ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06424.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06425.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06426.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06427.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

A prospective study of patients with upper gastrointestinal bleeding admitted to a haematemesis and melaena unit has revealed an incidence of Mallory‐Weiss tears of 8% (59 of 762 patients undergoing endoscopy). Prior vomiting was present in 60% and an associated upper gastrointestinal lesion in 44 percent. The majority of patients had a recent ingestion of alcohol and/or analgesics, whilst 34% had chronic heavy alcohol intake. Approximately 50% of patients required no blood transfusion, whilst 37% had over three units of blood. No patient in the group required surgical intervention, and one patient died because of general debility. This study suggests that the Mallory‐Weiss tear accounts for a significant proportion of patients admitted with upper gastrointestinal bleeding, but that the mortality and morbidity are

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06428.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

In a prospective study of patients with haematemesis and melaena, there were 22 admissions of patients with bleeding stomal ulceration, representing 2.5% of total admissions to the Unit. In 16 patients the bleeding was from superficial stomal lesions. These lesions, endoscopicaily and histologically, resembled alkaline reflux gastritis, a recently defined cause of postgastrectomy bile vomiting. Five patients presented with chronic ulceration following inadequate gastric surgery. One patient was admitted on two occasions. Nine patients received more than five units of blood and came to operation for continued bleeding. In seven of the surgical cases, the bleeding was from superficial stomal lesions. Our experience suggests that truncal vagotomy is necessary to control the bleeding in these patients. One patient presented with superficial stomal ulceration and carcinomatous change. This patient died. It is important to subject these lesions to biopsy, and biopsy with ‐ extension of a previous gastrectomy is indicated to control bleeding, and to exclude malignanc

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06429.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

A study has been made of demographic and extragastric variables in a gastric ulcer population; a comparison has been made with a control community population matched for age, sex and social grade.There are 600–700 ulcer deaths annually in Australia, chiefly due to bleeding. Those who die of an ulcer have their lives shortened by 13 years on the average, and the yearly cost of ulcer disease in Australia is approximately $174,000,000.As has been observed previously, there is a predominance of females in the gastric ulcer population, with a male:female ratio not exceeding 1 at all ages; in other countries, the ratio is 2–3:1.Female ulcer patients take analgesics more commonly and male ulcer patients smoke more commonly and drink less commonly than controls. Gastric ulcer is not associated with any characteristic personality traits nor is it associated with emotional stress. Patients with gastric ulcer tend to occupy positions of lower social grade and show social incongruity. Ulcers in smokers tend to be situated in the lower third of the stomach, but alcohol and analgesic ingestion do not influence ulcer site.The complete healing of an ulcer favourably alters its course for at lest four years. If it has healed, smoking, analgesics and alcohol exert no adverse effect. Socially, ulcer patients tend to be single, and on diagnosis gastric ulcer is associated with considerable social disability; with medical or surgical treatment, this disability disappears six months later.With the aid of early endoscopy, intensive care ward supervision and planned surgery, the mortality from acute upper gastrointestinal haemorrhage due to ulcer has fallen, now being les than 5% overall and less than 1% in those less than 60 years of

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06430.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

Over a 14‐year period we treated 2,290 cases of non‐malignant biliary tract conditions, and among them were 173 cases of acute suppurative cholecystitis, an incidence of 7.6%. A correct preoperative diagnosis of acute suppurative cholecystitis was made in only about half the cases because features of recurrent pyogenic cholangitis dominated the clinical pictureonmany occasions. The diagnosis was confirmed in all cases at operation. Cholecystectomy (88%) was performed whenever this was found to be safe, and cholecystostomy (12%) was carried out only in poor‐risk patients or when operative difficulties were encountered. The overall mortality of operation was 5.8%. Old age, preoperative shock, delay of operation and the presence of free perforation affected the prognosis adve

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06431.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

The management of 26 patients with retained stones in the biliary tree after surgery is described. Various methods have been used, but intermittent rapid flushing with one litre of isotonic saline solution, together with a slow infusion of heparin solution via the T tube, was the most successful. It required no specialized equipment, and is recommended as the first choice in treatment.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06432.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

Bile duct injury during cholecystectomy is almost always a high Injury of the proximal common hepatic duct, because the surgeon mistakes this duct for the cystic duct and a segment of it is removed with the gallbladder. Most of these injuries are preventable by following certain principles of careful surgical dissection of the ductal system during surgery. Surgical reconstruction is always difficult, and restrlcturing of the anastomosis remains the most important problem. Recent advances in surgical technique have minimized the risk of recurrent stricture formation. At present the most suitable reconstruction for the typical high common hepatic duct lesion is a hepaticojejunostomy Roux‐en‐Y, using transhepatic intubation and a “mucosal graft” type of procedure. Biliary reconstruction was performed on 32 patients referred to the writer during the past 13 years resulting In six recurrent strictures needing a second reconstruction. At the end of 1978,10 patientsare too early to evaluate, two are dead and 20 have obtained a good final result.We must publicise the fact that cholecystectomy is a dangerous operation THE LATE DR. FRANK

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1979.tb06433.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY