ISSN:0007-1323    

DOI:10.1002/bjs.1800760902

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800760903

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800760904

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractTyphoid perforation of the bowel carries a high risk of mortality and is a common surgical problem in many developing countries. This review examines the pathogenesis, and discusses diagnosis and management.

ISSN:0007-1323    

DOI:10.1002/bjs.1800760905

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractBetween November 1979 and December 1986, 263 patients were treated for primary breast cancer by local excision and radiotherapy at the City Hospital, Nottingham. Local recurrence within the treated breast occurred in 56 patients (21 per cent), in 18 (6·8 per cent) of whom it was gross and uncontrollable. An analysis of clinicopathological features shows patient age, nodal status, tumour size, presence of definitive vascular invasion, adjacent ductal carcinoma in situ and grade to be predictive of local recurrence. A Cox's multivariate analysis of these factors shows the first four to be independently significant. The factors can be combined as a prognostic index which allows identification of patients at high risk of local recurrence. On the basis of these findings we have altered our selection policy for patients suitable for breast conservation

ISSN:0007-1323    

DOI:10.1002/bjs.1800760906

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractWe have reviewed the local experience of 15 cases of thyroid lymphoma with a view to documenting the epidemiology, presentation, management and prognostic factors governing outcome for this rare condition. All the patients were European despite the fact that 15 per cent of the local population is either Maori or Polynesian. The average age at presentation was 62 years and 13 of the 15 patients were women. The duration of symptoms was short: on average 9 months. Where feasible a definitive resection of the lesion was performed but this could only be performed in six of the 15 cases. The commonest histological type was non‐Hodgkin's lymphoma which accounted for 14 of the 15 cases with the large cell variant being the most common (five cases). The mean period of follow‐up was 3·3 years: only eight patients were alive and well at that time. The prognostic factors that influenced outcome were: (1) the histology of the lesion — large cell lymphoma carried a bad outlook; (2) whether the lesion could be totally resected or not — five out ofsix patients undergoing total resection remain alive and well; (3) the presence of pre‐existing Hashimoto's thyroiditis was a favourable prognostic factor as only one patient without underlying Hashimoto's disease or positive antithyroid antibodies was alive at the end of the study; (4) male sex may also be an unfavourable prognostic factor as both men in the study died of disease 0·3 and 5 years afte

ISSN:0007-1323    

DOI:10.1002/bjs.1800760907

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractClinically localized carcinoma of the breast in 96 women was treated by wide local excision alone. The locoregional recurrence rate was 35 per cent at a mean follow‐up of 47 months. There was no significant effect of recurrence on survival because of the relatively high mortality rate from unrelated conditions in these mainly elderly patients. Recurrence was successfully managed with tamoxifen in the majority of cases, with few patients requiring radiotherapy or further surgery. Recurrence in the breast was associated with significantly less systemic disease and mortality than recurrence in the axill

ISSN:0007-1323    

DOI:10.1002/bjs.1800760908

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractA prospective study of 72 patients with non‐cyclical breast pain was carried out. Non‐cyclical breast pain was subdivided into true non‐cyclical mastalgia (35 patients) and musculoskeletal pain (37 patients), the latter including Tietze's syndrome and other causes of chest wall pain. Mean age at presentation was significantly greater in the musculoskeletal group (39·3 versus 33·9 years) with a shorter mean duration of pain (14·7 versus 35·4 months) compared with the non‐cyclical mastalgia group. True non‐cyclical mastalgia was commonly bilateral and located within the upper outer quadrant of the breast, whereas musculoskeletal pain was almost always along the lateral chest wall or costochondral junctions and unilateral in 92 per cent of cases. Breast nodularity was present in 54 per cent of patients with non‐cyclical mastalgia, but in only four cases (11 per cent) in the musculoskeletal group. Nine of 14 patients (64 per cent) with non‐cyclical mastalgia obtained a good clinical response to drug therapy (over half responding to danazol alone); 19 underwent spontaneous remission, but there was a prolonged mean time to pain resolution of 27 months. In the musculoskeletal group 33 of 34 patients (97 per cent) had a good response to steroid and local anaesthetic injection; three resolved spontaneously without treatment, with a mean time to pain resolution of 17 months. This study indicates that differentiation of musculoskeletal pain from non‐cyclical mastalgia may lead to more effective treatment with some prediction of th

ISSN:0007-1323    

DOI:10.1002/bjs.1800760909

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractIn Japan, R2lymph node dissection is standard practice for all curatively resected gastric cancer patients. From 1969 to 1984, data were collected prospectively to evaluate this procedure and to provide information for a more rational approach to node dissection for each individual case. A total of 3843 cases was included in this study and an evaluation was made of the prognostic variables and lymph node involvement at various locations. Using a computer program, it is possible to compile a group of treated patients, with prognostic variables exactly matching those of an individual patient. Analysis of this group can then give an indication of the extent of lymph node dissection required for an individual patient. This paper gives a demonstration of the structure of such a system by means of an example.

ISSN:0007-1323    

DOI:10.1002/bjs.1800760910

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractWhen performing total gastrectomy and oesophagojejunostomy with a circular stapling device two disadvantages are obvious; firstly, a purse‐string suture is needed, and secondly the instrument can be extremely difficult to introduce if the oesophagus is narrow, so that the risk of rupture is substantial. We therefore developed the following technique. When the specimen is attached only to the oesophagus and the Roux‐en‐Y loop has already been divided with a linear stapling device, a small incision is made on the back wall of the oesophagus and antimesenterically 6 cm distal to the cut end of the Roux‐en‐Y loop. The two forks of the GIA® or the PLC 50® instrument are introduced into the oesophagus and jejunum, and the two organs are brought together at the hiatus. The instrument is closed and fired. The residual opening is closed with a linear stapler which also includes the front wall of the oesophagus. With a knife, the oesophagus and excessive amounts of tissue are trimmed away, and the oesophagojejunostomy is completed. Fifteen patients (median age 67 years) had a postoperative hospital stay of 10 days (range 8–45 days) after this operation. Leakage occurred in one patient and one patient died. The anastomosis took 12 min to perform (range 8–20 min). Three reoperations were needed: intestinal obstruction, leakage and a negative exploration. The median width of the oesophagojejunal anastomosis 6 months after operation was 32 mm (range 27–40 mm). Oesophagojejunostomy performed with two linear staplers allows a quick and reliable anastomosis independent of oesophageal lumen size and a time‐consuming

ISSN:0007-1323    

DOI:10.1002/bjs.1800760911

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY