ISSN:0007-1323    

DOI:10.1002/bjs.1800720702

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800720703

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractFast neutron therapy has been used to treat 87 tumours of primary, recurrent or metastatic melanoma in 48 patients. Complete regression has been obtained in 71 percent of tumours and 91 per cent of all tumours were controlled for the remainder of the patients, lives. Median survival was 14·5 months; 30 of the 34 deaths were due to metastases. Complications arose in 22 per cent of sites and were either fibrosis, which was related to large treated areas, previous surgery or a higher than standard dose, or necrosis which was related to sites with poor circulation, such as in the lower limb. It is suggested that for the treatment of advanced local disease fast neutron therapy is more effective than X‐ray treatment and has a local control rate similar to that of surge

ISSN:0007-1323    

DOI:10.1002/bjs.1800720704

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800720705

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractFifty patients with medically refractory gastro‐oesophageal reflux were treated by the insertion of an Angelchik anti‐reflux prosthesis. All patients had a pre‐operative upper gastrointestinal endoscopy, 32 were investigated with 15 h overnight oesophageal pH studies combined with oesophageal bile sampling and 20 underwent oesophageal manometric studies. At pre‐operative endoscopy 45 patients had evidence of oesophagitis and the 5 who did not had pathological reflux demonstrated on overnight pH testing. Postoperatively the main clinical problem was dysphagia which appeared to settle with time but left one‐third of patients with mild dysphagia at the end of 12 months. A further 12 per cent had residual moderate to severe dysphagia which required the removal of the prosthesis in five patients (10 per cent). In only one patient was the dysphagia due to prosthetic migration and this was the first patient in the series. Subsequently, we have had no problems with prosthetic migration, disruption, or erosion into the oesophagus. The overnight pH studies confirmed the efficacy of the prosthesis in preventing reflux which correlated with symptomatic improvement. We conclude that, while the Angelchik anti‐reflux prosthesis is an effective device, it has a disturbingly high incidence of postoperative dysphagia though this appears to settle with time, leaving around 10 per cent of patients with severe dysphagia which will necessitate removal of the prosthesis and one‐third with mild dysphagia which may settle with the further pa

ISSN:0007-1323    

DOI:10.1002/bjs.1800720706

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractA prospective study has been made of the use of the Angelchik prosthesis in the treatment of hiatus hernia and gastro‐oesophageal reflux. Forty‐one patients under the care of one surgeon were studied over a 3‐year period. The operation is simple and safe to perform. Twelve patients suffered transient dysphagia which spontaneously resolved within 3 months. Satisfactory results were obtained thereafter in 80·9 per cent. Seven of the prostheses have been removed (17·1 per cent), all within 18 months of performing the operation. Dysphagia and recurrent symptoms were the main reasons for removal and in two of these stricturing was present pre‐operatively. We feel the presence of an established stricture is a contraindication to the use of the device. We have, however, been impressed by its use as a second procedure when previous surgery has failed and when revisional surgery for recurrent hiatus hernia is difficult due to dense adhesion formation. While it is still early to assess the legacy that the use of this prosthesis might incur, we would recommend conservatism if not abandonment of its use until longer‐term evaluation i

ISSN:0007-1323    

DOI:10.1002/bjs.1800720707

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractPopliteal artery aneurysm is a potentially limb‐threating lesion which is frequently difficult to diagnose by clinical examination or angiography. The risk of limb loss can best be reduced by early diagnosis. Over the past 5 years we have prospectively evaluated ultrasound examination of the popliteal space in screening patients with clinically suspected popliteal artery aneurysms. One hundred patients who were suspected clinically of having a popliteal artery aneurysm underwent bilateral ultrasound examination of their popliteal fossae. There were 21 patients who had abnormal scans. The problems identified were popliteal artery aneurysm in thirteen patients, popliteal artery ectasia in four patients, Baker's cyst in two patients, thrombosis in one patient and popliteal stenosis in one patient. Eight patients with eleven popliteal artery aneurysms by ultrasound also underwent angiography. Seven of the aneurysms were confirmed, four were missed. All eleven aneurysms were confirmed at operation. In addition, angiography did not demonstrate an aneurysm in any patient with a normal ultrasound. This study confirms that ultrasound examination is a quick, accurate, and non‐invasive method of screening for popliteal artery aneury

ISSN:0007-1323    

DOI:10.1002/bjs.1800720708

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe risk of rupture of an abdominal aortic aneurysm increases with size. It has thus been recommended that small aneurysms be continuously followed with some type of imaging technique to detect when aneurysm size constitutes an indication for surgery. The present study focuses on the growth rate of abdominal aortic aneurysms in 35 patients who were subjected to repeated computerized tomographic examinations of their abdominal aortic aneurysms. Several aneurysms were measured more than twice resulting in 57 different examinations. The mean growth rate of the transverse diameter was 0·52 cm/year. The individual growth rates were, however, variable. Aneurysms with an initial transverse diameter exceeding 6 cm showed a slightly but not significantly faster increase in size compared with smaller aneurysms. No correlation between initial size and growth rate could be established. Six patients died during the study period, two from myocardial infarction, three after elective aneurysm operations and one, refused for elective operation, died after rupture. It is concluded that the growth rate measured with computed tomography agrees well with previously reported estimates obtained with ultrasonography. It is recommended that small aneurysms particularly in patients with relative contraindications to surgery be followed with repeated examinations of size

ISSN:0007-1323    

DOI:10.1002/bjs.1800720709

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractThis study evaluates the use of ankle systolic Doppler indices for the detection of technical errors during reconstructive surgery. Measurements taken peroperatively, following declamping, are expressed as a ratio of brachial systolic pressure and compared with pre‐operative and postoperative readings. A study has been made of 377 limbs in 272 patients, including patients undergoing surgery for aneurysm, claudication and limb salvage. In the majority of patients the peroperative ratios were similar to, or improved on, pre‐operative levels. No technical errors or primary failures were apparent in those patients in which this was the case. In contrast, in the 27 limbs in which a pre‐operative ratio had been measurable, but no peroperative signal obtained, 21 technical errors were identified and corrected immediately. There were 16 limbs with severe ischaemia, and neither pre‐operative nor peroperative signals, in which the outcome was less certain. In ten, major amputation subsequently became necessary because of inadequate run‐off which was demonstrated radiologically. Finally, there were four limbs in which failure occurred postoperatively in spite of a restored peroperative signal. It is concluded that this simple technique is useful and

ISSN:0007-1323    

DOI:10.1002/bjs.1800720710

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800720711

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY