ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127440.x

出版商:Wiley    

年代:1994

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127420.x

出版商:Wiley    

年代:1994

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127414.x

出版商:Wiley    

年代:1994

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127415.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo present the outcome of 123 groin hernias treated laparoscopically between July 1991 and October 1993, and to discuss the advantages of preperitoneal hernia repair with mesh.DesignData for each patient were collected prospectively on a predetermined standard form. Every patient was assessed by an independent, non‐treating surgeon.Patients and settingNinety‐seven patients underwent laparoscopic hernia repair by two surgeons between July 1991 and October 1993. The patients were treated in several private hospitals and one public hospital in Sydney, NSW.Main outcome measuresEach patient was assessed for integrity of the hernia repair, the number of days before return to work, analgesic requirement after surgery, and complications.ResultsThere were five hernia recurrences, and repairs in three other patients were considered doubtful by the non‐treating surgeon assessor; these repairs were later judged to be sound. There were no infections and no serious complications. There was one scrotal haematoma, one incisional hernia through a trocar site, one hydro‐coele and one trocar injury to a large branch of the inferior epigastric artery. Sixty‐two per cent of patients required no analgesic injections. Patients covered by workers' compensation returned to work an average of 24 days after their operations and employed patients not covered returned to work an average of 12 days after their operations. Twenty‐one patients had been treated previously by open inguinal herniorrhaphy and all enthusiastically endorsed the laparoscopic repair because of reduced pain and earlier return to physical activity. One patient was found to have omental adhesions to the site of the hernia repair at a subsequent laparoscopy.ConclusionsLaparoscopic inguinal herniorrhaphy has the advantages of reduced pain and rapid return to normal activity when compared with open tech‐niques. The mesh prosthesis placed in the preperitoneal space behind the weakened inguinal region appears to confer strength and eliminates the disadvantage of tension observed with sutured repairs.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127416.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo analyse the results of an audit of laparoscopic repair of 222 hernias of the inguinal region.DesignFrom August 1991 to October 1993, 207 patients were referred for surgical management of groin hernias and underwent laparoscopic repair. Details of preoperative assessment, laparoscopic findings and repair details, together with postoperative outcome, were collated.ResultsThe 207 patients had 230 hernias. After laparoscopic assess‐ment only eight needed open repair. Laparoscopic repair was completed on 213 inguinal, eight femoral and one lateral groin incisional hernias. There were no emergency procedures. Four hernias have recurred. Postoperative complications have included two laparotomies, one for intraperitoneal bleeding and the other for bowel perforation. Resumption of normal activities or work was possible after an average of 13.4 days.ConclusionThe early results of laparoscopic inguinal hernia repair show that this is an acceptable method and offers the patient early resumption of normal activities.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127417.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectivesTo describe the establishment of a violence management team (VMT) to manage patients who exhibit violent behaviour in a general hospital (Flinders Medical Centre), and to review data collected in the first 44 months of operation.MethodsThe VMT consisted of a doctor, a senior nurse and four orderlies. Calls to the team were recorded and audited. Data were collected from patient case notes and supplemented, where necessary, with information from medical and nursing staff.ResultsThere were 282 calls for the VMT during the study period, most often to patients with organic mental disorders (45%), substance abuse disorders (18%) and personality disorders (15%). In 30% of calls, verbal placation alone was sufficient to manage the patient; however, 62% of patients needed physical restraint (i.e., were physically held by team members) and 53% were administered a sedative medication.ConclusionsViolent behaviour in patients in a general hospital is an important problem, often caused by organic mental disorders. This, and the need to restrain aggressive patients so that they can receive essential medical care, suggest that such behaviour should be treated as a clinical problem rather than one for security guards or the police. The VMT provides a mechanism for dealing with aggressive patients which ensures good patient management, as well as protecting the health and safety of staff. It is also a monitor for quality assurance purposes, and provides data to determine the causes of patient violence and to implement prevention programs.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127418.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo investigate treatment patterns for malaria and the use of Australian guidelines which were then current for the treatment of malaria in Queensland in 1992.Design and participantsA review of patient treatment and demo‐graphic details, obtained from the treating doctor by questionnaire, for all cases of malaria in Queensland in 1992 which were reported to Queensland Health (316 people treated for 341 episodes of malaria).ResultsPlasmodium falciparuminfections were treated according to the recommendations in the guidelines in 20% of cases. Thirty‐five per cent of infections were treated with chloroquine, even though most of these were acquired in countries where chloroquine or chloro‐quine/antifolate‐resistantP. falciparummalaria existed.Plasmodium vivaxinfections were treated with the recommended course of chloroquine in 58% of cases. Fifty per cent of patients withP. vivaxinfection were treated with primaquine, but only 57% of these received the dose recommended in the guidelines for the eradication of hypnozoites. Patterns of malaria treatment were basically similar in the malaria‐receptive zone and elsewhere in Queensland, althoughP. falciparuminfections in the receptive zone were treated according to the guidelines at a higher rate (32%) than in the rest of Queensland (13%).ConclusionIn 1992, many cases of malaria in Queensland were not treated according to the recommendations in the Australian malaria treatment guidelines. We suggest that improved distribution of simple but comprehensive guide‐lines for malaria treatment may assist medical practitioners in the provision of prompt, effective treatment, and help prevent the reestablishment of endemic malaria in Australia.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127419.x

出版商:Wiley    

年代:1994

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127421.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

This statement summarises current understanding of the role of microalbuminuria in diabetic nephropathy and describes its natural history and clinical relevance. It outlines core facts and makes recommendations for the management of patients with persistent microalbuminuria.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb127422.x

出版商:Wiley    

年代:1994

数据来源: WILEY