摘要:

AbstractA series of 112 consecutive femorotibial bypasses was reviewed in which glutaraldehyde‐stabilized human umbilical vein was used for the bypass. The duration of follow‐up was between 6 months and 2 1/2 years. Cumulative patency at 2 years for the entire group was 9 per cent. The state of the pedal arteries, site of the distal anastomosis and age of the patient influenced the results. The difference in the patency rates at 1 year between patients with 3 patent pedal arteries and those with only 1 is significant (P<0·001) as is that between those with 3 and those with 2 (P = 0·024). Of 49 patients with pre‐gangrene, in whom the bypass worked for a period in excess of 2 months, only 7 eventually required amputation in contrast to 32 of a group of 39 similar patients in whom the bypass faile

ISSN:0007-1323    

DOI:10.1002/bjs.1800700102

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractThe relative merits of gluteraldehyde tanned human umbilical vein (HUV) and polytetrafluorethylene (PTFE) as alternative arterial grafts have yet to be distinguished in clinical practice. A direct comparison between the thrombogenicity of these rival materials using human blood in an artificial circulation has therefore been made. Eight volunteers each donated 600ml of blood. The heparinized blood, now containing autologous113Inmlabelled platelets, was divided equally into paired artificial circulations incorporating 15 cm lengths of either 6 mm PTFE or HUV. The grafts were perfused for 45 min with a pulsatile flow mimicking the superficial femoral artery. Platelet deposition on the graft (graft activity) was expressed as the ratio of counts from the graft over those per millilitre of blood. The fall in platelet count over the 45‐min period and change in threshold aggregation responses were also measured. Platelet deposition was consistently greater on HUV with a mean (±s.e.) graft activity of 5·59±0·9 markedly exceeding that in the PTFE group of 1·16±0.1 (P<0·01). This increased consumption of platelets by HUV was demonstrated by a mean fall in platelet count in the circulating blood of 46·7±8·4 × 109/1 compared to a fall of 18·2 ± 6·2 × 109/l in the PTFE group (P<0·01). Furthermore, aggregation thresholds increased more after exposure to HUV compared to PTFE. The flow surface platelet deposition was confirmed by scanning electron microscopy and in addition patchy subintimal dissection was found in all the HUV grafts. HUV is markedly more thrombogenic than PTFE when examined in an artificial circulation under flow conditions similar to the human femoro

ISSN:0007-1323    

DOI:10.1002/bjs.1800700103

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractIntimal thickening in vein grafts is one of the major factors leading to graft failure. Studies have suggested that delayed re‐endothelialization and an enhanced permeability to proliferative factors (macromolecules) in the blood are associated with the development of intimal thickening in these vessels. The aim of this study was to determine the pattern of re‐endothelialization of vein grafts and the permeability of the new endothelium to a large molecule. Iliolumbar vein to iliac artery grafts 5 mm long were inserted microsurgically into 32 male albino Wistar rats. Graft re‐endothelialization and permeability, at times ranging from 2 to 140 days after grafting, were studied by scanning electron microscopy and vital staining with Evans Blue dye, which binds to plasma albumin and was used as a model of a large molecule. Re‐endothelialization of the graft had commenced by 2 days after grafting and in most animals was completed by 15 days. Some grafts exhibited local areas devoid of endothelium up to 4 weeks after grafting. The mechanism of re‐endothelialization involved the migration of a sheet of endothelium across the anastomosis from the adjacent artery. This sheet subsequently linked up with islands of cells which developed in the centre of the graft by 5 days. Evans Blue dye was detected in all areas where endothelium had been removed by the grafting operation. Permeability of the graft to the dye was seen during the 2–4 week period after grafting, a time at which previous studies have shown that intimal thickening develops in this vein grafting model. Thus, delayed re‐endothelialization and prolonged permeability to a large molecule (albumin) does occur in some experimental vein grafts. This may be the basis for intimal thickening which is known to occur i

ISSN:0007-1323    

DOI:10.1002/bjs.1800700104

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractOf 229 carotid artery reconstructions, 67 were performed in patients after a minor stroke. In this group of patients the operative mortality was 5·9 per cent, compared with 1·8 per cent in the group of patients without preoperative minor stroke operated upon during the same period of time. The 5‐year survival in the stroke group was 86 per cent and in the non‐stroke group it was 65 per cent. Excluding the postoperative mortality, the survival increases to 90 and 68 per cent respectively. The difference, which is significant at 6 years (P<0·05), is explained by a higher incidence of coronary artery disease in the non‐stroke group. The postoperative annual stroke frequency was 2·3 per cent in the stroke group and 2·4 per cent in the non‐stroke group. The stroke frequency on the operated side during follow‐up was 1·6 per cent per year for both groups together. It seems that a minor stroke is no contraindication to carotid artery reconstruction provided the timing of the operation is correct and other contraindications

ISSN:0007-1323    

DOI:10.1002/bjs.1800700105

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractThe effect of preventive intermittent calf compression on the incidence, distribution and extent of venous thrombosis after elective hip replacement was examined by randomized trial in 90 patients who were screened for postoperative thrombosis with125I‐fibrinogen leg scanning and impedance plethysmography, followed by routine venography on the seventh postoperative day. Venography showed that leg compression reduced the incidence of calf vein thrombosis from 45 per cent (21/47) in untreated patients to 16 per cent (7/43) (P<0·005), but not that of proximal (i.e. popliteal or femoral) vein thrombosis, which occurred in 23 per cent of treated and 26 per cent of untreated patients. However, proximal vein thrombosis appeared to be less extensive in treated patients. Proximal vein thrombosis was found in 40 per cent of patients who had hip replacement by a modified Charnley technique (17/43 patients), and 9 per cent of patients in whom a posterior surgical approach was used (4/43 patients) (P<0·005), strongly suggesting that surgical technique may influence the proximal vein thrombosis rate after elective hip replacem

ISSN:0007-1323    

DOI:10.1002/bjs.1800700106

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractOesophageal varices are the commonest cause of acute upper gastrointestinal bleeding in Egypt, due to the prevalence not only of schistosomiasis but also chronic hepatitis. Poor results of conventional treatment and shunt surgery led us to evaluate injection sclerotherapy, using fibreoptic endoscopy. In a controlled trial, 108 patients were randomly allocated to injection sclerotherapy or to conventional treatment (medical measures, with modified splenectomy and oesophagogastric devascularization in selected cases). We report the results in the first 108 patients, with a follow‐up of 1·35 months. Fifty‐three patients received injection sclerotherapy; 5 died (2 of recurrent bleeding) and 5 others had recurrent bleeding but were controlled by further injections. Thirty‐six of the 55 control patients underwent surgery; 5 died (2 of recurrent bleeding) and 2 others developed recurrent bleeding. Further bleeding occurred in 12 of the 19 patients who were managed by medical measures alone, with 7 dying. These early results indicate that injection sclerotherapy can be effective in urgent and elective situations and that it appears to have advantages over conventional medical and surgical trea

ISSN:0007-1323    

DOI:10.1002/bjs.1800700107

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractPilonidal sinuses which open through a primary communication into the anal canal are extremely uncommon. We here report 3 cases. The pathogenesis of these and other hair‐containing sinuses in the anal region is discusse

ISSN:0007-1323    

DOI:10.1002/bjs.1800700108

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractPatients presenting with acute anal fissure were randomized into two treatment groups in a prospective clinical trial. Both groups received treatment for 3 weeks with a stool softener and lignocaine jelly. Those entered in group 1 (35 patients) were asked in addition to insert an anal dilator (no. 2) twice daily while those in group 2 (31 patients) applied the anaesthetic jelly without a dilator. At 6 weeks 11 (31·4 per cent) patients in group 1 and 12 (38·7 per cent) patients in group 2 had been referred for sphincterotomy owing to failure of the treatment. At 6 months this figure had risen to 14 (40 per cent) in group 1 and 15 (48·4 per cent) in group 2. This difference was not statistically significant, suggesting that the addition of a dilator to the conservative treatment regimen did not diminish the likelihood of surge

ISSN:0007-1323    

DOI:10.1002/bjs.1800700109

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractThirty‐two patients required further abdominal operations 6–77 months after jejunoileal bypass for morbid obesity. Twenty operations were needed because of inadequate weight loss, while the remaining 12 patients had lost sufficient weight but had developed complications. In all 32 patients the lengths of functioning jejunum and ileum were measured and compared with those recorded during the original operation; elongation had occurred in 29. There was a striking difference between the median increase in jejunoileal length of 44 per cent when weight loss was inadequate and 7 per cent when weight loss was adequate (P<0.01). Similarly, intestinal circumference and mural thickness were greater in the first group. There appears to be a relationship between intestinal adaptation and the extent of weight loss after jejunoileal byp

ISSN:0007-1323    

DOI:10.1002/bjs.1800700110

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY

摘要:

AbstractA simple system for grading the severity of sepsis has been developed by scoring the attributes of sepsis under four headings: local effects of infection, pyrexia, secondary effects of sepsis and laboratory data. The information needed should be readily available at district general hospital level. The system produces a number which indicates the severity of sepsis and which varies with the patient's condition. This system could be useful in comparing patients with sepsis and studies on such patients in different centres.

ISSN:0007-1323    

DOI:10.1002/bjs.1800700111

出版商:John Wiley&Sons, Ltd.    

年代:1983

数据来源: WILEY