摘要:

AbstractA technique of proctocolectomy avoiding an ileostomy has been developed for patients with ulcerative colitis or polyposis coli. After excision of all diseased tissue a reservoir of terminal ileum is constructed which is brought through the rectal stump denuded of mucosa; an ileo‐anal anastomosis is then carried out.Twenty‐one patients (17 ulcerative colitis, 4 polyposis) have been treated and 20 followed for from 2 to 34 months (mean 13·5 months). There was no mortality but early complications occurred in 9 patients. All are currently well, with no disturbance of urinary or sexual function. Continence of faeces is complete in all during the day, but 1 patient evacuates unconsciously at night. The average frequency of evacuation is 3·8 times in 24 h. Ten patients void spontaneously. All patients tolerate a full diet and only 2 use medicaments to reduce frequency.This operation appears to be a satisfactory alternative to proctocolectomy with a permanent ileo

ISSN:0007-1323    

DOI:10.1002/bjs.1800670802

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractSurvival in the presence of malignant oesophagorespiratory fistula is usually limited to a few weeks.In this paper we describe our experience with 3 cases treated by retrosternal oesophagogastric bypass with oesophageal exclusion, and review the experience of previous authors using this and other forms of bypass.The results indicate that both survival and quality of life are considerably better with surgical bypass and exclusion than with any other form of treatment. Indeed, the survival times are frequently better than those achieved after palliative resection of oesophageal carcinoma without fistula.Retrosternal oesophagogastric bypass with oesophageal exclusion is recommended as a simple method of bypass for this condition.

ISSN:0007-1323    

DOI:10.1002/bjs.1800670803

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractA study was made of 326 patients first treated for clinical stage I cutaneous malignant melanoma by a wide excision (with or without split‐skin graft) but no nodal dissection and who subsequently developed recurrence of their disease. Thick lesions recurred far more frequently than very thin lesions, although evidence of partial regression in very thin lesions conferred upon the latter a liability to metastasize. Thicker lesions first recurred predominantly in the vicinity of the scar of primary lesion excision whilst very thin lesions first recurred either at regional lymph nodes or at remote sites. The disease‐free interval fell with increasing tumour thickness. As a result of this, local first recurrences developed more rapidly than remote first recurrences. The cumulative 10‐year survival rate for patients with local first recurrences was, however, significantly higher than for patients with remote first recurrences, as the survival period after local first recurrence was considerably longer than after remote first recurrence.We conclude that tumour thickness is an easily measured, objective predictor of the site and time of first recurrence from melanoma. Thus, by facilitating early detection of first metastastases, it may be possible to prolong survival

ISSN:0007-1323    

DOI:10.1002/bjs.1800670804

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractProphylactic metronidazole was compared with no treatment in a randomly allocated study of patients undergoing appendicectomy. A 1‐g suppository of metronidazole was given with the premedication and 200 mg t.d.s. orally for 7 days thereafter.There were 4 hospital wound infections in the 87 patients receiving metronidazole and 11 out of 83 in the no‐treament group (P<0·05). However, 60 per cent of wound infections occurred at home and the overall infection rates were not significantly different.The duration of postoperative hospital stay was longer in the control group (5·8 days ± 3·0 s.d.) than in the treated group (4·8·2·3; P<0·01).Only one anaerobic infection occurred in a patient receiving metronidazole but late infection was not prevented. Blood levels of metronidazole taken at the end of operation showed a wide variation but there was no correlation with subsequent infection. Culture of the appendix showed aerobic organisms in 88 per cent of cases and anaerobes in 72 per cent.It is suggested that an antibiotic which is effective against both aerobic and anaerobic organisms might have an advantage over metronidazole in a

ISSN:0007-1323    

DOI:10.1002/bjs.1800670805

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractThe effect of intravenous metronidazole as prophylaxis against postoperative wound infection was studied in a prospective, randomized, double‐blind controlled trial of 116 patients undergoing elective cholecystectomy. No significant difference was found in the infection rate between the treated and the control group

ISSN:0007-1323    

DOI:10.1002/bjs.1800670806

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractThe removal of the anti‐anaerobic antibiotic metronidazole has been studied in oliguric patients. The drug and its principal metabolite are rapidly removed by haemodialysis so that the plasma concentration quickly falls below the therapeutic range. Hence a further dose of metronidazole would be needed after dialysis to restore an adequate plasma concentratio

ISSN:0007-1323    

DOI:10.1002/bjs.1800670807

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractA prospective randomized trial was conducted on 301 adult males undergoing inguinal herniorrhaphy to assess the value of postoperative suction drainage. Hernias were classified into ‘complicated’ and ‘simple’. In the ‘complicated’ group suction drainage for 24 h significantly reduced the incidence of wound haematoma, seroma or infection from 48·7 per cent to 17·6 per cent (P<0·01); there was also a noticeable effect on the postoperative morbidity in the ‘simple’ hernias, although this just failed to achieve significance (4·5 per cent in the suction group compared with 9·8 per cent in the controls). It is concluded that suction drainage should be employed postoperatively following repair of hernias where dissection may be difficult or where other complicating

ISSN:0007-1323    

DOI:10.1002/bjs.1800670808

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractA case report of a patient with two extraperitoneal tuberculous abscesses in the abdominal wall diagnosed by ultrasound is presented.

ISSN:0007-1323    

DOI:10.1002/bjs.1800670809

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractTwenty‐four per cent of β‐cell tumours require more than one operation to control the hypoglycaemic syndrome. Almost all of them are small insulinomas undetectable by palpation of the pancreas. Arteriography is too insensitive to detect non‐palpable tumours. Transhepatic catheterizaation of the splenic and portal veins (TPC) can detect the position at which there is an abrupt increase in insulin level indicating the site of the tumour. Routine use of TPC allowed us to locate all 9 insulinomas in which this technique was employed, whereas of 15 patients not studied by TPC only 12 tumours were located at first operation, 2 of which were found by blind resection of the tail of the pancreas. We believe that routine application of TPC to all cases of suspected insulinoma would reduce the incidence of surgical failures, unsuccessful blind resections and lengthy trials of medical therapy before lapa

ISSN:0007-1323    

DOI:10.1002/bjs.1800670810

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractThe pathogenesis of renal failure in jaundice is controversial. Several factors have been incriminated, including intravascular coagulation. We have investigated this hypothesis by studying the deposition of radioactive fibrinogen in the kidney of jaundiced rats. Fibrinogen labelled with125I was injected into rats whose bile duct was subsequently ligated. The radioactivity in the kidney was compared to that in blood and the renal uptake ratio calculated. This ratio (mean ± s.e.mean) rose from 0·24 (± 0·04) to 2·93 (± 0·43) after ligation of the common bile duct. In contrast, in control rats who underwent a sham operation, the uptake ratio rose from 0·31 (± 0·03) to 0·96 (± 0·08). This deposition of125I fibrinogen in the kidneys of jaundiced rats was significantly greater (P<0·001) than that in control rats. The deposition was specific to the kidney compared with that in the heart, bowel, muscle and liver. In the control animal the uptake of125I fibrinogen by the kidney was not different from that by

ISSN:0007-1323    

DOI:10.1002/bjs.1800670811

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY