ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07467.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

This article briefly reviews recent advances in knowledge of the histology and function of blood vessels. It focuses upon the multifunctional roles of endothelium and smooth muscle cells. Particular reference is made to the synthesis of a number of factors now known to be involved in maintenance of the integrity of the vessel wall and the initiation of arterial disease. The cells of the vascular wall are much more versatile and dynamic than previously thought.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07468.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Gastric restrictive procedures for morbid obesity are frequently performed to reduce problems arising from the physical limitations and social isolation of massive obesity. Numerous reports have described changes in weight after gastric restrictive operations. yet few studies have documented changes in the secondary effects of obesity. This report deals with changes in psychosocial status and physical activity occurring in 240 patients who remained in the study 3 years after surgery. These patients were members of a group of 310 patients who were entered into a prospective randomized trial to assess the relative benefits of three forms of gastric restrictive procedure. Prior to operation, and at yearly intervals after operation, the physical activities and psychosocial status of each patient was assessed by a standardized semi‐structured interview. At the time of the three‐year interview the median weight loss for these patients was 29.5 kg which represents 53% of excess weight lost. This weight loss was associated with a marked reduction in the amount of food eaten. There was a significant increase in the number of patients smoking more than 20 cigarettes a day and a mild increase in alcohol intake. There were significant improvements in the level of self‐image and state of happiness. The social lives and sex lives of the majority of patients were improved and a significantly greater number of patients reported being in a stable emotional relationship at 3 years after operation than did so pre‐operatively. There was a marked increase in the number of patients in full‐time or part‐time employment from 38% prior to surgery to 60% at 3 years after operation. We conclude that, in association with significant weight loss after gastric restrictive procedures for morbid obesity, there is a broad improvement in physical and psychosocial factors at 3 years aft

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07469.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Five hundred and eleven patients with adenocarcinoma of the stomach were reviewed. Weight loss and abdominal pain were the most common symptoms. One‐third of patients were found to have proximal gastric lesions with dysphagia being a major symptom in 23% of all patients. Laparotomy was performed on 88% of patients with 56% of the entire series undergoing gastric resection.The overall 5‐year survival rate was 12.3% and for curative resection 43%. The 5‐year survival rate of patients undergoing total gastrectomy was 53% and for patients undergoing subtotal or partial gastrectomy the 5‐year survival rate was 42%. The operative mortality. similar in both groups. was 8.1% versus 5.6%.Palliation was better achieved by resection than bypass. Total gastrectomy for palliation was undertaken in 48 patients. This group of patients has achieved a good quality of life and a mean survival rate of 12.5

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07470.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

The use of perioperative blood transfusion (PBT), the immunological status pre‐operatively and at discharge from hospital. and the clinical course were examined retrospectively in 124 patients who underwent ‘curative’resection for gastric cancer at Shinkokura Hospital, Japan from 1979 to 1988. The general condition of patients with PBT was worse than that of those without PBT and the pre‐operative immunological status of patients with PBT was less favourable than that of those without PBT. At the time of discharge from hospital the immunological condition remained worse for patients who had been given PBT. Thc clinical course of patients with PBT was significantly worse. A dose‐response relationship was evident but the types of blood products did not influence the outcome. Cox regression analysis adjusting for potentially confounding prognostic factors revealed that the clinical course was not altered by perioperativc blood transfusion itself. These observations do not support the idea of adverse effects of perioperative blood transfusion on outcome of patients undergoing ‘curative’resection for g

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07471.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

The management of patients with an unsatisfactory result following antireflux surgery is often problematical. Ten such patients with failed antireflux surgery, for whom medical management had also subsequently failed, underwent reoperation via a thoraco‐abdominal approach. The anatomical cause of the surgical failure was determined pre‐operatively in most cases by endoscopy, radiology, manometry and 24‐hour pH monitoring. The most common reason for failure was a slipped Nissen fundoplication. A tight wrap, a disrupted wrap and a fundoplication hernia were less common cause. At folow‐up, only one patient had a poor result. Reoperation for failed antireflux surgery can yield good results and is facilitated by pre‐operative defintion of the cause of failure and wide operative

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07472.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Meningiomas should be considered in the differential diagnosis of space‐occupying lesions of the temporal bone. Five cases of meningiomas of the temporal bone are described and the literature reviewed. These tumours may stimulate Schwannornas and glomus tumours in their presentation and radiological findings. The tumours were managed by combining standard neurosurgical approaches with temporal bone and skull base technique

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07473.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Foreskin reconstruction and urethral stent urine drainage were used successfully in 17 Mathieu urethroplasties. No significant complications occurred. The techniques and their advantages are outline.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07474.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

A 35‐year retrospective review of all surgically significant pathological lesions of the ovary was conducted. Fifty‐one children had 53 ovarian lesions which required surgicla intervention. Of the 53 ovarian lesions seen in this series, 21 had presented with torsion. Five of these torted ovaries were microsocopically normal. Three children were castrated. One of these castrations could have been prevented if contralateral oophoropexy was done. In addition, one child, who had lost an ovary previously because of torsion, presented with major cystic disease of the remaining ovary. Torsion was aborted by ovarian cystectomy. Contralateral oophoropexy at the time of ipsilateral oophorectomy is recommended to prevent castrat

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07475.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Between 1979 and 1989, 92 patient were treated at St Geroge Hospital, Kogarah, for perforated duodenal or perpyloric ulcer. Mortality rate at 28 days was 18%. Life table analysis showed 1‐, 5‐ and 10‐year survival rates for his group to be 78%, 60% and 46% respectively. During the second half of the study period, increasingly older females with a history of cardiovascualr disease, arthropathy, chronic renal impairment and non‐sterioid anti‐inflammatory drugs (NSAIDS) intake were identified and found to be at greate risk of dying from their perforation. Age, cardiovascular disease and chronic renal impairment were demonstrated to be independent factors affecting survival. Patients treated by simple closure of the perforation had a long‐term survival rate equivalent to that of patients treated in other ways, although the number of these latter patients is small. Implications for the administration of NSAIDS are considered in the light of these findings. These results suggest that orthodox simple closure of perforated peptic ulcer and administration of H, blocking agents is the most appropriate treatment for patients presenting with perforated p

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1990.tb07476.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY