ISSN:0007-1323    

DOI:10.1002/bjs.1800831002

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800831003

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractIsolated limb perfusion (ILP) for limb melanoma remains controversial despite its frequent use for over 35 years. To determine whether it has proven benefits, reported results have been reviewed. The value of adjuvant ILP cannot be determined from the multitude of retrospective studies on this subject. Preliminary results of the large European Organization for Research and Treatment of Cancer–World Health Organization–North American Perfusion Group trial suggest that patients with melanomas of 1·5–3·0 mm in thickness who do not undergo elective lymph node dissection may have a locoregional control benefit from ILP. However, as long as a definite survival advantage for ILP has not been demonstrated, such treatment does not seem justified for these patients. The value of prophylactic ILP after resection of recurrent limb melanoma is also scientifically unproven. The potential prevention of further limb recurrence for only a limited period of time, as demonstrated in a rather small Swedish trial, probably does not justify routine use of ILP in these patients; a large international trial will be needed to assess whether ILP provides a survival advantage. For those with locally inoperable limb melanoma, ILP appears to be the treatment of choice since it results in complete disappearance of all macroscopic disease in a substantial proportion of patients, removing the need for amputation and providing palliation of symptoms. However, high limb recurrence rates and short duration of response need improvement. Results of alternative treatments should be compared prospectively with those of ILP in this clinical si

ISSN:0007-1323    

DOI:10.1002/bjs.1800831004

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractDrug misuse is now a significant problem in western society; many different Pharmaceuticals are administered by drug abusers as intravenous preparations. This has resulted in an increasing number of complications associated with prolonged intravascular and perivascular injection of abused substances. These complications of intravenous drug abuse may lead to limb‐threatening arterial injuries that present a considerable management problem in patients who often have significant co‐morbidity. This article provides a comprehensive review of the vascular complications that result from drug misuse by injection. It discusses the aetiology and clinical features of these complications and highlights the limited role of both the general surgeon and specialist vascular surgeon in the management of these patie

ISSN:0007-1323    

DOI:10.1002/bjs.1800831005

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractAnal fissure is a common problem that causes significant morbidity in a young and otherwise healthy population. Treatment has remained largely unchanged for over 150 years and the pathogenesis of this condition is not yet fully explained. Acute fissures should be treated conservatively with dietary modification. Chronic fissures do not respond to conservative treatment. The current recommended surgical treatment for chronic fissure is lateral internal sphincterotomy. However, there is a disturbance of continence in a sizeable proportion of those undergoing this procedure. As yet there is no proven non‐surgical treatment for chronic fissure. Although local injection of botulinum toxin and the topical application of nitrates show early promise, further controlled trials are neede

ISSN:0007-1323    

DOI:10.1002/bjs.1800831006

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractIntestinal mucosal barrier function in obstructive jaundice was assessed in an animal model and in patients. The effect of internal biliary drainage in patients was also examined. Bile duct ligation for 1 week in the rat resulted in significant bacterial translocation (in seven of 12 animals following ligationversusnone of the sham‐operated controls,P<0·01). Intestinal permeability, measured by the urinary recovery of orally administered polyethylene glycol, was also significantly increased (+ 66·2 per cent for ligationversus−11·6 per cent for sham,P<0·01). A prospective study was performed on 33 patients with obstructive jaundice undergoing internal biliary drainage, and results were compared with those in six non‐jaundiced patients undergoing laparotomy or endoscopic retrograde cholangiopancreatography and in 11 healthy volunteers. The lactulose: mannitol ratio was used as an intestinal permeability index. Mean(s.e.m.) intestinal permeability assessed before operation was significantly increased in jaundiced patients compared with control patients (0·050(0·010)versus0·016(0·003),P<0·005). The mean(s.e.m.) lactulose: mannitol ratio in the healthy volunteers was 0·020(0·003), which was similar to that in control patients. In the jaundiced group of patients the intestinal permeability index fell to within normal levels after 28 days of internal biliary drainage (0·050 before operationversus0·021 at 28 days,P<0·02). These data indicate that intestinal barrier function is impaired in obstructive jaundice and that this impairment is reversed by return of bile to the gas

ISSN:0007-1323    

DOI:10.1002/bjs.1800831007

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractMethods to minimize the effect of cold ischaemia on porcine islet isolation were investigated. Forty pancreata were randomized to intraductal collagenase delivery in University of Wisconsin solution (UW) or Hanks balanced salt solution (HBSS) (control) both before and after 65 min of cold pancreas storage. Collagenase was also administered in a specially designed cold storage solution (University of Leicester solution, ULEIC), before cold storage. Median islet yield was significantly greater if the pancreas was distended with collagenase in either UW (21 524 islet equivalents (IEQ) per g) or ULEIC (19 814 IEQ/g) before cold storage, compared with that after distension with HBSS (6924 IEQ/g) following cold storage (P<0·05). Islet fragmentation, islet purification and glucose‐stimulated insulin release were not significantly different after collagenase delivery in either UW or ULEIC compared with those after administration in HBSS. It is concluded that porcine islet yields can be improved significantly by intraductal collagenase administration in either UW or ULEIC immediately after excision of the pancre

ISSN:0007-1323    

DOI:10.1002/bjs.1800831008

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractThe rapid introduction of laparoscopic cholecystectomy has been associated with an apparently increased incidence of bile duct injury which has provoked worldwide concern. The true incidence and mechanism of iatrogenic ductal injury during the development of this procedure remain unclear. To assess this, the introduction of laparoscopic cholecystectomy in the West of Scotland has been audited prospectively over a 5‐year period. All cases of biliary ductal injury have been independently reviewed. Some 48 surgeons undertaking laparoscopic cholecystectomy in 19 hospitals submitted prospective data between September 1990 and September 1995. A total of 5913 laparoscopic cholecystectomies were attempted with 98·3 per cent completion of data collection. During this period 37 laparoscopic bile duct injuries occurred. The annual incidence peaked at 0·8 per cent and has fallen to 0·4 per cent in the final year of audit. Injuries occurred after a median personal experience of 51 (range 3–247) laparoscopic chole cystectomies in 22 surgeons. Major bile duct injuries occurred in 20 of 37 patients, giving an incidence of 0·3 per cent. Five mechanisms for laparoscopic ductal injury were identified, including tenting, confluence and diathermy injuries as well as the classical and variant classical types. Ductal injuries were discovered at operation in 18 patients with consequent repair giving a good clinical outcome in 17. Contributory factors (severe inflammation, aberrant anatomy and poor visualization) were present in only 13 of 37 cases. This audit suggests that, at least in the introductory period, laparoscopic cholecystectomy is associated with an overall bile duct injury rate higher than that reported previously after open cholecystectomy, although the incidence of major ductal injury is similar. The late downward trend in bile duct injury, however, suggests there may be a prolonged learning curve for this procedure. Improved understanding of the mechanism of injury may lead to yet further reductions in this compl

ISSN:0007-1323    

DOI:10.1002/bjs.1800831009

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractSome 114 patients (median age 52 years) underwent laparoscopic hernia repair as a day‐case procedure. Twenty‐one patients had bilateral and 11 recurrent hernias. Some 113 patients underwent transabdominal preperitoneal mesh repair but one required conversion to open operation. Mean operating time was 24 min for unilateral and 38 min for bilateral repair. In an operating session of 3·5 h, up to five patients (mean 4·4) underwent surgery and as many as seven hernias were repaired. More than 10 per cent of patients were found to have a previously undiagnosed hernia on the opposite side. A total of 111 patients were discharged home on the day of surgery. Major complications included one omental bleed and one small bowel obstruction. Seroma was the commonest minor complication and occurred in 7 per cent of patients. More than 35 per cent of patients needed no postoperative analgesia. To date there has been one recurrence (follow‐up range 2–1

ISSN:0007-1323    

DOI:10.1002/bjs.1800831010

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractProspective surveys of workload were carried out during 1989, 1990 and 1995. Analysis of outpatient referrals, inpatients and operations performed over periods of 3 months was undertaken and the changing patterns of general surgical and vascular surgical workload noted. The number of outpatient referrals rose throughout the study period because of a significant increase in the number of patients with both varicose veins and other vascular problems. There was an increase in the number of emergency admissions for vascular disease. The number of patients having general surgical operations fell; there was a corresponding increase in the number for arterial and venous disease. The general surgical component of a general surgical unit with a vascular interest is gradually declining, as increased numbers of patients with vascular problems are being referred and managed.

ISSN:0007-1323    

DOI:10.1002/bjs.1800831011

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY