ISSN:0007-1323    

DOI:10.1002/bjs.1800770102

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800770103

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractThis review examines the lack of improvement in terms of mortality and outcome in patients with acute pancreatitis. Energetic fluid replacement is the only treatment of proven value. There is a strong case for identification of patients with severe disease who may benefit from early operative intervention. Eradication of gallstones may prevent further attacks in patients with gallstone pancreatitis. The benefits of pancreatic resection and necrosectomy still require full evaluation.

ISSN:0007-1323    

DOI:10.1002/bjs.1800770104

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractAcute abdominal pain continues to provide not only a large workload for the general surgeon but also many diagnostic and management problems. Many different techniques have been introduced over the past two decades to help in the management of the acute abdomen and this review considers their relative claims to become incorporated into the process of clinical decision‐making. The evidence in support of formally structured patient interview pathways with or without computer‐aided diagnostic programs is now overwhelming and should become routine. Both laparoscopy and peritoneal cytology have an important role to play in the management of patients in whom the decision to operate is in doubt, and a combination of the two would be complementary. Ultrasonography has become increasingly popular for investigating the acute abdomen, and results from specialist centres are impressive. However, the problems of operator variation and the difficulties in providing a 24‐h service will probably prevent it from becoming a first‐line investigation in most hospitals. Although plain radiography has been available for many years, its routine use in the management of the acute abdomen remains controversial. Recent studies have confirmed that contrast radiography is an important adjunct to decision‐making, particularly in the management of large bowel obstruction, and there is increasing evidence to support its use in suspected small bowel obstruction, perforated peptic ulcer and acute diverticula

ISSN:0007-1323    

DOI:10.1002/bjs.1800770105

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractThe presentation, pathology and treatment of 30 patients with acute bleeding from gastric malignancies has been reviewed. Patients usually have a history of symptoms of less than 6 months prior to bleeding. Adenocarcinoma was the commonest type of tumour, and 74per cent were stage IV lesions. The proportion of lesions in the body of the stomach (57per cent) was greater than expected, suggesting that these are different populations of gastric tumour. Laparotomy was undertaken in 20 patients, 12 of whom had a resection. Resection was associated with a median survival of 17·0 months. Those with unresectable tumours or who were treated only by supportive measures had a median survival of only 2·5 months (P<0·01). Evidence of peritoneal or liver involvement should contraindicate surgical intervention as these patients have a high postoperative mortality ra

ISSN:0007-1323    

DOI:10.1002/bjs.1800770106

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractThe clinical experience with 11 patients undergoing ex situ operation of the liver (nine operations) or surgery on an in situ hypothermic perfused liver after vascular isolation (three operations) is described. These methods have been confined to situations and tumour stages otherwise deemed untreatable, or to situations where resection would not have been sufficiently radical. In one patient the ex situ approach avoided the need to undertake liver grafting for a benign tumour. To date, hepatocellular tumours and metastases not compromising global hepatic function or causing cholestasis are considered to be suitable conditions; cholestasis appears to be highly detrimental for the postoperative course after an ex situ procedure. Elaboration of methods for better grading of pre‐existing liver damage and of its prognostic significance is essential. The assessment of the final therapeutic value of the described procedure requires further experienc

ISSN:0007-1323    

DOI:10.1002/bjs.1800770107

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800770108

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractA postal survey of consultant surgeons in England and Wales was carried out to assess current attitudes towards screening for and treatment of hepatic metastases from primary colorectal carcinoma. The results showed that pre‐, intra‐ and postoperative screening were inadequate. There was no consensus as to which patients would benefit from major hepatic resection for colorectal liver secondaries. Fewer than one‐third of potentially operable patients underwent liver su

ISSN:0007-1323    

DOI:10.1002/bjs.1800770109

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractCommunication with the biliary tree is the most common complication of hydatid disease of the liver and up to a few years ago surgery was the only way to treat it successfully. The introduction of endoscopic sphincterotomy represented a great advance in the management of this disease. We report the results obtained with this technique in ten patients after surgical treatment of hepatic hydatid disease open to the biliary tree. The results were satisfactory in all cases, with no morbidity or mortality. Endoscopic sphincterotomy is now the first choice treatment for surgical complications of hepatic hydatid disease open to the biliary tree, as well as the drainage procedure of choice in patients with cholangitis due to hydatid disease.

ISSN:0007-1323    

DOI:10.1002/bjs.1800770110

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY

摘要:

AbstractMethyl‐tert‐butyl‐ether (MTBE), infused via a nasobiliary catheter, was used to treat 33 patients with bile duct stones in nine units around Britain. MTBE contributed to success in 12 (36 per cent) cases: seven passed stones spontaneously during MTBE infusion and five had partial stone dissolution allowing subsequent endoscopic extraction. MTBE was non‐contributory in 21 (64per cent) cases: four passed stones after MTBE was stopped, six were treated by subsequent endoscopic techniques without evidence of dissolution, seven underwent surgery, and four were treated conservatively (with one death). In at least ten of the 21 cases in which MTBE was non‐contributory, pigment stones were present. Forty‐two complications occurred in 26 (79per cent) patients. The efficacy of MTBE for treating bile duct stones might be improved by better methods of instillation and, since success may be related to technique, the use of MTBE should be restricted to units familiar with th

ISSN:0007-1323    

DOI:10.1002/bjs.1800770111

出版商:John Wiley&Sons, Ltd.    

年代:1990

数据来源: WILEY