摘要:

Abstract1One hundred and fifty Hong Kong patients with a diagnosis of tuberculosis of the thoracic or lumbar spine were allocated at random to operation by radical resection of the spinal lesion and insertion of autologous bone grafts (Rad. series) or by simple débridement of the spinal focus (Deb. series). All the patients were treated with isoniazid plus PAS for 18 months and daily streptomycin for the first 3 months.2The main analysis of this report concerns 64 Rad. and 66 Deb. patients with less than 3 vertebral bodies destroyed.3The clinical and radiographic condition of the two series on admission was similar.4In 60 of the Rad. and 63 of the Deb. patients the allocated operation was successfully completed; in the remaining 4 Rad. and 3 Deb. it had to be repeated or a different operation performed.5All the Rad, patients and only 4 Deb. patients were treated in plaster beds, the mean period of recumbency in bed being 73.2 and 11.2 days respectively.6Twenty per cent of the Rad. patients and 12 per cent of the Deb. patients had a clinically evident abscess and/or sinus initially; all had resolved by 18 months.1Of 22 Rad. and 20 Deb. patients with a radiographically evident mediastinal abscess initially and who at no time had a sinus or clinically evident abscess, the shadow had disappeared in 19 and 9 respectively by 12 months, in 19 and 17 respectively by 24 months and was still present in 3 and 1 respectively at 36 months.8The mean total vertebral loss on admission was 0.7 in each of the series; at 36 months there was a mean gain of 0.2 of a vertebra in the Rad. series and a mean further loss of 02 of a vertebra in the Deb. series (P<0∼001).9The mean angulation of the spine at the start of treatment was 23.0ofor the Rad. and 16.40for the Deb. patients. The mean increase over the 3 years was 0.90for the Rad. and 4.50for the Deb. patients (P = 0.1).10Radiographic evidence of bony fusion of the affected vertebral bodies had occurred in 31 per cent of 55 Rad. and 3 per cent of 58 Deb. patients at 6 months (P = 0.0001), in 89 and 53 per cent respectively at 18 months (P<0.0001)and in 93 and 69 per cent respectively at 36 months (P = 0.003).11At 18 months 89 per cent of the Rad. and 79 per cent of the Deb. patients had a favourable response to the originally allocated treatment. The corresponding percentages at 3 years were 87 and 86per cent. However, if the response was classified irrespective of any additional chemotherapy or additional operation received, the proportions with a favourable response increased to 97 and 95 per cent respectively.12Biopsy specimens from spinal lesions were obtained at operation in 149 patients. In 127 (85 per cent) the specimens were histologically tuberculous andlor yielded positive cultures for tubercle bacilli. The organisms were resistant to one or more of the three standard drugs in 24 of 108 strains but the influence on the results was min

ISSN:0007-1323    

DOI:10.1002/bjs.1800611102

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractThree patients who developed vertebral osteomyelitis following genito‐urinary surgery are presented. In each patient a persistent urinary tract infection was noted. Some months after operation these patients developed severe back pain, hut the correct diagnosis WIS not made initially because spinal X‐rays were at first normal. In I patienr an abnormal gamma bone scan was thought, mistakenly, to be diagnostic of metastatic bone disease and it was only when the pain increased after radiotherapy that a diagnosis of. spinal osteomyelitis was considered.The incidence of vertebral osteomyelitis in adults uppears to be increasing, and in order to make the correct diagnosis a high index of clinical suspicion is essential, particularly in patients who have had recent operations on the genito‐urinary s

ISSN:0007-1323    

DOI:10.1002/bjs.1800611103

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractCarotid arterial narrowing less than that considered to be ‘critical’ may cause turbulent blood flow. Eddying may aid the deposition of material from blood, and vortices may aid its embolization, leading to transient ischaemic attacks, the Cassandra of the stroke. Two scintillation detectors were collimated to monitor the distal portion of each internal carotid through the orbits, and a third, the root of the aorta. After the intravenous injection of 10‐15 mCi of technetium‐Wm, activity/time curves were obtained from 58 patients. Fourteen out of 24 patients considered to have cerebrovascular disorders had significantly different values of measured indices of carotid blood flow from a group of 24 ‘normal’ patients (P<0.02). Improvement in these indices was associated with clinical improvement in 6 patients studied bejore and after carotid endarterectomy. In 38 patients a comparison of the results of this technique (carotigraphy)and angiography was made, In unilateral carotid disease, results of carotigraphy correlate significantly with results of angiography, but bilateral symmetricnl carotid artery disease gives normal results of carotigraphy. Analysis by deconvolution of the inflow and outflow activity/time curves obtained during carotigraphy allows study of the individual artery and indicates that normal carotid arterial flow is effectively non‐turbulent. The prediction of turbulent flow by carotigraphy may allow assessment of the pathogenesis and a means of prevention of

ISSN:0007-1323    

DOI:10.1002/bjs.1800611104

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractExperience with a simple method of epicardialintramural pacer lead implantation on either ventricle using local anaesthesia for long term cardiac pacing in cases of symptomatic heart block is presented. The report concerns 40 patients with 41 implants. The follow‐up period was 6‐19 months. There were 3 operative deaths. One of the deaths was coincidental and the other 2 were attributed to bad selection. Early electrode failure due to the development of an exit block occurred in 1 case; he has done well after his right ventricular electrode was transferred to the left ventricle through the same incision using local anaesthesia. There has been no late electrode failure. Nearly all the survivors have obtained excellent results.The distinct advantages offered by this technique of epicardial pacing are discussed.The modification which has been introduced in extending the scope of pacer lead implantation to the left ventricle has increased the usefulness of the technique. Left ventricular placement of the electrode assures better intramural pac

ISSN:0007-1323    

DOI:10.1002/bjs.1800611105

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractThe role of the vagus in the gastrin response to a steak meal was investigated in patients with duodenal ulcer. Thirty patients were studied before and after vagal denervation of the entire stomach (selective vagotomy and s pyloroplasty). Basal and stimulated gastrin concentrations in serum, as determined by radio‐immunoassay, were higher postoperatively (87 pre‐/III postopera‐tively (basal)and 2431341 (peak) pglml). Thirty other patients were studied before and after denervation of the gastric body (highly selective vagotomy). Bnsnl and stimulated gastrin concentrations were also higher postoperatively in these patients (94/133 and 277/343 pg/ml respectively). The differences between the two groups were insignificant. Between individuals, gastrin responses varied markedly, but pre‐ and postoperative responses were positively related within the same subject. No differences were observed between patients with ‘positive’ or ‘negative’ Hollander responses to insulin. In 6 subjects studied 2 and 14 weeks postoperatively no difference was apparent between the two studies.It is concluded that antral branches of the vagi play only a minor role, if any, in the gastrin r

ISSN:0007-1323    

DOI:10.1002/bjs.1800611106

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractA prospective study was performed to determine whether the early postoperative disturbance of gastric emptying after vagotomy altered with the passage of time. In 20 patients the rate of emptying of a 10 per cent dextrose meal was measured by a double sampling dye dilution technique before and 3 months after proximal gastric vagotomy or selective vagotomy without a drainage procedure. Ten of these patients agreed to a further emptying study at 12 months after operation.Profound changes in the pattern of emptying occurred as a result of either operation. At 3 months after operation both selective and proximal gastric vagotomy were associated with an initial cascading of part of the meal (gastric incontinence). Selective vagotomy was then associated with an increase in the time taken for complete emptying, whereas after proximal gastric vagotomy the time taken for complete emptying was similar to that before surgery. In the next 9 months after operation no significant change occurred in the initial cascading, but the delay in complete emptying after selective vagotomy improved in some patients.

ISSN:0007-1323    

DOI:10.1002/bjs.1800611107

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractFour cases of rupture of the retroperitoneal part of the duodenum after blunt abdominal trauma are documented. Two of the patients continued with normal activity for some hours before presenting at hospital, and although the other 2 presented shortly after the injury, the diagnosis in both was made after a period of observation. Repeated abdominal examination is the best aid to diagnosis. Rupture of the second part of the duodenum is more common, Delay in diagnosis is associated with a high mortality.

ISSN:0007-1323    

DOI:10.1002/bjs.1800611108

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractEighteen cases of choledochal cyst affecting Chinese patients are reported. The clinical picture may be one of four types. In infancy, jaundice may be the only feature. In children and adults there may be the classic triad of features or an abdominal mass without jaundice. Terminally, there may be bleeding from oesophageal varices due to biliary cirrhosis. Barium meal examination is the most useful radiological investigation. Intravenous cholangiography is sometimes helpful. The various methods of operative treatment are discussed. Ten cases of cyst excision were performed without mortality.

ISSN:0007-1323    

DOI:10.1002/bjs.1800611109

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractA case of recurrent pneumococcal peritonitis is reported in which it appears that an intra‐uterine contraceptive device (IUCD) was implicafed in the infection. The pathogenesis and management of the condition are discusse

ISSN:0007-1323    

DOI:10.1002/bjs.1800611110

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY

摘要:

AbstractA case is reported of acute appendicitis complicated by disseminated intravascular coagulation and spasm of the peripheral arteries, which led to bilateral amputation of the feet. The cause of the complication is supposed to be endotoxaemia. The possibility of inhibited function of the patient's reticirlo‐endotheliai system is suggeste

ISSN:0007-1323    

DOI:10.1002/bjs.1800611111

出版商:John Wiley&Sons, Ltd.    

年代:1974

数据来源: WILEY