摘要:

AbstractA series of 310 patients with Hodgkin's disease having a staging laparotomy under the care of one surgeon (J‐C. G.) between October 1969 and June 1980 is presented. A total of 51 per cent had positive laparotomy findings, and 30 per cent had their staging altered, but there was a low incidence of positive laparotomy findings when performed within 2 months of initial treatment by chemotherapy. None of the investigations used to determine possible splenic or hepatic involvement preoperatively was found to be of any value, and their routine use is not recommended. Bipedal lymphography was found to give an accurate assessment of iliac and lower para‐aortic nodal involvement, and so the laparotomy protocol since 1975 has not included biopsy of these nodes. The incidence of minor complications was 31 per cent and of major complications 4 per cent. One patient died.Staging laparotomy has played an important part in the management of Hodgkin's disease over the past decade, but it is likely to assume a less prominent role in the 1980s as the role of chemotherapy in early Hodgkin's disease expands. In non‐bulky clinical stage I and II Hodgkin's disease, when radiotherapy alone is curative, then a staging laparotomy is justifiable because it will detect occult abdominal disease, especially in the lymphogram‐negative patient, which may require the addition of chemotherapy or more extensive radiotherapy. Laparotomy is essentially an operation to remove the spleen and to obtain adequate liver biopsy specimens in order to ascertain possible involvement of these two organs. Non‐opacified nodes at the porta hepatis and coeliac axis should also be sampled, as should a node from the poorly opacified upper paraaortic area. Routine oophoropexy is not re

ISSN:0007-1323    

DOI:10.1002/bjs.1800690402

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractFifty‐six patients who had undergone salvage surgery for residual or recurrent squamous carcinomas of the tongue between 1967 and 1977 were reviewed. Failure to obtain operative clearance led to certain local recurrence. The tongue or cervical lymph nodes were involved in 27 of the 28 patients who died with recurrent tumour. The overall age‐corrected actuarial postoperative survival was 45.1 per cent at 2 years and 35.3 per cent at 5 years. Survival was reduced in women and patients aged over 60 years at operation, and in patients whose tumours were at first biopsy moderately or poorly differentiated, classified as stage III or IV at initial presentation or preoperatively, or recurred within 6 months of completing primary treatm

ISSN:0007-1323    

DOI:10.1002/bjs.1800690403

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe tumours of 61 patients suffering from primary adenocarcinoma of the breast were assayed for oestrogen receptors (ER), using the dextran‐coated charcoal method. A statistically significant relationship (P<0.05) was found to exist between ER status and the histological grade of the tumour. No relationship was found between ER status and either tumour size or the pathological state of the axillary lymph nodes. It is concluded that it is a practical proposition to establish an ER assay service in a district general hospital, with subsequent benefits for the individual patien

ISSN:0007-1323    

DOI:10.1002/bjs.1800690404

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe pattern of pleural metastases in women with effusions secondary to breast cancer was evaluated by thoracoscopy in a series of 46 patients with previously untreated effusions. Metastases involving the visceral pleura were seen in 59 per cent of patients wheras parietal deposits were found in only 15 per cent. No tumour deposits were seen in 26 per cent of cases. No patients had both visceral and parietal tumour secondaries. Patients within each of these groups showed differences in rates of positive effusion cytology, chest wall recurrence and previous evidence of recurrent breast cancer.

ISSN:0007-1323    

DOI:10.1002/bjs.1800690405

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800690406

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe gastrointestinal tract is a favoured site for metastatic melanoma. Complications such as obstruction, bleeding or perforation should be alleviated by surgery in order to improve the patient's condition for further systemic therapy. Six patients with melanoma involving the gastrointestinal tract are presented: 3 were operated upon for metastatic lesions in the small bowel causing intussusception, 2 patients were treated for perforation of the small bowel and 1 patient with massive bleeding from metastatic melanoma in the stomach underwent gastrectomy. Two of the patients are alive 6 months and 4 years respectively after these operations. The other 4 survived between 6 months and 2 years.

ISSN:0007-1323    

DOI:10.1002/bjs.1800690407

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800690408

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractIntradermal skin tests were performed on 6 patients with histologically proved granulomatous starch peritonitis and on 15 control subjects. All patients with starch peritonitis developed an erythematous reaction at least 5 mm wide between 3 and 8 days after inoculation. Such a skin reaction was not seen at that time in any of the control subjects. The microscopic changes seen in the positive reactions were dense mononuclear perivascular exudates with organized giant cell or epithelioid cell granulomas in 4 patients and loose histiocytic aggregations in a fifth patient. This evidence of cutaneous delayed hypersensitivity suggests that an immunological response underlies granulomatous starch peritonitis and that intradermal skin tests are of value in its diagnosis.

ISSN:0007-1323    

DOI:10.1002/bjs.1800690409

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe variable location of the parathyroid glands is a significant factor in unsuccessful cervical exploration for hyperparathyroidism. Particular difficulty may be experienced when an overactive parathyroid is concealed within the substance of the thyroid. Currently available methods of localizing abnormal parathyroid tissue may well fail to indicate an intrathyroid location. The latter possibility should always be considered whenever thorough cervical exploration has failed to reveal a parathyroid tumour as such awareness may obviate re‐exploration or an unnecessary sternotomy. This report details the clinical features and operative findings in 6 patients whose primary hyperparathyroidism was due to an overactive intrathyroid parathyroid gland. Successful parathyroid surgery demands a strict routine exploration of the possible sites of overactive glands, virtually all of which are easily accessible through a standard collar incisio

ISSN:0007-1323    

DOI:10.1002/bjs.1800690410

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractElectrical calf muscle stimulation during surgery has been used for the prevention of deep vein thrombosis (DVT) with varied results in several studies. This effect is mainly achieved by the reduction of venous stasis in the legs. Another possible beneficial effect might be an increased fibrinolytic activity of the blood secondary to the muscle contractions. Previously, single electrical impulses have been used for stimulation, giving rise to ‘single twitches’ in the muscles. In the present study the effect on calf volume of muscle stimulation with groups of impulses giving a short‐lasting tetanus was investigated. Changes in calf volume were recorded by strain gauge plethysmography. Optimal values for duration, number and frequency of the impulses within the groups were determined. Stimulation with groups of impulses reduced calf venous volume approximately three times more efficiently than stimulation with single impulses. Calf muscle stimulation did not enhance the increase in fibrinolytic activity of venous blood observed after oesophago‐ or laryngoscopies under general anae

ISSN:0007-1323    

DOI:10.1002/bjs.1800690411

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY