ISSN:0007-1323    

DOI:10.1002/bjs.1800821102

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800821103

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800821104

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractMesenteric ischaemia may result from a wide range of pathological processes, each possessing unique clinical features, diagnostic difficulties, management strategies and outcome. Regardless of aetiology, prognosis depends crucially on rapid diagnosis and institution of treatment to prevent, or at least to minimize, bowel infarction. Progress in understanding the pathophysiology of mesenteric ischaemia has led to novel methods of treatment, so that in some circumstances therapy may be purely medical. More often surgery is required and is frequently life saving. Percutaneous transcatheter techniques are increasingly employed in both diagnosis and treatment. Close cooperation between radiologists, physicians and surgeons is therefore necessary if clinical outcome is to be optimized. This paper reviews the modern interdisciplinary management of mesenteric ischaemia in the light recent advances.

ISSN:0007-1323    

DOI:10.1002/bjs.1800821105

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractThis review addresses some of the immunological issues surrounding the complex problem of perioperative sepsis. It identifies an immunological paradox between the relative immunosuppression of the immediate postoperative period and the relative immune activation of established sepsis, in addition to discussing current knowledge of the mechanisms surrounding these phenomena. Much remains unknown about perioperative immunoregulation; there are a number of potential mechanisms, however, whereby local and systemic immune defences can be modified or enhanced. Provided patients at risk can be identified, such manipulations may find application in preventing infection and sepsis after surgery.

ISSN:0007-1323    

DOI:10.1002/bjs.1800821106

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractTo help determine whether adenocarcinomas of the proximal and distal large bowei reflect distinct entities, the expression of two splice variants of the metastasis‐associated cell adhesion molecule CD44, carrying exons v5 and v6 respectively, was investigated retrospectively in fresh frozen samples of 23 proximal and 41 distal carcinomas by immunohistochemical staining with specific anti‐CD44v5 monoclonal antibody VFF8 and anti‐CD44v6 monoclonal antibodies VFF4 and VFF7. Tumours were staged as: Dukes A, 0; Dukes B, 27; Dukes C, 31; and Dukes ‘D’, six. Compared with distal tumours, proximal lesions expressed significantly more CD44v5 (96versus87 per cent,P= 0·02) and CD44v6 (83versus61 per cent,P= 0·01). CD44v5 and CD44v6 are considered markers for tumour progression and aggressive behaviour. Their high expression in proximal carcinomas seems to contrast with the general belief that these tumours show less aggressive behaviour than left‐sided lesions. Further study of the biological significance of the expression of CD44 splice variants is the

ISSN:0007-1323    

DOI:10.1002/bjs.1800821107

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractStrictureplasty extends the surgical options for the treatment of obstructive Crohn's disease. Over 15 years, 52 patients had 241 strictureplasties at 76 operations with no operative mortality and with septic complications in only two patients (4 per cent). Median (range) follow‐up was 49.5 (1–182) months. Nineteen patients (36 per cent) required a second operation for Crohn's disease between 1 and 57 months after first strictureplasty. Most symptomatic recurrence was caused by new segments of stricturing or perforating disease, and recurrence of Crohn's disease was noted at only nine strictureplasty sites (3·7 per cent) in four patients. Seven patients (13 per cent) required a third operation for Crohn's disease. Patients undergoing strictureplasty alone were no more likely to require reoperation than those who had a concomitant resection at the first procedure (X2= 0·619,P>0·2). The reoperation rates after first and second operations were similar (X2= 0·021,P>0·2). Minimal surgery does not appear to lead to an accelerated or additional need for subsequent operation. Strictureplasty provides a safe, effective and rapid procedure to restore patients to good health while preserving the intestine and may be recommended for carefully selected strictures as an adjunct to conventional excisional surgical t

ISSN:0007-1323    

DOI:10.1002/bjs.1800821108

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractAnal sphincter pressures, rectal compliance and sensation in 19 women of mean age 77 (range 57–94) years were studied before and after Delorme's procedure for full‐thickness rectal prolapse. No patient had significant problems with defaecation after operation. There were no significant changes in anal sphincter pressures but the volume of first rectal sensation decreased from a median of 140 ml before surgery to 65 ml after the procedure (P= 0·01) and the maximum tolerated rectal volume declined from a median of 249 ml to 120 ml (P= 0·001). Rectal compliance was reduced from a median of 142.9 ml/kPa to 12.2 ml/kPa (P= 0·002). Improved rectal sensation and lowered compliance are associated with a reduced incidence of defaecatory problems after Delorme's pro

ISSN:0007-1323    

DOI:10.1002/bjs.1800821109

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractSystemic endotoxaemia is a well recognized feature of inflammatory bowel disease but its pathogenic role remains uncertain. This study examined plasma endotoxin and cytokine concentrations and the acute‐phase protein response in a hapten‐induced model of experimental colitis. On days 2, 8 and 14 after induction of colitis with trinitrobenzenesulphonic acid in ethanol (TNBS‐E), plasma endotoxin, immunoglobulin (Ig) G and IgM endotoxin‐core antibody (EndoCAb), tumour necrosis factor (TNF), interleukin (IL) 6 and α2‐macroglobulin (α2M) concentrations and colon macroscopic inflammation score were determined. At all time points there was significant colonic inflammation when compared with control values (P<0·0001). Animals treated with TNBS‐E had raised concentrations of endotoxin at all time points (P<0·04). In TNBS‐E‐treated animals EndoCAb concentrations were reduced on day 2 (P<0·0001) and later increased. There were increases in IL‐6 and α2M concentrations in TNBS‐E‐treated animals but no significant change in TNF concentrations. Endotoxin concentrations correlated with macroscopic inflammation score, IL‐6 and α2M concentrations. There was a less consistent correlation between EndoCAb concentrations and these parameters. These results suggest that endotoxin is a mediator of the systemic response in this

ISSN:0007-1323    

DOI:10.1002/bjs.1800821110

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractPlatelet‐derived serotonin released in response to tissue manipulation during surgery may contribute to mesenteric arterial vasospasm leading to postoperative anastomotic leakage after colorectal resection. Organ bath experiments were used to demonstrate the efficacy of naftidrofuryl fumarate (NFT) to oppose serotonin‐induced vaso‐constriction of human mesenteric arteries. Cumulative dose‐response curves were derived with and without NFT at 10−9and 10−6mol/l concentrations. The difference in maximal contractility between the three sets of curves (n= 8 for each) was significant (P<0.0001). Sensitivity to serotonin in each of the three curves was measured by calculating the concentration for half‐maximal response; differences were again significant (P<0.0001). NFT reduced serotonin‐induced contractility in a dose‐dependent fashion in rings of human mesenteric arteriesin vitro. This suggests a possible role for NFT in reducing mesenteric vasospasm in c

ISSN:0007-1323    

DOI:10.1002/bjs.1800821111

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY