摘要:

Summary1. Lipoedema is described with an illustration of a recent case.2. This condition should be distinguished from lymphoedema of the legs.3. The differential diagnosis is discussed.4. Comment is made on treatment.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1966.tb06053.x

出版商:Blackwell Publishing Ltd    

年代:1966

数据来源: WILEY

摘要:

SummaryA biopsy involves close co‐operation between a surgeon and a pathologist if a representative piece of tissue is to be obtained, and diagnosed.The surgeon must appreciate the limitations placed on the pathologist as he examines many tissues at an early stage of disease.The pathologist must seize every opportunity of correlating his histological evidence with the clinical history, X‐ray appearance, other laboratory investigations, and the ultimate course of the disease.Only in these ways can the patient benefit to the full from a bio

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1966.tb06054.x

出版商:Blackwell Publishing Ltd    

年代:1966

数据来源: WILEY

摘要:

SummaryA case of foetus in foetu or included twin is presented. The operative findings and the anatomical features of the foetus are described in detail.An included twin is usually a monochorionic, diamniotic, monozygotic twin of its bearer, which was included within it during development. Hence, the correct age must be the age of the host as it starts its origin and the development at the same time as a host.Clinically a foetus in foetu usually presents as anabdominal mass with or without pressure symptoms. Radiographically a foetus in foetu may be diagnosed with ease. it should be different from soft tissue mass of renal origin such as Wilm's tumour hydronephrosis. Nephroblastomas and teratomas may contain calcification but they lack the organization of a foelus in foetu.A foetus in foetu should be removed because of the danger of infection or infarction if it is allowed to remain within its host. The mass may be removed in its entirety or the sac may be evacuated and left in situ.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1966.tb06055.x

出版商:Blackwell Publishing Ltd    

年代:1966

数据来源: WILEY

摘要:

Summary1. Carcinoma of the sigmoid colon occurred mostly between 40 and 80 years of age, with the highest incidence between 60–70 years. The disease affected 3 patients in their twenties. Females are slightly more commonly involved.2. Two‐thirds of the patients had a typical non‐urgent mode of presentation. The barium enema occasionally produced a false negative result. The remaining one‐third presented either with acute large bowel obstruction or with perforation of the tumour. When perforation occurs, it causes an abscess (or intense inflammatory reaction) which may remain localized, burst into the peritoneal cavity, or discharge into the bladder and produce a vesico‐colic fistula.3. Sixteen per cent, of cases were not resected. Multiple peritoneal metastases, a large fixed mass (sometimes partly inflammatory) and poor condition of the patient were responsible.4. Palliative resection was performed in about 25 per cent, of cases. There were 3 deaths after resection. Two survived unexpectedly. One had a large sub‐serosal plaque of malignant tissue in relation to the primary tumour and associated with peritoneal free fluid; the other had small nodules on the surface of the small bowel, thought to be secondary deposits, but later shown to be carcinoid tissue.5. Curative resections were performed in 59 per cent, of the patients. Two of the 86 patients so treated died in the post‐operative period. A further patient developed a faecal fistula and required a colostomy to close it. A total of 51 patients were treated five years or more ago, and 44 (86 per cent.) survived. Five of the 7 failures had curative excisions after earlier treatment for acute large bowel obstruction. There have been 3 late deaths from recurrence, all intra‐abdominal.6. Large bowel obstruction complicated 36 of the patients. Caecostomy proved a satisfactory method of overcoming the obstruction, and was performed on 16 occasions. Resection was performed in 14 of the 16 patients, and an anastomosis in 13. Colostomy was an alternative method of decompressing the bowel, but did not appear to have any advantage over caecostomy. Immediate resection was used on occasions, but its place appeared limited. The long term prognosis of obstructed patients is only fair with 5 of 21 patients treated five years or more ago surviving.7. Perforation with abscess formation is a formidable complication because it complicates subsequent removal. If the abscess should discharge into the bladder, one‐stage resection is not only a satisfactory operation but is followed by good 5‐year survivals.8. A total of 80 patients were referred 5 years or more ago and 46 survived at least that period, an absolute five‐year survival rate of 57.5 per cent. Of 22 patients seen ten years or more ago, 8 survived, an absolute ten‐year survival of 36 per cent.9. It is concluded that one‐stage partial sigmoid colectomy with end‐to‐end anastomosis, without mobilization of the splenic flexure or rectum, and completed. without drainage or post‐operative antibiotics is the treatment of choice for

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1966.tb06056.x

出版商:Blackwell Publishing Ltd    

年代:1966

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1966.tb06057.x

出版商:Blackwell Publishing Ltd    

年代:1966

数据来源: WILEY

摘要:

Summary1. Carcinoma occurs in the upper left colon a little less frequently than in other segments of the bowel.2. Chronic ulcerative colitis is an important predisposing cause.3. There is a high incidence of obstruction and of perforation in carcinoma in this segment. 34/96 had large bowel obstruction, and 6/96 had perforations of the tumour.4. The resectability rate was 87.5 per cent. Palliative resection was performed in about a third of the cases, curative resection in just over half.5. Segmental resection with end‐to‐end anastomosis, whether palliative or curative, had a very high incidence of suture line separation. Twelve out of 53 had suture line disruption, and 2/53 had suture line recurrence.6. A total of 23 patients had subtotal colectomy with ileosigmoid anastomosis. There was one death, and one possible suture line leak. The bowel function has been excellent.7. The treatment of large bowel obstruction caused by carcinoma of the upper left colon has been mostly by one of two methods — preliminary caecostomy or by subtotal colectomy. Both give good results. If a transverse colostomy has been performed in a subsequent subtotal colectomy, it is best to exci

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1966.tb06058.x

出版商:Blackwell Publishing Ltd    

年代:1966

数据来源: WILEY

摘要:

SummaryThe arterial supply to the oesophagus was studied in 32 mortuary specimens. The findings were as generally described in the literature. The anastomosis between the superior and inferior thyroid arteries and hence the ability of the superior thyroid artery to supply a portion of the oesophagus, was noted. In general, the blood supply of the entire oesophagus was adequate with free anastomosis between its various branches. Nevertheless, it will not tolerate extensive mobilization during surgery. The relatively unsafe sites for anastomosis have been pointed out. The influence of haemodynamics has not been taken into account, in this review, and may be worthy of further investigation.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1966.tb06059.x

出版商:Blackwell Publishing Ltd    

年代:1966

数据来源: WILEY

摘要:

SummaryA case of massive resection of intestine is presented in whom 20 centimetres of jejunum was anastomosed to the transverse colon.After six months in hospital, the transit time of a carmine marker from mouth to anus was only thirty minutes. The management of this case is detailed.The definition of massive resection in relationship to infancy is discussed and a new definition suggested.From experimental work and from reported clinical cases it seems that with adequate care, small remaining segments of ileum and jejunum are sufficient for survival, growth and development, provided the terminal ileum, ileo‐caecal valve and colon are intact. If this complex has been excised and the jejunal segment is less than approximately 100 centimetres in length, the use of a Hammer type reversed segment interposed between the jejunal segment and the colon may well be a life‐saving proced

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1966.tb06060.x

出版商:Blackwell Publishing Ltd    

年代:1966

数据来源: WILEY

摘要:

SummaryPost‐operative occlusion of an obstructed femoral artery repaired with a vein patch may be prevented by extending arteriotomy incisions in both directions further than the removed intima. At the graft ends the reduction in lumen of the vessel is gradual, the intima is more easily re‐attached to adven‐titia and the patch is less emb

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1966.tb06061.x

出版商:Blackwell Publishing Ltd    

年代:1966

数据来源: WILEY

摘要:

SummaryA case of synovial sarcoma with an unusual presentation occurring in a 77 years old man is described. The primary tumour was a groin nodule, present for thirty years.Two uncommon associated features were a positive hydatid complement fixation test and a neutrophil polymorphonuclear leucocytosis of 100,000 per cubic millimetre.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1966.tb06062.x

出版商:Blackwell Publishing Ltd    

年代:1966

数据来源: WILEY