摘要:

AbstractA high gastric ulcer may be treated by excision, or the ulcer may be retained and healing encouraged by other means. If the ulcer is retained there is a small but definite risk of malignancy. Neither gastric drainage, nor the Kelling–Madlener operation, nor vagotomy and pyloroplasty ensures healing in a high gastric ulcer. Local wedge resection of the ulcer is attended by very poor results, and a high mortality and morbidity preclude the use of subtotal or total gastrectomy. Pauchet's procedure combines the advantages of limited gastrectomy and gastroduodenal anastomosis with complete removal of the ulcer. It is the recommended operation for high gastric ulcer

ISSN:0007-1323    

DOI:10.1002/bjs.1800590102

出版商:John Wiley&Sons, Ltd.    

年代:1972

数据来源: WILEY

摘要:

AbstractThree hundred and thirty‐one patients with severe haemorrhage resulting from erosive gastritis, representing 10 per cent of 3938 patients admitted with severe gastroduodenal bleeding during the past 30 years, are presented. The problems of diagnosis and management are discussed; particularly, the role of immediáte gastroscopy and the indications for surgical treatment and the surgical procedure best designed to control the haemorrhage.Forty‐seven patients required 51 emergency surgical procedures, and it was found that the Billroth‐I gastrectomy was far superior to any other operation. Polya gastrectomy, vagotomy, and gastric vasoligation were used, with a high incidence of recurrent bleeding and often necessitating a further emergency surgical operation—usually total gastrectomy. It is suggested that a possible explanation of this is the prevention of biliary reflux into the stomach, which is what the Billroth‐I gastrectomy seems to achieve. In 1 case presented, a patient with a Polya gastrectomy and erosions who had severe haemorrhage, bleeding was controlled by conversion to a Billroth‐I

ISSN:0007-1323    

DOI:10.1002/bjs.1800590103

出版商:John Wiley&Sons, Ltd.    

年代:1972

数据来源: WILEY

摘要:

AbstractPartial gastrectomies were carried out in 6 dogs. All developed stomal gastritis. Prevention of reflux by a Roux‐en‐Y loop allowed the mucosa to return to histological normality. These findings support the use of this procedure for the condition of postgastrectomy reflux gastritis in human subjects, and explain the need for a vagotomy at the same operat

ISSN:0007-1323    

DOI:10.1002/bjs.1800590104

出版商:John Wiley&Sons, Ltd.    

年代:1972

数据来源: WILEY

摘要:

AbstractA survey is presented of the clinical experience at St. Mark's Hospital with 83 patients suffering from metachronous cancer of the large intestine. It was found that there was a much improved chance of cure in those who were attending the follow‐up clinic at the time of the occurrence of their second growth. The reasons for this and the implications in cancer prophylaxis are discusse

ISSN:0007-1323    

DOI:10.1002/bjs.1800590105

出版商:John Wiley&Sons, Ltd.    

年代:1972

数据来源: WILEY

摘要:

Abstract1. Experience with 38 cases of Hirschsprung's disease seen over a 20‐year period is described.2. Only 24 per cent of cases presented with a combination of symptoms and signs such as to suggest the correct diagnosis on clinical grounds.3. Barium‐enema examination carries a high ‘true‐positive’ rate, but cases reported as negative must be viewed critically. A radiological diagnosis of idiopathic megacolon should not be accepted without supplementary rectal biopsy and/or anorectal pressure studies.4. Survival without surgery is compatible with Hirschsprung's disease, but the dangers of enterocolitis must be acknowledged.5. Rectosigmoidectomy, which includes resection to an area of normal innervation proximally and excision of part of the internal sphincter of the rectum distally, produces a satisfactory late functional result at an acceptable mortality‐rate.6. A colostomy prior to rectosigmoidectomy is advisable when there is a history of repeated attacks of subacute obstruction and one or more episodes of enterocolitis. A colostomy after rectosigmoidectomy is advisable in those cases which are submitted to laparotomy for intestinal obstruction in the period following operation, even when no mechanical cause for obstruction is demonstrable.7. Patients with problems relating to coprostasis following treatment of congenital anorectal disorders should be submitted to rectal biopsy, since a proportion of these patients reveal a deficiency of innervation of the distal large bowek which approximate to that seen in Hirschspru

ISSN:0007-1323    

DOI:10.1002/bjs.1800590106

出版商:John Wiley&Sons, Ltd.    

年代:1972

数据来源: WILEY

摘要:

AbstractTwenty patients with duodenal ulcer have been treated by a pylorus‐preserving gastrectomy. A functioning pyloric sphincter was maintained by retaining a 2‐cm. cuff of antrum and carrying out a Billroth‐I type of resection proximally. Basal acid output was reduced by 52.4 per cent and maximal acid output by 65 per cent. Gastric emptying time was prolonged, without producing stasis. A provocative test for the presence of dumping produced symptoms in only 1 patient following this operation in comparison with a high incidence of symptoms in patients who had had a Polya gastrectomy or vagotomy and drainage.The results suggest that the procedure may be of value in the treatment of chronic duodenal

ISSN:0007-1323    

DOI:10.1002/bjs.1800590107

出版商:John Wiley&Sons, Ltd.    

年代:1972

数据来源: WILEY

摘要:

AbstractThe incidence of abnormalities of micturition and sexual function after removal of the rectum is discussed. It is thought that surgical damage to the autonomic nerves in the pelvis is the main cause of disability in young patients with benign disease. The various modifications of the standard abdominoperineal dissection of the rectum which have been introduced to prevent injury during the operation are described. None has proved entirely successful.A new technique of rectal dissection, in which two surgeons concentrate on opposite sides of the bowel and carry out the dissection under direct vision in a bloodless field, is described. The results of its use in 24 patients are recorded.

ISSN:0007-1323    

DOI:10.1002/bjs.1800590108

出版商:John Wiley&Sons, Ltd.    

年代:1972

数据来源: WILEY

摘要:

AbstractTwenty‐eight patients who had received a renal transplant have been studied in order to determine the incidence and significance of vesico‐ureteric reflux in association with urinary infection.The ureters had been anastomosed either by uretero‐ureteric or ureterovesical techniques without an anti‐reflux procedure.Ten of the 28 patients had reflux into the transplant and 4 had reflux into a non‐functioning ureteric stump. Reflux was significantly more frequent in the ureterovesical group.Marked reflux in patients with recurrent urinary infections was associated with renal damage. Marked reflux in uninfected patients or mild reflux in patients with recurrent urinary infections was not associated with ren

ISSN:0007-1323    

DOI:10.1002/bjs.1800590109

出版商:John Wiley&Sons, Ltd.    

年代:1972

数据来源: WILEY

摘要:

AbstractThe results of surgery in a group of 7 patients with lymphangioma circumscriptum are presented. Lymphangiography was carried out in 5 of these patients and in 1 further patient who was not submitted to surgery.Lymphangiography of the affected limb revealed normal subcutaneous lymphatic vessels and normal filling of nodes in the regional node areas. No direct connexion between the lymphangioma and the subcutaneous lymphatics or regional lymph‐nodes was demonstrated.Lymphography helps to show the extent of the underlying pathology before operation. It is also helpful in showing the relation of the lesion to the main lymph pathways of the area so that they may be preserved during operation.Surgical treatment for patients with lymphangioma should only be undertaken if a definite cosmetic improvement can be assured. Even with discrete lesions regional excision has to be wide in extent owing to the marked tendency to subcutaneous extension of the abnormality. With these conditions satisfied the results of surgery should be good. With more extensive lesions partial excision of the most troublesome areas in one or more stages may give considerable benefi

ISSN:0007-1323    

DOI:10.1002/bjs.1800590110

出版商:John Wiley&Sons, Ltd.    

年代:1972

数据来源: WILEY

摘要:

AbstractTwo cases of spontaneous rupture of the oesophagus are presented. Thoracotomy and surgical closure of the perforations resulted in satisfactory outcome in both instances. It is believed that the second case is the only recorded case in which haematemesis from a bleeding duodenal ulcer was the precipitating factor, and also it is believed that he is the oldest survivor to be reported. The literature, aetiology, and treatment of this interesting disease are discussed.

ISSN:0007-1323    

DOI:10.1002/bjs.1800590111

出版商:John Wiley&Sons, Ltd.    

年代:1972

数据来源: WILEY