The British journal of surgery
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Forty patients with a diagnosis of gastro-oesophageal reflux disease established by 24-h ambulatory pH monitoring were treated by a short 360 degrees fundoplication. Results of postoperative evaluation at 6 months were compared with those from 50 normal volunteers. The amount of gastro-oesophageal reflux at pH monitoring decreased significantly and was less than the reflux in the normal subjects. ⋯ The pressure was similar to that in the normal subjects while a significantly longer intra-abdominal part of the high-pressure zone was created. The clinical results of the operation were evaluated in 38 patients by an independent gastro-enterologist, and were considered to be excellent in 22 patients, good in 13, fair in 2 and poor in 1 patient. The antireflux procedure provided good control of the gastro-oesophageal reflux in our patients by restoring the major components of the antireflux mechanism.
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Sequential changes of body temperature have been measured for 48 h in 147 patients after major elective abdominal, cardiac, orthopaedic and pelvic surgery. Core temperature (aural canal) started to increase immediately after surgery reaching a mean peak value of 37.5 degrees C 14 h (range 8-16) after the end of surgery. ⋯ A close examination of core temperature oscillations during a 72-h postoperative period and a comparison with a pre-operative 24-h cycle in a group of 14 patients who underwent cardiac surgery did not show any circadian rhythm. In the third part of the study, analysis of postoperative body temperature and metabolic rate showed a similar pattern of increase for core and mean skin temperatures, and oxygen consumption.
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A review of 353 lower limb amputations over the last 7 years has been performed to assess the results of the skew flap myoplastic below-knee amputation which was introduced in April 1983 because of reported advantages in terms of wound healing and earlier ambulation. Comparing the first 3 1/2 year period with the second, the total number of amputations decreased by 31 per cent. The number of above-knee amputations remained similar in the two periods (82,62), whilst the number of Gritti-Stokes amputations fell from 79 to 21 (0.001 greater than P greater than 0.01). ⋯ The time to full stump healing was significantly shorter in the skew flap group compared with the earlier Burgess type BK amputation (P = 0.001), and there was a trend to fewer stump failures in the skew flap group. We therefore feel that the skew flap amputation gives superior results to the Burgess BK amputation in terms of healing and a lower complication rate, allowing a higher proportion of BK amputations to be performed. A prospective randomized trial of the two techniques is in hand to determine the accuracy of this hypothesis.
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To assess the safety of a conservative approach to fibro-adenoma of the breast we prospectively studied 321 women with this clinical diagnosis, and performed aspiration cytology and excision biopsy. There was histological confirmation of fibro-adenoma in 217 (68 per cent), the remainder having various benign conditions and 4 (1.3 per cent) had carcinoma. Aspiration cytology had a sensitivity of 87 per cent and a specificity of 76 per cent for fibro-adenoma. ⋯ To estimate the risk of missing carcinoma we compared the annual frequency of carcinoma with fibro-adenoma in young women and found a ratio of 1:470 between 15 and 19 years, 1:133 between 20 and 24 years and 1:9 in the 25-29 age group. To assess patients' views on non-operative treatment of benign breast masses we asked 124 women, 10 days postoperatively, whether they preferred a conservative approach for a cytologically benign lump: 26 (21 per cent) opted for conservative management in the future and 8 (7 per cent) would have preferred conservatism rather than their recent excision. A conservative approach is safe for clinically and cytologically benign breast lumps in women under 25 years, but very few will accept it.
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During the 31 year period 1954 to 1985, 225 major hepatic resections have been performed for symptomatic primary carcinoma of the liver, of which right hepatic lobectomy was performed in 115, extended right hepatic lobectomy in 11, trisegmentectomy in 2, left hepatic lobectomy in 94, and middle hepatectomy in 3. In addition there were 107 partial hepatic resections for 89 asymptomatic small hepatocellular carcinomas. In the 225 patients undergoing major hepatic resection, the operative mortality was 8.0 per cent. ⋯ Of 207 cases who survived major hepatic resection, 119 cases died within one year after the operation, mainly due to recurrence of cancer in the remaining residual lobe, lung metastasis or late hepatic failure. The 5 year survival rate is 18.0 per cent, 12 patients are still alive and well after more than 5 years and the longest survival is 23 years. Of the 89 patients with small asymptomatic hepatocellular carcinomas, 28 died within one to four years of surgery because of a second new growth.