ISSN:0007-1323    

DOI:10.1002/bjs.1800741002

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800741003

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800741004

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractWarfarin inhibits metastasis in animal models by mechanisms that remain unclear. A better understanding of this phenomenon may clarify processes underlying metastasis in human cancer. We have studied the effects of warfarin on metastasis in a rat model by intravenous injection of Mtln3 mammary carcinoma cells and subsequent counting of pulmonary seedlings. To determine whether warfarin acts principally on the tumour cell or the host, we pretreated either cells or animals with warfarin before intravenous injection of 104Mtln3 cells. Pretreatment of tumour cells had no effect, whilst pretreatment of the host reduced median seedlings from 67 to 4·5 per animal (P<0·005). To determine whether warfarin was acting via its anticoagulant action, we reversed warfarin anticoagulation by intravenous injection of coagulation factors II, VII, IX and X. Restoration of coagulation for 12 h immediately after injection of cells completely reversed the warfarin effect (P<0·001), but if the injection of factors was delayed for 12 h it had no effect (P = 0·1753). We conclude that warfarin acts principally on the host, not the tumour cell, and that it acts via its effect on coagulation. The restriction of the effect to the first 12h after tumour cell injection suggests a mechanism involving intravascular processes such as tumour cell survival or endothelial adhes

ISSN:0007-1323    

DOI:10.1002/bjs.1800741005

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractLengths of stay for appendicectomy, inguinal hernia repair and cholecystectomy for the 16 districts in the Northern Regional Health Authority (NRHA) and 15 districts in the South East Thames Regional Health Authority (SETRHA) are examined using data recorded in the Hospital Activity Analysis. Considerable variations exist among districts, with the three longest stay districts for each procedure in NRHA having an age‐adjusted length of stay of 113 per cent of the regional average for appendicectomy, 125 per cent for hernia and 115 per cent for cholecystectomy. This resulted in>2000 additional bed days per year being occupied in the three longest stay districts in the NRHA compared with the regional average. The age adjusted length of stay for the three shortest stay districts for each procedure is 83 per cent of the regional average for appendicectomy, 75 per cent for hernia and 85 per cent for cholecystectomy. Similar differences are seen in the SETRHA, and derive from differences in the length of both pre‐operative and postoperative stay. Explanations for the observed variations are considered in terms of population, organizational and clinical variab

ISSN:0007-1323    

DOI:10.1002/bjs.1800741006

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractDeath within 30 days or survival after a major operation depends on three things: the severity of the disease and the operation, the technical proficiency of the surgeon and the ability of the patient to withstand both disease and operation. The first of these can be estimated by reference to published figures, the second can only be guessed at and the third has in the past been a matter of subjective judgement. With the aim of producing an objective assessment of the likelihood of survival, we have constructed a score system comprising 26 items including age, chronic disease and acute presenting disease. These items are each given a weight of 1 to 4 and the total fitness score for any patient ranges from 0 (fit) to 10 (unlikely to survive). We have validated this score prospectively in 1517 consecutive patients undergoing emergency or elective major abdominal operations (excluding appendicectomies and hernia repairs). In 492 operations in which the patient scored 0 or 1, one patient died (0·2 per cent); in 290 with scores of 2 or 3, one died (0·3 per cent); in 313 with scores of 4 or 5, five died (1·6 per cent). It was when the score rose to 6 or over that the chances of survival progressively declined: 16 died of the 105 patients who scored 6 (15·2 per cent) as did 74 of the 191 who scored 7 or 8 (38·7 per cent) and 70 of the 126 who scored 9 or 10 (55·6 per cent). We now use the score as part of our audit and enquire particularly closely into the death of any patient with a pre‐operative score of less

ISSN:0007-1323    

DOI:10.1002/bjs.1800741007

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractSurgery remains the only widely available and well‐proven means of stopping haemorrhage from peptic ulcers and preventing its recurrence but carries an unavoidable morbidity. If surgery is to be used to maximum effect with minimum morbidity, an accurate means of predicting which patients will suffer further haemorrhage is needed. Although over 80 per cent of patients who rebleed have the endoscopic stigmata of haemorrhage, a policy of operation in all patients with stigmata would lead to a very high operation rate and a high proportion of unnecessary operations, as one‐half of the patients with stigmata do not rebleed. Clinical data were collected prospectively from 278 cases of peptic ulcer haemorrhage. The data from a randomly selected 75 per cent of the cases were analysed by stepwise logistical regression. Patients who had the endoscopic stigmata of haemorrhage and who had a probability of further haemorrhage, calculated from the regression equation, of more than 0·2 were identified as a high risk group. This definition was validated using the 25 per cent of cases not used in the initial analysis. Eighty‐four per cent of patients in the high risk group suffered further haemorrhage and all such patients therefore require early surgery: such a policy would have resulted in an operation rate of 28 per cent. Thirty per cent of the patients who had further haemorrhage were not identified as being at high risk but none of them had a severe rebleed. The regression equation greatly enhanced the value of stigmata in guiding surgical decision making and merits further eval

