ISSN:0007-1323    

DOI:10.1002/bjs.1800710302

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

AbstractIt is not widely recognized that duodenal contents are implicated in the causation of severe reflux oesophagitis and stricture formation in patients with hiatus hernia. In a randomized prospective trial, including only patients with severe oesophageal changes, standard Nissen fundoplication has been compared with antrectomy and Roux‐en‐Y reconstruction. Twenty‐two patients were randomized to each group. The 42 surviving trial patients have been followed for an average period of over 5 years. Good results (Visick I or II) have been achieved in 91 per cent of 22 patients having antrectomy and Roux‐en‐Y anastomosis (Group B), compared with 65 per cent of 20 patients surviving after Nissen fundoplication (Group A). Poor results (Visick III or IV) seen in seven patients (35 per cent) in group A were almost all associated with failure of fundoplication to stop reflux. Two of these patients have subsequently had antrectomy and Roux‐en‐Y reconstruction with excellent results. Antrectomy with Roux‐en‐Y gastrojejunostomy appears to be superior to a standard anti‐reflux procedure as primary surgical treatment in these patients. The technique is recommended; (1) where the patient has a fixed irreducible hiatus hernia; (2) where previous surgery at the hiatus has failed and rendered re

ISSN:0007-1323    

DOI:10.1002/bjs.1800710303

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800710304

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

AbstractThe incidence and severity of postvagotomy diarrhoea has been studied in 32 patients who had undergone both vagotomy and cholecystectomy. Sixteen of these patients had had a proximal gastric vagotomy and 16 a truncal vagotomy and pyloroplasty. Diarrhoea was present in 68 per cent of patients in whom the vagotomy was truncal and in 31 per cent of those in whom it was proximal gastric. Matched groups of patients with truncal vagotomy with pyloroplasty and proximal gastric vagotomy without cholecystectomy were also compared. The possible mechanisms of this diarrhoea following combined vagotomy and cholecystectomy have been discussed.

ISSN:0007-1323    

DOI:10.1002/bjs.1800710305

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800710306

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

AbstractA new technique of hepaticojejunostomy is described. The technique involves the incorporation of a cutaneous access stoma in the Roux‐en‐Y loop of jejunum used for the anastomosis. This stoma provides permanent access to the biliary‐intestinal anastomosis and to the hepatobiliary tree for non‐operative management of chronic and recurrent biliary tract p

ISSN:0007-1323    

DOI:10.1002/bjs.1800710307

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

AbstractThe relationship between lymph flow, lymph node arterial and venous perfusion pressure and lymph node resistance have been studied in an in vivo isolated canine iliac lymph node perfused through an afferent lymphatic with heparinized canine plasma. The relationship between the rate of perfusion and perfusion pressure across the node was linear but the calculated resistance of the node decreased as the rate of perfusion increased. In nine dogs the mean resistance to lymph flows less than 0.1 ml/min was 180 mmHg/ml min, but 68 mmHg/ml min to rates of perfusion above 1.0 ml/min. An increase of venous pressure in the veins draining the node increased the node's resistance by 8.6 mmHg/ml min for each 10 mmHg increase of venous pressure. The effect on node resistance of an increase of venous pressure was greater at low rates of perfusion. A decrease of arterial pressure in the arteries supplying the node reduced the node's resistance by 2 mmHg/ml min for each 10 mmHg decrease of arterial pressure. Increases of arterial pressure had an opposite effect of a similar magnitude. The effect on node resistance of a change of arterial pressure in either direction was greater at low rates of perfusion.

ISSN:0007-1323    

DOI:10.1002/bjs.1800710308

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

AbstractSince ileal resection and ileal bypass are commonly performed in man and might stimulate colonic hyperplasia, their co‐carcinogenic potential was explored in male Sprague‐Dawley rats (n = 135). One week after 33 per cent distal small‐bowel resection, 33 per cent distal small‐bowel bypass or distal ileal transection (control), animals started a 6‐week course of azoxymethane injections (total dose 90 mg/kg ip). Findings in rats killed at 20 and 25 weeks were similar: bypass produced a higher yield of colorectal tumours (4.0 ± 0.6 per rat: mean ± s.e.) than controls (2.4 ± 0.4; P<0.05), but resection caused maximal enhancement (5.2 ± 0.5: P<0.01). In rats killed at 30 weeks, however, tumour yields were almost identical. Overall, resection increased colonic tumour yield by 55 per cent (P<0.02) and bypass by 32 per cent. Stathmokinetic measurements of crypt cell production rate (CCPR) at 20 weeks showed similar increases after resection and bypass both in residual functioning small bowel (109–200 per cent: P<0.01) and in colorectum (63–100 per cent: P<0.05). At 30 weeks these adaptive effects persisted, despite an overall increase in CCPR with age. Loss of functioning ileum enhances experimental colorectal carcinogenesis principally by reducing the latent period for tumour development. Resection has a greater effect than bypass probably by producing earlier hyperplasia, though later adaptive ef

ISSN:0007-1323    

DOI:10.1002/bjs.1800710309

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800710310

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

AbstractThe pattern of recurrent tumour following ‘curative’ colorectal surgery was examined in a necropsy series and a prospective clinical series. In the necropsy series the commonest pattern of recurrence was disseminated disease (73 per cent) and recurrence in a single site was much less common (27 per cent). In the clinical series recurrence in a single site was commoner (55 per cent). The difference between the two series is statistically significant (P = 0.02, χ2), and is probably due to under‐diagnosis of disseminated recurrence in the clinical series. In both series local recurrence and hepatic metastases occurred almost equally but usually as part of disseminated disease.We conclude that after ‘curative’ surgery for colorectal cancer, recurrence is usually disseminated (73 per cent) and therefore therapy adjuvant to surgery should be active systemically. Adjuvant therapy directed at a single site (e.g. radiotherapy or intrahepatic chemotherapy) should be combined with a system

ISSN:0007-1323    

DOI:10.1002/bjs.1800710311

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY