ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07430.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07431.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07432.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07433.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

The gastrointestinal tract is the largest endocrine organ in the body. However, gastrointestinal hormones are not confined to the gut and many of them are delivered to their target tissue by by neural and paracrine routes as well as the circulation. Regulatory peptide is therefore a more appropriate term than gastrointestinal hormone. The functions of these regulatory peptides include effects on intake, digestion and absorption of food, and changes in gut secretions, motility and growth. Since these peptides do not act alone but in concert it has been difficult to ascribe particular functions to individual peptides. However, the recent and on‐going development of specific regulatory peptide agonists and antagonists has resulted in major advances in our understanding of the physiology of these peptides. In turn these findings are creating new therapeutic avenues providing some return from all the research on these gastrointestinal regulatory peptides. The somatostatin derivative (octreotide or sandostatin) is the most obvious example. Although only approved in Australia for treatment of carcinoids and VIPomas, the prospects include treatment of other gastroenteropancreatic tumours, acromegaly, idiopathic diarrhoea, fistula closure, dumping, and ERCP or post‐operative pancreatitis. A new gastrokinetic agent, that acts via the motilin receptor, is undergoing trials for the treatment of impaired gastric emptying. The trophic effect of gastrointestinal peptides has clinical significance. For instance, gastrin antagonists inhibit cell proliferation of colon carcinoma cell lines. Furthermore the trophic effect of gastrin must be considered when potent gastric acid inhibitors, which cause a reflex increase in gastrin, are used. The outlook is for more mammalian regulatory peptides to be discovered adding further to the complexity. However, the continuing development of specific antagonists and agonists should help our understanding of the roles and interactions between the various components of the regulatory peptide syst

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07434.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Fifty ileo‐anal J pouches were constructed in 26 males and 24 females for ulcerative colitis (n=45) and familial adenomatous polyposis (n=5). Two‐thirds had proctocolectomy and pouch formation as a one‐stage procedure. Thirty patients had a handsewn pouch and anastomosis and 20 were stapled. Forty‐five patients had their defunctioning ileostomy closed for at least 2 months, of whom three have not been recently reviewed. One pouch was defunctioned for ischaemic stricture. The median time between pouch construction and ileostomy closure was 15 weeks and the time between closure and assessment ranged from 2 to 50 months (median 18 months). Median stool frequency was six per 24h in both the handsewn and stapled groups. Faecal incontinence occurred in 20% of patients with a handsewn anastomosis but in no patient with a stapled anastomosis (P<0.02). Soiling was also more common in the former group. Some 76% of patients noted an improvement in sexual activity since pouch surgery. Pouchitis has occurred in 20% of patients; 10% have had complications related to the pouch or anastomosis; 10% related to the ileostomy; and 6% have had small bowel obstruction. There have been no deaths. Overall, 88% of patients have had a good result, but none of the five patients with a poor result will revert to an il

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07435.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Small bowel obstruction (SBO) as a late complication of the treatment of Hodgkin's disease was found in 32 of 398 (8%) patients followed over a 20 year period. The vast majority of these patients had an initial staging laparotomy as part of staging protocols. Of 51 obstructive episodes, 13 were diagnosed clinically, 12 of the 13 had prior radiological or surgical documentation. Thirty‐one episodes were shown radiologically; four were demonstrated at laparotomy and three recurrent episodes were identified in an unspecified manner. The median duration of each episode was 3 days and the median time between commencement from treatment for Hodgkin's disease and the development of a SBO was 21 months. Thirty‐one of the 32 patients had had a staging laparotomy or prior abdominal surgery. Two patients had SBO because of non‐Hodgkin's lymphoma and one had SBO secondary to short bowel syndrome. These are thus not true complications of disease treatment. Twenty‐nine of the 32 or 7.2% of patients thus had possible treatment‐related SBO. The cause of SBO was recorded as adhesions from previous surgery in 27 of the 51 episodes. This was confirmed at laparotomy in 16 patients. Twenty‐five of the 32 patients had received abdominal irradiation but only three obstructive episodes were attributed to radiation enteritis and fibrosis. In one of 22 patients who received chemotherapy, Vinblastine was implicated as a cause for SBO. Eighteen patients required laparotomy to lyse adhesions while the others were treated conservatively with tube drainage. The aetiologies for these obstructive episodes can be attributed to staging laparotomy and its combination with other treatment modalities, and their incidence is likely to be lower in more recent series where more conservative staging procedur

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07436.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

It has been usual practice to manage gallstone pancreatitis conservatively over the acute phase and to perform an elective cholecystectomy after an interval of 2–3 months. Because of the risks of recurrent pancreatitis, and in an effort to reduce the high morbidity and mortality associated with severe pancreatitis, there has been a trend towards early surgical intervention and, more recently, endoscopic sphincterotomy. From the Greenlane Hospital experience during 1979–1987, and from a review of recent literature, a strategy is proposed for the management of acute gallstone pancreati

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07437.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

An alternative to cholecystostomy and standard cholecystectomy for ‘difficult’ gall bladders has been described previously. The procesured, partial cholecystectomy, involves leavingin situpart or all of the wall of the gall bladder which lies directly in relation to the liver and/or structures in the porta hepatis. Eleven such procedures have been performed over a 5 year period, and the common indication in all was severe inflammation or fibrosis in the region of Clot's triangle. One patient developed a self‐limiting postoperative bile leak. One patient has formed bile duct stones and appears to have oriental cholangiohepatitis. In the remainder of the patients, there has been no recurrence of biliary tract symptoms. The procedures id definitive and safe, and may usually be performed when cholencystostomy would have been under

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07438.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

A retrospective analysis was performed to define the indications and usefulness of computed tomography (CT) in the management of 62 patients with recurrent pyogenic cholangitis. When performed in 18patients in the acute phase for persistent fever inexplicable by ultrasonography and cholangiography, CT scans identified the cause of sepsis to be liver abscesses (n=7), impacted stones in left lateral segments (n=3) and right posterior inferior duct (n=1). When performed in 44 patients during remission, CT seans detected impacted intrahepatic stones as the cause of non‐opacification of segmental bile ducts on cholangiograms (n=15), demonstrated liver volume changes (segmental atrophy,n=31; hypertrophy,n=5), differentiated intrahepatic stones from pneumobilia (n=5) and revealed stones in segreagated intrahepatic bile ducts (n=4). Overall 75.8% of CT scans showed valuable intrahepatic findings which were useful in guiding the appropriate treatment for the intrahepatic pathology. In the others without demonstrable intrahepatic pathology on CT, patients were adequately treated for common bile duct pathology alone. It is recommended that CT should be performed when ultrasonography and cholangiography cannot elucidate the cause of persistent fever, when the cholangiogram shows non‐opacification of segmental bile ducts, or fails to demonstrate the cause of recurrent acute cholangitis, particularly in patients who have had previous bilio‐enteric drainage proce

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07439.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY