摘要:

AbstractJejuno‐ileal bypass has been performed in 226 massively obese patients, 190 of whom have been followed for a minimum of 1 year. End‐to‐side and end‐to‐end anasto‐moses were compared and no difference in the weight reduction achieved by either technique was seen throughout the 5‐year follow‐up. There was no significant difference in weight reduction achieved between groups of patients in which the jejunal length varied from 10 to 35 cm and the ileal length from 35 to 10 cm.The weight reduction achieved in the entire series averaged 36.7 ± 9.4 per cent at 2 years, after which no further loss occurred. Good psychological benefits were recorded. Remission of diabetes occurred in 12 of 13 patients and marked long term lowering of serum lipids was seen.Side effects included fluid and electrolyte disturbances and fatty changes in the liver during the first year, improving thereafter. Early cirrhosis of the liver occurred in 8.6 per cent. Other side effects included abdominal bloating, arthralgia and renal colic.The operative mortality was 0.9 per cent and the late mortality directly attributable to the jejuno‐ileal bypass, 3.1 per cent. In 19 patients the bypass was discontinued because of s

ISSN:0007-1323    

DOI:10.1002/bjs.1800660802

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractSerial estimation of muscle and serum adenosine triphosphatase (ATPase) activity was performed in 16 healthy control patients and 32 cases with tetanus. There was no significant difference due to age and sex in muscle and serum ATPase activity between the normal and tetanus cases. Tetanus patients showed a marked increase in muscle and serum ATPase activity as compared to normal. The ATPase activity increased with the severity of convulsion and disease. There was increased mortality in tetanus patients having higher values of muscle and serum ATPase.

ISSN:0007-1323    

DOI:10.1002/bjs.1800660803

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractA comprehensive examination of voice function and laryngeal symptoms was applied systematically to 20 patients undergoing thyroid surgery. Patients were excluded from the series if there had been previous neck surgery or if postoperative indirect laryngoscopy showed abnormal cord mobility. Examination before operation showed that patients with sporadic non‐toxic goitre or medically pre‐treated toxic goitre had impaired voice function based on stroboscopy, electroglottography, phono‐oscillometry and determination of voice range, phonation time, pitch, and peak flow. Three months after thyroid surgery the voice function was significantly improved although not normal in nontoxic goitre patients, whereas the voice function in patients with thyrotoxicosis was unchanged. The number of laryngeal symptoms was significantly reduced in non‐toxic goitres following surgery and unaltered in the group with thyroto

ISSN:0007-1323    

DOI:10.1002/bjs.1800660804

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractTwelve patients with lingual thyroid are reviewed. Two of these patients had a follicular carcinoma in the ectopic gland and both are well 5 and 16 years after treatment.The diagnosis is essentially clinical but confirmation may be made with a thyroid scan.Six patients were treated conservatively with thyroxine with good results. Six patients were treated by surgical excision, 2 undergoing autotransplantation of the excised gland into the anterior abdominal wall.

ISSN:0007-1323    

DOI:10.1002/bjs.1800660805

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractIn 14 patients having undergone abdominal surgery, plasma sodium, urine volume and osmolality and the urinary excretion of arginine vasopressin (AVP), the antidiuretic hormone in man, were measured daily for 7 days. Each patient was given 31 of intravenous fluids daily. In 8 patients the fluid was saline and in the other 6 it was dextrose‐saline.The plasma sodium did not change in the saline group whereas it fell in the dextrose‐saline group during the day of operation and then remained low. On the day of operation the urinary AVP increased to very high levels in both groups of patients. On that day and during the postoperative period the AVP level and urine osmolality were much higher in the saline group than in the dextrose‐saline group, which suggests that a loss or redistribution of extracellular fluid was not the cause of the high AVP. These results taken together suggest that it was the higher AVP level in the saline group that was required to keep the plasma sodium normal. On the other hand, the results suggest that in the dextrosesaline group, although the AVP was lower than in the saline group, it produced a urine osmolality greater than that necessary for balance so that the patients retained water and became hyponatraemic.The fall in plasma sodium was small compared with that seen in patients with symptoms of water intoxication, but it may nevertheless have clinical effects and is best avoided. The results suggest that in these patients hyponatraemia can be avoided if saline rather than dextrose‐saline is given on the day of op

ISSN:0007-1323    

DOI:10.1002/bjs.1800660806

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractBlood concentrations of glucose, lactate, alanine, free fatty acids, glycerol and 3‐hydroxybutyrate were measured during 24 h in 12 females undergoing elective hysterectomy under either general anaesthesia or epidural analgesia extending from T4 to S5. The results showed that the peroperative and immediate postoperative metabolic profiles in the group receiving general anaesthesia reflected substrate mobilization (increased glucose, lactate, 3‐hydroxybutyrate), and that epidural analgesia blocked these changes, probably mediated through an inhibited adrenaline response to surgery. Peroperative values of free fatty acids and glycerol were significantly lowered by epidural analgesia, indicating inhibition of lipolysis. Alanine decreased similarly in both groups. In the later postoperative period metabolic profiles were similar in the two groups, indicating that the influence of fasting may override the effect of the relatively minor tra

ISSN:0007-1323    

DOI:10.1002/bjs.1800660807

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractWe have determined the serum gastrin response to a standard test meal in 13 unoperated patients with combined fasting hypergastrinaemia (more than 150 ng/l) and basal hypersecretion of gastric acid (BAO more than 10 mmol/h). In 10 of 11 patients with proved or presumptive Zollinger–Ellison syndrome the peak postprandial rise in serum gastrin concentration was less than 50 per cent of basal value. The integrated gastrin response to feeding ranged from − 71.9 to 211.8 μg/l × 150 min. In 2 patients with proved hypergastrinaemia of antral origin, however, serum gastrin rose to 223 per cent and 225 per cent respectively of basal value after ingestion of the meal. The integrated postprandial serum gastrin responses in these patients were 66.8 and 22.0 μ/l × 150 min. Two patients with Zollinger–Ellison syndrome and total gastrectomy showed peak serum gastrin levels after feeding of 174 and 225 per cent of basal concentration. The integrated postprandial gastrin secretions were 365 and 366 μg/l × 150 min respectively.It is concluded that the serum gastrin response to feeding, when expressed as percentage change, may be helpful in the differential diagnosis of unoperated patients with fasting hypergastrinaemia and basal gastric acid hyp

ISSN:0007-1323    

DOI:10.1002/bjs.1800660808

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractPersistent and complete post‐vagotomy gastric atony was treated in 3 patients by intravenous infusion of oxytocin. Despite failure of both convetional treatment with gastric aspiration and intravenous fluids or jejunal feeding, as well as the reported trials with bethanechol chloride and metoclopramide, these patients promptly responded to oxytocin. It appears that the latter may represent a solution to this uncommon but recalcitrant complication of peptic ulcer surger

ISSN:0007-1323    

DOI:10.1002/bjs.1800660809

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractThis report describes a patient with primary hyperparathyroidism who became spontaneously normocalcaemic preoperatively. This was due to infarction in a parathyroid adenoma. Plasma parathormone (PTH) levels were monitored pre‐and postoperativel

ISSN:0007-1323    

DOI:10.1002/bjs.1800660810

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY

摘要:

AbstractTracheal collapse after thyroidectomy is uncommon; when it occurs, complete airway obstruction is often sudden, unexpected and fatal.In this paper a patient treated for tracheal collapse by tracheostomy and followed up for 1 year is described and, from a review of the literature, a further 9 cases are presented. The aetiology of the condition, the patient at risk and the technique of management are discussed.

ISSN:0007-1323    

DOI:10.1002/bjs.1800660811

出版商:John Wiley&Sons, Ltd.    

年代:1979

数据来源: WILEY