ISSN:0007-1323    

DOI:10.1002/bjs.1800830802

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800830803

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractThe peritoneum is mainly protected by the innate immune system. This consists of mechanical clearance of the peritoneal cavity, activation of complement, and the actions of polymorphonuclear neutrophils and macrophages. The specific immune system, which is mediated by the activity of lymphocytes, provides a secondary amplification system that may be of great importance for patients with intraperitoneal sepsis. This review provides an overview of the relevant innate immune mechanisms and explores the possible role of peritoneum‐associated lymphoid tissu

ISSN:0007-1323    

DOI:10.1002/bjs.1800830804

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractBoth normal and neoplastic breast tissues are stimulated by endocrine and paracrine hormones. Epidemiological studies have demonstrated the significant role that hormones, growth factors and cytokines have in the promotion, progression and recurrence of breast cancer. Significant variations in the hormonal environment occur based on age, the cyclical changes occurring during the menstrual cycle and (mammographically determined) variations in breast composition. These variations have a significant influence on rates of local recurrence of breast cancer and survival. This review analyses data relevant to these issues and suggests means by which operative results may be improved.

ISSN:0007-1323    

DOI:10.1002/bjs.1800830805

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractThe popularity of double stapling the ileal pouch‐anal anastomosis probably owes more to the technical ease it brings than to histological considerations or functional results. It is preservation of a ‘columnar cuff’ of mucosa, rather than the restricted site of the anal transitional zone, that should be the focus of research with respect to long‐term risk of malignancy and inflammatory complications. If cancer is present in colon that has been removed for ulcerative colitis, there is a 25 per cent incidence of dysplasia in the columnar cuff in the short term. In other circumstances, those who are spared from carcinoma by colectomy are likely to have a similar risk of developing dysplastic change in the columnar cuff with longer follow‐up. Double stapling the pouch‐anal anastomosis and preserving the anal canal mucosa improves function, but long‐term surveillance of the columnar cuff is then required, inclu

ISSN:0007-1323    

DOI:10.1002/bjs.1800830806

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractDr Keizo Sugimachi, Editor‐in‐Chief ofSurgery Today(The Japanese Journal of Surgery), has selected from the January, February and March 1996 issues of his journal for this quarter's digest. A digest ofBJSfor the same period written by Mr Colin Johnson, European Editor, appears in the Japanese jour

ISSN:0007-1323    

DOI:10.1002/bjs.1800830807

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractThe results of laparoscopic cholecystectomy in a group of 52 patients older than 69 years (group 1) were compared with the results of the same operation in a group of 338 younger patients (group 2). In group 1, 23 per cent of patients had acute cholecystitis and 13 per cent were operated on after an episode of acute pancreatitis. In group 2, 8 per cent of patients had acute cholecystitis and 4 per cent were operated on after acute pancreatitis. Pulmonary function was assessed prospectively before operation, 24 h after surgery and on the seventh day after operation, in 20 patients in group 1 and 30 in group 2. In group 1 there was one death (2 per cent); the morbidity rate was 14 per cent and conversion to laparotomy was required in 15 per cent. In group 2 there were no deaths, the morbidity rate was 11 per cent and the conversion rate 4 per cent. No significant differences were found between the two groups in mortality and morbidity rates. Preoperative values of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were significantly lower in group 1 than in group 2 (P<0.05); the values of FVC, FEV1and forced expiratory flow at 50 per cent 24 h after surgery were less depressed in group 1 (P<0.01) and also recovered more quickly in these patients 7 days after operation. Laparoscopic cholecystectomy gives excellent results in geriatric patients and can be recommended as the treatment of choice for symptomatic cholelithiasis in the elderly.

ISSN:0007-1323    

DOI:10.1002/bjs.1800830808

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractCholangiocarcinoma is very common in areas endemic for the liver flukeOpisthorchis viverrini.Survival after surgical treatment of cholangiocarcinoma associated with opisthorchiasis was studied prospectively in 30 patients, all of whom resided in an endemic area. The median age was 52 (range 32–69) years and twenty‐five patients were men. Seven patients had their tumours removed, four with concomitant liver resection. Twenty‐two patients underwent palliative biliary bypass procedures to a segmental duct. Laparotomy with biopsy of metastatic lesions was undertaken in one patient with multiple lymph node metastases and peritoneal seedlings. No patient received postoperative chemotherapy or radiation treatment. Patients were followed for 2 years or until death. The 1‐year survival rate after tumour resection was 86 per cent and the 2‐year survival rate 43 per cent. After palliative procedures the 1‐year survival rate was 26 per cent; no patient reached 2 years and the median survival time was 8 months. Survival after surgical treatment of cholangiocarcinoma in patients with opisthorchiasis is broadly similar to that reported for cholangiocarcinoma without liver fluke

ISSN:0007-1323    

DOI:10.1002/bjs.1800830809

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractA total of 590 exocrine pancreatic cancers of the body or tail of the pancreas, operated on between January 1982 and December 1988, were analysed. There were 128 pancreatic resections (group 1), 164 palliative bypasses (group 2) and 293 exploratory laparotomies which included 74 splanchnicectomies (group 3). The mortality rate was lower in group 1 (9 per cent) than in group 2 (19 per cent) (P= 0.012). The mortality rate exceeded 40 per cent in groups 1 and 2 for patients aged more than 70 years with pre‐existing organ failure. The morbidity rate was 32 per cent in group 1 and 29 per cent in group 2. Patients with metastases had a median survival of 3.4 months, whatever the operative treatment. In the presence of lymph node involvement there was no significant difference in survival between groups 1 and 2. Patients with no metastases and no lymph node involvement had 1‐ and 3‐year survival rates of 38 and 12 per cent respectively after pancreatic resection. Only patients with a small tumour (⩾ 4 cm), no lymph node involvement and no metastases achieved a significantly better survival after resection (P= 0.049). Curative resection should be reserved for a small tumour confined to the pancreas. Fewer than 10 per cent of patients will be suitable for surgery. For the other cases, resection must be considered as a palliative procedure without a significant improvement in survival. It seems justified to limit palliative surgery to candidates for digestive bypass and to use non‐surgical palliation for the

ISSN:0007-1323    

DOI:10.1002/bjs.1800830810

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractProinflammatory cytokine release was measured from peripheral blood mononuclear cells (PBMCs) isolated from six volunteers and, on admission, from 16 patients with acute pancreatitis. Tumour necrosis factor (TNF) release in patients did not differ significantly from that of volunteers, whereas both interleukin (IL) 6 and IL‐8 release in patients was raised when compared with that in the volunteer group (mean(s.e.m.) IL‐6 20.7(4.6)versus9.3(1.7) ng/ml,P= 0.03; IL‐8 283(40)versus128(22) ng/ml,P= 0.04). When variation in white cell count was accounted for, IL‐6 and IL‐8 release but not that of TNF was significantly greater in patients with severe disease than in those with mild disease. These results point to a complex upregulation of proinflammatory cytokine release from PBMCs in patients with acute pancreatitis, components of which relate to the clinical progress of th

ISSN:0007-1323    

DOI:10.1002/bjs.1800830811

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY