摘要:

AbstractAlthough intestinal obstruction from intra‐abdominal adhesions is a relatively common surgical emergency, the vast majority of adhesions are harmless and may be protective or even life‐saving. The causes of intestinal adhesions are presented, and various methods advocated to prevent adhesions are discussed. The surgeon is advised to reduce unnecessary adhesion formation by meticulous surgical technique, control those adhesions which inevitably form to obtain their beneficial effects, and to avoid the risk of subsequent obstruct

ISSN:0007-1323    

DOI:10.1002/bjs.1800690502

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractA group of 500 patients with a presumptive diagnosis of primary hyperparathyroidism (HPT) was operated upon at the Mayo Clinic between September 1974 and May 1980 using a standardized operative strategy. Clinical profiles, biochemical data, operative findings and pathological changes are reviewed. Of the 500 patients, 461 (92·2 per cent) were cured after primary cervical exploration. One patient died during the postoperative period, 1 had a permanent unilateral vocal cord paralysis and 10 (2 per cent) had protracted hypoparathyroidism. Owing to the continuing controversy regarding the appropriate therapeutic management of asymptomatic, uncomplicated and mild (‘biochemical’) primary HPT, we further evaluated this surgical experience by comparing the results of operation in two groups of patients: those with (‘biochemical’) HPT (serum calcium11 mg/dl). The cure rate in each patient group was greater than 90 per cent. A statistically significant increase in the incidence of negative cervical exploration (4 normal parathyroid glands identified and biopsied) was noted in the ‘biochemical’ group. However, parathyroid disease was found at operation in 92 per cent of these patients. We conclude that cervical exploration in all patients with primary HPT, including those with ‘biochemical’ disease only, is safe and that such an aggressive manageme

ISSN:0007-1323    

DOI:10.1002/bjs.1800690503

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800690504

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe use of bromocriptine has been evaluated in a double‐blind crossover trial of placebo against 5 mg bromocriptine over six menstrual cycles in 38 women with severe cyclical breast pain. Assessment using both the linear analogue system and clinical examination showed a statistically significant reduction in pain, tenderness and nodularit

ISSN:0007-1323    

DOI:10.1002/bjs.1800690505

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractWe performed a prospective assessment of intraoperative precision in determination of shunt length in 138 patients. The variations were slight and of the same order of magnitude in the jejunum and ileum. Precision in per cent of measured length was independent of the actual length and of the surgeons who performed the operations. The results indicate that factors other than errors in the measurements are responsible for variations in weight loss after jejunoileostomy.

ISSN:0007-1323    

DOI:10.1002/bjs.1800690506

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractTen patients with biliary‐type pain, in whom investigations of the biliary tract were negative, are reported. All the patients were sexually active premenopausal women and all had evidence of infection with Chlamydia trachomatis. Five patients submitted to laparoscopy had fibrinous adhesions between the anterior surface of the liver and the parietal peritoneum (perihepatitis). All 10 patients were diagnosed as suffering from the Curtis—Fitz‐Hugh syndrome caused by Chlamydia trachomatis. The clinical similarities between the Curtis—Fitz‐Hugh syndrome (right upper quadrant abdominal pain, perihepatitis and genital tract infection) and acute biliary disease are emphasized and the diagnostic implications

ISSN:0007-1323    

DOI:10.1002/bjs.1800690507

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractSeven patients suffering from chronic pancreatitis, with dilatation of the duct of Wirsung and obstruction of the intrapancreatic segment of the choledochus, underwent a pancreatic and biliary jejunoduodenal diversion. An isolated jejunal loop was used as a conduit between the bile and pancreatic ducts and duodenum in 3 patients, while in 4 patients separate isolated loops between the duct and duodenum were fashioned. The postoperative period passed without incident. All the patients were symptom free 3 months after operation.

ISSN:0007-1323    

DOI:10.1002/bjs.1800690508

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractNinety‐five (24 per cent) of 389 admissions with acute upper gastrointestinal haemorrhage had further haemorrhage. An analysis of factors leading to further haemorrhage was undertaken by considering patients' clinical history, physical state on admission and endoscopic findings. The risk of further haemorrhage was significantly greater in patients bleeding from oesophageal varices or peptic ulcer and in those patients who were sober, shocked or anaemic on admission. Overall, those over 60 years of age were more likely to rebleed, but this difference was not apparent in relation to endoscopic source of blood los

ISSN:0007-1323    

DOI:10.1002/bjs.1800690509

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThirty‐seven patients with recurrent ulceration after vagotomy were treated by Polya gastrectomy and have been followed up for a minimum of 3 years (median 5 years). The diagnosis of recurrent ulcer was made by endoscopy or at operation. Nine patients were initially treated with cimetidine and either failed to respond or relapsed on maintenance dosage. There were 2 operative deaths and 2 patients were lost to follow‐up. The results of Polya gastrectomy were Visick grade I: 61 per cent, Visick grade II: 15 per cent, Visick grade III: 9 per cent and Visick grade IV: 15 per cent. Two patients had further recurrent ulcerat

ISSN:0007-1323    

DOI:10.1002/bjs.1800690510

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY

摘要:

AbstractThis study is a critical prospective assessment of 37 patients with obstructive jaundice, treated by percutaneous transhepatic biliary drainage. The median duration of drainage was 18 days (range 44–56), and during this period clearance of bilirubin and improvement in creatinine clearance were obtained. Only 10 patients gained weight. Three patients required early laparotomy. Thirty‐three patients underwent definitive surgery. Of these, 8 died without leaving hospital. The incidence of infection rose during drainage, and infected bile was clinically significant. Two deaths were associated with infection, arising in the drainage system, producing intrahepatic abscesses around the drain track.While the evidence for a staged approach in the severely ill patient with obstructive jaundice is substantial, the procedure of percutaneous transhepatic tubal drainage carries significant hazards, under‐emphasized in previous reports. Further controlled assessment is required before this technique is accepted as the initial best option for decompression of the obstructed biliary

ISSN:0007-1323    

DOI:10.1002/bjs.1800690511

出版商:John Wiley&Sons, Ltd.    

年代:1982

数据来源: WILEY