The British journal of surgery
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The records of 174 consecutive patients with congenital diaphragmatic hernia were reviewed to analyse the changes in the presentation, treatment and outcome during the 45-year interval from 1948 to 1992. For comparison the period was divided into years 1948-1962, 1963-1972, 1973-1982 and years 1983-1992. The proportion of high-risk cases (symptomatic within 6 h of birth) increased from 50 per cent during the first period to 77 per cent during the second, to 86 per cent during the third and to 94 per cent during the fourth. ⋯ The mean(s.d.) lung weight ratio (combined lung weight divided by the lung weight expected for the body-weight) decreased from 0.70(0.49) during the second period to 0.56(0.36) during the third and 0.40(0.18) during the fourth. The increased proportion of more severe cases with very hypoplastic lungs explains the rise in the mortality rate of patients operated on for congenital diaphragmatic hernia. This may reflect a real change in the disease spectrum rather than improved referral.
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This retrospective analysis studied the effect of sclerotherapy on subsequent oesophageal transection in the management of patients with bleeding oesophageal varices and compared the result with that in those who did not receive sclerotherapy as the primary treatment. Fifty patients were treated by gastro-oesophageal devascularization and oesophageal transection for bleeding oesophageal varices over a 4-year period. Twenty-six patients did not receive sclerotherapy (group 1) and 24 received between one and four sessions of sclerotherapy (group 2) before surgery. ⋯ It is concluded that the decision to operate to control bleeding varices should be made early. One or two sessions of sclerotherapy before surgery does not increase intraoperative difficulty or the postoperative leak rate following oesophageal transection. The outcome of surgery is directly related to the state of liver reserve (Child grade).
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All patients with distal bile duct tumours over a 10-year period (October 1983 to December 1993) were identified by means of a prospective database. The medical records of 104 patients were reviewed. Univariate and multivariate analysis for predictors of outcome was performed. ⋯ The 5-year survival rate for radically resected, node-negative tumours was 54 per cent. Surgical resection is effective therapy for distal bile duct tumours. These patients have a better outlook than those having resection of pancreatic adenocarcinoma.
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A retrospective study was carried out of patients from a single institution over a 30-year period. Thirty-one patients presented with 33 fistulas, four non-enteric and 27 enteric. In 25 of 27 patients with a prosthesis-related enteric fistula gastrointestinal bleeding was present. ⋯ In-hospital mortality decreased from six of eight patients before 1970, to seven of ten between 1971 and 1980, and to four of 13 after 1981. In the long term, patients treated with an extra-anatomic reconstruction had a poorer prognosis than those treated by in situ reconstruction. This experience shows that diagnostic tests often fail to reveal a prosthesis-related fistula and that mortality can be substantially reduced by early exploration in patients with negative diagnostic studies.