摘要:

AbstractThe effects of peroperative electrical calf muscle stimulation with groups of impulses giving a short lasting tetanus of the calf muscles on postoperative deep venous thrombosis (DVT) and pulmonary embolism (PE) were compared with that of dextran 40 given perand postoperatively. The incidence of DVT and PE during the first 4–6 postoperative days was recorded. The diagnosis of DVT was based on the125I‐fibrinogen uptake test and phlebography and of PE on pre‐ and postoperative perfusion pulmonary scintigram and chest X‐ray examination. Both methods reduced the incidence of PE. Calf muscle stimulation reduced the DVT incidence in patients with malignant disease while the reduction in DVT incidence for the whole group only was significant in the stimulation as well as the dextran 40 group.Mean values for preoperatively determined levels of antithrombin III, beta‐thromboglobulin, fibrinopeptide A, plasminogen and ability to release fibrinolytic activity during venous stasis did not differ between those patients who developed or those who did not develop postoperative DVT or PE. However, antithrombin III levels below 80 per cent appeared to predispose to postoperative thromboembolism. The two prophylactic methods have similar effects on the incidence of postoperative thromboembolism. The stimulation method has certain advantages due to its safety and s

ISSN:0007-1323    

DOI:10.1002/bjs.1800691102

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractWith the two aims of rapidly reducing circulating thyroid hormone levels and controlling the symptoms of thyrotoxicosis, we have prepared 17 thyrotoxic patients for subtotal thyroidectomy, using a combination of potassium iodide administered for 10 days and the long acting beta‐adrenoceptor antagonist nadolol. All 17 patients had normal serum thyroxine levels after 10 days of such treatment although 10 still showed elevation of serum tri‐iodothyronine and considerable elevation in the most severely toxic patient. All patients were, however, clinically euthyroid preoperatively.Nadolol was adminstered once daily, hence avoiding the problems of drug administration in the immediate postoperative period, and plasma nadolol concentrations were high throughout the perioperative period. Serum thyroxine and tri‐iodothyronine levels were significantly lower and reverse tri‐iodothyronine levels higher 24 h postoperatively than before operation. All patients remained stable throughout the perioperative period.We conclude that this regimen has a number of advantages in the preparation of patients for thyroidectomy, in reducing the degree of thyrotoxicosis, in convenience of drug administration and in ensuring adequate circulating concentrations of beta‐adrenoceptor antagonist whilst still retaining a relatively short preoperative phase of drug

ISSN:0007-1323    

DOI:10.1002/bjs.1800691103

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractA series of 17 cases of parotid fistulas seen at one hospital over a 10‐year period is presented with detailed analysis of aetiological factors, clinical presentation and therapy. Distinctions between glandular and ductal fistulas have been enumerated and the poorer prognosis of the ductal fistulas, especially of the proximal part, is emphasized. Two‐thirds of the fistulas were iatrogenic. Malignancy and oral leucoplakia were unusual causes. Direct duct suture is rarely successful. Ablative surgery carries a significant risk of facial nerve injury. A wide choice of treatment exists for glandular and distal duct fistulas, while for the proximal duct injuries excision is usually necessary. A new alternative operation of vein grafting for such cases is described. Successful closure is obtained in only 50 per cent of patients with long standing fistulas with any method of treatm

ISSN:0007-1323    

DOI:10.1002/bjs.1800691104

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractGastric acid secretion was studied in 19 patients with bilharzial hepatic fibrosis and in 19 healthy controls. The patients had significantly lower volumes and acid output than the control group. After splenectomy and vasoligation, the patients' gastric secretion did not increase significantly. Gastric secretion was similar in 19 patients with bilharzial hepatic fibrosis who had never experienced any episode of bleeding and in 19 who bled.

ISSN:0007-1323    

DOI:10.1002/bjs.1800691105

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe results of antrectomy performed for recurrent peptic ulceration after vagotomy and drainage are frequently marred by bilious vomiting. Consequently, there has been interest in combining antrectomy with Roux‐en‐Y drainage to prevent this complication. The experience of one surgeon in revisional gastric surgery has been studied retrospectively. Thirty‐six patients have been reviewed in detail, 24 of whom had a combined antrectomy and Roux‐en‐Y anastomosis: 16 for recurrent peptic ulceration, 2 for non‐ulcer dyspepsia and 6 for bile reflux gastritis. None of these has required reoperation, and 12 of the 16 with recurrent ulcers have had a good result. Four of 12 who underwent antrectomy alone subsequently required biliary diversion. Combining antrectomy with a Roux‐en‐Y anastomosis prevents postoperative bile reflux gastritis and thereby the need for further revision on this account. The results of this approach compare well with those of other procedures used in the treatment of recurrent pe

ISSN:0007-1323    

DOI:10.1002/bjs.1800691106

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe results of truncal vagotomy and pyloroplasty for gastric, prepyloric and combined ulcers in 215 patients were evaluated 9–15 years after operation. The operative mortality was 1·9 per cent, and the recurrence rates in gastric, prepyloric and combined ulcer patients were 8, 13 and 0 per cent respectively. Recurrent ulceration was significantly related to acid serretion. The functional results were not different in patients with gastric and prepyloric ulcers, but significantly better in the small group with combined ulcer than in the group with prepyloric ulcer. No long term weight changes were seen. Gastric cancer was the cause of death in 2 men and 1 woman treated for gastric ulc

ISSN:0007-1323    

DOI:10.1002/bjs.1800691107

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe pattern of gastric emptying has been assessed after gastric bypass surgery using a double isotope technique for measuring solid and liquid emptying with a scintillation camera. Eleven control subjects and 12 patients, 12 months post‐gastric bypass, were studied. Stomal and gastric pouch size were assessed at endoscopy. Solid emptying was slower and liquid emptying was more rapid after gastric bypass surgery. Initial rapid emptying of solid occurred in the 4 patients with the smallest pouch diameters. There was no correlation between stomal size and rates of solid or liquid emptying nor between the weight loss produced by the operation and the rates of solid or liquid emptying, stoma or pouch siz

ISSN:0007-1323    

DOI:10.1002/bjs.1800691108

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe influence of delayed feeding on postoperative vomiting after Ramstedt's pyloromyotomy was investigated. Two feeding regimens were compared, both of which involved a gradual increase in the strength of feeds: regimen A incorporating a 4‐h fasting period and regimen B one lasting 24 h. Of the 67 patients who underwent Ramstedt's pyloromyotomy in 1978 and 1979, 33 were fed by regimen A and 34 by regimen B. Postoperative vomiting was significantly reduced both in incidence and severity in group B. This decrease in vomiting was accomplished without any increase in postoperative sta

ISSN:0007-1323    

DOI:10.1002/bjs.1800691109

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractAn undescended abdominal testis has a high potential for the development of malignancy. Surgery may require both an inguinal and an abdominal exploration. We have used selective testicular venography in 7 men for preoperative testicular localization. In 5, the origin of the testicular vein was identified using this technique and the information acquired proved to be of considerable assistance to the surgeon. We recommend that this technique is used routinely in the localization of the impalpable undescended testis.

ISSN:0007-1323    

DOI:10.1002/bjs.1800691110

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe prevalence of urinary stones in a group of subjects living with a permanent ileostomy has been determined by intravenous urography. Thirty‐nine of the ileostomists had previously suffered from ulcerative colitis, while the remaining 12 suffered from Crohn's disease. Four of the ileostomists who had had ulcerative colitis had urinary stones (10·3 per cent). These four subjects were all male, so that among the 23 male ileostomists who had had ulcerative colitis 17·4 per cent had urinary stones. No urinary stones were found in the ileostomists with Crohn's disease. Various factors thought to be associated with a liability to urolithiasis have been examined in the ileostomists and also in a control group of 39 healthy subjects matched for age and sex with the ileostomists who had had ulcerative colitis. The ileostomists commonly showed a reduced urinary volume, a low urinary sodium and magnesium content and low urinary pH. The ileostomists were much more prone to be hyperuricaemic than the controls, and hyperuricaemia was strongly associated with the presence of urinary sto

ISSN:0007-1323    

DOI:10.1002/bjs.1800691111

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY