ISSN:0007-1323    

DOI:10.1002/bjs.1800691002

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractWith increasing emphasis on sphincter preservation in the treatment of low carcinomas of the rectum, it is important to know whether such a policy results in satisfactory rectal function and long term survival. In 368 patients operated upon for carcinoma of the rectum between 1958 and 1980, a consistent policy of sphincter preservation was followed, and resulted in 222 (61 per cent) patients having a restorative resection (RR), whilst 132 (37 per cent) had an abdominoperineal excision (APE); 271 (76 per cent) had a radical operation with a hope of cure. Overall operative mortality was 5 per cent (2·6 per cent in the radical group) and the leakage rate in the 222 restorative anastomoses was 5 per cent. Follow‐up of 98 per cent of patients treated over 5 years ago has been possible. Special attention has been paid to the late results in patients having a restorative resection of tumours at and below 8 cm: all these patients are continent and there is no excess of late pelvic recurrence. Corrected 5‐year survival rates are 72 per cent for abdominoperineal excision and 84 per cent for restorative resec

ISSN:0007-1323    

DOI:10.1002/bjs.1800691003

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractSince both intraluminal and humoral factors have been implicated in postresectional intestinal hyperplasia, we investigated the relative importance of these factors by using cutaneous parabiotic rats with shared gut. Paired cutaneous parabiosis with a common peritoneal cavity was established in inbred Fischer rats. One month later, in one group of animals one member of the pair had a 64 per cent small bowel resection, while in the control group transection alone was performed. Immediately all the rats underwent intestinal crossover, achieved by anastomosing the proximal small bowel of each rat to the distal small bowel of its partner.In the jejunum 2 weeks later there was an 18 per cent increase in DNA content and a 26 per cent increase in wet weight in the animals with resection compared with their parabionts (P<0·05). There was no difference between the parabionts without resection and the control animals. Because of the intestinal crossover, the more proximally placed ileum from the rats without resection showed a 53–58 per cent increase in DNA content, 28–29 per cent increase in RNA content and 51–57 per cent increase in wet weight compared with the normally placed ileum from the partners that had resection and with the control (P<0·001). There was no difference between the control and the normally placed ileum from the animals that had resection. The position of the ileum after resection appeared to be the major influence on hyperplasia, since no measurable difference in nucleic acid contents was detected between the ileum of the animals with resection and the control. However, humoral factors do operate locally and may play a permissive role because the jejunum of the animals with resection showed DNA increase when compared with the

ISSN:0007-1323    

DOI:10.1002/bjs.1800691004

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractA retrospective study was made of 75 consecutive patients treated for a tumour of the head of the pancreas and the peri‐ampullary region from January 1978 to August 1981. These patients underwent either pancreatic resection—pancreatoduodenectomy (n = 24) and total pancreatectomy (n = 10)—palliative procedures (n = 29) or exploratory laparotomy (n = 12). Clinical signs and diagnostic procedures, such as ultrasonography and coeliac arteriography, were studied for their value in preoperative assessment of operability. Vaso‐invasion, as revealed by arteriography and, to a lesser extent, ultrasonographic signs of a tumour and the absence of jaundice were poor prognostic signs.The operative mortality was 8 per cent for the group as a whole, but somewhat higher (13 per cent) for the group that underwent pancreatoduodenectomy. No patient died after total pancreatectomy. The operative mortality was 27 per cent in all patients aged 70 years or older, but only 3 per cent in patients under 70 years. One‐year patient survival was 94 per cent after pancreatoduodenectomy for peri‐ampullary cancer and 57 per cent after resection for cancer of the head of the pancreas.The results of this study point to pancreatic resection as the treatment of choice for resectable tumours of the peri‐ampullary region and the head of the pancreas in patients under 70 years of age. Coeliac arteriography and ultrasonography have been found to be useful for preoperative classification of

ISSN:0007-1323    

DOI:10.1002/bjs.1800691005

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe clinical features and management of 90 thyrotoxic and 11 euthyroid patients with a single autonomous hot nodule in the thyroid have been reviewed to assess the results of surgery and radio‐iodine therapy. Symptoms and signs of thyrotoxicosis were often minimal but histories were frequently long with cardiac complications predominating. Thyrotoxicosis was permanently eradicated in the 60 patients treated surgically, although hypothyroidism occurred in 6·6 per cent. Twelve of the 37 (32 per cent) thyrotoxic patients receiving radio‐iodine needed further definitive treatment for persistent or recurrent thyrotoxicosis, but only 2 patients (5 per cent) became hypothyroid. Early surgery for the autonomous toxic thyroid nodule ensures control of the thyroid overactivity and minimizes the risk of permanent cardiac damage. The absence of morbidity justifies surgical excision of autonomous hot nodules in patients who are euthyroid to eliminate the risk of thyrotoxicosis superve

ISSN:0007-1323    

DOI:10.1002/bjs.1800691006

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractDuring a 10‐year period, 59 patients had a Hartmann operation for diverticular disease (n = 19), carcinoma (n = 21), anastomotic disruption (n = 5), injury (n = 3) and various other conditions (n = 11). Twenty‐two patients (37·3 per cent) died postoperatively. Wound infection or wound dehiscence occurred in 26 patients. Other complications inherent in this operation were colostomy necrosis or retraction (n = 12) and leakage of the rectal stump (n = 3). The mean hospital stay of the surviving patients was 28·4 days. Colorectal continuity was subsequently restored in 12 patients (32·4 per cent) and no difficulties were encountered with this pro

ISSN:0007-1323    

DOI:10.1002/bjs.1800691007

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThirty‐five consecutive patients undergoing apparently curative resection for colorectal carcinoma were staged by conventional methods (Dukes', degree of tumour differentiation and pre‐ and postoperative CEA). In addition, the presence or absence of occult hepatic metastases at the time of surgery was determined by sequential CT scanning.Thirteen patients died within 30 months of surgery. Conventional prognostic indices failed to define clearly those patients who died. In contrast, the presence or absence of occult hepatic metastases at the time of surgery clearly defined two groups of patients. Only 9 per cent of patients who possessed occult hepatic metastases survived 30 months compared with 88 per cent of patients in whom these metastases were not detected. The clinical implications of these results are discus

ISSN:0007-1323    

DOI:10.1002/bjs.1800691008

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractA series of 130 cases of oesophageal carcinoma managed by one surgeon in a unit with a major interest in oesophageal disorders is reviewed. The management policy has been an active one of resection in suitably selected cases, less favourable ones being treated by operative intubation before 1979 and by endoscopic intubation since 1979. Operative mortality and morbidity have been compared between the three groups, together with duration of survival and quality of swallowing as measured by a modified Visick grading. In the intubated groups, endoscopic intubation carried a hospital mortality of 15·6 per cent compared with 40·8 per cent in the operative group. It was associated with less morbidity and a better quality of survival, although survival times were comparable and did not exceed 18 months in either group. In the resection group, hospital mortality was 12·2 per cent, and both the mean survival and quality of swallowing were greater than in either endoscopic group.It is concluded that in suitably selected cases, resection can be performed with a mortality considered acceptable for palliative intubation whilst conferring greater survival and restoration of normal swallowing. In less favourable cases, endoscopic intubation is superior to operative intubation in terms of reduced mortality and better restoration of swallowi

ISSN:0007-1323    

DOI:10.1002/bjs.1800691009

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractIn a series of 161 patients treated surgically for Crohn's disease, 7 patients were seen with a psoas abscess as a complication of the bowel disease. Drainage only was not sufficient to check the rapid downhill course in these patients. Resection of the underlying bowel disease was performed in all patients. There was one death from pulmonary embolism and 3 patients required drainage on more than one occasion.

ISSN:0007-1323    

DOI:10.1002/bjs.1800691010

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractSeventy‐one patients with a clinical diagnosis of painful biliary tract disease have been entered into a double‐blind trial of glucagon. Twenty‐eight were excluded as gallstones were not proved: of the remainder, 21 patients received glucagon and 22 placebo. Glucagon‐treated patients were pain free 14·26 h(± 2·77 s.e.m.) after commencing treatment compared to 29·14 h(± 6·01 s.e.m.) for the placebo group (P<0·05). Tenderness in the right hypochondrium showed a significant improvement when assessed at 12 h (P<0·02) and 24 h (P<0·1) for those given glucagon. A significant difference in blood glucose levels was seen between the two groups (P<0·05). No serious side effects were observed. Glucagon relieves the pain and tenderness associated with painful biliary tract disease more effectively than con

ISSN:0007-1323    

DOI:10.1002/bjs.1800691011

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY