ISSN:0007-1323    

DOI:10.1002/bjs.1800750502

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800750503

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractA total of 152 consecutive children with oesophageal varices have been endoscopically reviewed since 1979. In all, 108 of these children presented with variceal bleeding which was managed by injection sclerotherapy. Variceal obliteration was achieved in 33 (92 per cent) children with extrahepatic portal hypertension and 54 (75 per cent) with intrahepatic portal hypertension. Prophylactic injection sclerotherapy was used to obliterate large varices in 11 children with no history of haemorrhage. Bleeding episodes occurred in 38 (39 per cent) children before variceal obliteration was complete. However, the mortality rate from variceal bleeding was only 1 per cent. Complications were oesophageal ulceration (29 per cent) and stricture (16 per cent) which both resolved with conservative management. During a mean follow‐up period of 2.9 years after sclerotherapy, recurrent oesophageal or gastric varices developed in 12 (12 per cent) cases, with rebleeding in 9 (9 per cent), but all responded successfully to a second course of treatment. These results are superior to contemporary surgical management and injection sclerotherapy should therefore currently be the primary treatment of choice for bleeding oesophageal varices in childre

ISSN:0007-1323    

DOI:10.1002/bjs.1800750504

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractIn order to assess the effect of the no‐touch isolation technique, in the treatment of large bowel cancers, on the site of first recurrence and disease‐free and overall survival, 236 patients were prospectively and randomly assigned to either the no‐touch isolation technique (117 patients) or to a conventional resection technique (119 patients). No patient with distant metastases or unresectable disease entered the study. The two treatment groups were comparable with regard to patient characteristics. Pre‐ and postoperative complications (including mortality within 30 days) were similar in both groups. After a complete follow‐up of 5 years, a tendency for reduction in the number of, and time to, occurrences of liver metastases was seen in the no‐touch isolation group (P= 0.14). This effect was most obvious in the sigmoid colon with angio‐invasive growth. Overall (P= 0.42) and corrected (P= 0.25) survival did not differ significantly among the treatment groups although in every analysis the survival data of the no‐touch isolation group were superior. The data do suggest a limited benefit of the no‐touch isolation technique. This observation is important since the morbidity and mortality of surgery were equ

ISSN:0007-1323    

DOI:10.1002/bjs.1800750505

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800750506

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractOne hundred and twenty‐three patients (M:F, 0.9:1; mean age 62 years) underwent 156 operations between 1954 and 1984 for correction of late colostomy complications (stenosis 65 patients, prolapse 16 patients, paracolostomy hernia 42 patients). Sixty‐three per cent of patients eventually had a good result but in some up to 5 operations were necessary. Local excision of scar tissue at the mucocutaneous junction was associated with a 61 per cent (43/71) success rate for relief of colostomy stenosis. Where local fixation failed to prevent recurrent colostomy prolapse (13/20, 65 per cent of local fixation operations), colectomy and ileostomy was the most effective second procedure (2/3,67 per cent success rate). Where local repair of a paracolostomy hernia failed (15/32,47 per cent of local operations), resiting of the stoma to the umbilicus or right side of the abdomen produced better results (3/7, 43 per cent success rate) than resiting to another trephine on the left side of the abdomen (2/14, 14 per cent success ra

ISSN:0007-1323    

DOI:10.1002/bjs.1800750507

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractThe prognosis of colorectal cancer in the elderly was examined in a study of 306 consecutive patients. The patients were divided into two groups: Group 1 included 171 patients of average age 77 years (range 70–97); Group 2 comprised 135 patients of average age 59 years (range 22‐69). There was no significant difference between the two groups with regard to the mode of presentation, the location and Dukes' classification of the tumours, the incidence of palliative operations, and the perioperative mortality. The surgical mortality rates in Group 1 were 6 per cent overall, 4 per cent after elective operations, and 16 per cent after emergency surgery; the corresponding mortality rates for Group 2 were 3 per cent, 1 per cent, and 20 per cent. Emergency surgery was associated with a significantly higher incidence of perioperative death at any age (P<0.001) and most deaths resulted from complications of coexisting medical disorders or thrombo‐embolic complications. Crude actuarial 5‐year survival curves showed an increased death rate in Group 1 after 18 months and a significantly lower 5‐year survival (P<0.05) but the age‐corrected survival curves for the two groups were not significantly different, and it was concluded that the prognosis for colorectal cancer in the elderly is not significantly different from that of young

ISSN:0007-1323    

DOI:10.1002/bjs.1800750508

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractThe mortality, morbidity and long‐term survival in stapled anterior resection for rectal carcinoma has been analysed in 74 patients. Twelve patients were Dukes' A, 26 B, 29 C, and 7 ‘D’ (submitted to hepatic resection). Operative mortality rate was 3 per cent. Three patients (4 per cent) had clinical anastomotic leakage. Two patients (3 per cent) developed anastomotic stenosis. Local recurrence was present in three patients (4 per cent). The mean (± s.e.m.) overall survival rate at 5 years was 67±6 per cent. There was no significant difference in survival between Dukes' B and C (70±10 per cent versus 59±10 per cent,P= 0.209). Patients with absent local spread had a significantly better 5‐year survival rate than those with positive local lymph nodes (80±7 per cent versus 54±9 per cent,P<0.01). The present results confirm the satisfactory use of the EEARstapler device for colorectal anastomoses in rectal cancer and in patients with resectable liv

ISSN:0007-1323    

DOI:10.1002/bjs.1800750509

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractRigid sigmoidoscopy is the method employed for examining the rectum and sigmoid colon in most general surgical clinics. Commonly, this is performed without any prior preparation of the bowel and with the patient in the left lateral (Sims') position. This study was designed to assess three factors relating to this method: preparation of the bowel; position of the patient; and the experience of the operator. The study shows that diagnostic accuracy without preparation is adequate in only 50 per cent of cases but, by employing a preliminary disposable (Fletcher's) enema, this can be improved to 80 per cent. Employing the knee‐elbow position gave only slight advantage over the usual Sims' position and operator experience did not improve diagnostic accuracy once familiarity with the use of the sigmoidoscope had been achieved. The study underlines the importance of preparation as an essential prelude to sigmoidoscop

ISSN:0007-1323    

DOI:10.1002/bjs.1800750510

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY

摘要:

AbstractCerebral angiography is still suggested as a first line investigation for patients with putative transient ischaemic attacks (TIA) and it is considered by most surgeons as a necessary prelude to carotid endarterectomy. That conventional cerebral angiography involves risk is well known, although the magnitude of this risk is not. Prospective studies of cerebral complications from this technique, published over the last decade, have been analysed to show that the major stroke rate after conventional cerebral angiography for patients with TI As is likely to be about 2.4 per cent. This must be taken into account if the true morbidity of carotid endarterectomy is to be appreciated (assuming conventional angiograms have been used). Furthermore, since many sufferers are assessed by angiography but not submitted to surgery, a policy of conventional angiography for patients with TI As puts a far greater number at risk than that actually having carotid endarterectomy.

ISSN:0007-1323    

DOI:10.1002/bjs.1800750511

出版商:John Wiley&Sons, Ltd.    

年代:1988

数据来源: WILEY