摘要:

AbstractGeneral surgical patients require intravenous nutrition either because their gastrointestinal tract is blocked, too short or inflamed or because it cannot cope. Such patients can be grouped into four nutritional/metabolic categories: normal and unstressed; normal and stressed; depleted and unstressed; depleted and stressed. The energy requirements of patients in each of these groups vary according to their energy expenditure. Normally nourished and stressed patients have the highest energy expenditure and therefore require the highest energy input (45–55 kcal.kg−1day−1). Other groups of patients rarely require more than 40 kcal.kg−1day−1. Energy can be given mainly as dextrose although calories needed above 40 kcal kg−1day−1should be given as fat (unless lipogenesis is desirable). In very stressed patients high rates of glucose infusion can themselves constitute a metabolic stress and fat may play a bigger role as a calorie source. For long term feeding, 1 litre of 10 per cent fat emulsion should be given weekly to avoid essential fatty acid deficiency.The level of nitrogen intake required to maintain a positive nitrogen balance is a lot higher in surgical patients than the suggested recommended dietary allowances for normal subjects. It is dependent not only on the nutritional and clinical state of the patient but also on the levels of energy and nitrogen intake given. When energy intake is below energy needs, normally nourished patients cannot retain nitrogen, although depleted patients can. When energy intake exceeds energy needs, both normally nourished and depleted patients retain nitrogen at levels of nitrogen intake ranging from 250 mg kg−1day−1(depleted and unstressed) to over 400 mg kg−1day−1(stressed). Depleted patients can maintain a positive nitrogen balance at lower levels of calorie and nitrogen intake than normally nourished patients and in this respect are analogous to a growing child. In all surgical patients, energy and nitrogen intakes can be manipulated to provide for a controlled maintenance or restoration of either wet lean tissue and/or fat. There is little place for protein sparing therapy or the use of insulin and anabolic steroids to promote nitrogen retention in surgical patients requirin

ISSN:0007-1323    

DOI:10.1002/bjs.1800710102

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800710103

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

AbstractThe Large Bowel Cancer Project is a collaborative prospective study of 4228 patients with a histologically proven adenocarcinoma, of whom 2336 (55 per cent) survived a ‘curative’ resection. Follow‐up information is available on 2220 patients (95 per cent). Subsequently, 309 (14 per cent) have developed a local recurrence confirmed by: biopsy (127; 41 per cent), clinical examination (77; 25 per cent), X‐ray (15; 5 per cent), a raised CEA (2; 1 per cent), or some other method — e.g. CT scan or a confident unbiopsied laparotomy finding (88; 29 per cent).Statistically significant factors (χ2test, P<0.05) associated with local recurrence are: Dukes' classification: A 4 per cent; B 13 per cent; C 18 per cent Tumour differentiation: Well 11 per cent; Moderate 14 per cent; Poor 21 per cent Obstruction: Absent 13 per cent; Present 21 per cent Perforation: Absent 13 per cent; Present 28 per cent Tumour mobility: Freely mobile 11 per cent; Others 21 per cent Operation performed (rectal and rectosigmoid tumours): Abdomino‐perineal 12 per cent; Anterior resection 18 per cent; Surgeon (Consultant only): Range20 per cent. Stratification of the above variables altered only the statistical significance pertaining to tumour differentiation (P<0.1, d.f. = 2). In particular, the differences between Consultant surge

ISSN:0007-1323    

DOI:10.1002/bjs.1800710104

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

Abstract1988 patients with an adenocarcinoma of the rectum (1292; 65 per cent) or rectosigmoid (696; 35 per cent) have been studied. A resection (1700 patients) or polypectomy (124 patients) was performed in 1824 (92 per cent) and, of the former, 1376 patients either underwent abdominoperineal (AP) excision of the rectum (788 patients) or an anterior resection (598 patients). The in‐hospital mortality was 63 patients (8 per cent) for AP and 44 (7 per cent) for anterior resection, and a curative resection had been performed in 504 (71 per cent) of those undergoing an AP, and 393 (71 per cent) of those undergoing an anterior resection. Follow‐up information is available for 478 patients (95 per cent) who underwent an AP and 370 (94 per cent) who underwent an anterior resection.More patients have developed a local recurrence after an anterior resection (67; 18 per cent) than after AP (57; 12 per cent) (Logrank χ2= 6.6, d.f.=1, P<0.02) (stratified for sex and Dukes' stage). This difference is not accounted for by a lesser margin of distal clearance after an anterior resection; firstly because the margin of clearance was not different in those who did and those who did not develop a local recurrence (AP: whole group = 4.4 cm, local recurrence = 4.5 cm; anterior resection: whole group = 3.0 cm, local recurrence = 3.1 cm) and secondly because for each centimetre of distal clearance there was a consistently greater probability of recurrence for anterior resection (Logrank χ2= 9.1, d.f. = 1, P<0.01) (stratified for sex, Dukes' stage and distal clearance ma

ISSN:0007-1323    

DOI:10.1002/bjs.1800710105

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800710106

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

Abstract824 patients with operable rectal carcinoma were randomly allocated to be treated by surgery alone, 2000 rad in 10 daily fractions and 500 rad as a single fraction. No difference has been demonstrated in the actuarial survival rates to 5 years. The local recurrence‐free and metastasis‐free rates are similar in all groups. There is also no evidence that the pre‐operative radiotherapy benefited patients in subgroups by Dukes' stage. The complication rates were also similar in the three treatment g

ISSN:0007-1323    

DOI:10.1002/bjs.1800710107

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

AbstractA technique is described for assisting the performance of distal mucosal proctectomy in ulcerative colitis by peranal eversion of the lower rectum. The ease, accuracy and expedition of the mucosal excision have been impressive. In 9 of 16 patients having this procedure as part of an ileo‐anal anastomosis (with a pelvic ileal reservoir) the functional results seemed to be similar to those obtained in 14 patients submitted to the same operation but with an endocavitary technique of rectal mucosectom

ISSN:0007-1323    

DOI:10.1002/bjs.1800710108

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

AbstractA balloon filled with barium has been used to simulate a soft stool for the radiological study of disorders of defaecation. Lateral radiographs demonstrate the level of the pelvic floor in relation to the pubococcygeal line, the change in the anorectal angle and the behaviour of the anal sphincters.In 12 patients with faecal incontinence, successfully treated surgically by postanal sphincter repair, the anorectal angle was reduced from 135°±4.4° (s.e.m.) to 103°±4.1° and the anorectal junction rose by 1.5±0.4 cm.In 10 patients with slow‐transit constipation there was no pelvic descent and no change in the anorectal angle on straining. These patients were unable to expel the balloon and the results suggest that the pelvic floor does not relax

ISSN:0007-1323    

DOI:10.1002/bjs.1800710109

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

摘要:

AbstractA case of ischaemic proctitis apparently caused by adventitial fibromuscular dysplasia of the superior rectal artery is reported and the results of a survey of 50 superior rectal and marginal arteries from post mortem and surgical cases are described. Abnormal musculature was demonstrated in varying degree in the adventitia of 28 of 50 asymptomatic patients. Our findings indicate that a spectrum of this vascular abnormality exists in the elderly which is rarely severe enough to contribute to symptomatic large bowel ischaemia.

ISSN:0007-1323    

DOI:10.1002/bjs.1800710110

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800710111

出版商:John Wiley&Sons, Ltd.    

年代:1984

数据来源: WILEY