ISSN:0007-1323    

DOI:10.1002/bjs.1800741008

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractFrom 1979 to 1984, 141 consecutive patients (110 men, 31 women) underwent highly selective vagotomy (HSV) for duodenal ulcer (DU). All patients had received pre‐operative treatment with full dose H2receptor antagonists (H2RA). Indications for surgery were: persistent relapse on withdrawal of H2RA, 107 (75·9 per cent); no response to H2RA, 30 (21·3 per cent); intolerance of H2RA, 1 (0·7 per cent); acute DU bleed, 2 (1·4 per cent); duodenal stenosis, 1 (0·7 per cent). Follow‐up with a median of 47 months (24–85 months) revealed six patients (4·4 per cent) with endoscopically proven recurrence, three of whom were on non‐steroidal anti‐inflammatory drugs (NSAIDs). Only one patient with recurrent DU was a non‐responder to H2RA pre‐operatively. Twenty‐five patients remained symptomatic after HSV without ulcer recurrence, of which a highly significant proportion (41 per cent) were non‐responders (P<0·001). The pre‐operative response to H2RA does not indicate the likelihood of ulcer recurrence after HSV. However, non‐responders are more likely to continue with dyspeptic symptoms despite the successful healing of their ulcers. The DU recurrence rate in patients taking long‐term NSAIDs is disappointingly high (33 per cent), putting the use of HSV i

ISSN:0007-1323    

DOI:10.1002/bjs.1800741009

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractThe results of 48 Roux‐en‐Y (RY) diversion procedures are reported: 41 were performed as secondary procedures and 7 as part of a primary operation for peptic ulcer. There was no operative mortality, but four patients developed temporary fistulae in the postoperative period and three patients required reoperation. Good clinical results were found when RY diversion was performed as a primary procedure or when the indication for operation was peptic ulceration. The overall results, however, were poor: 24 patients (50 per cent) felt that they had not benefited and 32 patients (67 per cent) remained in Visick grades 111 or IV. The main cause of failure was gastric stasis, especially of solid food. Gastric emptying studies were carried out after RY diversion in 22 patients, most of whom had symptoms of stasis. Emptying of liquids was found to be normal in most patients, but emptying of solids was delayed, the median t1/2for solids being 160 (75–370) min compared with 67 (50–85) min in DU patients. Bilious vomiting improved significantly after RY diversion, but 18 patients (38 per cent) complained of vomiting food and 32 patients (67 per cent) experienced postprandial distress or pain. Loss of the antral mill, vagotomy of the gastric remnant and, perhaps, resistance to gastric emptying by the Roux loop itself may together explain the delay in gastric emptying of solids after RY di

ISSN:0007-1323    

DOI:10.1002/bjs.1800741010

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY

摘要:

AbstractThe‐risk of malignant change in pre‐invasive breast disease such as proliferative atypia (PA) or the risk of invasive carcinoma arising from ductal carcinoma in situ (DCIS) remains uncertain in individual women because of the absence of any prognostic criteria. In order to clarify this, the cellular DNA content (ploidy) of 51 screen‐detected lesions has been investigated. Cellular DNA measurements were made by static cytometry following Feulgen staining of disaggregated tissue sections and the resulting histograms classified as either diploid or aneuploid. Thirteen cases of PA and twelve of DCIS were compared with twenty‐six biopsies showing DCIS with adjacent invasive carcinoma (DCIS+Ca). In the latter group, ploidy of the invasive carcinoma was compared with the associated DCIS in 16 cases. Aneuploid cells were found in approximately 30 per cent of PA and DCIS lesions but in 23 of 26 cases of DCIS+Ca. Of 16 assessable cases of co‐existing DCIS and micro‐invasive carcinoma both were aneuploid in 11, both diploid in 1, and in 4 cases the DCIS was aneuploid whereas the invasive carcinoma was diploid. These results suggest that aneuploidy may be of value in predicting the most biologically aggressive of these pre‐inv

ISSN:0007-1323    

DOI:10.1002/bjs.1800741011

出版商:John Wiley&Sons, Ltd.    

年代:1987

数据来源: WILEY