ISSN:0007-1323    

DOI:10.1002/bjs.1800780302

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800780303

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractAcute limb ischaemia poses a threat to both the limb and life of a patient. Until recently, attempted revascularization by thrombo‐embolectomy or vascular reconstruction held the best chance of limb salvage. Thrombolytic techniques afford an alternative method of management for this condition and are effective in selected patients. Low‐dose intra‐arterial streptokinase is the most established method of thrombolysis, although the recently developed tissue plasminogen activator offers a promising alternative. Intra‐arterial thrombolysis is not an easy option, being labour intensive and requiring close co‐operation between surgeon and radiologist. Thrombolytic and surgical techniques are not mutually exclusive but are best used to complement each other. Ideally patients with acute limb ischaemia should be managed by surgeons with knowledge of, and access to, optimal current surgical and non‐surgical

ISSN:0007-1323    

DOI:10.1002/bjs.1800780304

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractThis paper reviews the subject of regeneration of the spleen and discusses the role of splenic autotransplantation following splenectomy for trauma.

ISSN:0007-1323    

DOI:10.1002/bjs.1800780305

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractPrimary hyperhidrosis, although lacking a precise definition and of unknown aetiology, disrupts professional and social life and may lead to emotional problems. A variety of treatment methods are used to control or reduce the profuse sweating which involves mainly the palms, soles and axillae. The simplest method, the application of topical agents, is usually attempted first for axillary and plantar sweating. Iontophoresis may provide relief especially in patients with plantar or palmar involvement. In severe cases operative intervention is necessary. Excision of sweat glands is successful in patients with axillary hyperhidrosis but the role of suction‐assisted removal of axillary sweat glands remains to be determined. Sympathectomy remains the standard by which other treatments must be judged. For upper thoracic sympathectomy a variety of surgical approaches are used with satisfactory relief of hyperhidrosis. Complications related to the surgical approach, such as Horner's syndrome, brachial plexus injuries, pneumothorax and painful scars may occur, while following sympathectomy compensatory hyperhidrosis is usual and hyperhidrosis may recur. Plantar hyperhidrosis which may be exacerbated or ameliorated by upper thoracic sympathectomy and which fails to respond to non‐operative intervention is relieved by lumbar sympathect

ISSN:0007-1323    

DOI:10.1002/bjs.1800780306

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractA group of 54 patients with acute or chronic limb ischaemia were initially treated with low dose intra‐arterial thrombolytic therapy using streptokinase (10000 units h−1) or plasminogen activator (0·5 mg h−1). Complete thrombolysis was obtained in 90 per cent of patients with symptoms of less than 1 week duration, and in 50 per cent with symptoms of greater than 1 week (P<0·05). Successful lysis in 36 patients was followed by successful bypass surgery in seven, percutaneous angioplasty in 13, no further treatment in 13, repeat thrombolysis in two and amputation in one. Failed therapy was associated with major amputation in 40 per cent. One patient died of haemorrhage and another of stroke as a direct result of thrombolytic treatment. The most common complication was haematoma at the site of cannulation of the vessel. Intra‐arterial thrombolytic therapy can be very useful for the management of acute and chronic limb ischaemia, but complications do occur and patients should be carefully

ISSN:0007-1323    

DOI:10.1002/bjs.1800780307

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractIntraoperative blood loss is an important factor in reconstructive surgery for aortoiliac disease because it is clearly associated with an increase in the operative morbidity and mortality rates. To minimize intraoperative blood loss, a blood‐tight vascular prosthesis has been developed by impregnating a knitted Dacron™ prosthesis with bovine collagen. To study a potential reduction of intraoperative blood loss using these collagen‐impregnated prostheses, we conducted a prospective randomized trial involving the collagen‐impregnated prosthesis and its non‐impregnated substrate, the Dacron knitted non‐impregnated prosthesis. During a 2·5‐year period, 123 consecutive patients (undergoing 81 procedures for aneurysmal disease and 43 procedures for occlusive disease) were admitted for elective aortic reconstructive surgery. Equal numbers of the two prostheses were randomly implanted. Various parameters were monitored: intraoperative blood loss before aortic cross‐clamping (phase 1), during implantation of the prosthesis (phase 2) and after release of aorta cross‐clamping (phase 3); the number of intraoperative and postoperative blood transfusions; and, finally, all preoperative and intraoperative factors that might contribute to intraoperative blood loss. A significant overall difference in intraoperative blood loss between the collagen‐impregnated (2425 ml) and the non‐impregnated (1907 ml) group was found (P = 0·003). However, this difference could not be attributed to collagen impregnation because no statistically significant difference in blood loss was found in the relevant period of operation (phase 3). Similar results were observed in patients operated on for both aneurysmal and occlusive disease (2600 versus 2195 ml and 2105 versu

ISSN:0007-1323    

DOI:10.1002/bjs.1800780308

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractThirty‐nine gastrointestinal complications occurred in 35 of 4473 patients (0·78 per cent) who underwent surgery involving cardiopulmonary bypass during an 8‐year period. The mortality rate when one of these complications occurred was 22 (63 per cent) representing 11·5 per cent of the 191 deaths from all causes in the series. The relative risk of developing a gastrointestinal complication was 1:249 when the heart was not opened, 1:66 when it was and 1:5 after cardiac transplantation. Gastrointestinal bleeding (n = 20) was the most common complication of whom nine (45 per cent) died, followed by intestinal infarction (n = 12) with eight (67 per cent) deaths and acute pancreatitis (n = 6) all of whom died. There was one death after surgery for gastrointestinal bleeding (n = 7). No patient survived bowel infarction without operation but resection was possible in five of the eight who underwent surgery, four of whom survived. The results demonstrate that surgical intervention is not associated with undue mortality but inappropriate conservative therapy is poorly tolerated in this high‐ris

ISSN:0007-1323    

DOI:10.1002/bjs.1800780309

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe effects of platelets on the development of intimal thickening of arterially transplanted autologous vein grafts was investigated using canine poor run‐off models. A new apparatus consisting of a shielding lead block to measure in vivo platelet adherence only on the intima of the vein graft was developed. In 23 dogs,51Cr‐labelled platelets (20 μCi/kg) were injected and isotope emission over the grafts was counted. Platelet adherence was expressed as the thrombocyte accumulation index (TAI), i.e. the ratio of counts over the graft under an abnormal flow condition in the poor run‐off model to those over the graft under normal flow conditions of the contralateral leg. The TAI of the total graft (TTAI) was significantly high immediately and on the first and third days after implantation. The TAIs of the proximal (PTAI) and distal (DTAI) portions of the vein graft were also high at these same times. At 7, 10, 14 and 21 days, the TAI was almost equal to 1·0, a time at which endothelial regeneration was complete as confirmed by scanning electron microscopy. Thus, the prominent intimal thickening of arterially transplanted autologous vein grafts in dogs, induced under an abnormal flow condition, correlates well with the enhanced platelet adherence on the intima of the vein grafts in an early period after impla

ISSN:0007-1323    

DOI:10.1002/bjs.1800780310

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe increasing demand for fully trained vascular surgeons in the UK has highlighted the need for urgent review of that training. Such a review must examine the number of trainees required and the number and role of teaching centres. Vascular surgical training should only take place where an integrated approach, including experience in interventional radiology and intensive care, is available. The relationship of vascular to general surgery must now be defined with training needs in mind if we are to provide an appropriate service within the next decade.

ISSN:0007-1323    

DOI:10.1002/bjs.1800780311

出版商:John Wiley&Sons, Ltd.    

年代:1991

数据来源: WILEY