ISSN:0007-1323    

DOI:10.1002/bjs.1800760102

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800760103

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800760104

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractAutogenous saphenous vein is generally considered to be the best material for arterial bypass grafts below the inguinal ligament. Recent results have suggested that the advantage of vein over prosthesis is more pronounced in a distal situation, but it is not immediately apparent whether the difference is sufficient to justify a policy of using prosthesis for the initial above‐knee graft to preserve the vein in case later surgery is required. An attempt has been made to answer this question. The literature has been reviewed to obtain estimates of the patency rates for grafts in different situations and a mathematical model has been set up using these figures to predict the outcome of different treatment policies. The model can be used to predict the result of alteration or inaccuracy in the data or to make use of the results of newly reported studies. The model predicts that the use of prosthesis for an initial graft will reduce the overall patency and substantially increase the requirement for reoperation, even if the present data give a substantial overestimate of the advantages of vein above the kne

ISSN:0007-1323    

DOI:10.1002/bjs.1800760105

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800760106

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractComplications of intravenous nutrition are uncommon but may prove problematic in patients requiring long‐term nutritional support. This article reviews the complications associated with intravenous catheters with particular emphasis on problems associated with insertion, catheterrelated sepsis, venous thrombosis, catheter occlusion, endocarditis and intracardiac thrombus formatio

ISSN:0007-1323    

DOI:10.1002/bjs.1800760107

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractBetween January 1973 and January 1988, 188 patients with unilateral iliac artery occlusion were treated at The Middlesex and University College Hospitals, 185 for primary disease and three for blockage of a previous aortobifemoral graft. In the early part of the series, a variety of operations, including aortofemoral and iliofemoral bypass, and endarteriectomy, was used. Femorofemoral bypass was at first reserved for patients who were considered unfit for major surgery, but the results seemed so good that it was adopted as the procedure of choice. Latterly, percutaneous transluminal angioplasty became available, and the role of this is discussed. Over the 15‐year period, 150 patients underwent femorofemoral bypass (all but two receiving a prosthetic graft). Of these, 90 per cent had disabling claudication and 8 per cent had critical ischaemia. There were six early deaths (within 30 days of operation) and five late deaths, and two surviving amputees; nine patients could not be traced. The remaining 128 patients have been assessed at intervals of from 3 to 92 months, both clinically and with Doppler studies. The cumulative patency was 86 per cent at 13 years, and all of these patients experienced subjective and haemodynamic improvement in the recipient limb. Eight grafts occluded in the early postoperative phase. In five patients there was deterioration in the donor limb; it is postulated that the effect was due to causes other than the operation. There were two serious postoperative complications due to technical error, one of which led to early above‐knee amputation. These are presented in detail. In the light of this experience, the advantages and indications for femorofemoral bypass and the results to be expected from it have become clarified, and the technique standardized so that errors can be avoided. We suggest that femorofemoral bypass is now the operation of choice for unilateral iliac artery occlus

ISSN:0007-1323    

DOI:10.1002/bjs.1800760108

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractGated heart pool scan measuring left ventricular ejection fraction (LVEF) was performed preoperatively in 72 patients presenting for elective repair of abdominal aortic aneurysm. Patients with a positive cardiac history were more likely to have a LVEF of ⩽45 per cent (P35 per cent had a greater chance of dying (P35 per cent. Preoperative evaluation of LVEF can select patients at high risk of cardiac death from repair of abdominal aortic aneurysm. Such patients could be followed conservatively if they remain asymptomatic and the aneurysm does not enlarge. If operation is considered mandatory, patients with a low LVEF should receive intensive perioperative monitoring with enhancement of ventricular per

ISSN:0007-1323    

DOI:10.1002/bjs.1800760109

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractA study of plasma arginine vasopressin (AVP) levels and their relation to changes in arterial pressure was undertaken in 13 patients undergoing open heart surgery. Seven of the patients received high doses of intravenous morphine (1 or 2 mg/kg) as part of their anaesthetic, whereas the other six did not. Increases in the AVP levels during cardiopulmonary bypass (CPB) were significant in both groups, but were significantly greater in the patients not receiving morphine (median 86·1 fmol/ml) than in those who did (47·5 fmol/ml). In both groups there was a linear correlation between the natural logarithm of the plasma AVP level and the percentage fall in the mean arterial pressure, although the slope of the relationship was significantly less in the group receiving morphine than in the group not receiving morphine. These results indicate that in patients undergoing cardiac surgery the neuroendocrine reflex control of plasma AVP levels in relation to changes in arterial pressure is intact, but that the sensitivity of the reflex (i.e. the increase in plasma AVP level for a given fall in arterial pressure) is reduced by the administration of high doses of intravenous morphin

ISSN:0007-1323    

DOI:10.1002/bjs.1800760110

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractThis report of a series of 25 patients with cervical paragangliomas reviews the experience of one surgeon over a period of 13 years. A total of 26 resections were performed with no mortality and no hemiplegia. Two patients required carotid reconstruction. Eight patients had a permanent cranial nerve palsy but in seven this was due to involvement of the nerve by the tumour. Lymph node involvement occurred in two patients. Only one patient has developed recurrent tumour. These tumours are locally malignant and resection offers a chance of cure.

ISSN:0007-1323    

DOI:10.1002/bjs.1800760111

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY