摘要:

AbstractThere is little uniformity in either the indications for operation, the classification of the pathology or the operative management of generalized or faecal peritonitis secondary to perforated diverticular disease. Nevertheless, this review has shown a clear advantage both in terms of immediate mortality and morbidity for primary resection over conservative operations in which the colon is retained in the abdomen. We propose that, when a clinical diagnosis of localized sepsis secondary to diverticular disease is made, the management should be nonoperative with systemic antibiotics and supportive therapy. Operation should be reserved for those patients with obvious generalized peritonitis or failure of conservative treatment. When operation is necessary the affected sigmoid loop should be resected and the operation completed as a Hartmann's procedure in all but the most favourable circumstances when a primary anastomosis may be considered after on‐table irrigation of the colo

ISSN:0007-1323    

DOI:10.1002/bjs.1800711202

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

AbstractTyphoid perforation still has a high mortality rate (19‐59 per cent) and controversy regarding the management of patients with this complication still abounds. We report our experience of 26 children with histologically proven typhoid perforation with an operative mortality of 9‐0 per cent. Timed surgery with ulcer excision, simple two‐layer closure of the defect and copious peritoneal lavage were

ISSN:0007-1323    

DOI:10.1002/bjs.1800711203

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

AbstractThe accuracy of direct vision brush cytology at colonoscopy was compared with colonoscopic biopsies, colonoscopy alone and radiology in the diagnosis of colonic strictures. There were 82 brushings in 79 patients; 55 had malignant and 24 had benign lesions. Cytology was correct in 66 (81 per cent), and biopsy was less accurate with 53 (68 per cent) correct reports. The combined accuracy of cytology and biopsy was 88 per cent. Whilst an endoscopic diagnosis was usually correct (96 per cent), direct vision brush cytology had an important place in the accurate tissue diagnosis of colonic strictures, particularly those in the rectosigmoid.

ISSN:0007-1323    

DOI:10.1002/bjs.1800711204

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800711205

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

AbstractWe report 53 patients who developed small bowel obstruction some time after the treatment of a primary malignant tumour. Previous treatment of the primary tumour in these patients had been by abdominal surgery (22 patients) or pelvic radiotherapy (20 patients) but 11 of the patients had not received previous abdominal surgery or radiotherapy. All the patients had a laparotomy in an attempt to relieve the obstruction. Seventeen patients had a cause for the obstruction other than secondary malignancy. This was noted particularly when the patients had had pelvic radiotherapy, when radiation change of the ileum causing obstruction was common. Thirty‐six patients had obstruction due to secondary tumour and it was found possible to overcome the obstruction in all but two of these. The operative mortality in the patients with secondary malignancy was 19 per cent, but 15 patients (42 per cent) survived for more than a year and the median survival was 11 months. It is concluded that a policy of aggressive surgical intervention is desirable in patients who develop small bowel obstruction after previous treatment for malignant diseas

ISSN:0007-1323    

DOI:10.1002/bjs.1800711206

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800711207

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

AbstractLymphoscintigraphy was used to delineate the lymphatic drainage of the rectum and distal colon in 18 patients with carcinoma of the rectum or sigmoid colon, in four with inflammatory disease of the large bowel and in 20 controls without colorectal pathology. Abdominal imaging was performed after submucosal injection of either 4mCi99mTc‐antimony sulphide colloid or 0.5 mCi99mTc‐dextran into the rectum through a proctoscope. In nine patients with colorectal carcinoma, abdominal imaging was performed immediately pre‐operatively and the excised specimen of large bowel was also imaged in vitro immediately postoperatively. The presence or absence of nodal uptake of radionuclide on abdominal scanning did not discriminate between normal and diseased large bowel, and the extent of nodal uptake demonstrated either by abdominal scans or by in vitro scans of excised specimens bore no relationship to the presence or absence of nodal metastases demonstrated histologically in the cancer patients. Pelvic lymphoscintigraphy as performed in this study has no demonstrable value in the diagnosis or staging of colorectal c

ISSN:0007-1323    

DOI:10.1002/bjs.1800711208

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800711209

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

AbstractTwo hundred and twenty‐three patients with colorectal carcinoma were treated consecutively at the University Hospital of South Manchester from May 1976 to January 1981. Twenty‐four patients (10.7 per cent) were found to have more than one colorectal carcinoma. In 18 patients this was recognized either immediately or within 6 months of the initial diagnosis–‐synchronous carcinoma. In the other six cases a second carcinoma was found at a later time–‐metachronous carcinoma. The incidence of synchronous, and consequently the combined incidence of synchronous and metachronous carcinoma, was higher than previously documented. The anatomical distribution of the multiple carcinomas and the sex incidence in these patients was similar to that seen in patients with a single carcinoma of the large bowel. A high association of adenomatous polypi with multiple large bowel carcinomas was observed. The possibility of more extensive colonic resection in the younger patient with a favourable carcinoma i

ISSN:0007-1323    

DOI:10.1002/bjs.1800711210

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

AbstractThe poor response rates to chemotherapy for colorectal cancer justify attempts to rationalize selection of patients for treatment, and the development of systems to evaluate new cytotoxic agents. Refinement of prognostic indices may identify colorectal cancer patients at a higher risk of recurrence who merit more aggressive treatment. We report our experience with the stem cell assay and pulse thymidine labelling in 43 primary colorectal cancers. Thirty‐six tumours were evaluable, and clonogenic growth was obtained in 30 (83 per cent). In 24 tumours (67 per cent) growth was adequate for meaningful interpretation of a cytotoxic drug assay. Frequency of growth and colony forming efficiency did not correlate with histopathological grade, Dukes' stage or tumour cell kinetic indices. Thymidine labelling indices correlated with Dukes' stage (A and B versus C and D, P<0.01, Mann–‐Whitney U test). Cytotoxic assays with 5‐fluorouracil and 5′‐deoxy‐5‐fluorouridine were undertaken in 18 cases (14 primary carcinomas, 4 malignant ascites), of which 14 were evaluable and 3/14 (21.5 per cent) were chemosensitive in vitro. Both drugs were equally effective in vitro at clinically attainable plasma concentrations. This is in accordance with the response rates observed clinically with 5‐FU chemotherapy in

ISSN:0007-1323    

DOI:10.1002/bjs.1800711211

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY