摘要:

SummaryThe pathology and clinical picture in typical cases of spontaneous rupture of the oesophagus have been described. The rupture is usually a longitudinal tear in the left lateral wall of the oesophagus commencing just above the diaphragm. Mediastinitis, mediastinal emphysema, and pyopneumothorax develop. Vomiting, pain, dyspnoea, abdominal rigidity, and surgical emphysema in the neck, occurring in that sequence, is the typical clinical picture. Untreated cases usually die in forty‐eight hours.Atypical clinical pictures and their causal atypical pathology have been described.Awareness that the condition exists, a knowledge of the symptom sequence, a carefully taken history, the detection of air in the mediastinum or neck, and signs of fluid and air in the pleural cavity, will enable an early correct diagnosis to be made in typical cases. A portable X‐ray film which includes the neck, chest and upper abdomen should always be done. Air in the mediastinum and the absence of air under the diaphragm are the two most significant radiological findings. Aids to diagnosis are pleural aspiration, a lipiodol swallow followed by a chest X‐ray, and thoracoscopy.When the history is atypical, and when the hydro‐pneumothorax is confined to the right pleural cavity, a lipiodol swallow and an oeso‐phagoscopy must be done, as such patients may have pre‐existing oesophageal disease or a perforation at a level higher than the usual supra‐diaphragmatic site.Cases are classified as follows:–“Early”—diagnosed within thirty‐six hours of onset.“Intermediate”—diagnosed between thirty‐six hours and one month of onset.“Late”—diagnosed more than one month from the onset.The following treatment has been recommended:—(a) “Early” cases — immediate thoracotomy with repair of the oesophagus and drainage of the mediastinum and the pleural cavity should be done.(b) “Intermediate” cases —(i) If a total empyema is present— thoracotomy, decortication, and drainage of the pleural cavity and mediastinum should be done. The oesophageal rent should not be repaired.(ii) If the empyema is small and loculated—drainage of the empyema and the mediastinal abscess is all that is required.(c) “Late” cases—thoracotomy, decortication, excision of the oesophago‐pleural fistulous track, and repair of the oesophagus should be done.Management of the post‐operative feeding problems in all three groups of cases have been discussed.Nine cases of spontaneous rupture of the oesophagus treated surgically between 19

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1959.tb03830.x

出版商:Blackwell Publishing Ltd    

年代:1959

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1959.tb03831.x

出版商:Blackwell Publishing Ltd    

年代:1959

数据来源: WILEY

摘要:

SummaryExcision of the head and neck of the femur for a benign chondroblastoma was performed because of a pathological misdiagnosis of osteogenic sarcoma.2. There was a recurrence after the excision of the tumour because tumour cells had been spilled along the drill hole in the great trochanter during the diagnostic curettage.3. At the third operation the great trochanter was excised after which there was no recurrence.4. There is good function, no pain, but 3′shortening at the present time, four years late

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1959.tb03832.x

出版商:Blackwell Publishing Ltd    

年代:1959

数据来源: WILEY

摘要:

SummaryBiligrafin reinforcement is a valuable adjunct to the Graham‐Cole test. Indications for the additional test are given.Results of a series of 60 cases suggest that radiological methods can be further improved, and that more pre‐opcrative information can be obtained in patients with gallbladder dise

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1959.tb03833.x

出版商:Blackwell Publishing Ltd    

年代:1959

数据来源: WILEY

摘要:

Summary1The rationale, and application of the radioactive phosphorus uptake ratio test in the diagnosis of intra‐ocular and cutaneous melanomata, has been described and illustrated.2Preliminary results recorded for 27 patients (12 with cutaneous, and 15 with ocular disease) indicate that the32P uptake test is useful, a differential uptake of 1.3 being taken as significant.3A correlation has been obtained between the32P uptake ratio, and the tumour nucleoprotein content based on measurements of volume and density of tumour cell nuclei.4Attention is drawn to possible biological differences between melanomata of the iris and those of the choroid.5The correlation of32P uptake ratios with histological diagnosis of malignancy in these tumours, is discusse

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1959.tb03834.x

出版商:Blackwell Publishing Ltd    

年代:1959

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1959.tb03835.x

出版商:Blackwell Publishing Ltd    

年代:1959

数据来源: WILEY

摘要:

SummaryThe management of cases of complicated anal fistulae is discussed in detail.It is concluded that there should be no further trouble from a fistula after operation, and that in no case should rectal incontinence develop as a result of the operation.These conclusions are based on a personal series of 164 cases of anal fistulae, both complicated and uncomplicated.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1959.tb03836.x

出版商:Blackwell Publishing Ltd    

年代:1959

数据来源: WILEY

摘要:

Summary1The greatest number of deaths in the series followed operations on newborn babies.2The common causes of fatal complications in the neonatal group were delay in treatment, respiratory depression, fluid and electrolyte imbalance, infection and defective intestinal anastomosis. Measures which may prevent these complications have been reviewed.3Deaths of older infants and children most commonly followed intussusception, appendicitis and post‐operative intestinal obstructio

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1959.tb03837.x

出版商:Blackwell Publishing Ltd    

年代:1959

数据来源: WILEY

摘要:

Book reviewed in this article:NEOPLASTIC DISEASE AT VARIOUS SITES. Volume 2– Tumours of the Blodder: Edited by DAVID M. WALLACE, O.B.E., M.S., F.R.C.S.RE‐EDUCATION OF THE INJURED SHOULDER: By R. BARRIE BROOKES.ORTHOPAEDICS IN GENERAL PRACTICE. Is it Rheumatism, Doctor?: By W. H. GERVIS, M.D.(Cant.), F.R.C.S.A PRACTICE OF THORACIC SURGERY: By A. L. d'ABREU.A SYNOPSIS OF SURGERY; Edited by Sir CECIL WAKELEY.TEXTBOOK OF BRITISH SURGERY: By Sir HENRY SOUTTAR and J. C. GOLIGHER.CARDIOLOGY: By WILLIAM EVANS, M.D., D.Sc., F.R.C.P.CLINICAL CHEMISTRY IN PRACTICAL MEDICINE: By C. P. STEWART and D. M. DUNLOP.COLD INJURY: GROUND TYPE: Medical Department, United States Army in World War II: By Col. TOM F. WHAYNE, M.C., U.S.A.(Ret.), and MICHAEL E. DE BAKEY, M.D.EMERGENCY WAR SURGERY, NATO HANDBOOK: Edited by JOHN BOYD COATES, Junior. U.S. Armed Forces Issue, prepared by Medical Services of NATO Nations.SURGERY OF THE COLON: By E. S. R. HUGHES.SURGERY OF THE SYMPATHETIC NERVOUS SYSTEM: By Sir JAMES PATERSON ROSS, K.C.V.O., LL.D., M.S., F.R.C.S., F.R.A.C.S., F.A.C.S.TREATMENT OF CANCER AND ALLIED DISEASES. Vol. 2. TUMOURS OF THE NERVOUS SYSTEM: Edited by GEORGE T. PACK, M.D., F.A.C.S., and IRVING M. ARIEL, M.D., F.A.C.S.SURGERY OF THE HEAD AND NECK: By R. A. WISE and H. W. BAKER.THE PATHOLOGY AND MANAGEMENT OF PORTAL HYPERTENSION: By R. MILNES WALKER.OUTLINE OF FRACTURES – INCLUDING JOINT INJURIES: By JOHN CRAWFORD ADAMS

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1959.tb03838.x

出版商:Blackwell Publishing Ltd    

年代:1959

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1959.tb03839.x

出版商:Blackwell Publishing Ltd    

年代:1959

数据来源: WILEY