摘要:

AbstractPatients with primary disease of the lymph system may present with hypoproteinaemia and peripheral oedema. The latter may be partly lymphatic and partly ‘famine’ oedema due to low serum protein.The hypoproteinaemia may be shown to be due to protein loss into the gut. At laparotomy characteristic changes caused by mesenteric lymph obstruction are visible. They may be further elucidated by mesenteric lymphography.Three patients have been treated by excision of the worst affected length of bowel and anastomosis. Their clinical and nutritional states have improved. There have been no complicati

ISSN:0007-1323    

DOI:10.1002/bjs.1800610802

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractA prospective study is presented of the clinical features and laparotomy findings in 26 patients who were re‐explored for complete mechanical small bowel obstruction which occurred when they were in hospital after abdominal surgery. This complication occurred particularly in patients after colorectal and pelvic surgery and operations for acute appendicitis. Attention is drawn to the fact that small bowel distension occurring after the fourth postoperative day is usually due to mechanical obstruction or intra‐abdominal sepsis and rarely, if ever, due to ‘adynamic ileus’.Evidence is presented that plain abdominal radiography is of high diagnostic accuracy in postoperative small bowel obstruction and that early re‐exploration of the abdomen and surgical relief of the mechanical obstruction are indicated in these

ISSN:0007-1323    

DOI:10.1002/bjs.1800610803

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

Abstract1The effect of postoperative peritoneal lavage on survival, peritoneal wound healing and adhesion formation has been studied in rats both with and without fecal peritonitis.2Peritoneal lavage with both Hartmann's solution and noxytiolin through an indwelling peritoneal cannula resulted in a delay in peritoneal wound healing in the absence of fecal peritonitis. There was also an increase in the incidence of adhesions.3Induction of a fecal peritonitis followed by operation 2½–3 hours later resulted in 100 per cent mortality within 24 hours. This mortality was reduced by 66 per cent following peritoneal lavage with Hartmann's solution alone, although this resulted in a delay in peritoneal wound healing. Peritoneal lavage with noxytiolin did not reduce the mortality ra

ISSN:0007-1323    

DOI:10.1002/bjs.1800610804

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractIn 6 dogs with innervated antral pouches (3 with vagally innervated fundic pouches and 3 with vagally denervated fundic pouches) gastric secretion was stimulated by a range of submaximal doses of pentagastrin, each infused intravenously for a period of 6 hours.During the three consecutive 2‐hour collection periods of each test the antral pouch was perfused with isotonic saline of pH 7 0, 1.0 and 7.0 respectively at a rate of I ml/min. Neither acid nor pepsin secretion was inhibited by antral acidification. When the antral perfusion rate was increased to 3 ml/min there was still no inhibition of acid secretion from either type of fundic pouch.In each dog the acid response of the fundic pouch to perfusion of the innervated antral pouch with 0‐5 per cent acetylcholine was significantly reduced when the pH of the perfusate was lowered from 7.0 to 1.0.The results provide no support for the existence of either an antral inhibitory hormone or inhibitory neural reflex active against pentagastrin‐stimulated gastric secretion in the dog. It would seem that antral inhibition of gastric secretion is the result of a diminished release or formation of endogenous ga

ISSN:0007-1323    

DOI:10.1002/bjs.1800610805

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractThe role played by gastric fluid refluxed from the stomach into the oesophagus of patients with symutomatic sliding hiatal hernia has been evaluated in terms of gastric bile salt concentration and acid secretion rates. Patients with a peptic stricture had a higher basal acid output than control subjects. Approximately half of both hiatal hernia groups studied had periods of increased total bile salt concentrations either while fasting or following a test meal, This would indicate abnormal pyloric function in these patients. The quantitative examination of total and individual bile salts in solution in gastric juice suggests that a combination of gastric acid pepsin and bile may be a major, factor in the pathogenesis of the clinical responses to gastrooesophageal reflux. Neither total nor individual bile salt concentrations found in gastric juice helped to differentiate between the specific types of response seen in symptomatic sliding hiatal hernia.

ISSN:0007-1323    

DOI:10.1002/bjs.1800610806

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractIn a retrospective study 119 (9.1 per cent) of 1311 patients undergoing peptic ulcer surgery developed postoperative bile vomiting. Patients aged over 60 years at operation appeared particularly at risk. The sex distribution was equal. Operations that aim at reducing acid secretion had a similar incidence of vomiting, although the complication was not seen following 55 simple gastrojejunostomies. Vomiting developed within I month of operation in 39 per cent of patients, and 57 per cent suffered a significant degree of disability for 6‐14 years after onset. Twenty‐four per cent of patients underwent reoperation. Aetiological factors were gastric outlet obstruction and gastritis due to bile reflux; pre‐existing constitutional and psychological abnormality seldom contributed significantly to the syndrome. It is concluded that bile vomiting as a persistent and disabling complication of gastric surgery demands objective physical and psychological assessment prior to a decision regarding manag

ISSN:0007-1323    

DOI:10.1002/bjs.1800610807

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractAbnormal terminations of the common bile duct, as demonstrated by operative cholangiography, occurred in 23 per cent of 120 patients with biliary tract disease. The importance of this observation in biliary surgery is discussed.

ISSN:0007-1323    

DOI:10.1002/bjs.1800610808

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractThe main objective of this investigation was to establish the incidence of hypothyroidism and recurrent goitre following partial thyroidectomy. Accurate measurements of the thyroid remnants and resected specimens have been made in all cases. The postoperative thyroid status has been assessed clinically and also biochemically by serum thyroxine as iodine, T3resin uptake, free thyroxine index and thyroid‐stimulating hormone estimations. Serum calcium and phosphorus have also been measured and the necessary histological material reviewed.Postoperative hypothyroidism occurred in approximately 11 per cent of previously toxic and 6‐5 per cent of non‐toxic patients, becoming evident in most cases within a year of operation. The T3resin uptake measurement following operation in this and previous series suggests that in many patients there is a compensation process which is maintained by increased secretion of thyroid‐stimulating hormone. No evidence has been adduced that patients who show this compensation mechanism are, as some have suggested, in a state of ‘subclinical hypothyroidism’ or that they become overtly hypothyroid later.In this series hypothyroidism was more closely related to small remnant size than the presence of lymphadenoid change. A significantly higher proportion of patients with small thyroid remnants became hypothyroid in both toxic and non‐toxic groups. Remnants of about 8‐16 ml ‘cuboid’ volume (roughly 8‐16 g by weight) have seemed reason

ISSN:0007-1323    

DOI:10.1002/bjs.1800610809

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractSamples obtained from the thyroid veins as well as from the great veins of the neck of 35 patients with primary hyperparathyroidism were assayed for parathyroid hormone. The overall distribution of the hormone was used to predict the location of the parathyroid tumour. In 27 patients the site of the adenoma was correctly predicted, and in a further 4 the side of the neck in which the tumour was to be found was forecast correctly; in only 4 patients was the technique unsuccessful. Thus, useful information was obtained in 31 of the 35 patients studied (88 per cent). Preoperative localization of parathyroid tumours in this way is of greater value than merely sampling large veins alone, particularly when there has been previous exploratory surgery.

ISSN:0007-1323    

DOI:10.1002/bjs.1800610810

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractA deeply situated leiomyosarcoma of the foot is a rare condition. The clinical presentation of such a case in a young man was confused with that of a postoperative arteriovenous fistula. The patient was treated initially by local excision of the tumour and later by amputation. The criteria for histological diagnosis and assessment of malignancy are discussed.

ISSN:0007-1323    

DOI:10.1002/bjs.1800610811

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY