ISSN:0007-1323    

DOI:10.1002/bjs.1800771002

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800771003

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractAn association between colorectal cancer and previous peptic ulcer surgery is reported. In a prospective screening study, 100 asymptomatic patients (80 men and 20 women) who had undergone truncal vagotomy at least 10 years previously were investigated by barium enema, colonoscopy and gallbladder ultrasonography. Control data were obtained from forensic autopsy subjects. The incidence of neoplasms ≥1.0 cm in the vagotomized group was 14 per cent (11 adenomas, 3 carcinomas) and 3 per cent in controls (P = 0.01). Duodenal bile obtained at endoscopy from 21 vagotomized patients with normal gallbladders and from 21 control patients undergoing endoscopy was analysed by high performance liquid chromatography. The mean percentage of cholic (CA), chenodeoxycholic (CDCA), deoxycholic (DCA) and lithocholic (LCA) acids in the bile of vagotomized patients was 32.3, 45.6, 20.7 and 1.4 per cent respectively compared with 45.3, 36.2, 17.9 and 0.7 per cent respectively in controls. The increased proportions of CDCA and LCA and decreased proportions of CA in the duodenal bile of vagotomized patients were significant (P<0.001; P = 0.02; P = 0.007). Abnormalities in bile acid metabolism may help to explain the increased risk of colorectal neoplasia 10 years after truncal vagotom

ISSN:0007-1323    

DOI:10.1002/bjs.1800771004

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractProcoagulant activity (PCA) in normal urine has been recognized for over 50 years. Although tissue factor (TF) is produced by certain tumours, and is increased in both tumour‐associated macrophages and blood monocytes, the possibility that it might also be increased in urine has not been studied in patients with cancer. We have measured urinary PCA in hospital controls without inflammatory or neoplastic disease (n = 79), in patients with rheumatoid arthritis (n = 8), inflammatory bowel disease (n = 79), colorectal cancer (n = 70) and in patients undergoing colonoscopy (n = 50). Urinary PCA was higher (P<0.001) in patients with colorectal cancer and inflammatory bowel disease than controls or patients with rheumatoid arthritis. Fourteen (88 per cent) out of 16 colonoscopy patients subsequently found to have carcinoma or inflammatory bowel disease had levels above the control upper quartile, compared with 8 (24 per cent) out of 34 with normal colonoscopy (P<0.007). TF inhibitors confirmed the nature of the PCA and Western blotting studies indicated a urinary TF molecular weight of approximately 38000. These studies provide further evidence of abnormal haemostasis in malignancy and suggest that determination of urinary TF may provide a useful screening test in patients undergoing colonoscop

ISSN:0007-1323    

DOI:10.1002/bjs.1800771005

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractA total of 145 consecutive patients receiving a colorectal anastomosis were randomized to ‘test’ or ‘no test’ once the anastomosis had been completed. Anastomotic testing was performed with the pelvis filled with saline and the rectum distended by sigmoidoscopic insufflation of air. Any leaks demonstrated were oversewn. A water‐soluble contrast enema was performed on the tenth postoperative day. Seventy‐four patients were randomized to ‘test’ and 71 to ‘no test’ but one patient was withdrawn from each group leaving a total of 143 for analysis. The two groups were well matched for age, sex, diagnosis and operative details. Eighteen (25 per cent) air leaks were detected and repaired in the ‘test’ group. After operation there were three (4 per cent) clinical leaks in the ‘test’ group and ten (14 per cent) in the ‘no test’ group (Fisher's exact test, P = 0.043). There were eight (11 per cent) radiological leaks in the ‘test’ group and 20 (29 per cent) in the ‘no test’ group (P = 0.006). Intraoperative air testing and repair of colorectal anastomoses significantly reduces the risk of postop

ISSN:0007-1323    

DOI:10.1002/bjs.1800771006

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractOf 60 patients presenting with acute obstructing carcinoma of the left colon, 49 underwent immediate resection either by radical subtotal/total colectomy (31 patients, group I) or by radical segmental resection (18 patients, group II) of whom three had immediate anastomosis after on‐table bowel irrigation and 15 had a planned staged procedure. The operative mortality rate was 3 per cent in group I and 11 per cent in group II (not a statistically significant difference). However, substantial differences were found for major morbidity (6 versus 44 per cent in groups I and II respectively; P<0.01) and mean length of hospital stay (17 days in group I versus 35 days in group II; P<0.05). All three patients who had on‐table lavage developed anastomotic leaks which necessitated a second operation to form a stoma. Six patients (19 per cent) in group I required antidiarrhoeal medication in the immediate postoperative period. However, subsequent improvement in stool frequency was noted in all patients. It is concluded that subtotal/total colectomy is an acceptable means of managing patients with obstructing carcinoma of the left colon in that it is associated with a low morbidity and mortality rate and good functional resu

ISSN:0007-1323    

DOI:10.1002/bjs.1800771007

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractPrevious retrospective studies have suggested an association between consumption of non‐steroidal anti‐inflammatory drugs (NSAIDs) and the complications of diverticular disease. Ninety‐two patients were entered into a prospective study of the complications of diverticular disease over a 3 year period; 31 were taking NSAIDs, compared with only four age‐ and sex‐matched controls from a representative general practice (P<0.001). A second control group comprised 306 patients with cancer of the colon in whom NSAID consumption was again significantly lower than in patients with diverticular disease (22 of 306 versus 31 of 92, P<0.001). Of the 31 patients taking NSAIDs, 19 presented with a perforation or peritonitis. By contrast, only eight of the 61 patients not taking NSAIDs had such complications (P<0.001). Eleven patients presented with bleeding of whom five were taking NSAIDs and six were not. Patients admitted with complications of diverticular disease have a high incidence of NSAID intake, and it appears that NSAID consumption is associated with a more severe form of th

ISSN:0007-1323    

DOI:10.1002/bjs.1800771008

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800771009

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractEfforts to explain the possible effects of blood transfusion on the recurrence of colorectal cancer have been based entirely on the immunosuppressive effects of blood transfusion. However, the relationship between solid tumour development and the immune system is inconclusive. We have investigated an alternative mechanism involving the potential role of growth factors in this phenomenon. Using a human fibroblast: [125I]deoxyuridine uptake mitogenesis assay, the relative amounts of growth factor in the plasma of stored blood were measured. There was a progressive increase in mitogenesis from day 0 (n = 6) to day 28 (n = 6; P<0.001, Mann‐Whitney U test). The effect of growth factors on the development of liver and intraperitoneal metastases was studied in Hooded Lister fats. Following an intraportal injection of 105MC28 tumour cells, the experimental group (n = 25) received 2 ml of syngeneic serum intravenously for 4 days. Likewise, colonic anastomoses were performed on omentectomized rats and the peritoneal cavity seeded with 103cells. The experimental groups (n = 20) received either 2 ml serum intravenously repeatedly or 3 ml serum intraperitoneally (n = 19). There was no significant increase in liver metastases or peritoneal disease following intravenous infusion of serum but serum delivered intraperitoneally resulted in a significant increase in tumour from 22 per cent in the controls to 89 per cent in the study group (P<0.01). Growth factors released from platelets following blood loss into the peritoneal cavity may be important in enhancing local recurrence of colorectal cance

ISSN:0007-1323    

DOI:10.1002/bjs.1800771010

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractManagement of the patient with mastalgia who fails to respond to first line therapy is a difficult problem and there is a group of patients who do not respond to any therapy. A group of 126 patients with mastalgia who failed to respond to first line therapy and completed further treatment options was studied. The response rate of those with cyclical mastalgia fell to 57 and 25 per cent for second and third line therapy respectively. Equivalent figures for non‐cyclical mastalgia were 24 and 21 per cent. Danazol maintains a high response rate after the failure of other drugs, whereas the second line response to bromocriptine and evening primrose oil is poor. Unresponsive patients were matched to a group of patients who responded to first line therapy, and reproductive and historical factors were compared using the x2test, but failed to identify which patients would respond to therap

ISSN:0007-1323    

DOI:10.1002/bjs.1800771011

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY