at the initial operation in 19 of the 22 patients with a benign tumour treated surgically. Of the other 3, the tumour was removed at a second operation in 2 and at a third operation in 1. Two of the 22 patients died following the operation.Diazoxide was administered to 21 patients, before and/or after operation. It was given preoperatively to 17 patients, in all of whom it prevented the development of hypoglycaemic symptoms, but in 2 it caused serious fluid retention and had to be discontinued. Seven patients have been successfully treated with long term diazoxide, either as an alternative to surgery or following an unsuccessful operation, 1 of these being the patient with an islet‐cell carcinoma. In these patients diazoxide has been given for up to 12 years without apparent side effects.Selective coeliac angiography was performed in 13 patients. In no patient did it provide critical information that significantly influenced the treatment of the patient.Percutaneous, transhepatic portal venous catheterization was performed in 4 patients and indicated the site of the tumour in 3, 2 of whom had had 1 previous operation and 1 had had 2 previous operations, at none of which was a tumour found: in all 3 patients the tumour was removed at a subsequent operation.The application of these findings to the management of patients with an insulinoma is discussed and a scheme of management is pro

ISSN:0007-1323    

DOI:10.1002/bjs.1800660602

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractThe blood supply of the human bile duct has been re‐evaluated using high resolution resin casts prepared from 24 fresh human cadavers. The refined technique used yielded casts of all vessels, including capillaries, and produced a clear picture of the blood supply of the human bile duct for the first time. The arterial supply of the supraduodenal duct was shown to be axial, with the main vessels, which have been named the 3 o'clock and 9 o'clock arteries, running along the lateral borders. The retroportal artery, which has not been described by previous workers, was present in all complete casts and was a major source of the axial blood supply to the supraduodenal duct in 32 per cent of them.The major importance of this new knowledge of bile duct blood supply may well lie in the understanding of the aetiology of postoperative bile duct strictures and in their prevention. An explanation is proposed for the long strictures sometimes seen after minimal surgical trauma to the bile duct, based on damage to the small vessels supplying the duct; guidelines to prevent such damage are presented. Ischaemia of the bile duct may also explain some of the biliary problems that have followed human liver transplantation and other procedures involving biliary anastomosis, such as Whipple's operatio

ISSN:0007-1323    

DOI:10.1002/bjs.1800660603

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractMeasurement of liver blood flow has been carried out by three different methods in 14 dogs to assess the accuracy of xenon‐133 clearance following portal vein injection.Electromagnetic flowmetry with flow probes on the hepatic artery and portal vein resulted in a mean value of 121.9 ± 39.3 ml min−1100 g−1. An indicator dilution study utilizing chromium‐51‐labelled red cells gave a mean value of 119.4 ± 31.4 ml min−1100 g−1and the xenon‐133 clearance following portal vein injection, 120.3 ± 33.8 ml min−1100 g−1. One‐way analysis of variance showed no statistically significant variation between these three groups. There was a close correlation between xenon‐133 clearance and electromagnetic flowmetry and between xenon‐133 clearance and the indicator dilution technique.These data suggest that xenon‐133 clearance following portal vein injection gives an accurate assessment of liver blood flow and this technique (as well as direct parenchymal injection) c

ISSN:0007-1323    

DOI:10.1002/bjs.1800660604

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractThe results of a retrospective comparative study of 122 patients who underwent explorations of the common bile duct in a district general hospital over a 5‐year period are presented. Seventy‐eight patients had a supraduodenal choledochotomy, 32 had a transduodenal sphincterotomy and 12 had a combination of both procedures.Particular attention was paid to postoperative complications in relation to the grade of the surgeon performing the operation and also to the age of the patient.A total of 78 (64 per cent) patients had definite stones in the common bile duct. Of these patients, 7 (9 per cent) were subsequently shown to have retained stones, all having been operated on by registrars. Registrars also did more negative explorations than consultants.Nine patients (7.4 per cent) died, all but 1 of them being over the age of 70 and 4 of them having had a combined procedure.We conclude that transduodenal exploration should be avoided in patients over 70, particularly when added to a supraduodenal explorat

ISSN:0007-1323    

DOI:10.1002/bjs.1800660605

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractRenal function and other factors that possibly affect the outcome of operation were measured in 24 patients with obstructive jaundice and in 15 non‐jaundiced controls. The preoperative features that were associated with a poor postoperative recovery from obstructive jaundice were a raised serum fibrinogen/fibrin degradation product concentration, infection, hypoalbuminaemia and a low glomerular filtration rate. Preoperative serum fibrinogen/fibrin degradation product concentrations were raised in 4 of the 6 jaundiced patients who died after surgery but in none of the controls, in whom there was no mortality.In the jaundiced patients there was a greater incidence of postoperative renal impairment than in the controls. All patients were given mannitol during operation. Further mannitol was required after surgery in 13 of the 24 jaundiced patients in order to maintain urine flow rate despite adequate intravenous fluids being given. In contrast, only 1 of the 15 control patients required postoperative mannitol.It is emphasized that repeated doses of mannitol can lead to a profound natriuresis and adequate intravenous saline should be give

ISSN:0007-1323    

DOI:10.1002/bjs.1800660606

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractA series of 311 Chinese patients with acute pancreatitis admitted to Queen Mary Hospital, Hong Kong, over a 10‐year period is reviewed. Biliary tract disease was associated with pancreatitis in 52.4 per cent of patients and 77.9 per cent of them had stones, mud or parasites in the common bile duct. Fever and jaundice were present in 55 per cent and 41.2 per cent of patients respectively. Because of the prevalence of recurrent pyogenic cholangitis among the indigenous population, emergency operation, with the aim of common duct decompression, was conducted in 54.3 per cent of patients during the acute episode, with a mortality rate of 14.8 per cent. Five of 142 patients (3.5 per cent) died whilst on conservative treatment and all 5 had haemorrhagic pancreatitis. The overall mortality rate was 9.6 per cent. Exploration of the common bile duct, which was carried out in 57.4 per cent of patients in the acute phase, was not associated with a higher mortality than when laparotomy alone was performed, and 19 patients had sphincteroplasty without any death. Subtotal pancreatectomy was performed in 2 patients with haemorrhagic pancreatitis with 1 deat

ISSN:0007-1323    

DOI:10.1002/bjs.1800660607

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractTwo cases of haemobilia due to haemorrhagic cholecystitis are presented; only 28 other cases have been described. As there are so many more dramatic causes and treatment for haemobilia it is important for the surgeon to recognize that a common operation will suffice for this rare condition. In both cases bacteria were grown from the bile and it is to be hoped that bile culture will be recorded more commonly in future in cases of this interesting condition.

ISSN:0007-1323    

DOI:10.1002/bjs.1800660608

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractAn unusual case of hydatid cyst of the gallbladder is presented. The difficulties in diagnosis are discussed. There is no other report of such a cyst in the world literature.

ISSN:0007-1323    

DOI:10.1002/bjs.1800660609

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractBenign cysts of the spleen are rare. Six cases have been managed in this hospital in the past 25 years. The history, physical findings and investigations are reviewed. It is suggested that splenectomy is the treatment of choice as it carries a low morbidity and mortality.

ISSN:0007-1323    

DOI:10.1002/bjs.1800660610

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractTwenty‐two patients with recurrent ulceration following vagotomy with and without a drainage procedure have been treated with histamine H2‐antagonists and followed for up to 3 years. Four of a group of 6 patients responded to a single therapeutic course. Ten of 16 patients assigned to long term maintenance treatment remain symptom‐free. Cimetidine may be an alternative to further surgery in the treatment of some patients with recurrent ulceration after vag

ISSN:0007-1323    

DOI:10.1002/bjs.1800660611

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY