ISSN:0007-1323    

DOI:10.1002/bjs.1800771202

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800771203

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractStercoral perforation of the colon is rare. The 64 reported cases are reviewed to define the syndrome of Stercoral perforation, and to facilitate accurate diagnosis and treatment. Features of localized or generalized peritonitis were universal; however, only 11 per cent were correctly diagnosed before operation. Recognition that the disease involves a segment of colon rather than only the focal point of perforation is essential to adequate surgical treatment. It is postulated that this is the reason for the higher postoperative mortality following closure of the perforation and proximal colostomy (57 per cent) or exteriorization alone (43 per cent), compared with resection of the diseased segment and exteriorization (32 per cent). Resection and exteriorization is therefore the treatment of choice is most situations.

ISSN:0007-1323    

DOI:10.1002/bjs.1800771204

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractThe diagnostic and therapeutic options in early gastric cancer are reviewed. In Japan, the rate of detection of early gastric cancers has increased so that minute gastric cancers can now be identified as a result of advances in diagnostic methods. The results of histopathological staging of a large number of resected specimens have led to three surgical options based on size and depth of the primary lesion, namely classical R2resection, radical resection with limited lymphadenectomy and endoscopic surgery.

ISSN:0007-1323    

DOI:10.1002/bjs.1800771205

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractAspects of acute and chronic adrenal insufficiency of interest to surgeons who treat cancer patients are reviewed. Clinical features and the management of both primary and secondary types are considered with reference to classification, aetiology, diagnosis and treatment. Specifically considered are the management of patients with Addison's disease and metastases. Prompt recognition and treatment of adrenal insufficiency can avert potentially life‐threatening situation

ISSN:0007-1323    

DOI:10.1002/bjs.1800771206

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractDuring treatment of the injured patient it is assumed that the cardiovascular responses follow recognized physiological principles. Studies in humans have shown that injury causes a profound suppression of arterial baroreflex function which alters the normal relationship between heart rate and blood pressure and casts doubt on this assumption. To investigate the mechanism of baroreflex suppression, we have studied the effects of the two major components of injury, blood loss and tissue damage, on baroreflex function in healthy volunteers. Baroreflex function was assessed using suction stimulation of the carotid sinus. The loss of 500 ml blood had no effect on baroreflex sensitivity. A human laboratory model of tissue injury reduced the ability of the baroreflex to compensate for a rise in blood pressure (P<0.05, Wilcoxon signed rank test). We conclude that tissue damage, rather than hypovolaemia, appears to mediate the effect of injury on baroreflex function in the injured. Blockade of neural signals from damaged tissue may have a role in the treatment of injury.

ISSN:0007-1323    

DOI:10.1002/bjs.1800771207

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractThere is histological and functional evidence that the internal anal sphincter is abnormal in patients with idiopathic faecal incontinence. The in vitro responsiveness of the internal anal sphincter to nor adrenaline (an important sympathetic neurotransmitter) and electrical field stimulation (known to stimulate the intrinsic innervation) has been studied. Muscle strips from eight patients with incontinence undergoing postanal repair and five controls undergoing' resection for low rectal carcinoma were studied. The contraction‐response curves for nor‐adrenaline were significantly different, and the EC50, the concentration required to produce 50 per cent of maximum contraction, was higher in incontinent patients (P<0.001). Electrical field stimulation produced initial contractions in four of the control group which were blocked by phentolamine. This contraction was not present in the incontinent patients (P<0.01). These results indicate an abnormality in the adrenergic innervation of the internal anal sphincter in patients with idiopathic faecal incontine

ISSN:0007-1323    

DOI:10.1002/bjs.1800771208

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractA prospective controlled randomized trial testing adjuvant postoperative combination chemotherapy (5‐fluorouracil, lomustine (CNU) and vincristine)versusno adjuvant therapy in patients operated on for Dukes' C colorectal cancer is reported. In total 334 patients aged less than 70 years were recruited: 205 patients with colonic and 99 with rectal cancer, but there were three protocol violations and these cases are excluded from further consideration. Twenty‐seven patients had a limited resection of their cancer. After 5 years follow‐up there was no significant difference in the tumour‐free survival rate or in the survival rate between the treated and control groups. Twenty‐nine of the 147 patients who started chemotherapy discontinued this treatment because of side‐effects, mainly from the gastrointestinal tract. In 30 patients treatment was discontinued because of recurrent disease. The conclusion is that systemic administration of combination chemotherapy for colorectal cancer after operation is not worthwhile in routine clinic

ISSN:0007-1323    

DOI:10.1002/bjs.1800771209

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractWithin a prospective randomized screening study for early detection of colorectal cancer with rehydrated Hemoccult II® test, the possibility of increasing the specificity of the test by retesting patients with an initially positive Hemoccult II test was investigated. Of those offered the test 3561 (62.6 per cent) returned it and it was positive in 210 cases (5.9 per cent). The repeat test was performed by 184 patients and was positive in 68 (1.9 per cent). All those with a positive initial test had rectosigmoidoscopy to 60 cm and a double contrast enema. A carcinoma was found in one in seven patients with a positive retest but in only one in 100 patients with a negative retest (P<0.001). The specificity of the test was, therefore, increased from 95 per cent to 98 per cent and the sensitivity was unchanged. Rescreening was offered at a later date and increased numbers were available: 7147 patients returned the test and 369 (5.2 per cent) were positive. The test was repeated in 360 patients and 118 (1.7 per cent) were positive. A colorectal neoplasm was found in one in three of those with a positive repeat test, compared with one in seven of those with a negative repeat test. In conclusion, screening for early detection of colorectal cancer with a rehydrated Hemoccult II test may be followed by investigation of only those patients with a positive retest. Such a procedure will reduce the work‐load by 60 per cent without reducing sensitivi

ISSN:0007-1323    

DOI:10.1002/bjs.1800771210

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractEpidermal growth factor (EGF) receptor expression was estimated in 50 invasive human colorectal cancers using immunohistochemistry and the degree of expression was quantified from integrated optical density measurements on the stained sections. All tumours stained positively, but Dukes' C tumours exhibited significantly higher levels of receptor than either Dukes' A or B tumours. In addition, histologically high grade cancers expressed receptors more strongly than those of low grade. It is concluded that a high EGF receptor concentration is associated with poor prognostic factors in colorectal malignancy.

ISSN:0007-1323    

DOI:10.1002/bjs.1800771211

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY