ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1978.tb07287.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1978.tb07288.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

It is now clearly established that proximal gastric vagotomy, which has been in clinical use for over seven years, has lower mortality and morbidity rates than all other forms of operation currently used in the treatment of chronic duodenal uicer. Although no long‐term figures are yet available, the ulcer recurrence rate is not likely to be greater than that for truncal vagotomy. The technique is not without problems, however, and has yet to gain wide acceptance in this countr

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1978.tb07289.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

In the five‐year period 1972 to 1976 the authors' preferred treatment for patients with chronic duodenal or prepyloric peptic ulcer requiring surgery was proximal gastric vagotomy. In spite of this preference, only two‐thirds of such patients were so treated. Most patients with bleeding and stenosis were treated by bilateral truncal vagotomy and drainage, and a few by Polya gastrectomy. Proximal gastric vagotomy proved to be a safe elective operation without mortality and with a proven ulcer recurrence rate so far of 6%. Compared with those who had bilateral truncal vagotomy and drainage, the proximal gastric vagotomy patients complained less often of diarrhoea but more often of weight loss and reflux. Two patients have had persistent postprandial non‐peptic pain, thought possibly due to upper gastric isch

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1978.tb07290.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1978.tb07291.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

This study is of the results of surgical management of bleeding chronic peptic ulceration at Prince Henry's Hospital, retrospective for the periods 1951 to 1960 and 1961 to 1970 and prospective for 1972 to 1977. During the latter five years all patients were admitted from the community to a haematemesis and melaena unit with a defined policy of management and prospective data recording for computer analysis. There was a continuing improvement in mortality over this 25‐year period, especially with duodenal ulcer. No clear distinction could be made between conservative surgery and partial gastrectomy in terms of reduced surgical mortality in duodenal ulcer. Bleeding gastric ulcer remains a difficult problem, with a current surgical mortality of 21

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1978.tb07292.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

The interrelationship of gastrointestinal bleeding, acute perforation, and pyloroduodenal stenosis was examined in a hospital series of 1,457 patients with duodenal ulcers. The proportion of each complication among the total number of ulcer patients after various periods of ulcer symptoms was determined. There was little variation in the proportion with bleeding as the duration of symptoms increased, whereas the proportion with perforation decreased and the proportion with stenosis increased with increasing duration of ulcer dyspepsia. The association of bleeding with perforation (26 patients) was more common than the association of bleeding with stenosis (12 patients), and more so than the association of perforation with stenosis (4 patients). To explain the paradoxical relationship of perforation and stenosis it was proposed that perforation occurred when the pathological process in ulceration was such that there was more tissue destruction than tissue repair, and that stenosis would result if there was more tissue repair than tissue destruction.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1978.tb07293.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

Five methods of diagnosis have been compared prospectively in 43 patients referred for suspected reflux oesophagitis. A final diagnosis of reflux oesophagitis, as defined by the presence of at least two of the three features of typical symptoms, abnormal endoscopic findings, and abnormal findings on oesophageal biopsy, was made in 27 patients.Observer error in the interpretation of endoscopic and histological appearances was small. Measurement of resting pressure of the lower oesophageal sphincter (LES) failed to identify individual patients with reflux oesophagitis, although the mean pressure in 26 patients with oesophagitis (10 1 ± 5 2 mm Hg) was significantly lower than in 13 patients without oesophagitis (16.8 ± 10.2 mm Hg, P<0.005). Barium studies were unhelpful, as a hiatus hernia was present in only 14 and barium reflux in only 11 of the 27 patients with oesophagitis. Acid perfusion (Bernstein test) was positive at 15 minutes in 23 of the 27 oesophagitis patients, but was falsely positive in seven of the 14 patients without oesophagitis. By accepting only those responses to acid perfusion which were positive at or before seven minutes, the false positive responses were reduced to one out of the 14 patients. Typical symptoms and/or an early positive Bernstein response will correctly identify most patients with reflux oesophagitis, but the diagnosis should be confirmed by endoscopy and biopsy when important therapeutic decisions are pendin

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1978.tb07294.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

At the Royal Prince Alfred Hospital, most patients with bleeding varices have been poor‐risk alcoholics. A high proportion were receiving a State pension. The early mortality due to bleeding varices was 53%. This figure comprised a 60% mortality following conservative management and 40% after urgent shunt. All patients having urgent operations which were not portal decompression died. No patient who had an elective shunt died. In a mean follow‐up period of 15.4 months, a further 14% of survivors died.No form of conservative management appeared to have much effect on the natural history of the bleeding. A blood replacement of more than five litres indicated that spontaneous cessation of haemorrhage was unlikely. Shunt operations usually controlled haemorrhage, but hepatorenal failure was common after the urgent shunts. The cost of operation was greater than that of conservative management, but in neither case was it considered excess

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1978.tb07295.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

Achalasia cardia is the commonest benign obstructive lesion of the oesophagus in India. We have reviewed 100 cases over a 20‐year period. This is the largest series that has been reported from India. Some unusual features were observed. Males were more often affected than females in a ratio of 2.3:1. Children below the age of 10 years are not often affected, but we had 10 subjects in this age group. In our series dysphagia for solids has been the main presenting feature. Barium swallow X‐ray studies of the oesophagus were diagnostic. The treatment of choice has been surgical, and a modified Heller's operation has been the chosen procedure. Our preference is for the thoracic approach. Postoperative complications were few. Long‐term follow‐up of 65 patients over a 19‐year period revealed excellent results in SO patients (76.9%). good results in 10 (15.4%), and fair and poor results in two (3.1%) and three (4.6%)patient's respectively. The fair and poor results occurred in patients with recurrence of symptoms or stricture formation due to reflux oesophagitis. The excellent results, even on long‐term follow‐up, we believe are due to the adequate myotomy that

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1978.tb07296.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY